A Very Common Trigger of Hind Limb Lameness, Pain and Arthritis

Analysis by Dr. Karen Shaw Becker

ccl tear in dogs

Story at-a-glance -

  • Damage to cranial cruciate ligaments (CCLs) is the most common soft tissue injury in dogs
  • While there are several contributors to CCL damage, nutritional deficiency may be a root cause in a majority of cases
  • Treating CCL damage non-surgically requires a healing and maintenance protocol that includes aggressive physical therapy, natural supplements, a nutritionally optimal fresh food diet and gentle exercise

Cranial cruciate ligament injuries are serious, debilitating and, unfortunately, very common in dogs. In fact, CCL ruptures are the No. 1 soft tissue injury seen in veterinary medicine today.1 The cruciate ligaments are bands of fibrous tissue around the knee. Each knee joint (called a stifle in dogs) in the hind legs has two cruciate ligaments that connect the femur (the bone above the knee joint) with the tibia (the bone below the knee joint).

The cruciate ligaments are the main stabilizers of your dog's knee joint. They cross over each other, with one band running from the inside to the outside of the knee joint, and the other from the outside to the inside. In humans, the CCL is called the anterior cruciate ligament (ACL).

Inside the knee joint between the femur and tibia is cartilaginous material called the meniscus. The job of the meniscus is to absorb shock and assist with load bearing, and it can be damaged when there is injury to the cruciate ligaments.

CCL injuries are seen in dogs of every size and age, but they are seen more often in certain breeds, including the Akita, Chesapeake Bay retriever, Labrador retriever, Mastiff, Newfoundland, Rottweiler, Saint Bernard and Staffordshire terrier. Research has identified a genetic component for the disease in Newfies and Labs.

Breeds unlikely to develop CCL disease include the basset hound, Dachshund, greyhound and Old English Sheepdog. The condition is almost never seen in cats.

Most CCLs That Rupture Have Been Deteriorating for Years

Rupture of the CCL is a very common reason for hind limb lameness, pain and arthritis of the knee in affected dogs. Ruptures can be partial or complete. According to the American College of Veterinary Surgeons (ACVS), and in my own experience, in the vast majority of affected dogs, ruptured ligaments have been gradually deteriorating over a period of months or years.2

When the CCL tears, the knee bones no longer move normally, and your dog will have difficulty putting weight on the leg without it collapsing. That's because the tibia is no longer supported by the cruciate ligament and thrusts forward when any weight is exerted on the leg.

With complete tears, only surgical correction or replacement will make the joint fully functional again. The type of surgical technique selected and the competence of the surgeon dictate outcome success, along with rehabilitation therapy and long-term joint support.

However, the majority of dogs suffer from recurring sprains rather than complete ruptures. In these situations, I recommend you avoid surgery as long as possible by instituting an intensive management protocol, which I'll discuss shortly. CCL injuries are painful for your dog, and without proper treatment, permanent joint damage can result. Unfortunately, estimates are that from 40% to 60% of dogs with CCL disease in one knee go on to develop the problem in the other knee.

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What I Learned From My Canine Patients About What Causes CCL Injuries

Very little of the CCL damage I see in my practice is the result of sudden trauma severe enough to cause a rupture. The CCL injuries I treat are influenced by one or more of these four factors:

  1. Trauma (like being hit by a car)
  2. Size, weight, breed, sex hormone and vaccine status
  3. Dogs eating poor-quality processed diets (usually with very low-quality synthetic vitamins and minerals added to meet AAFCO minimum nutrient requirements)
  4. Dogs eating homemade prey model diets fed by misguided pet parents who believe offering any type of fresh food is all that matters, recipes are unnecessary and "balance will occur over time" without intentional additions to meet specific nutrient deficiencies

The vast majority of dogs I see with CCL damage are tearing their ligaments in non-traumatic ways as they go about their doggy lives. Large and giant breeds have more CCL injuries than smaller dogs, but they comprise only a small percentage of my patients. Genetics may play a minor role,3 but about 75% of the dogs I treat don't fit into any of these categories.

Dogs who've been spayed/neutered have more CCL damage than intact animals, which makes sense since sex hormones appear to have a protective effect on the musculoskeletal system. Overweight and poorly conditioned dogs tax their ligaments more than lean dogs, but my patients aren't fat or out of shape.

In fact, the CCL-injured dogs in my practice are active and healthy, not over-vaccinated, and still have their ovaries/testes and therefore, their sex hormones. I eventually concluded that nutrition was a probable cause for the majority of CCL injuries I was seeing.

