My golden retriever Carly was diagnosed with a CCl injury. My vetnarian gave me a list of orthopedic surgeons. I came home and started researching everything I could about this injury and all of our options.

I contacted several surgeons over the phone and came to a conclusion. The cost of surgery was very expensive and I had read many reviews of dog owners who had decided to opt. for surgery and stated that their dog either re-injured themselves on the same leg or the oppisite leg. I did not want to put my dog through surgery and the amount of pain associated with that.

I decided to try conservative management first. I spoke with the vetnarian and she was very supportive of my decision. I ordered a casting kit from Ace Ortho Solutions and when it arrived at my vetnarians office she casted my dogs leg so that she could be fitted for a custom leg brace. The brace cost about $650. Since the company did not accept care credit my vetnarian allowed me to pay her using the care credit so that I was able to make payments and she paid the company for the brace. It couldnt have worked out better.

It has been approximately 4 months since my dogs injury and she had to wear the brace for about two months. I would leave it on during the day when she was most active and took it off at night. I am very happy that I made the decision to choose conservative management. The surgery is not guaranteed.

I also bought Carly a dog life jacket and let her swim as much as possible with a feeling of security. I purchased a handheld lightweight massage and Carly enjoys every second of it! Also, not to mention that the brace I purchased was waterproof so she could swim with it on.

If you are struggling with the costs I just want to inform everyone that their are other options and resources you just need to do your homework. I hope this will be of some helpful information to anyone who is in the position I was in 4 months ago and had never even heard of this injury before.

Conservative Management and Knee Brace – Carly is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Here’s a story that should provide hope to anyone with a pooch with a CCL problem…

We have a 140lb. Newfoundland. He is very active and blew out his right CCL 6 years at 18 months. It started with a tear. He wiped out on our tile floor. We were devastated.

We took him to a specialist. He immediately wanted to cut. That didn’t give us the warm and fuzzies. We then went to another about an hour away from us. He said the ligament was torn, but not ruptured so there was hope. He suggested waiting to see what happened.

Well, a month or so later, Porter blew his knee completely. Started just toe tapping and wouldn’t put much weight on it. We went back to the vet and he suggested TPLO. We went through with the surgery. About $4,000! It’s heavy duty surgery. But, Porter came out in flying colors. Took a solid 7 or 8 months before we let him off leash, but the surgery worked pretty well.

I say pretty well because he’s always been a bit light on that leg since then, but he runs, jumps and doesn’t show any signs of discomfort.

Everything was great until December, 2009. That’s when he started limping on his left side. He had now injured his other knee, which is about a 50/50 chance with large breeds after they have one knee rupture. We’re not sure what he did, but he is very active and runs/jumps all by himself, so he probably fell in our yard or running up our stairs.

This time we did a lot of research about Conservative Management. We really didn’t want to put him or us through surgery again. After speaking to a couple of different vets and people who had gone this route, we decided to take a chance. The vets really didn’t give us much hope as they said usually CM only works on smaller animals, but it was worth a shot.

Porter was confined in a small room and when we were home we’d let him out, but only under VERY close supervision. He was always on leash. No stairs, no walks except for potty breaks in the yard. He was confined to a 3×5 area when we weren’t home. This went on for 3 months.

At that point we started short (5 minute) walks a couple of times a day. still always on leash. From that point we increased his walks over time to about 15 minutes by 6 months.

At 6 months we let him off leash in our yard. He was still supervised and we didn’t let him run. A little trotting was about it. We continued to walk him 2 or 3 times a day for 10 to 15 minutes a time. Every month we’d give him a little more freedom. By 12 months you’d never even know he was hurt!

Now (Nov, 2011), He’s now back to full activity…swimming, running, acting like a nut! We still don’t allow him to jump off things and we don’t chase him a lot or let him deak back and forth, which puts a lot of stress on knees. But, other than that, he’s free to do as he wishes. He couldn’t be happier.

We put Porter on various supplements…fish oil, vitamin E, Glucosomin/chondroitin. We also cut his food slightly to be sure he didn’t put weight on. We continue with the supplements to this day.

We also started him on Adequan. This is a miracle drug for arthritis pain! we give it to him once every 6 weeks and you can see the difference in him. It’s incredible. I highly recommend it. Find a vet that will let you inject it and you’ll save a ton of money.

