My 4 year old black Lab, Tide, had the Traditional Repair done on her knee back in December 2008.

Onset of Cruciate Ligament Injury

At about 5 1/2 months old Tide started to limp. Of course, being the crazy worried Mommy that I am, I thought Hip Dysplasia right away. Off to the vet we went where our doctor told us it’s probably just a soft tissue injury and to keep her rested for a few weeks and see how she does. Tide was scheduled for her spay two weeks later, so to ease our mind, we had x-rays taken of her hips. The x-rays came back that her hips were fine.

Two weeks passed with Tide not doing much but laying around, b/c of her spay incision. The very first day she took off running, like the 6 month old Labrador that she was, and started toe touching again. I immediately called the vet and brought her back in. I was in very upset and couldn’t understand how she was still limping, if this was in fact, a soft tissue injury. Our vet suggested leaving her for a few hours to be evaluated by an orthopedic vet, so of course, that’s what we did. No more then 30 minutes later after dropping her off, the Orthopedic Vet called telling us that Tide had Panosteitis, PANO, also known as growing pains in large breed dogs. He assured me that it was something she would out grow and that she would be back to her healthy self soon. He also told me that the pain would switch from leg to leg and not to restrict her exercise. To let Tide be the judge of what was too much if she was having discomfort and pain. What a relief!

Tide’s first summer was like a dream come true for an 8 month old Labrador. She swam for hours, ran on the beach, absolutely adored going out on the boat and seemed 100% healthy. That is except for those days where she ran a LITTLE too hard, but not knowing at the time, thought it was just the PANO flaring up. Towards the end of July was when Tide’s toe touching really started to concern me. I would watch Tide like a hawk, still do, and noticed that most of her limping, if not all, was ALWAYS on that back right leg. The doctor told me that it would switch legs, which it didn’t seem to be doing. Tide also was getting up very slowly from lying down. So, I started researching and contacted my vet. I asked about a torn cruciate and OCD and she said not to worry about her cruciate because she was so young. She told me that, most likely, the pain Tide was experiencing was probably still from the PANO. She prescribed me with Deramaxx, an anti-inflammatory, to ease some of Tide’s discomfort, and said to keep an eye on her. At the time, Tide was 10 months.

Another month went by and Tide STILL continued toe touching on that same leg after days of swimming and running around. I gave it another few weeks and then one day, I had enough. We were out on the boat all day and came home like normal. Nothing was out of the norm, but that night, after getting up from her nap, Tide lifted her leg completely off the ground and would not use it. I think that is when it really hit me that we were dealing with something other then PANO. I can’t tell you how painful it was to see my 11 month old Lab limping like a crippled dog. Broke my heart!

Dog Knee Surgery – Choosing Traditional Repair

I made an appointment to see another orthopedic surgeon (I’ll call her Dr. S from now on), who BTW, I HIGHLY recommend if you are in the NJ area. Our first visit with Dr. S was a scary one. After manipulating Tide’s leg and almost every other joint in her body, Dr. S. pin-pointed that Tide’s pain was coming from her knee. She suggested x-rays and a drawer test under sedation. Needless to say the x-rays came back that there was something going on in her knee, lots of fluid, but she wasn’t sure what. She was leaning towards a torn cruciate or OCD, a genetic disease. Dr. S. also said that there was no laxity, from what she could tell, in Tide’s knee when they did the drawer test. At this point we were pretty confused. The only advice our surgeon could give us, at this point, was to either get a second opinion, and/or scope her knee. To me, scoping was NOT an option. So off for more opinions we went. If I knew then what I know now, I would have opted for the scope right then and there.

So, two more Orthopedic vet visits later, and a trip out to UPenn for a third opinion, and we still have no idea if Tide’s knee issues are from a torn cruciate or OCD. UPenn threw in a third possibility of a Luxating Patella which was quickly thrown out of the mix when we went back to see our original surgeon, Dr. S. So here we were, with our 13 month old Labrador, being told that the only thing left to do was to put Tide under anesthesia and scope her knee to see what the problem was. We went home from the vets that night pretty distressed and confused. I just wanted to make my puppy’s pain go away, for good.

