Talk To Me About Dog ACL/CCL Injuries: My Dog Ruptured Their Cruciate Ligament

Cranial cruciate ligament (CCL) damage is one of the most common causes of hind leg lameness in dogs.

If your dog suddenly starts limping on their hind leg, particularly a large breed dog, the chances are they suffered a CCL injury. The essential thing to note, that without treatment, your dog’s knee will only become worse over time, developing arthritis and affecting the rest of your dog’s body as well as their quality of life.

It doesn’t mean, however, that every hind leg lameness means your dog hurt their knee. Other potential reasons your dog might become lame on a hind leg include:

  • nail and pad injuries
  • foreign bodies
  • other soft tissue injuries
  • infections
  • arthritis
  • hip dysplasia
  • luxating patella
  • inflammatory conditions
  • cancer
Talk To Me About Dog ACL/CCL Injuries: My Dog Ruptured Their Cruciate Ligament


The knee joint is where the shin, thigh, and patella bones meet in the form of a hinge. It allows the dog to walk and run. If you ever wore a cast, you know how difficult it is to move around when the joint is immobilized.

The cranial cruciate ligament (CCL) is the equivalent of ACL in the human knee. CCL is one of two little ligaments inside the dog’s knee, or stifle, that contribute to the stabilization of the joint. I say contribute because there are other stabilizing structures in place. In fact, the CCL is supposed to be a backup, not the primary means of joint stabilization.

Further information: Ruptured Anterior (Cranial) Cruciate Ligament
Further reading: Hanging by a Thread? Stabilizing Forces in the Canine Stifle

Talk To Me About Dog ACL/CCL Injuries: Anatomy of the Cruciate Ligament
Healthy and torn cruciate ligament. Image PDSA

CCL injury

Some of the factors that contribute to CCL injuries in dogs include:

  • genetics
  • breed conformation
  • inflammation
  • metabolic issues
  • hormonal inbalances
  • gradual degradation
  • obesity
  • poor physical condition
  • early spay/neuter

While we believe we have it all figured out, it might not be so.

Does cruciate disease result from abnormal biomechanics on a normal ligament, normal biomechanics on an abnormal ligament, or a combination of both?

Animal Medical Center of Southern California

Further information: Canine Cruciate Ligament Injury

However things arrive to that point, when the CCL ruptures, it allows the bones in the joint move beyond the range the knee was designed for. The result is pain, inflammation, and arthritis.

What does a CCL injury look like?

Common signs of cruciate ligament tears include:

  • lameness/reduced weight bearing on the affected leg
  • weight shifting
  • an abnormal sitting position with one leg kicked out to a side rather than tucked in as normal
  • swelling may or may not be present
  • difficulty rising
  • trouble or reluctance to jump
  • reduced activity
  • popping noise (if the meniscus is damaged)

Your veterinarian might discover other signs such as:

  • reduced muscle mass/muscle atrophy
  • decreased range of motion

A dog with a torn CCL will be hesitant to bear weight on the affected leg or he may not put that foot down at all.

Dr. Andy Roark’s Low-Down on Cruciate Ligament Tears

Diagnosing CCL injuries

Diagnosing CCL injuries is relatively straightforward and includes:

  • physical examination
  • gait and sitting stance observation
  • joint manipulation (drawer sign)
  • diagnostic imaging
Talk To Me About Dog ACL/CCL Injuries: Injury Grading
Dog CCL Injury Grading

Cruciate ligament tears in dogs rarely occur due to an acute trauma to a previously healthy knee. Rather, they are typically the result of gradual weakening and gradual degradation.

CCL tears can be either complete or partial.

More information: Dog CCL Injury Grading: Cruciate Tears “All or None, or Partial?”

Talk To Me About Dog ACL/CCL Injuries: Drawer Sign
Drawer Sign

One of the key parts of the diagnosis of a ruptured cruciate ligament is the demonstration of abnormal movement—drawer sign.

A healthy joint will not move in such a way. The failure to elicit the drawer sign, however, doesn’t meat the knee is unstable; some strong dogs might be able to resist. When repeated under sedation or anesthesia, it becomes apparent.

More information: ACL/CCL Injuries In Dogs: Is There Such a Thing As A False Positive Drawer Sign?

Treatment options for CCL injuries

So now that it has happened, what do you do? You have to do something. The thing about ligaments is that they don’t heal very well. With minor damage, regenerative therapy, along with other measures, might allow healing. Most of the time, however, the goal of treatment is to stabilize the knee by other means.

