Hello Everyone,

But sadly, against my better judgement, I let her rip when we were out, because she has such a high prey drive, it was the only way to rid her of some of her restlessness. She is supposed to be Chow/Border Collie, which explains the high prey drive! So last week, at the park as so many times before, ZOOM, man she’s gone chasing a squirrel up a tree.

She came out of the bush, with her left rear leg, just gimpy, limpy along. Not until later at the house that night did I notice the extent of her injury. I freaked, cause I knew this was not good. The injury occurred on (I believe) Sunday, and by Monday we were off to the vets.

Long story short, she has blown her ACL and I am devastated. Moving along to a few weeks later, after getting her on Deramaxx for the pain, I wind up at the Idaho Humane Society. I had a visit with the executive director of the center, who is an orthopedic surgeon. We did the exam, had x-rays taken for the first time, and much to my despair, not only is her left leg shot, her right is even worse!

Much to my horror, she also has hip dysplasia in both hips with arthritis and arthritis in both legs also. So in trying to decide to do surgery or CM, after reading about all of you guys that have taken that road I figured, what the hell…. I can not do surgery on legs, hips, and God knows what else! I was so bummed, I am so worried about my girl.

It is horrid to see my wild child, become crippled. (tears, and more tears) So as it stands, right now I too am having to just try to keep her comfortable and out of pain. I restrict her movements, am trying to get a little weight off her (she’s 48 lbs or so) and I have her Rimadyl and Tramadol also. Doc. said to give her 2000mg. of MSM and Glucosomine, which is good to know cause I only was going to give her 1000 of each. That for about 2 months, (2000mg) while she is trying to recover.

This is a difficult thing to watch, but thank goodness I will be home with her not having to work (unemployment!). I can assist and watch over her! I am an old lady myself, but have no children, so you know how neurotic us pet owners can be with “our kids!” So, keep writing guys, this is very helpful – I don’t feel so alone and sad, knowing others out there are struggling with the same problems! Thank you all, and I will keep you guys informed, as we travel this very bumpy road of destiny!!

Appreciatively,
Eilen Baldwin
Star, ID.

Healing a CCL Tear Without Surgery – Jasmond Baldwin 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

Hello All,

My 90 lb American Bulldog/Pitt mix had the Tightrope Procedure 3 days ago. He is 8 years old, and besides the knee injury, is in excellent health. We think he injured the knee exiting the pool several months before. We noticed a limp right after he jumped out (in-ground pool). It seemed to get better and I resumed our 2 mile/day walks. A couple months after, we could tell it was no longer healing. To the vet we went and started this journey.

One thing I would like to note, is that when it comes to recovery and outcome, it may be important to ask your vet and include in your experience how much if any at all of the meniscus of the knee is removed during surgery. Some dogs have to have this scraped out and some have had it intact. My vet stated it depends on the severity of the injury, current arthritic level, and damage already acquired to the meniscus. This can affect the dogs recovery experience. As well as if there was a partial tear or full tear, did the surgeon remove all of the CCL???

In our case, the meniscus was left intact, and the CCL was scraped and removed (was a full tear).

Our dog is doing great thus far. We picked him up the morning after surgery (central California). He came out of the kennel bearing weight and using the repaired leg. Although this should be restricted, it was a good sign. My biggest initial fear was regarding how we would manage to pick him up and get him home safely. My husband was out of town, and I am 8 months pregnant. Luckily the techs lifted him in the car and we were able to assist with a sling/sheet to get him out at home.

He is an indoor dog and quite large so we have never crated. What we did do is buy a baby/toddler “superyard” and set it up in the living room for the recovery. He is happiest when he can see me and be with me at all times. I currently am not working so this has worked in my favor due to the surgery.I was worried that he would need assistance to get up from a laying down position and being pregnant, this type of lifting would be a no-no for me. He was able and willing to get up, leash walk outside to pee, and back inside with no assistance from a sling. He is cautious with the leg but is bearing some weight on it.

He is eating fine, but I have spoiled him by feeding 1/2 his regular dry food and 1/2 rice, chicken, garlic, and veggies. The garlic will stay on the menu through recovery (8-12 weeks) due to the miracle food it is. He is taking 50 ML Tramadol twice a day, Dermaxx in the morning, Cephlexine 500 ML 2 times a day for 10 days, and 1500 ML Glucosamine (the dr recommended the brand Shift due to a study that reviled it actually had the amount in it that was stated and was absorbed quickly. This is a human brand, not veterinary brand). I have him outside to pee about 5 times a day and get about 3 good pees from him. He has yet to go #2. If he doesn’t go by tomorrow, I’m calling the vet for supplement advice. What do you give a dog?? Prune juice??? Colace???

Again, so far I can’t evaluate more than my dogs endurance (he is doing soooo well. no whining, no visible discomfort passed what the pain meds can handle, eating and drinking normally…I should mention I give him home made broth -no salt- and water mixture a couple times a day just to keep the hydration up). As far as the surgery and the surgeon, 3 days is too soon to evaluate. One thing I do know is that my surgeon was able to use internal stitches and NO STAPLES. It meant no bandage and no e-collar. He is not much of a licker and hasn’t licked the wound much. It wept for the first day and he did lick so out of precaution, we are all on anti-lick supervision duty. I understand infection is a huge risk in these surgeries. I wash the incision area twice a day with betadine. If you do this, you can’t bandage the leg until all the betadine is dry. We are bandage-free so it didn’t matter to us. Another hint is to never BLOW on the incision area if you think the betadine burns. Blowing introduces bacteria from your mouth. Use a magazine and fan away.