We read much of this site before deciding on CM. Many people make the same comment about their dog being too active and thinking they won’t be able to control them or the dog will be too sad sitting around all day. Believe me, it’s harder on the owner than the dog. If you have the willpower to control your dog, you can do this. Really, it’s not much different than TPLO. You’d still have to keep the animal calm for months.

One interesting thing, last year we had Porter’s right knee xrayed. It was quite damaged by arthritis. We were told that was one of the main reasons to undergo surgery…to reduce arthritis. That apparently didn’t work! Some day we are going to have both knees xrayed to see the difference.

A final thought…my wife blew out here knee for a 2nd time last year. We went to one well known surgeon…he said he needed to operate.

Based on Porter’s outcome, we were somewhat skeptical. We went to NYC to see another top notch surgeon. He said no surgery…basically follow the same CM idea. It’s been a year now and her knee is doing very well without surgery!

To sum it up, CM worked very well for us. I would highly recommend trying it, but you HAVE to COMMIT yourself to it. It’s going to be hard, but if you stick to it, it can work. I’m sure there are cases where surgery is the only way out, but don’t be too quick to decide on this route. I don’t see any reason to not try CM before cutting.

I definitely don’t buy the idea that arthritis will be worse if you wait…we didn’t wait and Porter still got pretty bad arthritis in the repaired leg.

I know if you’re just going through this now with your dog, you’re probably very upset. Believe me it’s not the end of the world. Your dog will get better…it’s just going to take some time and a lot of care.

TPLO and Conservative Management – Porter is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

I have a rescue Basset Hound/Golden Retriever mix who is almost 4 years old. He is a very mellow, chill couch potato that does have spurts of energy and playfulness, unlike our constantly crazy Yellow Lab. About 7 months ago, they were playing in the yard and he must have somehow hurt himself because after napping for a couple hours he wouldn’t put his left rear leg down. He even moaned every once in a while in pain. We called our vet that night (not a surgeon), and he said he was pretty sure it was his CCL and that we can have him evaluated first thing in the morning. However, in the morning he was able to walk on his leg just fine and no moaning or lameness since – so I was reluctant to even take him to the vet. The vet explained the drawer test to us, and then performed it on our baby (who let out the most heartbreaking squeals of pain I have ever heard).

I was a little miffed by the way our vet recommended TPLO. We wanted to do our homework, so we saw an orthopedic surgeon who said he only partially tore his ACL and he recommended TTA surgery, but suggested we first try glucosamine/MSM/chondroitin pills along with strict rest for 8 weeks. We combined that with another antioxidant with glucosamine in a powder form. We were relieved that he suggested this first, as the TTA/TPLO are scary to me. He seemed to recover beautifully, he is a mostly chill dog so he didn’t much mind strict rest! He had no obvious limp and seemed to bear weight pretty evenly for months so we started to slowly introduce some exercise about 2 months ago. At the same time, we decided to switch to cheaper glusocamine pills and he remained to be doing great. We let him off the leash, take him for long walks, and he hasn’t had any signs of pain or lameness.

However, as of 2 weeks ago, he seems to be regressing. I took him for a walk, and wouldn’t even use his leg after a couple of hours. So we went back to strict rest and he was fine to put weight on it again the very next morning, just like at Day One over 7 months ago. Although he is using his leg, he does slightly favor his good leg and are concerned that the rest and glucosamine just isn’t enough for him, but I am praying that switching back to the other pills will do the trick.

Let me tell you, I love the hell out of my dogs, and have done more research and called more vets (holistic, surgeons, etc) than you’d ever imagine. We are trying to figure out what the next step should be. No matter what, we are going back to the other pills and they arrive tomorrow. We are also putting him on a diet dog food, he could lose a couple pounds. I have started massaging and icing his knee. I’m also doing a little physical therapy on him at home using a really helpful youtube video I found. Maybe a brace would help him?

