Cranial cruciate ligament disease is one of the most common orthopedic issues in dogs. It often costs thousands of dollars to treat, especially if there's surgery involved.
If you notice that your dog is limping or showing signs of lameness, it’s possible they’ve torn or ruptured a ligament. Here’s how to work with your vet to get your dog back to health.
Where Is the Cranial Cruciate Ligament in Dogs?
“The stifle joint in dogs is the equivalent of the human knee. Ligaments and muscles support its stability, and both the cruciate ligaments play a vital role in its stability,” explains veterinary Surgeon Dr. Sophie Bell.
“There's a cranial and caudal cruciate ligament, but it's the cranial ligament which is most likely to tear in our dogs completely or partially.”
The cranial cruciate ligament is sometimes called the anterior cruciate ligament, or ACL.
The ligament connects the back of the femur (the bone above the knee) with the front of the tibia (the bone below the knee). The cruciate ligament helps keep the tibia in place beneath the femur, and this stabilizes the knee joint.
What’s Cruciate Ligament Disease?
Just like humans, dogs experience tears and strains to muscles and ligaments through everyday physical activity. Cruciate ligament injury is a common example.
But, Dr. Bell points out, most cases are not from a sudden injury but are caused by a more gradual disease of the cruciate ligament over a period of time.
“Although trauma can lead to a sudden rupture, for dogs, it’s usually due to degeneration over time, which is termed cruciate disease.
“Degeneration can occur over months to years, so middle-aged to older dogs will be at a higher risk," Dr. Bell adds. "Once it begins to degenerate, it is hard to stop the process, and even with rest and medication, it's difficult for it to fully heal and return to normal stability.”
It’s not just dogs that have cruciate ligament problems, says Bell: “Cruciate rupture can occur in cats, but for them, trauma is more than likely the cause.”
How Can I Tell if My Dog Has a Cruciate Ligament Injury?
Look out for the following symptoms if you think your dog may have torn its ACL:
Lameness or weakness in one or both hind legs
Unable to bear weight on the injured leg
Limping or reluctance to use one or both hind legs
Joint occasionally clicking
Limping becomes worse with exercise but improves with rest
Unwillingness to play or run
Reluctance to get up, jump, run or go up and down stairs
Stiffness and difficulty getting up and sitting down
Swelling around the knee joint
Signs of muscle atrophy
When a dog partially tears its cruciate ligament, it can quickly get worse due to continued physical activity. They'll begin compensating for the injury by transferring more weight onto the healthy leg, which weakens the ligaments. In over half of all cases, dogs will go on to injure a second knee.
“If the cruciate ligaments of both legs are affected at the same time, the dog may have a general stiff gait,” says Dr. Bell.
Which Breeds Suffer From Cruciate Ligament Injury?
Some breeds are particularly prone to cruciate ligament injuries, including:
Old English Sheepdogs
Our pet insurance claims data shows that cruciate ligament problems are most common in Labradors, Rottweilers, and Golden Retrievers, but we saw claims for it in over 150 different breeds and mixed breeds in 2021.
What Are the Causes?
When dogs suffer ligament injuries, it’s normally the result of subtle, slow degeneration that has taken place over a period of weeks, months, or sometimes years. The ligament weakens, and a tear eventually occurs.
Acute (sudden) cruciate ligament injuries are less common. They’re normally caused by strenuous or exuberant activities, like running and jumping, which have impacted a healthy ligament.
Common causes for cruciate ligament injuries in dogs are:
Everyday Activities: Everyday physical activities such as walking, running, and jumping will naturally cause wear and tear to joints and ligaments, especially if a dog is in poor physical health.
Aging: Older dogs are more likely to suffer ligament injuries due to the natural aging process.
Breeding Practices: Poor breeding practices can result in dogs with hereditary and congenital conditions from birth. These dogs develop health issues that can lead to joint and ligament damage.
Being Overweight: Many dogs in the US are now classified as clinically overweight or obese. Excessive weight puts more stress on a dog's ligaments over time.
Hip Dysplasia: Dogs with hip dysplasia are more likely to develop cruciate ligament tears.
Even your dog’s gender can increase the risk. “The risk is higher for females than males and the risk is increased in neutered dogs over those who are entire, says Dr. Bell.
Neutering may indeed play a part. “This study suggests that neutering breeds such as Labs and Golden Retrievers before the age of 12 months increases their risk of joint disease by four times.
“As these are breeds prone to cruciate rupture, delaying neutering until later might be advised," says Dr. Bell. "Discuss it with your vet to help you decide.”
Diagnosing Cruciate Ligament Injury
Your vet will diagnose cruciate ligament rupture with X-rays and by manipulating the joint.
It’s possible that you’ll be referred for more advanced imaging. A CT scan may be used, but that’s unusual.
What Are the Treatments?
Surgery is usually the best option if your dog has completely torn their cranial cruciate ligament, especially if they’re young — but it comes at a price.
Surgery can cost more than $2,000 per leg. Then there are the additional costs of physical therapy and sometimes hydrotherapy for rehab. And costs could increase if there are any post-op complications.
“There are several surgical options. But usually, a TPLO (tibial plateau leveling osteotomy) or TTA (tibial tuberosity advancement surgery) are performed," says Dr. Bell.
You’ll usually be referred to an orthopedic specialist for these surgeries.
TPLO cruciate ligament surgery is particularly expensive, commonly costing over $4,000 per leg (depending on your dog’s weight).
The success of any surgery will depend on your dog’s age and health. Any surgery is riskier in older dogs.
“There’s an improved outcome if physio and hydrotherapy are started pre-operatively and continued after surgery,” says Dr. Bell. “Your dog will need to slowly build up with exercise, and it can take up to three months to return to normal exercise after surgery."