For a few days my fiancé and I talked it over at length and finally decided that scoping Tide’s knee was the best option. I called Tide’s surgeon and she assured me I was doing the right thing. I thought all was good to go and we could just schedule the knee arthroscopy and be done, but then she asked me if Tide should undergo surgery while she was already under sedation. I didn’t hesitate, and said most definitely, yes. Why would I put my dog through any more of this? Let’s just get it done. Then Dr. S. confused me once again. She gave me the different surgical procedures, she felt most comfortable doing for a torn cruciate, if it did happen to be that, and told us to think about it. We did, I researched a little, and then had to call Dr. S for some advice. She explained each and every procedure thoroughly, first TPLO, which she felt was the most invasive out of the three and being Tide was so young, and still growing, didn’t think it was the best option. Then there was TTA, that she pretty much threw out of the equation completely before she even explained it, and finally, the Extracapsular Repair, Traditional. Dr. S. felt that the Traditional repair was by far the best option for Tide being she was only 72 lbs at the time, young, and, we didn’t know this at the time, but her cruciate was only partially torn. So here we were, faced with having to make a decision that could change Tide’s way of life forever. Not and easy thing to do at all. I started researching like a mad woman online for feedback and advice on different surgical options for a torn cruciate and also for OCD and made my decision.

Day of Surgery

Tide went in for arthroscopic surgery and knee surgery on December 4, 2008. Dropping her off in the morning was by far, the hardest thing I have EVER done in my entire life. Tide is like my child, so imagine dropping your 2 year old off to have surgery. Dr. S. thankfully kept in touch throughout the day, to keep me calm, and called when they finally knew what was causing Tide’s lameness. She had partially torn her cruciate and already had some arthritis in the knee, so she had the tear for quite some time, possibly since 5 ½ months old. The first thing I asked was what about the PANO and she said that she probably just had both issues. Poor dog.

Day After Surgery

We picked Tide up the following day after surgery not knowing what to expect. We took all the extra precautions at home and built her a ramp and made sure we had everything ready to keep her rested and healthy. I just didn’t know what to expect and after reading stories, I was pretty nervous to say the least. But, when I saw her come through the waiting room doors, I was in shock. Here I was expecting this bandaged, groggy, whimpering, sad, pitiful dog, and out walked this happy and excited puppy. She was walking on all fours, still can’t believe that, and when she took one look at us, came bounding over, taking the vet tech with her. Not even surgery can slow my baby down. I just couldn’t believe how great she looked! Her incision was remarkably clean and it looked like it had been a week old already.

Recovering from Dog Knee Surgery

As I’m sure you know, keeping a young Labrador down was not an easy task. However, lazy Tide took to lying around, being pampered and smothered with love, the first five days after surgery, just fine. I would say after a week she was ripping to go though. She just couldn’t understand why there was no more running over to the neighbor’s to say hello, or jumping on the couch like normal. She eventually, after lots of refusal, figured out that being lazy and just hanging with mommy and daddy was the best thing to do. She went for short walks, after 2 weeks, on leash, and over time we increased the length to over a mile, sometimes even more. Eventually, after we got the OK from the surgeon, we started swim therapy which I really feel helped in her rehabilitation.

2 1/2 Years Later

Today, Tide is 2 1/2 years post OP and I couldn’t be happier with the outcome. I have her on daily doses of Glucosamine and Chondriotin, as well as Trixsyn, and she hasn’t had any issues, knock on wood. Tide runs, swims, and jumps just like a normal 4 year old Lab should. She does come up lame on occasion after a long strenuous day, but my surgeon assured me that it’s perfectly normal with the type of procedure we chose. Now I just have to worry about that other knee. YIKES!