Both my Rottweilers ruptured their CCLs when I was feeding a homemade "prey model diet," which focuses on "balance over time" (versus knowing you're meeting minimum nutrient requirements) and usually is short or completely devoid of adequate amounts of fresh vegetables, seeds and nuts (which meet hard-to-come-by nutrients, including manganese).

My animal chiropractor (who started as a human chiropractor) was the first to suggest my own dogs and my canine patients could be mineral-deficient, specifically lacking dietary manganese, which as it turns out is the root cause of many human ACL injuries.

Manganese is necessary for healthy ligament development and maintenance. A dog's manganese requirements are high. Food sources vary on the amount of manganese present. Read "What's Behind the Epidemic of Cranial Cruciate Ligament Disease" to understand why I suspect today's dogs aren't getting sufficient manganese.

Pain Management and Joint Support

The recovery and maintenance protocols I design for my patients are based on each dog's specific circumstances, age, activity level and job (for example, agility athletes and police dogs have different ligament stress than other dogs). Treating CCL disease non-surgically involves three essential strategies: controlling pain, restoring function and strength to the injured leg, and supporting and improving joint health and slowing degenerative joint disease (DJD).

Medications should be given for as long as necessary to control both the pain of the CCL injury, as well as any maladaptive pain that has developed as a result, such as low back pain.

Instituting chondroprotective agents (CPAs) as soon as possible helps reduce further damage to joints. For genetically predisposed breeds this means beginning CPAs proactively, at six to 12 months. The most commonly used CPAs are perna mussel (green-lipped clam), eggshell membrane, glucosamine sulfate, MSM and cetyl myristoleate.

Dogs who have had substantial CCL injury should be on progressive joint supportive protocols for the rest of their lives to slow degenerative joint disease in the injured knee and improve ligament resiliency in the other knee.

I also use injections of Adequan and platelet-rich plasma therapy4 to slow joint degeneration and promote joint fluid production in cases of chronic knee problems. Prolotherapy, which involves injecting small amounts of various natural substances into the soft tissues of a damaged joint, can be beneficial for these patients as well. 

In addition, I incorporate many natural anti-inflammatories for long term management, including boswellia, devil's claw, feverfew, proteolytic enzymes, SAMe, scutellaria, serrapeptase, superoxide dismutase (SOD), turmeric and ginger, and willow bark (dogs only — not for cats).

There are some excellent homeopathic remedies and Chinese herbs that can be beneficial as well, but these natural treatments should be given in addition to CPAs, not in place of them.

Diet Recommendations

Feed a homemade, fresh food diet you are absolutely sure is balanced for optimal nutrient intake, including 3.1 mg of manganese per 1,000 kcal (calories). This is the average amount of manganese provided by the canine ancestral diet. Dogs fed a ligament-supportive diet should not have degenerative cruciate damage over time. My recommendations for feeding a manganese rich diet:

  • Follow a homemade recipe that gives amounts of manganese per serving or 1000 kcal
  • Call the pet food company and ask what guidelines they follow, or how much manganese (per 1000 kcal) is in their food, so you know you are meeting optimal intake for your dog (AAFCO minimum is 1.25mg/1000 calories)
  • Supplement, as necessary (with whole foods or a supplement such as Standard Process E-Manganese) to meet Mn requirements

In addition, it's very important to keep your dog lean and well-conditioned, preferably intact (opt for an ovary-sparing spay or vasectomy, when possible), and titered versus over-vaccinated.

Rehab Therapy and Exercise

There are several orthopedic braces that can be beneficial for limiting range of motion and supporting the rest of the body (including the over-stressed, opposite knee joint). I have found it's important to match the type of brace to the breed of dog, so work with an animal rehab therapist to determine which brace will be most beneficial for your dog.

Once a dog's pain and lameness are improved, a physical rehabilitation program can be instituted to improve function and rebuild strength. I have found water therapy to be very beneficial in helping dogs recover from CCL injuries, because it helps build strength and muscle mass with little to no discomfort.

On an underwater treadmill, your dog can exercise in a normal posture without putting excess weight on damaged joints. Water also provides resistance during movement, which helps strengthen muscles. During this time, I also typically recommend laser therapy, the Assisi loop,5 acupuncture and electroacupuncture to help alleviate joint pain.

Chiropractic care can help your dog's postural imbalances and may help reduce compensatory stress on the other knee. In addition, massage is excellent for tight, overworked muscles.

It's important to note that even with intense therapy, there are cases where complete rupture eventually occurs. That's why many dogs ultimately require CCL surgery to maintain their quality of life. Every patient and situation is different, so the challenge is always finding the methods of treatment that are most suitable and helpful for the individual pet and his family.