Cassy CCL
09.02.19

A blog about Cassy the dog’s CCL Injury and Recovery

I felt called to share my experience with my dog’s CCL Injury as I benefited so much from others’ stories, and because I think it’s important to know that there are treatment options out there. It’s also helping me keep my sanity during such a stressful time. Please note: I am not a Veterinarian or animal specialist of any kind – if your pet is injured please see a vet right away! Below is our experience from my point of view, and my recommendations are that of a dog owner.

I’ll be updating this blog as we journey through this challenge to find wellness for my little Cassy.

Cassy the pitbull

Cassy is a rescue dog who came into my life care of an amazing rescue group called Flirting with Fido in Victoria, BC where I used to live. She had a rough 3-year start to life in East L.A. where she was abused, malnourished and abandoned, and as a result she was shut down when we first met. She started out as a foster, and was soon adopted as my forever fur-baby. She is like a child to me and I would do anything for her. She is a Dogo Argentino Pitbull X, and she is the most passive and affectionate animal I have ever encountered. She has always been very lazy and would prefer the options of napping on the couch, sunbathing in the yard, or digging a hole in the bushes and napping there – so very low energy. She is approx. 9.5 years old right now, weighs a lean 50 pounds, and she has had arthritis in her knees and elbows for a couple of years. She also had a previous injury to her front right paw that didn’t heal well, so it gives her issues (slight limp).

What is a canine CCL injury?

CCL stands for Cranial Cruciate Ligament, and it is the canine equivalent to the human ACL (Anterior Cruciate Ligament). It is one of the ligaments responsible for stabilizing the knee while weight bearing. A canine CCL injury is one of the most commonly seen orthopedic problems for dogs. The levels of severity can be classified as: stretched, pulled, partial tear or full tear (rupture or torn).

Normal to torn canine CCL

Symptoms of the injury

Depending on the severity, symptoms can range from having a hint of lameness to being unable to bear weight on the injured leg. There may also be swelling and heat on the inside of the knee.

Treatment Options

There is no “best” CCL procedure, but there are procedures “better suited” to each individual dog depending on a number of factors such as:

  • Age
  • Weight
  • Activity level
  • Existing problems with the other legs (including a torn CCL in the other stifle)
  • The owner’s expectations and financial means
Tibial Plateau Leveling Osteotomy (TPLO)

This method changes the angle and relationship of the femur and the tibia. The overall intent of the surgery is to reduce the amount that shifts forward during a stride. This is accomplished by making a semicircular cut through the top of the tibia, rotating the top of the tibia, and using a bone plate to allow the tibia to heal.  This realignment of the surfaces within the stifle helps to provide stability during a stride, and helps to reduce future joint inflammation and OA. By carefully adjusting the angle or slope of the top of the tibia, surgeons are able to replicate a more normal configuration of the knee joint and reduce mechanical stress.

Tibial Tuberosity Advancement (TTA)

TTA is similar in concept to TPLO but is considered slightly less invasive. The TTA procedure is more commonly performed in dogs with a steep tibial plateau, or angle of the top part of the tibia. With this method the front part of the tibia is cut and separated from the rest of the tibia. A special orthopedic spacer is screwed into the space between the two sections of bone to slide the front part of the lower knee forward and up. This moves the patellar ligament (the thick fibrous band that runs on the front of the knee from the top to the bottom of the joint) into better alignment, thereby removing some of the abnormal sliding movement. A bone plate is then attached to hold the front section of the tibia in the proper position. By changing the alignment of the patellar ligament, the forces that cause the femur to slip backward when the CCL is torn instead move straight down the tibia, resulting in less shearing force or instability.

Extracapsular Stabilization

ECLSThe Extracapsular Stabilization method uses a loop of a special type of suture material (an artificial ligament) that is placed from the back of the knee joint around to the front, where it is anchored just below the knee. This suture material stabilizes the joint and prevents the tibia from slipping back and forth after the cruciate ligament has torn. This procedure typically requires two bone channels (tiny holes) to be drilled — one at the front of the tibia and the other on the outer (lateral) aspect of the femur at the level of the stifle joint —so the artificial ligament can be passed through them.

TightRope® (TR)

Different materials and a slight variation in the traditional extracapsular repair have resulted in the TightRope® procedure. This method uses a customized needle and a special suture material affixed to bone anchors. The TightRope® procedure requires drilling two bone channels (resulting in four holes) — one from side to side through the tibia and the other from side to side through the femur — to run the suture material through, thereby stabilizing the joint. The use of these unique bone anchors helps reduce the need for additional suture material in the joint.

