Approach to the CCL Dog

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On this week's episode of The Vet Blast Podcast presented by dvm360, Adam Christman, DVM, MBA, welcomes Karl Maritato, DVM, DACVS-SA, and a 2024 Veterinary Hero award winner, on the show to chat all about cranial cruciate ligaments (CCL) in canine patients. Throughout the episode, Maritato and Christman go over the surgical options for these patients, the importance of proper techniques, the use of braces and rehabilitation protocols, and how he encourages pet owners to consider long-term care as well as the benefits of timely surgery.

Below is a partial transcript

Adam Christman, DVM, MBA: Where do you begin in terms of physical exam on your approach, when you're thinking, 'Oh, this one might have torn their CCL'?

Karl Maritato, DVM, DACVS-SA: Well, the first thing I do is try to not think that. I try to be unbiased, and I try to do the same exact physical exam every single time that I do it, when it's the hind limb, I always start in the toes, and I start just pushing and moving every digit through range of motion. And I'll be honest with you, if I do think the ACL is the problem, I'll actually kind of skip over that joint, because I don't want to run out of doggy minutes before they get upset with me. So I'll guide my hands up and down their legs. I just try to feel for symmetry. I try to feel for muscle atrophy. The biggest thing that I'm feeling for, if I'm feeling for an ACL just by when I'm rubbing my hands on their legs, is I'm feeling for a medial buttress in comparing the 2 sides.

The biggest trick, I think, or thing that tricks most of the veterinarians, is the partial tears, and especially when they're somewhat early. You know, I certainly get a lot of texts saying I'm going to send you a dog. I'm not getting any drawer. So I don't know if it's an ACL. And then when I feel it, you know, I know immediately it is an ACL, because you can feel that medial buttress just really sticking out compared to the other side. So start at the toes, work my way up, just feeling muscle mass, manipulate the ankle, make sure that's all good. Another thing that can trick people is when they think it's an ACL, particularly if it's an Australian shepherd or breed like that, is luxation of the superficial physical flexor tendon. So I always try to feel the ankle to make sure that there's no popping going on down on the caudal aspect of that calcaneus. And then I run my hands up, and then that's where I start to feel for buttresses, as well as for muscle atrophy in general.