Extracapsular Repair Surgery (Traditional) – Tide is a post from: Dog Knee Surgery and Ligament Injuries

Duke, age 5, 110-lb, Black Lab tore his ACL in January of this year. Tried conservative management, but seemed to have frequent relapses.

Took to UofFL small animal hospital, and they wanted to do TPLO. My local Vet then suggested doing a TTA. I decided to try CM a little longer and told him so. Finally, went back to the Vet and said I didn’t think CM was going to do the trick whereupon he said he thought there was enough fibre left to do the traditional imbrication procedure. I went ahead with it and the initial progress seemed very slow…

Now, it’s been almost 8 weeks post op, and Duke has made a huge leap in progress in the last week or so. Starting swimming therapy with him tomorrow. Would love to compare notes with any other Lab owners who have had same procedure done, and hear success/failure stories. I have had Duke on Glucosamine/Chonrdoitin since his surgery.

Extracapsular Imbrication (Traditional Repair) – Duke is a post from: Dog Knee Surgery and Ligament Injuries

At this point, it seemed likely that his problem was structural and so I took him to see a vet that specialized in orthepedic problems. He spent a considerable amount of time asking questions about how his symptoms had appeared and progressed as well as looking over his medical records. Finally he examined Baxter’s leg and diagnosed a CCL rupture. He showed me as he examined him how his knee was moving to an extent and manner that was not normal. (and was obviously painful)

We discussed two alternatives, extended inactivity (also called Conservative Management) or a traditional extra-capsular repair. He said that smaller dogs often will recover with extended inactivity and without surgery, and that Baxter at 23 pounds was right on the line bteween where he typically recommended surgery vs inactivity.

Ultimately, given Baxter’s energetic temperment we decided that surgery would be a quicker and more reliable route to recovery.

This particular Vet would only consider traditional repair for Baxter and would not recommend TPLO or TTA. I don’t know if it was due to Baxter’s smaller size or his own experience, but he was quite adament about it. Given that this surgeon had done 200 to 300 of these proceedures a year for many years, I figured he knew what he was talking about and scheduled the surgery.

The surgery went well and Baxter did not need any miniscus removed. (a complication I was told was common) He stayed overnight at the vet and I took him home the next morning. I was very surprised to see him led out to me on a leash and walking with less limping than he walked in with! He was a little out of it the first day home, but continued to walk on the leg with some limping. By day 4, he would sometimes forget to limp if he was in a rush to get somewhere. (the refridgerator usually)

After 10 days, his stiches came out and he was allowed to start taking short walks although stairs, jumping, and playing with other dogs was still forbidden. As of today (21 days) he is doing great and although he sometimes limps as he walks around, he often doesn’t. He is also clearly in much less pain than before the surgery and hasn’t taken any pain medications since his stitches were taken out.

I was prepared by stories on this site and other resources for a much more difficult recovery for Baxter. I know that he is not “fixed” yet and that will still require many months of carefully monitored activity, however I was amazed at how quickly he has recovered to a happy and pain-free condition. I spoke to the surgeon about it and he admitted that Baxter was doing better than average, but that he had seen plenty of dogs recover as easily as he has.

I will try to update this as he continues to recover, but I wanted to get his story out to anyone considering this surgery. It can clearly be a difficult proceedure to recover from, but it isn’t always as bad as some of the other experiences shared on this site!

Post Surgery Update

You would never know anything was wrong. It was a great thing to do and the recovery process went much easier than expected.

We work full-time and have 2 young boys, but kept him safely in a dog pen with the “cone of shame” on as long as necessary. Let him out to go potty and to walk. The walks also helped with some weight loss.

Kept him on a leash through week 12 – even when out of the pen so he couldn’t run around the house. It was not as daunting as I first imagined. I do cringe a bit now when I see him leaping over things in the yard and chasing birds!