We were so saddened by his setback that we are revisiting the possibility of surgery, as much as we don’t want him to go through that. But I am afraid of arthritis – some say NOT doing surgery causes it, some say surgery causes it. We don’t know what the best thing is for our dog and we want to do the right thing and make an educated decision. The TPLO/TTA seems so invasive, and aren’t sure if it’s worth the risk/cost. Or if since he is generally lazy the conventional surgery would be better for him. Maybe the Tightrope would be better, but I have researched and there are many failed cases of those as well as the other types of surgeries. Any advice or general direction would be greatly appreciated! Thank you in advance for your time!

We are trying to figure out what the next step should be, as surgery is something we are considering but we don’t know what the best thing is for our dog and we want to do the right thing and make an educated decision. The TPLO seems so invasive, and aren’t sure if it’s worth the cost or if since he is generally lazy the conventional surgery would be better for him. Any advice or general direction would be greatly appreciated! Thank you in advance for your time!

A Conservative Management Experience – Pudge is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Hello! In June my 7 year old English Bulldog, Kata, was running on her walk when she seemed to step wrong or something. She continued to run and play, not seeming to be bothered much. I assumed it was just a pulled muscle or something.

Then last week we had her off leash and she took off after a cat. She came home limping and would not put any weight on her left rear leg. I took her to the vet a few days later and the vet thinks it is a cruciate ligament injury. The vet did not do x-rays (as she knew if we decided on surgery the surgeon she referred me to would want to do her own) so I do not know the extent of the injury.

She is currently on Rimadyl (only a week’s supply as of now) and is putting weight on the leg, but not a lot. I can tell it is uncomfortable for her to squat when going to the bathroom. Overall she is pretty mellow, only trying to jump and “trot” when someone comes home. We have not been walking her and she is devastated since right now it is finally starting to cool off (we live in AZ). I am so torn as to what is the best choice for a 7, almost 8, year old bully who still seems full of life and not in much pain.

I want her to be able to run and play though, but don’t want to put her through a painful surgery and recovery if she can recover with just CM.

How to tell? I know that there is no rush to make a decision, however, I feel like the more time that passes the older she gets and more risk comes with age for surgery. HELP!

Conservative Management Advice for CCL Injury – Kata is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Looking for more information on experiences using canine chiropractic, laser therapy and nutrition to help your dog heal form a CCL knee ligament tear or rupture? Keep reading to see how Pepe is progressing using Conservative Management.

I’ve also put him on a raw food diet to ensure that he’s getting the best possible nutrition.

He’s a laid back boy so it’s not too hard to keep his activity at a minimum. I’ve been picking him up to get on the bed, but after reading some of these posts maybe I should not let him go up and down the stairs. I’m also looking at chiropractic and acupuncture as complementary treatments.

I spoke with the Dr. in my office today, and he is going to use a chiropractic instrument (activator) to adjust his spine, and also a cold laser on the knee. This is one of my huge benefits of working where I do! Complementary and alternative medicine is hopefully going to be beneficial for Pepe.

June

Pepe is doing okay… Still not using the leg but does touch his foot down quite a bit.

Two weeks ago Pepe was treated with the activator by going three times down his spine. It’s spring loaded, and as he goes through each vertebrae, he can tell where there are energy blockages by Pepe’s movements after each. Then when he repeats he can tell if those spots “clear”. He had his 2nd treatment last week, and then well wait 2 weeks for the next.

Pepe is also getting the cold laser, but it really works best if you can treat every day for multiple sessions.

I can definitely see a difference in Pepe’s demeanor after the adjustments. He just looks perkier and the way he holds his ears just look like he’s happy and normal!

I still have him on 2 Gotu Kola Complex (MediHerb) tabs per day, as well as 2 Boswellia Complex tabs per day. Additionally, I am feeding him raw “meatballs” from Nature’s Variety and break the herbal tablets in half and stuff them in chunks of the meat. I also sprinkle his food with 1/2 t of Canine Musculoskeletal Support (Standard Process) each day as well.

Our Dr. has seen quite a few dogs completely recover and stabilize the joint on their own, but it’s a slow process. I’m still convinced that with the alternative treatments avoiding surgery may be possible.

