cranial cruciate disease and management
What is the CCL?
The cranial cruciate ligament, or CCL, is an important support structure
in the knee of the dog. It runs between the femur (thigh bone)
and the tibia (shin bone), preventing excessive movement
between the two bones.
The CCL is made of dense connective tissue. With
injury, the tibia and femur are less stable in relation to one
another, and that instability can lead to pain and further injury.
Cranial Cruciate Disease in Dogs
In dogs, a CCL tear is rarely a sudden, acute injury like the ACL tears often seen in human athletes. Instead, it is typically a symptom of cruciate disease, characterized by a slow degeneration of the ligament that can begin months or even years before a complete tear occurs. This degeneration is often caused by factors such as joint injury, malfunction, or overuse, leading to inflammation and abnormal knee mechanics.
Common causes of cruciate disease include:
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Concurrent luxating patellas
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Hip dysplasia
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Previous joint sprains
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Hind leg conformation that increases impact on the knee
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Obesity or excess weight, which puts additional stress on the knee joint
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Age related degeneration of the ligament
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Immune-mediated disorders that cause inflammation in the joint
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As the CCL slowly frays, dogs often develop scar tissue that helps stabilize the knee joint, minimizing the instability that might accompany an ACL tear in humans. However, regardless of the rate at which cruciate disease progresses, the end result is similar:
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Inflammation in the joint and joint capsule
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Potential for meniscal tears
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Degeneration of cartilage and joint fluid
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Long-term pain and dysfunction in the knee joint
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Osteoarthritis development, leading to chronic pain and reduced mobility
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Muscle atrophy due to decreased use of the affected leg
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Compensatory injuries to other joints, such as the hip or opposite knee, due to altered gait and weight distribution
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Decreased quality of life and difficulty performing daily activities
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While sudden, complete CCL tears can occur in dogs, they are far less common than the gradual degeneration associated with cruciate disease.
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How do we diagnose cruciate disease?
Diagnosing cranial cruciate ligament (CCL) disease in dogs begins with a thorough history and a skilled physical exam. Subtle signs like intermittent lameness, difficulty rising, or reluctance to jump can be early clues, especially in partial tears. A detailed orthopedic exam is essential to evaluate stifle stability, pain, effusion, and muscle asymmetry.
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Veterinarians use tests like the cranial drawer and tibial thrust to assess passive laxity in the joint. These require careful positioning, good patient relaxation, and clinical experience to interpret—particularly in cases with chronic changes or partial instability. Palpation for medial buttress, joint effusion, and pain during flexion or extension provides additional insight.
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Meniscal injury may also be present and is often suspected when there's a palpable click, sharp pain on range of motion, or mechanical block to movement. Imaging like radiographs, musculoskeletal ultrasound, or MRI can support diagnosis, but the foundation of a good workup is a careful, hands-on exam tailored to each individual patient.
What about surgery for Cruciate disease?
Surgery is often the first recommendation following a CCL injury in dogs, but it's important to understand that it only addresses one aspect of a complex disease process-- instability. Unlike the traumatic ACL tears seen in young, athletic humans, cruciate injuries in dogs are typically the result of chronic degeneration. This means that by the time a tear occurs, the joint is already inflamed, unstable, and undergoing arthritic changes. Surgical stabilization does not repair or replace the torn ligament, nor does it address the inflammation, pain signaling, cartilage damage, or overall joint health that contribute to long-term dysfunction
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Just like in human medicine, where patients fall into broad categories of copers, non-copers, and adapters, we believe that dogs can also be sorted into these groups. Some dogs do well with conservative management alone, others may eventually need surgery, and many fall somewhere in between. With that in mind, we encourage pet owners to consider trying non-surgical management first, especially in partial tears or when the dog is still comfortable and functional
A non-surgical, multimodal plan may include physical rehabilitation, neuromuscular retraining, regenerative therapies (such as shockwave, PRP, or stem cell treatments), pain management, bracing, weight optimization, and joint-supportive supplements. These interventions not only help reduce instability, but also actively treat the underlying degenerative disease, slow arthritic progression, and improve comfort and mobility
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Surgery is always available as a later option, but taking time to address the full picture, rather than rushing to fix a single symptom, often results in better long-term outcomes. Our goal is not just to stabilize a joint, but to restore function, relieve pain, and support the whole patient.
Non surgical modalities
Non-surgical modalities are central to managing cruciate disease, whether or not surgery is pursued. CCL injury is a degenerative process that affects not only ligament integrity, but also the joint capsule, cartilage, surrounding muscles, and nervous system. A multimodal treatment plan allows us to target pain, inflammation, instability, and long-term tissue health; all of which are critical for successful outcomes.
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At Red Sage, we offer a wide range of non-surgical modalities, each selected based on the individual patient’s needs and stage of healing:
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