Canis ISSN: 2398-2942

Stifle: cranial cruciate ligament disease

Synonym(s): CCL rupture, CCL insufficiency

Contributor(s): Joseph Harari, Prof Mark Rochat

Introduction

  • Extremely common cause of hindlimb lameness.
  • Normally complete, or partial, rupture of cranial cruciate ligament - grouped according to etiology (A,B,C).
  • Signs: acute hindlimb lameness or acute deterioration of a more chronic problem.
  • Diagnosis: cranial instability of stifle (cranial draw test Stifle: cranial drawer test /cranial tibial thrust).
  • Treatment: usually surgical repair, in small dogs conservative treatment may suffice.
  • Prognosis: good.
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Follow the diagnostic tree for Cranial Cruciate Ligament Disease Cranial cruciate ligament disease.
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Pathogenesis

Etiology

  • Uncertain (idiopathic).
  • Senile degeneration (aging)/normal wear/tear.

Predisposing factors

General

  • Obesity.
  • Conformation, eg straight angles in knee/hock joints.
  • Increasing age.

Specific

  • Athletic event.

Pathophysiology

  • Rupture is often complete.
  • Partial rupture involves one of bands making up ligament - usually craniomedial band - may be bilateral.
  • Group A: traumatic. Excessive rotational or hyperextension forces → rupture normal ligament.
  • Group B: unknown factors result in degeneration and subsequent rupture of ligament.
  • Group C: unknown etiology.

Timecourse

  • Variable, but progressive, weeks → months unless Group A traumatic.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Hayashi K, Manley P A & Muir P (2004) Cranial Cruciate Ligament Pathophysiology in Dogs With Cruciate Disease: A Review. J Am Anim Hosp Assoc 40 (5), 385-390 PubMed.
  • Marsolais G S (2002) Effects of postoperative rehabilitation on limb function after cranial cruciate ligament repair in dogs. J Am Vet Med Assoc 220 (9), 1325-1330 PubMed.
  • Wilke V L et al (2002) Comparison of tibial plateau angle between clinically normal Greyhounds and Labrador retrievers with and without rupture of the cranial cruciate ligament. J Am Med Vet Assoc 221 (10), 1426-1429 PubMed.
  • Sandman K S, Harari J (2001) Canine cranial cruciate repair techniques; is one best? Vet Med 96 (11), 850-856 VetMedResource.
  • Geels J J, Roush J K, Hoskinson J J, McLaughlin R M (2000) Evaluation of an intracapsular technique for cranial cruciate ligament rupture: clinical, radiographic, scintigraphic and force plate analysis findings in 20 dogs. Vet Comp Orthop Traumatol 13 (4), 197-203 VetMedResource.
  • Kudnig ST (2000) Intra-articular replacement. Aust Vet J 78 (6), 384-385 PubMed.
  • Smith B (2000) Extracapsular stabilisation. Aust Vet J 78 (6), 382-383 PubMed.
  • Watt P (2000) Tibial plateau levelling. Aust Vet J 78 (6), 385-386 PubMed.
  • Chauvet A E et al (1996) Evaluation of fibular head transposition, lateral fabellar sutures and conservative treatment of cranial cruciate ligament injuries in large dogs: a retrospective study. J Am Anim Hosp Assoc 32 (3), 247-255 PubMed.

Other sources of information

  • Anderson J (1994) The stifle. In: Manual of Small Animal Arthrology. Eds. J Houlton & R Collinson. Cheltenham: BSAVA, p 280.


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