CCL Knee Surgery and Rehabilitation

A dog's cranial cruciate ligament (CCL), similar to the ACL ligament in humans, when torn may need repaired by an orthopedic surgeon. The following information relates to recent experiences with the tightrope technique of repair.

Our 4 year old Doberman tore her CCL running up and down a steep hill at top speeds and quickly coming to a stop and turning to run back in the other direction. The first signs of a problem were slight limping. She appeared as if she hurt a muscle in her leg and needed to rest it. After a day or two of not running, she no longer exhibited any symptoms. As the summer went on, the limping happened more frequently. We took her to a vet that x-rayed her hips to see if dysplasia was the issue. Her left side showed a slight irregularity in the hip joint so the prognosis was the pain was coming from that and she was given some pain medicine and put on joint supplements. The instructions were to let her run and use her joints just like when a human has a sore joint it is better to utilize the joint to keep it strong. Unfortunately the more she ran, the more problems she exhibited. Upon taking her to a different vet, they began looking at her knees and that the problem might lie there noticing a slight bulge next to her knee joint. We were then sent to a surgeon specializing in this area. Upon testing, they were immediately aware it was related to her CCL and we were presented with the surgery options.

We selected a relatively new procedure called a tightrope. This is less evasive than the metal bone plate implant with teeth like claws that go into the bone and requires part of the bone be cut. The tightrope wraps around the joint, through a small hole in the bone, and is tied in a knot. The knot does not protrude through the skin as it is tucked under the muscle. The main incision along the knee is approximately 6" in length with another small incision on the inside of the knee of 2", both held in place with staples.

After surgery, there is a long 8 week rehabilitation time. For the first 2 weeks an e-collar is required in order for the dog not to lick the incision to eliminate possible infection. The surgeon stated that if the incision becomes infected, it could get inside the leg and once that happens, it would adhere to the implant and there would be no way to get rid of it and the implant would have to be removed and replaced. Also for the first 2 weeks, the dog needs to be confined to a small area that has solid footing. The risk of slipping needs to be eliminated due to if the dog slips and falls prior to complete healing, the implant could be damaged. Also, they are not to go up and down stairs during this time as well. When it's time to go outside, the dog must be on a lead and during the first 2 weeks a sling is utilized. The sling is placed under the dog's belly and held with straps along with the lead. The sling is not used to pick up the dog and not allow them to utilize their repaired knee, but instead is in place to be a source to prevent them from falling allowing you to catch them should they slip.

The instructions for the entire 8 weeks is that your dog cannot go outside by themselves off lead. After the initial 2 weeks, they can be let into other areas of the home to walk around with you. However, there are still issues with slipping and falling which should be addressed. Consider laying down throw rugs if you have wood or tile floors to prevent slipping. Even though your dog may appear to be feeling better, she is still not completely healed so we need to be cautious and attempt to eliminate possible hazards.

After 2 weeks, we took her back to the surgeon to have the staples removed. At this time, the rehabilitation begins. For the first week after staple removal, we were instructed the dog can be taken on one 15-minute walk a day. The next week the walk is to be increased to one 20-minute walk a day. The next week and the remaining time the walks are increased to two walks per day of 15-20 minutes each. It is recommended if there are any hills along the path, it would be good to allow them to walk up and down those to help build strength. There are also exercises you can do with the affected leg to assist with range of motion. A physical therapist can also be used and one of the techniques they may utilize is a water treadmill.

The most difficult part of this process is the dog cannot rationalize the situation and that being kept in one room of the home with limited access is good for them. Even just into the recovery, my dog wanted to play, was anxious to be let out of the living room, and was bored. Even though she appeared healed, there was evidence she was not fully utilizing her repaired leg. The majority of her weight for several weeks was on three legs. This was evident by her "tapping" her repaired leg. When standing, she would tap her foot on the floor thereby not placing full weight on it. The surgeon stated this is common and that over time with rehabilitation, she would gain the strength back and be back to normal placing equal weight on all four legs.

The above information is what I experienced following the procedure which might provide some insight if you are considering the surgery for your dog. However, for specific medical details, advice from your veterinarian or a specialist is critical.