Traditional CCL Repair for Small Dogs – Baxter is a post from: Dog Knee Surgery and Ligament Injuries

This has been one of the most stressful decisions I’ve ever been presented with…

Elly is my 14 y.o. husky mix. He’s had generally good health; I’ve had him since he was a pup. I wanted to do the conservative maintenance, but the more I researched the more I realized that we needed to try the tightrope surgery (I think this is what he got although the surgeon did not call it a name?). He had fully torn his CCL and part of his meniscus. They drilled a hole in his tibia and wrapped a strong fibrous cord through that to a portion of his femur. Again, this was a hard pill to swallow; I did not want to see him in pain or go through the rehab.

Day 4 felt like a miracle: he started to put weight on the inflicted leg. I pretty much stopped using the towel at that point.

Day 5 and 6 post-op: again, he showed major improvement.

Now it is day 11: he’s doing two 15 minute or more walks per day, which is great! Still NO stairs, but life is better. Those first days were really stressful and it is good to have family/friend to help: it is so sad to see your animal in such a dire state. But they progress, so hang in there. We’ve got a long way to go but things get more normal each day!

He had the surgery done at the Animal Surgical Clinic in Shoreline, WA on 4/29/11. It was $3000. Let me know in the comments below if you have any questions:)

Traditional Repair: Extracapsular Stabilization – Ellyot is a post from: Dog Knee Surgery and Ligament Injuries

My very active and large Labrador retriever partially tore his right CCL when he was only 9 months old. My vet examined him under sedation and the knee was stable albeit slightly more loose than the other side. He was put on 8 weeks of rest and Previcox. I leash walked him for the 8 weeks and allowed him free in the house and off lead to go to the bathroom but no running around or rough-housing. He continued to limp slightly at night until between week 6 – 7 when the lameness disappeared and hew as 100%. He then went on to have 5 months of very normal activity – running, leaping, playing, rough-housing. He also grew to weigh 110 lbs.

Suddenly when we thought we had it beat, the leg completely tore. He was holding it up and would not even place it down – hopping on three legs. He was seen by my vet, as well as an orthopedic surgeon who came highly recommended, and does both traditional lateral suture and TPLO surgeries and was trained by Dr. Slocum. Both advised (given his size and activity level) that a TPLO would be best – allowing him to recovery more quickly and with less risk of injury after surgery. I did not feel comfortable with the TPLO and opted for a traditional surgery.

I was advised that a traditional surgery most certainly does work well for a large and/or active dog, however, the first 8 – 10 weeks is critical for a successful outcome. The dog must not be allowed to do too much or else the wire can be stretched and break too soon causing instability due to not enough scar tissue. However the surgeon advised that once the scar tissue is formed that the knee is just as stable as if the dog had a TPLO. There is no more chance of a failure with a traditional once that scar tissue is allowed to build just because you have a big and active dog.

I was extra extra careful and did not allow my dog off lead for the first 10 weeks even in the house. He was in an x-pen in the family room and crated at night and leash walked 4 times per day. We went through a lot of bones and stuffed Kongs.

At 13 weeks he did get away – ran and slipped outside. He came up lame again, however, two days of rest and he was fine.

At 4 1/2 months post-op he is doing terrific – can’t tell which leg had the surgery and he’s trotting around soundly and is allowed off lead. He is not back to rough-housing outside with other dogs at the dog park yet – not until 6 months post-op.

We are at the 5 month mark this week and he’s doing great – galloping off leash in the snow and going for 2 mile walks. A traditional surgery can be very successful for a very large and active dog.

