Injury to the cranial cruciate ligament (CCL), referred to as the ACL (Anterior Cruciate Ligament in people), continues to be the most common cause for orthopedic lameness in dogs. This condition is sometimes referred to as Cranial Cruciate Ligament Disease (CCLD). We recognize the condition in all breeds, ages, and sizes of dogs: from 5 lb. Yorkies, to 250 lb. Mastiffs. Both surgical and nonsurgical options exist for treatment of this condition.
During your consultation, Dr. Petersen will discuss with you in depth what CCL injuries are, and the various treatment options available to manage the injury: surgery (TPLO, TTA, lateral suture) vs. non-operative management. Pros and cons of the various operations/options and expected outcome potentials, home care needs, rehab, complications, etc. will also be discussed in detail.
TPLO – Tibial Plateau Leveling Osteotomy
We recommend TPLO for surgical treatment of CCL injuries in dogs. This technique is extremely versatile and applicable in virtually all sizes and shapes of dogs. The technique was developed in the mid 1980’s and today considered to be the preferred method to treat CCL injuries. The TPLO procedure requires meticulous surgical technique and is not without the potential for significant complications if the procedure is done poorly, or if appropriate postoperative home care is not followed. Dr. Petersen started doing the TPLO procedure in the mid 1990’s and has performed thousands of successful TPLO procedures to date*. Outcome expectations following the TPLO procedure are that the dog will return to normal (or near normal – 95%) levels of function, with no limitations. Full recovery typically requires 3-4 months.
NOM – Non-Operative Management
Nonoperative management (NOM) for CCL injuries can be effective, but is dependent upon several patient-related, and owner-related, factors: patient age, body condition score (BCS), temperament, stifle related (or other orthopedic) comorbidities, owner desired activity level, owner dedication and willingness to follow through with rehabilitation. Patient outcomes are quite variable, dependent upon the aforementioned factors, and usually require a 12-24 month commitment to rehabilitation. Dogs with partial CCL injuries can do OK with conservative management in some cases. The partial CCL injury always progresses, but the rate and degree at which progression occurs is never well defined. Dogs with complete CCL injuries, meniscal damage, or steep TPA’s (tibial plateau angles) typically don’t do as well with conservative management. Non-operative management always results in progressive OA (osteoarthritis) changes and loss in ROM (joint Range of Motion), but outcomes can equal those achieved with lateral suture techniques** in some cases. Again, successful outcomes may require 12-24 months of rehab efforts and an acceptance that most dogs will not regain previous levels of activity ability. TPLO stabilization can be considered in the future if non-operative management does not result in an acceptable outcome. A stifle brace or orthotic is also an option; however, we have limited experience with these and there is very little published in the scientific literature to support their use.
(*please see related testimonials regarding TPLO surgeries)
(**we do not recommend the lateral suture technique for most dogs).