Conservative Management (CM)

While there are numerous options for surgical management, surgery is not always feasible for reasons such as:

  • Existing medical issues
  • Pet owner financial concerns
  • Staging procedures for bilateral CCL insufficiency

Options do exist for the conservative treatment of partial or full CCL tears for which patients are unable to undergo surgical intervention. Some methods include:

  • Physical therapy
  • Chiropractic adjustments
  • Acupuncture
  • Massage
  • Nutrition
  • Nonsteroidal anti-inflammatory drugs
  • Medicinal herbs
  • Prolotherapy
  • Weight loss for overweight dogs
  • Laser therapy
  • Rehabilitation therapy such as isometric, isotonic, isokinetic, and eccentric exercises (once pain and inflammation are relieved)
  • Functional stifle (knee) braces

Cassy’s Injury

January 7, 2019

We were walking when all of the sudden her back left leg went lame. This same back leg had been quite stiff for a good 6-months prior (was said to just be arthritis), it was so stiff that she hardly bent the knee when walking. After her leg went lame she was attempting to hobble on 3 legs, holding the one up in pain.

I took her to Fishcreek Animal Hospital here in Calgary, Alberta as that’s her usual vet. Dr. Woo saw her and kindly poked and prodded, took x-rays, and came to the conclusion that it was likely an arthritis flare up, or maybe she slipped and pulled a muscle on the ice. Cassy was prescribed Gabapentin and I was told to do hot and cold therapy, and keep her walks as short as possible. I am now carrying her up and down 16 winding stairs three times a day, which I’ll admit is a good workout for me. The next day she was putting a little weight on the bad leg but limping heavily, and there after she would limp while walking with little improvement if any over the next few weeks. I was concerned, and I no longer trust the vet’s assessment so I decided to get a second opinion. Note: always get a second opinion.

February 2, 2019

I took Cassy to the Carstairs Veterinary Clinic which is a 45 minute drive North of Calgary for a second opinion. My brother took his dog Jax here for laser therapy and highly recommended them. We saw Dr. Mallory Green who I think did a quality and thorough assessment. She was professional, relatable, gentle with Cassy, and straightforward which I appreciate. She was confident it was a full CCL tear and recommended Dr. Tom Picherack of the clinic do a TPLO surgery as soon as possible. She said the surgery would cost roughly $3,500.00 – and even more if I had it done in Calgary!

This is when panic set in for me … I got researching options, and I got overwhelmed … REALLY overwhelmed.

My parents’ dog Kage, an active 90 pound German Shepherd, had the TightRope surgery on both his legs. He was 2.5 years old for the first one, and had the other leg done at 5 years old on Vancouver Island, and had great success there after and lived a long life!

February 11, 2019

We went to see Margaret Kraeling at The Canine Fitness Centre in SE Calgary for a full exam and laser treatment. She concluded that it is a partial CCL tear.

So I’m conflicted and confused … one person says “it’s arthritis, here are some pills, lets wait and see” … another says “it’s a full tear – lets book surgery ASAP” … and another says “it’s a partial tear, let’s try conservative management and go from there.”.

Margaret said there was equal swelling on both knees on the lateral, her left hip-flexor is tender, her left hip is sore at full extension. She did a drawer test which told her it was only a partial tear and not a full tear. She’s concerned that Cassy’s left hip is not in good enough shape to be able to support a knee after having surgery on the same leg. She recommends Conservative Management for the next few months, so Cassy is booked in for hydra therapy and laser sessions. She did 3B laser therapy on all of Cassy’s joints, and recommends I ask our vet about cartrophen injections for the joints. She was very happy to hear Cassy already gets Glucosamine and Omega 3 supplements, and I’d mentioned that I used to give her CBD Oil and Golden Paste – so we are to continue that as well.

She said Cassy may need surgery in the future (could be as soon as within 6-months), but that Conservative Management and rehabilitation should be utilized at this time. She is partial to the Extracapsular Stabilization method of surgery if we need to go down that path, and recommended Dr. Gheorghe Rotaru of Heartland Veterinary Clinic in Airdrie, Ab.

February 12, 2019

The over the phone 30-minute BodyTalk session for Cassy with Cassandra of Cassandra Clegg Health & Wellness was a great experience (as always)! BodyTalk is a system of integrative health care that takes a holistic approach to healing, based on proven principles of energy medicine. I have personally tried 3 different BodyTalk professionals for my own health challenges, and I have only found success, results and so much clarity with Cassandra – so be choosy with who you see for this modality. She did a session with Cassy years ago and blew me away!

