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Don’t be shy… Post on our NEW Dog Knee Injury Forum!

In response to the high volume of comments a lot of the post have been getting, I’ve opened up the forums as a way for dog owners to connect and discuss their dog’s orthopedic issues with one another.

How to post on the Dog Knee Injury Forum:

1) You must register for a user name to post on the forum.

2) After you’ve registered and retrieved your password from your email, log in (I recommend changing the password to something you’ll remember) and start posting!

3) Keep the comments on topic, and be nice. If anyone encounters any issues on the forum please post in the comments on this page/use the contact form, and I will look into it.

CCL Repair Forum for Dogs is a post from: Dog Knee Injury

Ben’s Story:

Ben is a 4 year old Standard Schnauzer. We believe he suffered a partial tear in his Left CCL in December 2008. We didn’t give CM (Conservative Management) a chance until about July 2009, when he was diagnosed with a CCL tear. Prior to that, it only appeared to be a minor injury. Since July 2009 when we started CM, Ben would start walking and standing normally, but would often suffer set back after set back. I will be the first to admit that most of the set backs were due to my stupidity. I guess it could be argued we never gave CM a chance.

A few weeks ago, we gave up and did some more research. The Vet indicated that he could be healed through CM, but if we wanted him to be the athletic dog he used be, then he would need surgery. Ben was/is my hiking buddy and used to go on 7-8 mile hikes in the Utah Mtns all the time. He could run for hours and hours without taking a break. The Vet believed he would never be able to do that through CM without being down the rest of the day and/or next day. We scheduled him for TTA surgery with an Orthopedic surgeon that is believed to be the best in Utah, if not the best in West. From our research, the TTA surgery appears to be far superior to the TPLO. Dogs tend to be healed within 3-4 months. Also, they tend to be weight bearing on the leg within 24-48 hours. Within 2 weeks, some dogs are pain free.

Ben made it through surgery just fine today. The Orthopedic surgeon called us and indicated to our surprise that Ben had a complete tear in his CCL and the Meniscus was completely torn as well. If I knew he had that much damage, I think we would have scheduled surgery much sooner. The Orthopedic Surgeon did tell us that he does not believe Ben will suffer anymore arthritis than normal because of our delay in scheduling surgery. His joint appeared to be clean with only minor swelling. The surgeon believed his recovery will be just as good as if we scheduled him back in 7/09.

At this point it is anyone’s guess if he would be better or worse with CM. As of now, we have the peace of mind that knowing the end is near. With CM, we never knew when the road would end. I will post updates on Ben’s recovery over the next several weeks.

Day 1 (after TTA surgery)
When I picked Ben up from the Vet, he was completely opposite from what I expected. I expected a dog that looked like he had been to hell and back. Instead, Ben was dragging the Vet tech into the room. As we were talking to the Vet, he sat on his leg that just had surgery. The Vet was impressed with the very little swelling around Ben’s leg. As we walked outside, he was practically dragging me to the car. His spirits are completely high, and looked like he wanted to go play.

As we were getting into the car, I was planning on picking him up and placing him inside the car. Instead, I opened the door and he leaped into the car. He missed and gave me a complete heart attack. I caught him as he was falling to the ground. I expected him to cry out in pain, but he acted like nothing was wrong. Once inside the car, he was jumping from seat to seat like nothing was wrong. Once he was home, he immediately went for his food.

At this point he is just toe touching on the leg with the surgery, but he is getting around fabulous on his 3 legs. About 5 hours later, I took him for his first walk. We walked past a few houses before we turned around. As we got close to home, I noticed he started walking on his leg. He continued to walk on it (with a limp) the rest of the evening!!!!!! It looks like my biggest challenge at this point will be keeping him under control so that he can heal properly.