Treatment options depend on the degree of the tear, the dog’s overall condition and health, size, activity level and other factor.

Treatment options include:

  • conservative management with or without brace
  • physical therapy
  • regenerative and cell therapies
  • surgery

I describe the various options in more detail in the articles linked below.

Non-surgical solutions

CCL Tears Conservative Management: My Two Cents on Non-Surgical Treatment of Cruciate Ligament Tears
Conservative Management

Whether or not conservative management is a viable option for you dog depends on several factors such as their

  • size/weight
  • age/activity level
  • overall health/other medical conditions
  • degree of damage

The best candidates for this approach are dogs who are:

  • less than 30 pounds
  • less active
  • older

More information: CCL Tears Conservative Management: My Two Cents on Non-Surgical Treatment of Cruciate Ligament Tears

Regenerative Medicine and CCL Tears: My Two Cents on Regenerative Approach to Treating Cruciate Ligament Tears in Dogs
Regenerative Medicine

Can regenerative medicine help treat CCL injuries in dogs?

There are two options to consider when looking for regenerative treatment for a partially torn cruciate ligament:

  • stem cell therapy
  • platelet-rich plasma therapy (PRP)

Some sport dogs orthopedic specialist like to combine the two.

Further reading: Regenerative Medicine and CCL Tears: My Two Cents on Regenerative Approach to Treating Cruciate Ligament Tears in Dogs

Surgical solutions

If your dog is still young and is otherwise healthy, surgery might be the best option. We’ve been through this with Jasmine twice. It is heartbreaking, but I do believe it’s the best thing to do.

Which surgery to chose? In the past, surgeons attempted to replace the ligament. However, just as a torn ligament cannot heal, it cannot be easily replaced either. So that leaves us with joint stabilization techniques such as:

  • extracapsular repair/suture technique
  • TightRope stabilization
  • Tibial plateau leveling osteotomy (TPLO)
  • Cora-based leveling osteotomy (CBLO)
  • Triple tibial osteotomy (TTO)
  • Tibial tuberosity advancement (TTA)
  • Simitri stable in stride stabilization (SSIS)

Which option is best for your dog depends on the dog. Which one is better – the answer depends on who you ask. Research your options thoroughly.

Most often though you’ll run into a surgeon who does and believes in one of them. Make sure your surgeon is comfortable with the chosen technique and has the experience and skill needed to do it well.

Dog CCL Injuries Extracapsular Repair
Extracapsular Repair

This is an older type of surgery, largely abandoned particularly for larger breeds. However, it can work under the right circumstances.

It is the least invasive technique. With a bit of luck, the sutures will keep the knee stable long enough for fibrous/scar tissue to develop. The scar tissue then stabilizes the knee effectively.

Further information: CCL Injuries Extracapsular Repair: My Two Cents on the Lateral Suture Stabilization or LSS in Dogs

CCL Tears TightRope Repair: My Two Cents on the TightRope® CCL Fixation System
TightRope Stabilization

The TightRope stabilization technique was conceived as an improvement on the traditional suture repair.

They are both variations of the same idea.

The RightRope repair uses stronger material which is more of a cord than a suture and it anchors it through both the tibia and femur.

This technique didn’t seem to take root and it appears the initial excitement wore off.

Further information: CCL Tears TightRope Repair: My Two Cents on the TightRope® CCL Fixation System

Tibial Plateau Leveling Osteotomy: My Two Cents on TPLO Repair
Tibial Plateau Leveling Osteotomy (TPLO)

TPLO has been considered the gold standard for the treatment of canine CCL tears. Does that make it the best option?

While I find it quite invasive, it does provide good stability when it’s done well.

I do feel that there is quite a bit of room for error, as well as it comes with inherent challenges that can lead to complications.

More information: Tibial Plateau Leveling Osteotomy: My Two Cents on TPLO Repair

Cora-based Leveling Osteotomy: My Two Cents on (CBLO) Repair
Cora-based Leveling Osteotomy (CBLO)

CBLO is the next-generation TPLO. Veterinary surgeons were looking for ways to address issues that were causing potential complications in TPLO patients.

To me, the CBLO indeed looks much better thought-out and elegant.

At this time, however, it is a novelty surgery which might cause challenge both with availability and the level of surgeon’s experience.