Cassandra found that most of Cassy’s pain is up around her left hip, around the thigh and to the knee. She assessed she had tight connective tissues around the muscles, that the knee joint isn’t quite in properly, and that things really tight all around the knee. She didn’t report a tear in the CCL but notes it is wearing down. Interesting stat: It usually takes a blunt trauma or injury in humans to tear the ACL, and this can be the case with dogs – but more often than not, the CCL tends to deteriorate over time (more so in certain breeds). Cassandra mentioned a bunch of things I had to google so I won’t bore you with technical terms, but she did some remote energy healing to loosen things up all over (including the C1 vertebra, neck and adrenals) and it REALLY showed the next day! Cassy’s left hip is noticeably looser with a much wider range of motion, and she’s putting more weight on her left leg. She’s walking completely different from how she was before the BodyTalk session, and has a little more pep in her step and confidence! So grateful. We were also recommended a Holistic Veterinarian from a friend of Cassandra, one who has a lot of experience treating CCL injuries from a holistic angle – so I’ve booked yet another assessment.

Cassy’s first Hydrotherapy Session at Canine Fitness

This we’ve now determined was the WRONG course of action and not recommended for a dog with an untreated ligament injury! It is however a great tool for post-surgery recovery, or for dogs that have knee braces for support – and as directed by a veterinarian.

March 4, 2019

We saw Dr. Taylor of Taylor Holistic Vet via the Sundance Animal Hospital in SE Calgary for an assessment. She is a leading specialist in Osteopathy – which she describes to be “the deep fix, not the quick fix“. Her treatment methods use 3 approaches:

  1. Visceral / Organ Manipulation (VM)
  2. Craniosacral Therapy (CST)
  3. Manipulation of Joints / Spine (aka ‘Adjustments’)

Dr. Taylor believes Cassy has a partial CCL tear, and performed a thorough assessment and treatment/adjustment using the above three approaches. We are booked in to see her next week, so will see how the adjustments took hold and whether we will need a third session. She leans on the Conservative Management side of things at this point for Cassy, and thinks she may benefit from a custom knee brace. These braces cost around $1,000.00! She thinks that due to Cassy’s arthritis in both elbows and knees, that surgery may not be the best fit. So we will check-in next week!

March 12, 2019

Dr. Taylor session #2 went well, she did another hour and a half adjustment that Cassy is responding well to. She also recommended some homeopathic medicines (only $8 each):

March 14, 2019

We met with Dr. Catherine Pampiglione at the Canine AquaFitness and Veterinary Rehab Centre in Okotoks, AB for a FREE 30 minute meet and greet to discuss getting a brace with them.

I have decided (with the help of Dr. Taylor) that the best route to take is Conservative Management by way of a custom made orthotic knee brace. So we have just started the process of ordering her one made by My Pet’s Brace via Canine AquaFitness and Veterinary Rehab Centre in Okotoks, AB.

The process of getting a custom brace for Cassy will likely take anywhere from 3-5 weeks and goes like this:

  1. Initial consultation with vet
  2. 1-hour casting session with vet and vet assistants
  3. I mail the cast to MyPetsBrace in Pennsylvania
  4. The brace is made within 10 business days
  5. The brace is then mailed to our vet here
  6. Cassy gets fitted at the vet’s office
  7. There are 2 reassessments/adjustment/follow-up sessions

Costs Incurred (ongoing) in Canadian Dollars

01/07/2019 | Initial Vet Visit + X-Rays + Meds = $338.48

02/02/2019 | Second Vet Visit + X-rays + Meds = $114.14

02/07/2019 | Recommended Supplements = $57.73

02/11/2019 | Rehabilitation Initial Exam = $184.80

02/12/2019 | BodyTalk Session (30 min) = $55.00

02/16/2019 | Laser therapy + Hydrotherapy = $50.40

02/23/2019 | Laser therapy + Hydrotherapy = $50.40

03/02/2019 | Laser therapy + Hydrotherapy = $50.40

03/04/2019 | Third Vet Assessment + Adjustment #1 = $231.00

03/12/2019 | Dr. Taylor adjustment #2 = $136.50

03/14/2019 | Dr. Catherine Pampiglione meet + greet = FREE

03/22/2019 | Leg casting + 3 appointments (fitting + 2 follow-ups) = $596.40

03/22/2019 | Custom orthotic brace ($799 USD + tax) + shipping = $1,428.77

Total = $3,294.02

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