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Conservative Management in Cranial Cruciate Injuries

Conservative management is a non-surgical option for treating cranial cruciate injuries in dogs. Depending on the size of your dog, the severity of the injury and the duration of time since the onset of the CCL damage, your veterinarian may suggest CM in lieu of surgical intervention. Conservative management is focused around three basic principles:

  1. Weight management
  2. Exercise moderation/rest
  3. Using anti-inflammatory medications

Baby BoxerMaintaining your dog’s body weight at normal, or slightly below normal, levels will reduce the load placed on the injured joint, and may help to improve its function. This will allow your canine to strengthen the joint without adding any additional strain, adding stability and range of motion. Restriction of activity for at least 6-8 weeks after injury is a key part of successful CM. After about 2 months of little to no exercise you may begin reintroducing your pet to weight-bearing activities such as short walks, making sure to avoid any extremes in activity. Controlled walks and exercise will help to maintain and strengthen muscle mass while avoiding re-injury; owners need to be careful to limit their dog’s play during this time as there is an elevated risk of injuring the other leg while the originally affected leg heals. The use of anti-inflammatory medications during this time will help to limit painful episodes and encourage healing.

The outcome associated with conservative management of cranial cruciate ligament injuries is based on body size. Approximately 70-80% of small breed dogs and cats will return to acceptable levels of function over a 6 week period of time. Conversely, only 15-20 % of dogs over 30 lbs. will return to acceptable function. Surgery is often recommended for medium to large breed dogs that are over 30 pounds.

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6 Responses to Conservative Management in Cranial Cruciate Injuries

  1. Bodhi August 4, 2008 at 1:01 pm #

    Bodhi is a 3 year old Olde English Bulldogge. Last spring, he sustained a leg injury while wrestling and jumping with a dog in the dog park. He was stiff for a couple of days and then was completely asymptomatic until a month ago, where he injured his left leg swimming at the beach. This time it was different – he was sometimes toeing the ground after getting up, not putting any weight on it while standing, and then would usually be asymptomatic for the rest of the day without any limping.
    We took Bodhi into the vet who promptly said it was most likely a cruciate tear and would need surgery. He ordered a full set of xrays on both knees and hips.
    When we got the xrays back, the vet (another one at the same clinic) noticed nothing unusual and sent us home.
    We were very relieved, and chalked it up to a pulled muscle – as at this point Bodhi was asymptomatic with no limping.
    After a few days, we got a call from the same vet who had forwarded off the xrays to another clinic who had an orthopedic specialist. The diagnosis from her was possible cruciate tears in both knees, some arthritis and buttressing in the left knee, and fluid in both knees. Recommendations were to do arthroscopic surgery to both knees to see how severe the tears were, and then TPLO surgery to repair them.

    At this point, we didn’t know who or what to believe. Digging around in our bulldog’s knees for a possible partial tear (I forgot to mention negative drawer tests at all examinations) seemed too extreme and too invasive at this point.
    Bodhi was still off and on limping even though we were giving him CM with controlled walks only so we did need to do something.
    For us, surgery (ANY type of surgery, be it for human or canine) should be the last resort. In Bodhi’s case, an inconclusive diagnosis was even more confusing for what we should do.
    After much research, we opted for the rehab route. Massage therapy, accupuncture, aquatherapy…and we are in the process of getting a stifle brace for Bodhi’s knee.
    I searched the online resources, and as reading many stories of ill-fitting braces with bad customer service and no support – I finally found a certified prosthetist who custom makes prostetics and orthotics for canines in our city! She answered all our many questions and was very supportive.

    http://www.pawsability.ca/home.asp?PageID=677&sMenuID=683

    The process takes 3 appointments, first is the casting of the leg, then fitting with the preliminary brace, then finally dispensing of the finished product.
    We are hoping that this will help with Bodhi’s knee to support it while he is healing. I cannot stress how much better it is to find someone in your hometown who can custom fit an orthotic device for your dog.
    (Just think, you wouldn’t buy a pair of jeans or a bra from Ebay and expect it to fit your body perfectly.)
    I have also read that an improperly fitted brace may injure the knee or surrounding muscles and tendons further.
    We have just had our first appointment with the leg casting, so I will give an update when we actually get the device next week and see how Bodhi does…

  2. Jackie Keizer October 30, 2009 at 10:04 pm #

    I am very curious to know how this turned out for you and Bodhi. I see that the original post was over a year ago so you should have some good information by now on how helpful the brace was. My dog has just been diagnosed with a possible CCL tear and i am looking for non surgical alternatives. I haven’t found a followup to this post on the site. Would you mind reporting on your brace?

    Thanks.

  3. Ken February 3, 2010 at 10:48 am #

    We have been using the A-Trac leg brace for our 11 year old Yellow Lab
    mixed breed dog. He had been getting progressively more lame over the
    past several years, and by the time we finally got the diagnosis of
    cruciate ligament disease in both hind legs, he could barely limp
    across the parking lot at the clinic. For some reason, he seemed to
    be somewhat better by the time our A-Trac brace arrived almost three
    months ago. Since he had been suffering for years, all I can think of
    is that he figured out to be much more careful not to exert himself.
    Nevertheless, he had lost most of the muscle mass in his haunches from
    disuse.