Traditional Surgery for Large Breeds – Garth the Lab is a post from: Dog Knee Surgery and Ligament Injuries

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 Surgery and Ligament Injuries

Our Dog Beau

Our dog Beau is a seven year old Golden Retriever and master of the household! He’s friendly, fun, energetic and spoiled! Unfortunately, we learned early in his first year that he also has hip dysplasia. Until now, this has not stopped him from having an active, doggy life. However, in late November we noticed some on again, off again limping and after a few days of this, we took him to the vet to check it out.
After an exam and x-rays (done under sedation) the bad news turned out to be a ruptured cranial cruciate ligament. Our vet said that this is a common injury in dogs, particularly large breeds and particularly dogs with hip dysplasia who tend to alter their gait and put added stress on the knee ligaments. While humans tend to tear these ligaments in sporting activities (the football player who misses the season due to a torn ACL), dogs put much more stress on their knees (stifles) and are more prone to rupturing these ligaments over time, without a significant trauma. We were presented with the following options for Beau:

1. No surgery. Treat with rest, physical therapy, pain and anti-inflammatory medications. Our vet did not feel that the ligament in a dog this size would heal on its own, however, and indicated that the likely outcome would be abnormal wear and tear leading to arthritis which would continue to worsen over time, becoming chronic and debilitating.

2. TPLO surgery (Tibial Plateau Leveling Osteotomy). This is a surgical procedure in which the head of the tibia is surgically altered and plated to create a new joint angle. A new angle is created in the stifle to prevent the femur from sliding off of the tibia. This surgery would need to be performed by an orthopedic veterinary surgeon and would be very expensive. We were never actually given an estimate for this surgery, but my research puts the cost in the $3,000 – $4,000 range. Our vet indicated that this procedure is considered by some to be the gold standard in treatment. However, due to it high cost and invasiveness, she did not recommend it for a seven year old dog.

3. Traditional Repair surgery (Extracapsular Imbrication). This procedure uses a strong leader line placed within the knee to provide stabilization. As it was explained to us, the downside of this procedure is that the line will eventually break and it is impossible to say when. It could be that the line lasts five years, or it might only last two months. With a large dog like Beau, our vet didn’t feel this was our best option.

4. Modified Traditional Repair surgery. This is the same procedure as in number 3 above, except that the dog’s own muscle is used to provide the stabilization, which is much stronger. As the area heals, it heals around this graft of muscle and further increases the knee stabilization. The cost of this surgery, as well as the surgery in 3 above, depended in part on whether or not the meniscus was damaged. The meniscus is the pad between the bones of the joint – a shock absorber. Estimates for this surgery were from $1,700-$1,900. Our vet recommended this option, which would be performed in their offices by a different veterinarian with extensive experience in this procedure.

To be honest, we didn’t give option 1 too much consideration. Neither my husband nor I could bear the thought of our middle aged (but not old), active dog declining early in such a painful manner. On the other hand, TPLO surgery was simply too expensive for us to consider and our veterinarian seemed to think this surgery would be warranted for a young dog, but not a seven year old dog. Option 3 seemed too risky and also was not recommended by our vet for a dog of Beau’s size. Thus, we elected for the Modified Traditional Repair using the dog’s own muscle to stabilize the knee. I was unable to find much information on this modified type of repair on-line, but it may be that there is a particular name for it which I was not searching under. I did see information on the Tightrope repair surgery, but our veterinarian felt that this was not in favor currently. One very sober fact: the vet told us that 40% of dogs that rupture the CCL eventually rupture the CCL in the other leg. Whatever choice we made, we best be prepared to make it again.
Unfortunately, we learned the next day that the veterinarian who was to perform the surgery was out of town for several weeks. The surgery was scheduled for December 8^th and our job was to keep Beau quiet and calm until then!

Our Dog Beau and His CCL Injury is a post from: Dog Knee Surgery and Ligament Injuries

How is Tightrope CCL Different from Extracapsular Imbrication or Traditional Repair?

The major difference between extracapsular imbrication/traditional repair methods and tightrope ccl is the way in which the knee joint is stabilized.  In a traditional CCL repair, a leader line (suture, or you can also think of this as a fishing line) is woven across the knee in a figure-eight pattern, connecting a bony protrusion on the femur to a small hole drilled in the top of the tibia.  The veterinary surgeon is able to access the knee through an incision on the knee a few inches long.   During the healing process, the leader line serves as a temporary way to stabilize the knee while scar tissue forms.  Eventually the leader line will break, and the scar tissue is solely responsible for providing knee joint stability.