We have mild swelling around the ankle and knee, but not too much redness. I have done a few ROM exercises with him and he does not seem to mind. His knee thus far shows great flexibility and no limited movement. I have iced the ankle and knee a couple times. He does hate that, so I will not push it.

He has a check up in 2 weeks. At that time we will evaluate if we can start short leash walks and if we can get him in the pool to start laps. I will check back in often and update. I plan to be extra vigilant regarding the other knee and will be looking for signs of weakness from over use. The last thing we want it to have the other knee go. I do know there is a 50% chance of that but so far the vet said the other knee seems very stable.

Best to all who are enduring the TightRope surgery. All other options seemed way to invasive to me. (And to my dog, LOL!). Please keep posting updates on your dogs recoveries as well. Hopefully this info can be helpful to others and to vets.

Regards!!
Mrs. B

TightRope CCL Repair – Bohdi is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

One way I found to save some cash when Tucker had his CCL repair was to order his medication and other pre and post surgery needs (like Kong toys, bully sticks, and pet bedding) online.  I purchased his collar, glucosamine and chondrointin supplements, pet pads, and special treats using PetCareRx.  My veterinarian even ok-ed his antibiotic orders through their site, easily saving us a couple hundred dollars!  Their web interface is really simple to use, and there was not a single product I needed that I could not find on their site.  I highly recommend using them if your dog is going into surgery or is recovering from surgery, their prices are absolutely unbeatable.  Plus, any order over $35 qualifies for free shipping – I have NEVER seen that on any of the other pet sites out there.

Ordering Pet Medication Online is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Following a CCL repair surgery or during the Conservative Management process, your dog is likely to experience a significant amount of pain related to the injury to their knee ligament. For surgical pain or injuries that your pet my be dealing with, there are some holistic alternatives which are extremely effective in dogs.

• Acupuncture – Acupuncture has been shown to both relieve pain and relax your pet, helping him or her cope with stress better.
• White Willow Bark – White willow bark is an herbal remedy that can take the edge off minor pain, but should NOT be used on cats.
• Arnica – Arnica is a homeopathic remedy that can be powerful for post-surgical pain, or pain from injuries. For severe pain a typical dose of arnica is the 1M or 10M potency, but for exact dosages and directions, please consult your holistic veterinarian. Arnica is applied topically, so you will need to take precautions to ensure your dog does not remove the arnica from their skin.
• Calendula Officianlis – Herbal or homeopathic gels containing calendula officianalis are wonderful for putting on incisions. They help with pain, itching, and irritation; many humans use them on their own surgical incisions with much success, and the relief is often immediate and unmistakable. Dogs tend to leave their incisions alone much more readily when they are treated with calendula.
• Fish Oil – Fish Oils containing Omega-3 Fatty Acids can be very helpful in reducing inflammation in dogs. One daily dose of 1000 mg is sufficient to aid any discomfort related to inflammatory processes, including arthritis.
• Yucca – Yucca can be helpful for dogs with inflammation and arthritis. Yucca root can be found in a tincture that can be placed in your dog’s food, and it should be used daily for maximum effectiveness.

There is nothing holistic about suffering or pain, and if your dog is in real distress, you may want to explore other pharmaceutical options for pain management; this is especially true in the case of dogs that develop chronic pain post-operatively due to arthritis. Many of the holistic techniques mentioned above can go hand in hand with conventional veterinary medical treatments. For example, if your dog has arthritis or similar conditions, acupuncture can be powerfully effective in combination with allopathic medications, and the drug Adequan actually rebuilds cartilage and lubricates and cushions your pet’s joints. Let the NSAID handle the pain, but continue using alternatives to help heal and support the body.

We all want to do what is best for our pets, and making sure they are comfortable throughout the surgical process is important in their overall recovery. Be sure to attentively listen to your dog’s needs and be open to pursuing other avenues with regard to pain management to assure the best outcome for your dog.

If you want information on buying natural supplements or homeopathic treatments for dogs, please visit our – Homeopathic, Alternative and Natural Medicine Guide

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

Many veterinarians will try to pressure owners into immediately proceeding with surgical intervention to repair a dog’s damaged cranial cruciate ligament (CCL) by saying early intervention will decrease the likelihood of arthritic changes to the knee. There is some truth to this – restriction of the knee joint after injury does help to minimize the progression of arthritic tissue in a dog with a CCL injury, but the necessary amount of restriction can be reached with conservative techniques as well as surgery. Restricting your dog’s activity following a cruciate ligament injury is your best defense against arthritis, and no owner should ever be made to feel as though surgery is their only option.

The truth is, all dogs that sustain a cruciate ligament tear or rupture are at an increased risk for arthritis, no matter at what point surgery (if ever) is undertaken. There is no evidence that dogs who recover using Conservative Management (CM), and dogs who recover with surgery show any differences in the development of future arthritic problems. Proper restriction during recovery and avoiding high-risk activities after recovery, together with weight control, good nutrition, and joint-supporting supplements are what minimize the chances of future arthritic problems – not immediate surgical intervention.

Does CCL Repair Surgery Lessen Arthritis Risk? is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information