TTA Surgery and CM – Ben’s Story is a post from: Dog Knee Injury

Beau at Three and Four Weeks Post Op CCL Repair is a post from: Dog Knee Injury

This week we have seen a big improvement in Beau’s ease in getting around. In fact, he thinks he’s superdog! He clearly isn’t feeling much pain, so we have eased off on the Tramadol, but continue to give him the Metacam and the Acepromozine for sedation. The most difficult part of the week is getting him to just lay around. We’ve invented some little games to keep him busy but still – such as a toy we have that has stuffed, squeaky squirrels hidden in a stuffed tree and he has to work to get them all out. To up that game a bit, we hide a small cookie at the bottom. When he’s really full of himself, a small rawhide chewie settles him down a bit – but they sure don’t last very long. He’s never done well with the big rawhide bones – loves them, but his gums start too bleed. We have some very thick sweet potato chewies that do last longer, but they are expensive.

At the end of the week, Beau had a check up and got his sutures removed. His leg is getting a bit of hair back and the twelve inch incision looks very good. We were very lucky that Beau did not mess with his incision. I was ready with a pair of old boxers and a T shirt, to cover and distract, but they turned out to be unnecessary. The vet was pleased with his progress and indicating we were now entering the physical rehabilitation period. The idea is to build his muscle back up without over stressing the knee joints/ligaments. Her recommendations for the next month:

1. Swim Therapy. The vet hospital has a separate facility with hydrotherapy pool and trainer and is always pushing this. We did this a few years a go when we were first told Beau had hip dysplasia but it’s just too expensive to do it on a regular basis. I’m sure it’s wonderful, but we just couldn’t do that his entire life. However, a limited post op period is doable. We told the vet we could either do it one time a week for a longer period of weeks or two times a week for a shorter period of weeks. She preferred the longer period of weeks, so we’ll be taking him one a week for ten weeks. We do have our own pool that Beau swims in (it’s in ground, so it’s easy for him to get in and out) but we live in Ohio, so this isn’t an option until summer!

2. Stairs. Beau is now to be encouraged to do stairs either once a day for ten minutes or twice a day for five minutes. This is somewhat of a relief to me, since I’m worried that he’ll try this anyway. We’ll still have to keep the stairs blocked off most of the time, however, because the vet doesn’t want him just following us up and down the stairs all day long.

3. Walking on inclines. We are to take him on walks of initially five minutes, increasing an additional five minutes each week to an area with small inclines and zig-zag walk him up and down the inclines. This could have been challenging – Ohio is pretty flat! – but we live a street away from a golf course. We can drive there, get on the path, and walk him up and down the hills. The vet suggested these walks 3 times a week for now.

Beau’s Story – Two Weeks Post Op CCL Repair is a post from: Dog Knee Injury

To prevent further injury, we needed to keep Beau quiet. No running, no jumping and lots of rest. We were given Metacam for pain and Acepromozin as a sedative. It just about killed me to see my happy, active dog so sleepy – even though I knew it was for his own good. And in between doses, he was all fired up! I learned quickly that keeping him quiet was going to be big challenge. He wasn’t limping much anymore, and I’m sure he’d forgotten all about it. As a dog who has probably had some minor pain with his hips for many years, I think Beau is tough and just pushes through.

Because Beau would be favoring the leg and losing muscle tone, our vet suggested that we perform a Passive Range of Motion (PROM) exercise by gently bicycling his leg. We performed the exercise three times a day, followed by a massage on the rear back muscles and cold compresses to the knee area. Beau didn’t mind the massage or the icing, but he was definitely not crazy about the PROM exercise! We learned to do this exercise when the sedative was at its peak.

The three week waiting period also gave us time to figure out how to prepare the house for the months of recovery. We bought remnant carpeting to cover hardwood floor areas and we borrowed a gate to block off certain other areas. Stairs would not be permitted for some time, so we prepared to sleep in the living room with Beau. (Our thirteen year old son quickly volunteered for this duty, but I’m insisting that he take this job only on non-school nights!) We live in Ohio, and that means the months of December, January and February will be filled with snow and ice. With mandated leash walking, I wonder which one of us will be in for knee surgery next?! Time to load up on pet safe ice melter. We had some good ideas and some ideas that weren’t workable, but the upside of delaying the surgery was having the time to think the options through and prepare. And I, the neat freak, also used the time to adjust to the fact that my house would not be in order again for several months!

