Updated: Jan 21, 2021
Cranial cruciate ligament disease (CCLD) is a disease affecting the cranial cruciate ligament (CCL) in the stifle (knee) joint. It is the most common pathological condition of the stifle joint of the dog. It is categorised as a partial tear or complete rupture of the CCL, which causes great pain and instability of the joint.
Symptoms you may see in your dog if it has had a CCL tear or rupture include pain when the stifle joint is touched, limping, reluctance to exercise, hind leg extended when sitting, weight shifting to one side of the body when standing, stiffness after exercise or heat and swelling at the joint.
Symptoms can be sudden or gradual.
Below is a diagram of the stifle joint looking from the front of a dog:
The Canine stifle from the front, indicating the position of the CCL (Source: Canapp, 2007)
Surgery is often recommended for treatment of the disease, to stabilise the joint, re-establish normal joint kinematics, resolve pain and return the patient to full function; and this is often successful. However, studies have offered evidence that surgical procedures sometimes fail to stabilise the stifle. This may be due to prolonged immobilisation (or disuse) after the surgery, which has been found to be associated with degenerative changes to the surrounding connective tissue such as ligaments, cartilage, muscles and bone. This ultimately leads to the build-up of scar tissue, meaning the joint does not function properly, has restricted motion, soft tissue weakness and joint pain as well as osteoarthritis.
Consequently, studies have looked into earlier use of the joint after surgery and post-operative rehabilitation. They have found greater results than cage rest alone. Results include earlier and more complete return to function, reduction in the chances of reinjury, pain and scar tissue formation. It also has been shown to cause increases in muscle size and strength and reduce the development of osteoarthritis. Furthermore, it has been suggested that gentle but immediate (i.e. the day after surgery) physical therapy post CCL surgery leads to better functional recovery and stability of the stifle joint.
Low impact exercises, including swimming and walking (hydrotherapy) help greatly by increasing muscle strength and stability of the joint whilst avoiding the worsening of osteoarthritis. This will be coupled with electrotherapies and manual therapies such as massage and stretching to relieve pain and inflammation, increase joint range of motion, preserve muscle mass, promote appropriate functioning and decrease stress and anxiety in your dog.
If you suspect your dog may have a partial tear or complete rupture, you should contact your vet, or if your dog has had CCL surgery in the past they may benefit from veterinary physiotherapy, please get in touch if you have any concerns or questions.