“You may need to use a sling to help your dog out to the toilet in the first two weeks, and your vet may encourage you to use ice packs to aid healing," Dr. Bell adds. "You’ll also need to provide mental stimulation for your dog during this stage.”
Can a Dog Recover From a Torn Cruciate Ligament Without Surgery?
Dogs can sometimes recover from cruciate ligament damage without surgery, but you need to consider their age, their general health, and the severity of their injury.
If left untreated, a partially torn or ruptured cruciate ligament can improve within three to six weeks for most dogs, especially small ones.
“They will certainly appear better with rest from exercise but not back to 100%, says Dr. Bell.
“These dogs can be on and off lame for years. Another important point is that if one cruciate ruptures the chances of the other one rupturing is over 30%.
If your dog’s not a good candidate for surgery, or it’s financially out of reach, non-surgical treatments are an alternative. Non-surgical treatment for ACL injuries, along with rest and medication, can take between six weeks to two months for recovery, followed by a gentle regimen of exercise.
Alternatives to Surgery for Cruciate Ligament Injuries
For partial tears, non-surgical treatment can be a better alternative. It's less invasive and cheaper than surgery.
“Non-surgical options are only a potential option for dogs weighing under [33 pounds],” says Dr. Bell. “The problem is if a partial tear is left untreated, the joint will develop osteoarthritis. This is likely to mean that if you then opt for surgery later on it won’t be as successful compared with operating earlier.”
Here are some treatments your vet might suggest:
Dog braces provide therapeutic support and stabilization before and after surgery for dogs with cruciate ligament tears. A knee brace can be a good option if you have an older dog and you have concerns about the risks of surgery.
A brace can help with stabilizing the injured knee as well as balancing the back and hip areas of the dog, helping prevent further injury.
Swimming is an excellent form of exercise for dogs. It’s great for their overall health and provides an aerobic workout that tones and strengthens muscles. Swimming is a low-impact activity and doesn’t put as much stress on a dog’s joints and tendons.
When submerged, the water takes a dog’s weight and supports their body. There is less stress and impacts on bones and joints than with land exercises. Swimming is good for healing and rehabilitation from injury or surgery, especially for dogs who are older or overweight.
You can take your dog to a swimming area that provides facilities for pets, but avoid ponds, lakes, or the sea, as the cold water can dull your dog’s sense of pain and cause them to overdo it.
Hydrotherapy is exercising in water; it provides many of the same benefits as swimming.
The water allows dogs to exercise but without the stress on muscles and joints. This form of therapy can help dogs suffering from cruciate ligament ruptures, arthritis, and joint pain.
A canine physical therapist can help your dog recover from cruciate ligament injury by manipulating muscles, tendons, ligaments, and connective tissue.
Prolotherapy, also known as nonsurgical ligament reconstruction, is a medical treatment for cruciate ligament tears and associated joint pain. It’s used to treat joint pain and increase ligament strength for humans, but it can also help dogs.
Prolotherapy can be performed on most dogs, but it is more commonly used for middle-aged and older dogs. The treatment involves an injection into the affected area every three weeks for a total of four injections.
Many dog owners report a reduction in pain and increased mobility within the first two treatments. The treatment helps the growth and formation of new connective tissues in areas where it‘s become weak.
Cold Laser Therapy
Laser therapy can help dogs with a variety of conditions: sprains and strains, arthritis, and swelling caused by disc problems. It’s especially good for puppies with torn cruciate ligaments.
Laser therapy focuses on penetrating the affected area. There’s no surgery or drugs needed, as the laser works to stimulate blood circulation and regenerate cells. The warm heat generated will feel like a massage for your dog.
The laser stimulates a chemical reaction called photobiostimulation. It releases endorphins (the happy chemical!) which help dogs and other pets feel better. It’s good for muscle and tissue healing and helps speed up the recovery process.
Does Pet Insurance Cover Cruciate Ligament Surgery?
Cruciate ligament surgery can be very costly. You’ll need a pet insurance policy with a high reimbursement limit (or no reimbursement limit) to cover the entire cost. At ManyPets, we have no annual or lifetime limits for reimbursement. This goes for all health conditions, including cruciate ligament issues.
Most pet insurance providers should cover cruciate ligament treatment if your dog first shows symptoms after you purchased a policy. But check your policy documents carefully – there are sometimes some specific exclusions around cruciate ligaments. For example, some insurers have a separate vet fee limit just for cruciate ligament injuries, which is a lot lower than your overall vet fee limit.
Be aware that insurers may treat cruciate ligament disease as a "bilateral condition," meaning that if your dog had one cruciate ligament issue before your coverage began, a subsequent cruciate ligament issue in a different leg will not be covered after you purchase your policy: The subsequent issue will be treated as the same pre-existing condition.
ManyPets does have this exclusion, but only if the condition arose before your policy effective date or during your 15-day waiting period. Conditions — bilateral or otherwise — will not be considered pre-existing if they arise after your policy is in full effect.
How to Prevent Cruciate Ligament Injuries in Dogs
These are Dr. Sophie Bell’s top tips for preventing cruciate ligament injuries:
Keep exercise regular and consistent. For instance, don't take short walks during the week, followed by huge amounts of high-impact exercise during the weekend.
Don’t walk puppies excessively while they're young, and avoid high-impact sports such as jumping until at least 12 months — or even longer for large and giant breeds.
Throwing a tennis ball can lead to excessive wear on joints, especially for older dogs and dogs with arthritis.
Keep your dog at a healthy weight.
Consider joint supplements early in life for active breeds and breeds prone to cruciate ligament conditions. Omega-3 and omega-6 fatty acids are potential options and can be found in salmon oil, green-lipped mussel, and flaxseed oil.
Learn exercises to strengthen your dog’s core muscles.