More information: Cora-based Leveling Osteotomy: My Two Cents on CBLO Repair

Triple Tibial Osteotomy: My Two Cents on TTO Cruciate Repair
Triple Tibial Osteotomy (TTO)

Triple Tibial Osteotomy (TTO) in in my opinion a clever, sensible take on the CCL surgery and I liked it better than the TPLO and TTA. In fact, it is an improvement in form of a hybrid of the two.

In spite of that, it remains obscure and largely not available in North America.

Further information: Triple Tibial Osteotomy: My Two Cents on TTO Cruciate Repair

Simitri Stable in Stride: A Unique Surgical Option to Treat Cruciate Injuries in Dogs
Simitri Stable in Stride Stabilization: The Hinge Technique

The Simitri Stable in Stride Stabilization is an emerging technique which is unique in its approach.

This surgery achieves stabilization by a hinge implant—you could think of it as a heavy-duty ligament replacement outside the knee joint.

Further information: Simitri Stable in Stride Stabilization: The Hinge Technique

Tibial Tuberosity Advancement (TTA)
Tibial Tuberosity Advancement (TTA)

The tibial tuberosity advancement (TTA) was one of the first modern surgical options to address cranial cruciate ligament tears in dogs.

The difference in the approach is that instead of changing the tibial plateau angle to achieve joint stabilization, TTA uses the strength of the patellar tendon.

The technique went through several evolutionary steps and improvements.

Further information: Tibial Tuberosity Advancement: My Two Cents on the TTA Repair

Talk To Me About Dog ACL/CCL Injuries: Post-Op
CCL Injury Post-Op Care

What happens after your dog’s surgery is just as important as the operation itself. Make no mistake—successful surgery is only half of the final outcome.

Exercise restrictions and physical rehabilitation are essential for your dog to regain normal function of the knee. Don’t let your surgeon send you home without a detailed post-op plan for your dog.

Further information: CCL Surgery Post-Op Care: Example Plan for Your Dog’s Recovery after Cruciate Ligament Surgery

Canine Full Cruciate Ligament Tears: Physical Therapy for Full CCL Tears
Physical Therapy for Full CCL Tears

Physical therapy is paramount to your dog’s successful recovery from a CCL surgery.

You can work with a certified animal PT and with guidance, you can do some of the exercises at home.

Always consult with your surgeon about the type of exercises and their timing.

More information: Physical Therapy for Full CCL Tears

Talk To Me About Dog ACL/CCL Injuries: Seccond CCL
Dog Knee Injuries: Why The Second CCL Often Goes Too

Given the fact that, in most cases, cruciate ligament tears are a result of a chronic process, the likelyhood of CCL tear in the second leg is high.

Not only that ligaments in both knees are likely to have weakened, the uninjured leg has to withstand additional weight-bearing while the dog is limping.

More information: Dog Knee Injuries: Why The Second CCL Often Goes Too

Preventing CCL injuries in dogs

There are measures you can take to minimize the risk, the most important of which is weight management. Effectively, when you review the list of contributing factors earlier, you can influence some of them.

Keeping your dog slim, fit, and healthy will help prevent injuries.

Talk To Me About Dog ACL/CCL Injuries: Prevention
Preventing CCL Tears in Dogs

Is there a way to prevent cruciate ligament tears in dogs?

Achieve an optimal body condition score for your dog, keep them healthy and strong, and consider curbing activities that increase the risk of knee injuries.

Further information: Preventing CCL/ACL Tears in Dogs: How to Keep Your Dog from Busting Their Cruciate Ligament

Talk To Me About Dog ACL/CCL Injuries: Early Spay and Neuter
CCL Tears And Early Spay And Neuter

Available data shows that the odds of CCL tears in dogs spayed and neutered before 6 months of age is seven-fold higher than in intact dogs.

For example, these dogs have significantly greater tibial plateau angle which is considered one of the anatomical risk factors.

Further information: CCL Tears And Early Spay And Neuter: Is There a Connection?


So you see there are choices. Each of them has its pro’s and cons. My main points here are, know your options, and do your homework. Always. One cannot make a good decision without information. Understand all your options, discuss them with your veterinarian or surgeon and then make a decision.

Don’t wait too long though, this is one of those problems that will not go away by being ignored. A delay will only cause additional problems down the line.