Preparing Beau for CCL Repair Surgery is a post from: Dog Knee Injury

The standard rehabilitation procedure for Tightrope repair is a bit different than TTA and TPLO, due to the less invasive nature of the procedure.  When dogs return home from Tightrope repair, owners are instructed to allow their dog to utilize the leg as they wish.  For some dogs this means they will start putting weight on it the next day, and for other dogs it could be 2-4 weeks before they feel comfortable bearing weight on the surgical leg.  Keeping your dog still while in the house, and keeping leashed walking to a minimum (bathroom breaks only) is critical during the first few weeks home no matter what procedure you choose, and exercise/movement restriction is advised for the first 8 post operative weeks.

At 4 weeks post op, most veterinarians will instruct owners to begin introducing their dog back to walks, particularly walking uphill in an attempt to rebuild loss muscle mass.  It is a good idea to start out by taking a few short walks every day, gradually working up to longer and less frequent walks.  This will prevent strain on the knee joint, which can hinder the healing process.  Post operative exercises need to be controlled, leashed walks, as any running, jumping, or roughhousing during the first 8 weeks can be detrimental to the stability of the knee and recovery process.

Upon his arrival home, your dog will need to take a number of medications for pain, inflammation, infection prevention, and possibly sedation.  If your buddy is not a willing pill taker, it is a good idea to try to get them into the habit of taking a small snack such as a piece of cheese, peanut butter, or a hot dog slice after their meals.  Each dog is different with regard to how long they need to be on a particular pain, inflammation, antibiotic, and sedation regimen, but usually the antibiotics are taken over 10 days, with the pain/inflammation/sedation used on an as needed basis.

As a general rule, just pay close attention to your dog and be sure to tailor their recovery to their particular needs.  There is no such thing as having a post operative dog rest too long, but there is always the risk of damage to the repair if your dog tries to do too much, too soon.  Tightrope CCL, like other traditional repair methods (lateral suture, extracapsular imbrication), is simply a way to stabilize the joint while scar tissue is being formed, it is not a replacement ligament.

Tightrope CCL Surgery Recovery is a post from: Dog Knee Injury

More and more veterinarians are starting to recommend post operative physical therapy for cranial cruciate ligament repair patients.  While opinions differ from one veterinary surgeon to another, proponents of canine PT believe that physical therapy in the post-op CCL repair dog can help bring a dog back to full function in a shorter amount of time vs. traditional rest following surgery.  Veterinarians are presently conducting studies to show the efficacy of PT in animals, and to prove that it has a similar restorative mechanism as PT in humans. 

The second part of canine PT is begun as inflammation has started to resolve, and healing begins to be the predominate theme in the wound. During this time pro-PT veterinarians believe that enough stress should be applied to healing tissues to stimulate and optimize healing without threatening the stability of the joint. Ideally, phase two activities should parallel the gradual increase in tensile strength observed in the wound. If one is too aggressive with PT during this period, failure can occur; conversely, if one lags in PTH activities, the goal of early return to function is not accomplished.

Exercises included in canine PT:

1.   Sit and stand.

2.   Corner stands.

3.   Figure-eight walks.

4.   Wheel barreling.

5.   Stretching of hamstrings, quads. (without stimulation).

6.   Decline treadmill followed by incline treadmill.

7.   Leg weights.

8.   Unbalancing activities..

Right now PT is favored in dogs with working backgrounds such as agility or hunting, but it has begun to pop up amongst other owners as well.  Not all veterinary offices offer PT services, and you should check with your vet prior to CCL repair as to whether or not it is something your doctor recommends. None of these exercises should be attempted on your dog by anyone other than a trained professional, and premature movement of the joint in a post-op CCL repair dog can compromise the stability of the joint and ultimately cause the repair to fail. Always follow the direction of your veterinarian when exercising your dog during the post operative period.