4 Months

Alternative Treatment for CCL Injury – Pepe is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Here’s my story:

• Luscus, 18 month old Cane Corso, 125lbs
• Level 2 tear right rear CCL
• Occurred at beach when he slipped on a wet rock as 2 dogs jumped on his back (playing)
• After drawer test doctor recommended tplo surgery

Reasons Conservative Management was selected:

• To cut the bone of a dog still growing did not seem reasonable
• Level 2 tear only
• Post surgical complications of TPLO

Conservative Management Treatment:

• Entire floor covered with non slip rugs
• Dog kept in confined area large enough to lay down and stretch when alone
• When I was home, dog confined to single room and kept calm
• Leashed walks, dog always kept to slow walk. Week 1 distance = 0 feet; walked just enough to get to grass
• Week 2 walking distance increased 25 ft only if no setbacks/injuries during week 1
• Each week continued increasing distance per walk
• Always kept dog calm, no playing, jumping, etc.

• Approximately 4 weeks dog was walking normal and wanting to do more
• I waited until end of 6th week to begin rebuilding muscle and ligament strength with light running
• Continued to add time spent running each day, similar to how walking distance was increased each week
• End of week 9 dog was at full activity and strength
• Never had a recurrence or re injury

Personal Comment:

• Even if you opt for surgery – the above recovery period applies
• With all the great braces available conservative management becomes easier

Conservative Management, A Non Surgical CCL Repair – Luscus is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Hudson, a Lab mix, came into my life in April 2002 as a rescue from a local shelter. He was discovered abandoned at a car wash and he has never been alone again. Hudson is just a dude who loves his Daddy and Mommy and we adore him. I would sell all my possessions and live in a box if that is what it took to care for him. Judging from other posters to this site, my feelings are no different than others regarding their pets. But I have made some mistakes along the way.

At approximately 4 year of age, he showed significant hesitation in his normal activities. Short version is – We discovered serious hip dysplasia, had full hip replacement on both sides, and he had a full and healthy recovery.

About 2 years ago, he came up limping on right rear leg. Testing indicated hips were fine, but knee was suspect. Admittedly we were upset being hit with a $1300 bill to find out what was done earlier (hip replacement) was ok and now you can spend more finding out what is wrong. As we contemplated making an appointment with recommended doctor for evaluation of knee, Hudson stopped limping, so we postponed evaluation and life went on.

About 3 weeks ago he started limping again. Not fully off the right leg, but favors it when getting up and during initial walk. He did (and still does) stand on it to pee (about 30% of time, uses left leg the remainder). We started him on fish oil (twice daily) as an anti-inflammatory. I poorly thought this was just a flash-back to earlier and keeping him inside more and not chasing/playing with his buddies would suffice.

Starting this week it appeared to be getting worse. So we took him in (I notice folks do not mention vet or clinic names, so I won’t…but will if asked). He had x-rays taken (and they asked if they could do routine blood work for kidney/liver function to gauge general health…I said ok). During our wait a nurse/technician showed us x-rays of horrible knee joints and told TPLO was the only way to go. It will fix our dog…this was before any evaluation!

Surgeon was delayed for some reason, so nurse/technician brought us Hudson’s x-rays. I am not a vet, but they looked nothing like what we had been shown. Realize you cannot tell a ligament tear/rupture from an x-ray, but you can measure bone misalignment, get some feeling for buildup of scar tissue, arthritis, etc. She started back-peddling a bit and said she was not that experienced (earlier she boasted of her 10+ years assisting this surgeon) and doctor was better at seeing the problems.

Regardless, doctor showed up. After a brief introduction (5th time at this hospital, 1st time with this fellow) he brushed by my wife and myself, stooped down to dog and pulled his leg. Hudson yelped and ran for the corner. Doctor said Hudson had torn ligaments in right leg (as indicated by the dog’s pain) and needed TPLO surgery right away. He also said we needed to do the left side also as typically during the recovery the stress generated on the non-repaired knee will cause it to fail. It was best to do both at same time…$4200 a piece (less ~$1200 discount for doing both at same time) and he had opening in his schedule for Thursday (this was a Tuesday). I started to remember the blood work being done…they already thought this was a go without any discussion/consultation? Reason for so quick was ligament was most likely not fully ruptured so meniscus was likely intact, so it needed to be done ASAP to prevent more damage. We gathered Hudson who fortunately could still walk; I took him to our car while my wife paid our bill ($398.10 for 2 x-rays, general blood work and our consultation).