Related articles:
Why Is My Dog Limping? Causes of Lameness in Dogs—Symptoms To Watch For In Your Dog

Further reading:
The Pathophysiology and Medical and Surgical Treatment of Cruciate Ligament Disease

Categories: CCL injuriesJoint issuesKnee issues

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Jana Rade

I am a graphic designer, dog health advocate, writer, and author. Jasmine, the Rottweiler of my life, was the largest female from her litter. We thought we were getting a healthy dog. Getting a puppy from a backyard breeder was our first mistake. Countless veterinary visits without a diagnosis or useful treatment later, I realized that I had to take Jasmine's health care in my own hands. I learned the hard way that merely seeing a vet is not always enough. There is more to finding a good vet than finding the closest clinic down the street. And, sadly, there is more to advocating for your dog's health than visiting a veterinarian. It should be enough, but it often is not. With Jasmine, it took five years to get a diagnosis. Unfortunately, other problems had snowballed for that in the meantime. Jasmine's health challenges became a crash course in understanding dog health issues and how to go about getting a proper diagnosis and treatment. I had to learn, and I had to learn fast. Helping others through my challenges and experience has become my mission and Jasmine's legacy. I now try to help people how to recognize and understand signs of illness in their dogs, how to work with their veterinarian, and when to seek a second opinion. My goal is to save others the steep curve of having to learn things the hard way as I did. That is the mission behind my blog and behind my writing. That is why I wrote Symptoms to Watch for in Your Dog, which has turned out being an award-winning guide to dog owners. What I'm trying to share encompasses 20 years of experience.

  1. I watch a lot of the veterinarian shows on Animal Planet. It never fails that a dog owner comes in and their dog needs surgery because of an acl or a ccl injury. It amazes me what veterinarians can do now.

  2. Ouch. I have a messed up knee and that hurt just reading about it. I’m surprised about the connection to early spay neuter. I would never have thought of that being connected.

  3. We’ve been fortunate so far that none of our dogs ever had a serious leg injury. It is always good to know what to look out for and possible solutions.

  4. FiveSibesMom

    Great informative post! I am (sad to say) a bit of an expert with ACL/CCL injuries. Four out of five of my Huskies injured theirs.. One blew out both at same time (vet said they were “shredded” and worse case he ever saw, her meniscus, too) and it was an emergency situation. Her sibling blew out his over the next two years. My epi-Husky tore his and my eldest gal tore hers, but they both healed via Conservative Management Care.Oh, and did I mention I blew out mine, too?! :-/

    • Oh, wow, you are an expert on CCL injuries. So terrible to blow both knees at the same time including the menisci. I’m glad they all recovered.

  5. This was really interesting to read. I try to do my best to stay informed about potential injuries and illnesses that could impact my pups, as well as what to watch for – but I’ll be honest… I really didn’t know much about CCL injuries. It’s definitely not the worst thing that could happen, but it’s always better to be prepared.

  6. Ouch, Layla hops with her left back leg in the air, she has been doing it since I got her but my vet is not concerned and checks it each time we are there. She will do it for about 5 minutes at the beginning of a walk and then start trotting along with no problems. Thanks for the post though always good to learn

    • That is so strange your vet is not concerned at all. Did you film it? Could it be luxating patella? Low grade luxating patella would not require surgical intervention, just supportive approach.

  7. This info was so helpful! My dog was recently diagnosed with IVDD, but that is commonly misdiagnosed as CCL/ACL injury. I’ve been curious about it and many of the symptoms do seem similar.

    • Personally, I’d say CCL tear is better than IVDD. But I agree with you–after she healed from her CCL surgeries, Jasmine came home completely lame on her hind left leg. It looked totally like a busted knee except there was no ligament to bust. Chiropractic adjustment fixed it.

  8. This sounds a truly painful condition and almost made ME limp in sympathy with suffering dogs. I am glad that you include a list of other conditions so people may not go straight to panic mode (but go to the vet because this matters most).

    Your post is really comprehensive and lays out the various options clearly so owners can try to understand and make an informed decision, or at least know the right questions they can ask with their vet when discussing options.

    I hope your post will make the worry less for any dog owner who has to cope with CCL.

    • It is the same as ACL tears in athletes. It is painful and leads to damage and degradation of the joint too.

      But I can tell you that Cookie had the exact same lameness and it turned out being a porcupine quill fragment between her toes.

  9. It’s interesting to read about all the potential treatment options for CCL injuries. I’ve heard horror stories about dogs rupturing their CCLs and despite the fact that my dogs aren’t the typical size/breed you see it in I’ve always been a bit paranoid about them rupturing their CCLs.

    • There was a time when I considered a CCL tear a tragedy. Given the worse things my dogs have been through since, I look at it differently now.

      Small breeds can bust their CCL as well but it is not as common.

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