In tightrope repair, a stronger material called Fiber Tape is used to connect bone to bone.  The FiberTape is held in place on the bone via metal anchors and small holes drilled through the bone.  The surgeon makes a few small incisions to access the points of attachment to the bone.  While the Fiber Tape will eventually degrade and possibly break over time, it is thought of as a superior material for larger dogs due to its greater durability and strength – buying your dog more recovery time.  While in place the Fiber Tape will act to control tibial thrust and prevents the cranial drawer sign, while allowing your dog to maintain full range of motion.

Both traditional repair and tightrope are considered to be minimally invasive procedures when compared to other surgical options like TTA and TPLO, which both involve cutting and changing of bone angles.

Tightrope Surgery vs. Extracapsular or Traditional Repair is a post from: Dog Knee Surgery and Ligament Injuries

Not surprisingly, surgery is almost always advocated by surgeons . It is likely that surgery does help reduce the amount of arthritis that occurs, but in a long term study of cruciate ligament surgery in dogs in Australia, about 50% still had detectable arthritis in surgically repaired joints and about 10% of dogs were persistently lame despite attempts to surgically stabilize the joint. Tibial plateau leveling osteotomy (TPLO) has become the top choice for surgical CCL repair among many orthopedic veterinarians, and it can be done in both large and small dogs. Supporters of TPLO will say its good choice for the situation in which there is a bilateral cruciate rupture since it seems to be a strong repair procedure, but there are many instances where dogs have done equally as well with either TTA or a traditional repair.

One benefit of doing a traditional extracapsular repair, in addition to saving a few thousand dollars, is that you still have other options for repair if for some reason the traditional repair fails. If you are choosing surgery for a dog with a double CCL rupture, make sure to research each procedure carefully before blindly going along with a procedure you know nothing about. TPLO, TTA and traditional repairs are all very different procedures, and each carry their own set of risks vs. rewards. The best way to find out what is right for your pet is to do as much research as you can and find a veterinarian that is willing to discuss your many options for surgical intervention.

If surgery absolutely isn’t an option, there is a very good chance that in a few weeks, to a few months, you will find that your dog is doing OK without any type of surgical intervention -especially if you can manage the weight loss. There are a number of great resources both on this website and the web with instructions on how to succeed with CM.

CCL Injury in Both Back Legs is a post from: Dog Knee Surgery and Ligament Injuries

For both humans and animals alike, any surgical procedure carries a risk of complications. You dog should have a full evaluation done, complete with blood work and other baseline testing, prior to surgery to help minimize any risks. Pre-surgical testing can often diminish the risk of death from anesthesia and other preventable complications related to your canine’s health. Overall, complications with cruciate surgery occur in approximately 5 to 10% of patients. Complications can range from mild and easily resolved, to more severe complications requiring additional surgery, expense and disability. While uncommon, complications do arise during and after extracapsular repair procedures, and you should have a discussion with your veterinarian regarding ways to minimize and avoid these risks.

Complications and risks associated with traditional repair techniques for cranial cruciate ligament surgery are as follows:

• Adverse reactions to anesthesia including nausea, vomiting, fatigue and in rare cases – death.
• Infection of the surgical site.
• Seroma – a build up of fluid at the surgical site which must be drained (aspirated).
• Allergic reaction to sutures or medications used.
• Allergic reaction to leader line, making re-operation for removal necessary.
• Patellar luxation – knee cap dislocation.
• Entrapment of the peroneal nerve – which can lead to paralysis and/or loss of the limb.
• Blow out of stifle joint, tearing of leader line. This requires surgical intervention and a TPLO is often used for repair.
• Tearing of mensicus.

Extracapsular CCL Repair Complications is a post from: Dog Knee Surgery and Ligament Injuries