Hard to drive when you are crying like a baby (I’m 58). Lots of stuff on my mind, but on the productive side I knew we needed much more information.

That brings me to this site (and similar ones) where experiences are shared. After reading many of your contributors stories and experiences, we contacted our regular vet (he is mostly a large animal fellow who takes care of our horses but has always been honest with us and we have known him for years…and right now I needed a professional I could trust) and relayed our experience. He stated the surgeon at the hospital had already contacted him (our local vet was the referral for the hip dysplasia diagnosis) and told him the dog had a ruptured CCL in right leg and damage in the left. The dog was tough (how do you know this…because Hudson only yelped and did not bite him when he pulled his leg?) and could take both TPLO procedures at once. Our local vet did not say (and my wife asked directly) this surgeon tried to convince him to convince us, just wanted him to know the facts before we talked to him.

Anyway, our local large animal vet reviewed the x-rays and blood work (results fine), watched Hudson walk, gave a careful exam to both Hudson’s legs and felt (while he was not certain as the dog really tensed up and this stiffens the muscles making checking play in the joint difficult to detect) that he would not initiate the TPLO process (or any other surgical remedy) at this time. He also stated he would not do any surgical process simultaneously-risk was too high, animal may just quit due to the pain/rehabilitation stress). Our local vet was not certain the status of the ligaments. He did place a call to a radiographer and discuss passive options to determine ligament condition (CT scan was not viable; MRI was, but at a cost of $1500 to $2500). He felt the conservative management approach we learned from this site and told him about was a good one to try for at least 60 days. He felt nothing was to be lost and much to gain. It would give us some time to obtain even further information.

So we are on day 1 of our CM venture. Food is changing (we have historically believed you should take a few days to fully change from current food) to a weight management recipe (he is at least 10 lbs. overweight), Hudson remains on 2 tablets daily of Fish Oil capsules, we have started him on twice daily Chondroitin/Glucosamine tablets (SAM’s version) (pulverized), I have ordered the Yucca Oil Extract (another anti-inflammatory), we have spoken several times to Dr. Spatt and ordered the A- TraC Dynamic Brace (hopefully get middle of next week), Hudson is under house arrest (as my Mom call’s it)…minimal walking on leash only!. I will now be sleeping downstairs…no steps…we have put up barricade to stairs.

I am not a person of strong faith but I am praying daily for my dog to recover. This experience has placed his mortality in the forefront of my mind and I truly cannot imagine his not being my best friend forever.

I am open to any ideas to assist in this process. That includes experiences with a surgical remedy, though at 9 years old and having been through 2 hip replacements (although it truly went fine and he was given a better quality of life to date) I currently cannot imagine putting him through a similar or more invasive process again at this time in his life.

Thank you for your time.

Conservative Management Instead of TPLO – Hudson is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Help!  My dog is limping – Could it be a torn ligament?

This guide is a good starting place for anyone looking for more information on dog knee problems, specifically cruciate ligament injury in dogs.  This article will give an overview of dog knee injuries covering everything from symptoms to recovery.

What is a Cruciate Ligament Injury?

An injury to the CCL (also known as the cranial cruciate ligament and sometimes called the ACL) can cause lameness in dogs, and is one of the most common causes of rear leg lameness. The function of the cruciate ligament in dogs is to stop the femur (large bone at the top of the leg, above knee) and tibia (smaller bone at bottom of leg, below knee) from rubbing against one another. When the cranial cruciate ligament is torn or ruptured the leg loses stability because these bones are now free to move back and forth on top of one another, causing friction, inflammation, possible meniscal injury and eventually arthritis.

During activities with a healthy dog ACL ligament there will be tension on the ligament, preventing the femur from pressing into the tibia, creating a sliding motion for fluid movement. If your dog is walking or running with a cruciate ligament tear there will be no tension on the CCL, allowing the bones to unnaturally move together, causing pain, lameness and an aversion to using the leg. The best way to think of this would be to envision the ligament like a rubber band, but instead of holding the bones together, the rubber band is in place to prevent the bones from coming into contact. When the rubber band is snapped, there is no longer a gliding joint in the knee and there is contact between the bones.