Physical Therapy in Post CCL Repair Dogs is a post from: Dog Knee Injury

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 Injury

1. Get your dog used to his new place well before the surgery date. If you are crating a dog that is not used to being crated or confining a dog that is used to having run of the home, it is important to get them used to this change prior to bringing them home from surgery. I recommend starting this transition as soon as you are aware of the upcoming surgery.
2. Cover your floors with non-skid carpeting; this is especially important if you do not already have carpeted floors. You will want to do everything possible to ensure your dog has no chance of slipping or sliding on an uncovered floor.
3. Disconnect the doorbell and place a sign on your door advising people not to knock; the more quiet you can keep your home, the better for your dog.
4. Have leashes hanging on the doorknobs everywhere in the home where your dog may go outside for bathroom breaks; there is nothing worse than searching for a leash to let your dog out when they are in pain, or getting them all riled up because you can not find their leash.
5. Have chicken stock, rice, boiled meat, and pumpkin on hand in case your dog is refusing his regular food after surgery.
6. Prepare the area your dog will sleep the first night home by covering the bottom layer with plastic. If your dog is not staying overnight at your veterinary clinic the day of surgery, there is a good chance that he may wet himself during the night due to the high volume of IV fluids they are giving during surgery.
7. Have ice or ice packs to help reduce swelling for the first few days after surgery. You may also want to have hot compresses available for the 3rd day on – it is best to follow your veterinarian’s advice with regard to the use of hot and cold compresses.
8. Cover the windows to prevent your dog from getting overly excited by outdoor creatures and excitement. Again, do everything possible to keep your dog’s recovery area safe and quiet.
9. Make sure you understand the dosing instructions and have the proper medications for your dog upon leaving the clinic. Everyone has their own way of managing medication administration, some make charts, others record the times given, and some people will tailor medications around meal time. We found that the easiest way for us was to set up a web-based calendar (we use Google Calendar) to send us an SMS text message whenever a dose was due.



10. If you have steps, make sure your dog does not have access to them; use a gate or barricade to prevent any premature stair climbing.
11. Boredom usually sets in pretty quickly for dogs during the post operative period, and having indestructible toys on hand can help to alleviate some of this stress. Frozen Kongs and bones can provide hours of distraction, which is a must for an owner that is unable to be with their pet at all times.
12. Make arrangements to take time off from work or have someone check in with your dog throughout the day for at least the first few weeks post op.

Preparing Your Home for a Post Operative Dog is a post from: Dog Knee Injury

Swimming is an excellent non-weight bearing activity, but only after the incision site itself has had time to heal. All therapies should always be cleared through your veterinary surgeon, prior to their implementation. If you have access to a pool and a dog that loves to swim, this can be a great way to help them regain lost muscle mass while working on ROM exercises in a zero resistance environment (decreasing the likelihood of injury).

Some owners have also chosen to go a more holistic route with their dog’s post operative therapy, seeking out the assistance of a professional skilled in acupuncture.  The use of animal acupuncture, and similarly acupressure, in a dog recovering from ccl repair surgery may help alleviate post op discomfort, which can help your dog to heal more quickly from surgery.  A growing number of veterinary clinics are now integrating western techniques such as acupuncture and massage into their practices, with many offering these services on site.  Acupuncture and acupressure can be used in conjunction with ROM exercises and hydrotherapy under the supervision of your veterinarian.

The long term prognosis for animals undergoing surgical CCL repair is good, with clinical reports of improvement in 85-90% of the cases. Unfortunately, degenerative joint disease or osteoarthritis progresses regardless of treatment. Long term outcome includes a decrease in activity over time, an increasing level of disability, an adverse response to cold weather, and stiffness after inactivity related to progressive degenerative joint. Weight loss, an exercise regime of daily moderate activity, and the use of joint supporting supplements like glucosamine and chondroitin can help to improve these adverse clinical symptoms.

Physical Therapy After CCL Repair is a post from: Dog Knee Injury