    It took me about an hour to figure out and adjust the brace the first
    time. We started out slowly– just putting on the brace maybe two or
    three times a week accompanied by much praise and treats. We went on
    short walks (a treat in themselves), and I can’t tell you how excited
    I was when he first walked four blocks. Unlike prior to the brace, he
    would not limp after his walks– sometimes for days afterward.
    Clearly he was limited by his strength, and we had to slowly build him
    up. Last week we walked 2 miles, and though he was clearly tired, he
    did not limp and did not seem to be in any pain. This past weekend we
    walked 4 miles! I am ecstatic. We just got back from a 45 minute
    walk that didn’t faze him at all (see photo below). He is off one of
    his pain meds, and we are thinking of ending the other one he is still
    taking.

    This all seems nothing less than miraculous after three years of a dog
    obviously in terrible pain who could no longer run or go for walks
    over one or two blocks, and indeed had trouble standing up from a
    sitting position. I am totally impressed. We only use the brace when
    he goes on the extended walks, but that seems to be fine.

    There are things about the brace that could be improved for ease of
    use. I can’t see the ends of the velcro straps when they are in
    place, and can’t feel them to take them off either. If the ends were
    a different color, or better yet, tipped with some non-velcro material
    to make them easier to feel when taking the brace off that would be of
    great help– obviously I can figure that out myself, but thought it
    might be of use in making the product more attractive.

    Another thing that is a little bit of a nuisance is that the velcro
    straps stick to the elastic parts of the brace, making it a little
    frustrating untangling the whole thing. I don’t know whether there is
    a fix to that– I thought of a coat of latex on the elastic webbing,
    my wife suggested an outer nylon sheath to keep the velcro away from
    the elastic.

    Finally, the back strap leading from the chest halter can’t seem to
    find a d-ring located directly over the center of the dog– the last
    available d-ring is still a little off to one side. This probably
    doesn’t matter at all, except aesthetically. The back strap supplied
    was very long and much of it hung down uselessly. I finally cut it
    off, but it began fraying and the strings got caught up in the
    velcro. Cutting off the frayed end and heating the end of the nylon
    strap over our gas cooktop put an end to that issue.

    Again, this has worked unexpectedly well. I want to take the dog back
    to the very skeptical vet that measured him for the brace to have his
    haunches re-measured. To me, regaining the muscle mass will be the
    clearest sign of success. My own goal was to be able to once again
    walk him up to our local park– he can walk up to and around the park
    twice now. Our dog was the one member of the household you could
    always count on to be happy and glad to see you. We was never sad,
    never got mad at anybody, and full of joy. To see him lying around in
    pain all day, unable to run or even walk outdoors was terrible for
    everyone. Thank you so much for bringing back this joy to our lives.

    Thank you so much!

    Ken Dragoon

  4. MikeM March 30, 2010 at 5:12 am #

    Our Maggie, an 11yr old Cocker Spaniel (Buff), tore her crucius and ruptured her meniscus (I likely misspelled both of those) in her right rear knee Saturday (3d ago). She also has advanced arthritis in both front shoulders, so now she ‘see-saws’ when she walks – hopping on one rear leg and hunching her front down because her shoulders hurt, even with the pain meds.

    We have been to two vets, and both say that surgery is not an option for her, and we reluctantly agreed – she is on long term steroids to maintain her liver function after liver failure 3.5 yrs ago. She had surgery then to remove her gall bladder (full of mucus) and spleen (growth on it, turned out to be non-malignant). The steroids are keeping her alive, but she is also on a life-term course of antibiotics now because her immune system is gone, from the steroids, as well as the bone and joint damage from them.

    So Maggie is in a bad situation.

    We are going to have her fitted with a brace for her knee – but if the other one ruptures we will have no other options but to let her go, and that just wrecks me.

    I worry about her dealing with the brace – I can only hope that putting it on and taking it off is not a long and arduous process. I don’t know that she would chew it off, but I wouldn’t put it past her either.

    Some of the posts I have seen about the braces do scare me though. If it rubs and causes a sore, it will become infected and painful – even dangerous as she has a compromised immune system. She heals very slowly as well.

    No good options. 🙁

  5. Amber July 30, 2010 at 6:53 pm #

    Mike M, I hope that your dog is doing okay. You might try Walkin Wheels wheel chairs for dogs. I’m reading very good things.

  6. Kimber's Mom October 16, 2010 at 7:31 pm #

    Two of my precious canine companions had TPLOs and developed osteosarcoma (bone cancer) a few years later. The metal implants had corroded and my shep/husky had to have his leg amputated to alleviate the pain. It states on his biopsy results that he had osteosarcoma at the site of the implant. (He did not have this prior to the surgery… nor did my other dog). For three TPLOs, two implant removal surgeries, one amputation, and cancer treatments for both, my expenses were at least $17,000.00. They died within a year of each other.
    So when my 100 lb Shiloh shepherd tore her ACL a month after I lost my precious shep/malamute, I was told she needed surgery. Over my dead body was she having a TPLO, so I educated myself on Conservative Management with the help of a wonderful Yahoo Group (Conservative Management). We had a custom made brace for our girl, and long story short, SHE MADE A COMPLETE RECOVERY WITHOUT SURGERY!!!!! You can see videos of her running around with her brace on and after she healed (without the brace). You can also read about her at my blog (click my name to read). I will be forever grateful that what I learned from others prevented my dog from having to have an invasive surgery that is NOT without risks.

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