Acute vs. Chronic Causes of Cruciate Ligament Injury

Acute injury is generally associated with trauma. If the CCL (also referred to as ACL because of it’s similar function to the human ACL) is injured acutely it will most often be due to improper rotation of the knee and hyper extension. This can occur in many different ways such as a dog taking a misstep off a curb, stepping into a divot, jumping or becoming stuck, using a jerking motion to free him/herself.

Chronic injury of the canine ACL is generally associated with disease, age related degenerative changes of the ligament, excess weight (obesity) and conformation of the knee joint (certain large breed dogs are more prone to these types of injuries due to the way their back legs are formed). In the case of chronic injury of the cruciate ligament, there is very little that can be done to prevent the injury from taking place.

Size Matters

Small and large dogs fair differently with the same type of ACL injury. Studies have shown that dogs weighing less than about 25 pounds can experience a full recovery from ligament damage without surgery. This is not true in dogs above the 25 pound threshold. While dogs over 25 pounds may appear to be improving with conservative methods, these larger dogs rarely return to their full function without any issue. This is not to say that there has never been a case of a medium to large sized dog recovering from a torn CCL with only conservative management, but does demonstrate that smaller dogs have an easier time fully recovering using the conservative approaches.

Symtoms of a torn, ruptured or injured CCL will vary from dog to dog, and depending on whether the injury was acute or chronic in nature. Some dogs with a fully torn cruciate may only exhibit mild lameness, while others with a tear may not bear any weight on the leg at all. This again varies based on the type of dog, their size and whether other structures within the knee (particularly the meniscus) were also damaged. Below are some of the most common symptoms associated with a dog knee ligament injury.

Symptoms of a Dog ACL Tear:

1. Decreased range of motion.
2. Hind leg extended straight when sitting down (this is known as the sit sign).
3. Crackling noise of bones rubbing against each other – the medical term for this is Crepitus.
4. Dog exhibits signs of pain when knee (stifle) joint is touched.
5. Exercise intolerance.
6. Limited range of motion or mobility.
7. Stiffness, limping or unwillingness to use the leg after exercise.
8. Knee joint is swollen and/or hot to the touch.
9. Thick, tight, hard and/or firm feel to knee.
10. When standing will only place weight on the toe instead of using entire foot (called toe-touching). An early sign of toe-touching is to only have weight on one side of the body when standing.

There are other conditions with symptoms similar to a dog ACL injury such as: arthritis, knee sprain, meniscal injury, hip dysplasia, patellar fracture, patellar luxation, myelopathies, lyme disease and others. Please schedule an appointment with your vet if your dog shows any of the CCL tear symptoms listed above.

What if my dog’s CCL is never repaired?

This, again, depends on their size, breed and a number of other factors. Some dogs without a CCL may do just fine, while others may use the ability to use their leg. One truth for any dog without a supporting knee ligament is the fact that they will be more succeptible to injuring other structures within the knee, particularly the meniscus. The role of the mensicus in the knee is to act as a cushion, and absorb shocks. Damage to the meniscus is serious and typically leads to arthritic change and lameness.

What to Expect During Your First Veterinary Visit for a Suspected CCL Injury

Consultation and Review of Symptoms

Your veterinarian will review your dog’s symptoms and time of onset.  Going through a detailed history will allow your vet to determine if conditions with similar symptoms may be ruled out at this time.

Physical Exam

Walking Gait

Your veterinarian will want to watch your dog walk and run to see how they are balancing their weight and using the affected leg.

Palpation of the Joint

Your veterinarian will touch your dog’s knee to assess the joint looking for signs of:

• Swelling or Inflammation
• Loss of Muscle Tone
• Pain or Soreness
• Range of Motion
• Popping of the Joint
• Fluid Accumulation

Drawer Sign Test

During the drawer test the veterinarian with stabilize your dog’s femur with one hand while manipulating the tibia with the other. If the tibia moves forward, known as a positive drawer because of the way the bone moves similar to a drawer being opened, the ligament is ruptured.   A negative drawer sign does not necessarily mean your canine does not have a cranial cruciate injury, and false negatives can happen if your pet is tense, if the injury is old and if there is arthritis.

Tibial Compression Exam

Another test, similar to the eliciting the drawer sign, is the tibial compression test. During this exam your veterinary physician will stabilize the dog’s femur with one hand, while flexing the ankle with the other. In dogs with a ruptured cranial cruciate ligament, the tibia will display forward motion upon flexion of the ankle joint.  Again, a negative tibial compression exam does not rule out a cruciate ligament injury, and many factors can contribute to a false negative result.

How to Test a Dog for a Knee Ligament Injury

X-Rays for CCL Injuries

Radiographs are usually taken, not to diagnose a cruciate ligament injury (soft tissue damage is not clearly visible on x-ray), but to rule out other diseases such as cancer and hip dysplasia. An xray will confirm the presence of fluid in the joint as well as arthritis, which will help to confirm the diagnosis of a cruciate ligament injury.

Ultrasound for CCL Injuries

Ultrasound may be used to positively diagnose a CCL injury. Unfortunately a minority of medical clinics are equipped to do ultrasound, and many veterinarians rely on the results of the consultation with you, physical exam and ruling out any other conditions by x-ray to make the diagnosis of a CCL injury.

My Dog Has Received a Positive Diagnosis of a CCL Injury – What Are My Treatment Options?

There are two major avenues for treating a dog knee ligament injury – conservative management or dog knee surgery.

What Is Conservative Management?

Conservative management is a non-surgical option for treating cranial cruciate ligament (CCL) injuries in dogs. Depending on the size of your dog, the severity of the injury, presence of other damage (particularly to the meniscus – remember, this is the part of the knee that acts as a shock absorber) and the duration of time since the onset CM may be a good option for your dog. As mentioned above, dogs weighing less than 25 pounds tend to have better outcomes using conservative techniques than larger dogs.

A variety of techniques can be used if you choose Conservative Management (CM) for your pet.

Conservative Management Includes:

“Standard” Conservative Management

• Rest – Your dog should remain inactive during the recovery period, abstaining from rough play, prolonged exercise or any movement that may cause any pressure or unwanted movement within the knee joint.
• Weight Control (and reduction if necessary) – One way to reduce stress on the joint is to keep your dog’s weight under control, and if possible, underweight is better during the recovery process.
• Anti Inflammatory Medications – There are a number of Holistic (ex – Yucca Root) and Prescription (ex – Rimadyl) medications available that can help to make your pet more comfortable as the knee heals.

“Optional” Conservative Management

• Dog Knee Brace – There are a variety of dog knee braces available including the orthopets canine stifle brace and atrac dynamic brace.
• Veterinary Acupuncture – Acupuncture for dogs is available, and can help to de-stress your pet as their body heals.
• Veterinary Chiropractic - A chiropractor can work with your dog to make sure your pet is free from any subluxations or other blockages.
• Physical Therapy for Dogs – Working with a certified canine physical therapist can help to ensure your dog maintains muscle tone and range of motion in the leg following their injury.

What Are The Different Types of Surgery for Dog ACL Injuries?

Dog Knee Surgery Options:

TPLO Surgery (tibial plateau leveling osteotomy)

This surgery adjusts the slope of the tibial plateau (preventing unwanted forward motion) by cutting and rotating the top of the tibia, and keeping it in position with a bone plate (which can be removed after healing).

TTA Surgery (tibial tuberosity advancement)

The TTA surgery also focuses on changing the angles of the bones within the knee joint. In a TTA the tibia is cut and moved forward to create stability. The new position of the bone is held into place with a bone plate (which can be removed after healing).

TTO Surgery (triple tibial osteotomy)

The TTO is a combintation of the TPLO and TTA techniques. It moves the tibial crest forward, as a TTA does, and also adjusts the tibial plateau to 90 degrees, as the TPLO does.

Tightrope Surgery

Tightrope CCL is an extra capsular technique using the lateral suture stabilization (LSS) procedure in conjunction with a material called FiberTape to provide bone to bone stabilization.

Extra Capsular Suture (traditional repair, extracapsular imbrication)

This is referred to as a traditional repair because this was once the conventional treatment for CCL tears. The extra capsular suture uses a strong leader line suture in a figure eight pattern around the knee to provide stability and keep the knee in a normal position.

Fibular Head Transposition (fibular head transfer)

The fibular head transfer surgery utilizes another ligament in the knee, the lateral collateral ligament, to take the place of the CCL. In this surgery the fibula is rotated so that the lateral collateral ligament can perform the function of the CCL.

Dog CCL Surgery Recovery

Depending on where the ligament surgery was performed, your dog may stay overnight to be monitored and receive pain medications following the procedure. TPLO surgery recovery can be different from TTA surgery recovery, so it’s important to follow the recommendations of your vet during the post operative period. Your dog’s sutures will be removed within a week or two of the procedure, and follow up appointments are typically done at 2 weeks, 4 weeks, 8 weeks and 12 weeks. Again, depending on the type of surgery done, radiographs may be done during these follow up appointments.

During the 6-14 week period following surgery it is very important to severely limit your pet’s activities. For approximately three months following dog knee ligament surgery your pet should be confined to a crate, small room or enclosed area when you are not able to be with your pet. You will probably want to make use of a dog cone collar – Elizabethan collars or Pro collars are my favorite. Make sure to post operative doggy proof your house and make sure they have no opportunity to slip, slide, jump up onto furniture, climb up stairs or engage in any activity that may damage the healing knee.

While outside you should accompany your dog for bathroom breaks, and they should always be controlled on a leash – you never know when a post operative dog may get the urge to chase a squirrel! You may increase the length of walks during the recovery period under the recommendation of your veterinarian and judging by how well your dog is recovering. I strongly recommend not letting your dog off leash at all during the first few months following surgery just to be on the safe side. Your veterinarian will most likely encourage you to have your pet use the injured limb immediately following surgery, but do not overdo it. Physical therapy during this time can also be very beneficial, and swimming is a great way to ensure your dog gets to use their leg (helping to maintain strength and muscle mass) without engaging in any activities that may be harmful to the knee.

Cruciate Ligament Injury in Dogs is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

It allowed my dog to move around – our dogs are outdoor dogs on a larger property and I was not able to control his activity while gone – the stabilizers helped, and I was able to wean him off the pain meds within 1-2 weeks using the brace 24/7. Being a Physical Therapist, I followed the protocol fairly closely – making adaptions depending on his progress. When the time came after 3 months or so we began the weaning process using our common sense, such as taking it off on the weekends only and then increased slowly by 1 day at a time. After a total of 4-5 months I felt comfortable leaving the brace off completely, HOWEVER we do not encourage jumping in any way shape or form anymore since we believe it happened jumping in/out of our pick up truck. Now we lift him or use a ramp.

I can only recommend this brace, it did the trick if you follow the protocol and use common sense. It was worth every dime, thank you so much for making something like this available!

A-Trac Dog ACL Brace and Conservative Management – Bayou is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

I have a small (42 lbs) APBT (American Pit Bull Terrier) female named Emma. 2 years ago, as of this Christmas, she just stopped using one of her rear legs. As soon as we got back into town I took her to my Vet. She was put under and it was found that she had the drawer symptom. The vet gave us some pain killers, explained the treatment choices and sent us on our way.

I exhausted myself reading all I could and just tried to make the best decision for her. Well, two weeks later I came home from work and my baby could not walk. She just hopped not moving EITHER OF HER REAR LEGS! I freaked out and started bawling my head off! Thank god for a husband that keeps a level head! I took a deep breath and called my vet. A day later and we had a confirmation that she had blown the other CCL! At this point I knew I could not afford both legs. I had a hard time convincing my husband to agree to one! I decided to try conservative methods and if she was not better in 8 weeks, then I would get one leg done.

I totally restricted her. I mean totally. NO walks, NO jumping and pretty much no activity. I got a doggie litter box and a lot of toys and crossed my fingers.

Well, now here we are two years later and Emma RUNS EVERYWHERE! No one would ever guess she ever had any issues. Will she have arthritis? Yeah probably, but so will the dogs that had Tightrope, Ex-cap, TTI, and TPLO. Her scar-tissue does the same thing as the tightrope and ex-cap.

And people if your vet is telling you that your little 20 pounder needs surgery, get a second opinion! I am just saying what do you have to loose? If you restrict the activity level, no considerable damage will occur so do not think that. And if you are thinking “geeze I could never manage to keep my dog that constricted” just forget about treatment right now as the recovery period after a surgical fix is about the same as conservative therapy.

Just my and Emma’s 2 cents.

Conservative Management Success – Emma is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information