When massaging your dog following a cranial cruciate ligament (ACL or CCL) injury it is important not to just focus on the injured knee joint, but the entire body, especially when initiating the massage. Some of the benefits of canine massage include: enhancing the human-animal bond, relieving pain and decreasing swelling.

Dr. James suggests a massage technique starting by working from the toes up to the affected knee joint. While massaging the area around the joint (or anywhere else in the body) you may encounter “knots”. You can relieve the pressure in these points by placing firm, direct compression on the area for about 20 seconds, leaving time for it to rest before returning to the area.

Massage Therapy for Dogs – Video is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

PROM or Passive range of motion exercises are an important part of canine physical therapy following a cranial cruciate ligament (CCL) injury. PROM exercises are useful whether your dog has undergone surgery such as a TTA, TPLO, traditional repair, etc. or if you’ve chosen to do Conservative Management. The goal of PROMs are to increase the movement and flexibility within the joint by stretching the tendons and muscles in a careful, controlled manner.

Dr. James St. Clair of TopDog Health and Rehabilitation demonstrates how to perform Passive Range of Motion Exercises, and explains their importance with regard to maintaining range of motion within the dog knee joint.

Passive Range of Motion Exercises – Video is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Dr. James St. Clair of TopDog Health and Rehabilitation demonstrates stair exercises for dogs with cruciate ligament injuries. Like many of the other exercises, stairs should only be incorporated when your dog is ready, i.e. using the leg fully while walking without any discomfort.

Controlling your speed during this exercise is key – The slower you climb, the longer your dog’s foot remains on the step, which makes it more effective.

These slow, controlled stair exercises work to strengthen all the major rear muscle groups, also assisting with extension and flexion of the hind legs.

Stair Exercises – Video is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

This exercise is most often used in dog agility, but adapting it for home use can be a great way to help your dog regain strength and range of motion following a cruciate ligament injury. Using cones or any other apparatus available, you can quickly set up a course for your dog to weave through.

of TopDog Health and Rehabilitation’s Dr. James St. Clair demonstrates the use of the Weave Poles (or Cones in his case).

Weave Poles – Video is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Cavaletti Pole Exercises are an excellent way to help increases strength and improves your dog’s balance. Dr. James St. Clair of TopDog Health and Rehabilitation explains the best way to use the Cavaletti Poles to help your dog heal and rebuild muscle, strength and balance following a cruciate ligament injury.

At TopDog Health and Rehabilitation, they use thin PVC pipes as Cavaletti poles. The PVC is then suspended between traffic cones that are pre-drilled with holes. A broom stick handle can work great, as well!

Cavaletti Exercises – Video is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

TopDog Health and Rehabilitation’sDr. James St. Clair show us how to master the “Sit to Stand Exercise” – which are basically squats for dogs.

Dr. James suggests viewing your role in your dog’s recovery as that of a personal trainer, focusing on the form. When performed properly, this exercise can be a powerful asset to rebuild muscle in the hind leg, while also improving overall range of motion in the knee joints.

Sit to Stand Exercise – Video 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

While each veterinarian typically has their own recovery protocol, the following is what you can expect as part of a standard TTO surgery recovery protocol.

Appointments

At first your veterinarian will want to see you a few days after the procedure, then at 1-2 weeks, and then at 6 weeks. At the 6 week post op appointment, x-rays will be taken of your dog’s leg to make sure that everything is healing properly. During these post operative visits it is important to discuss your dog’s progress with your vet, making note of any changes or anything else that just “doesn’t seem right”.

Medication

Your vet will also prescribe oral antibiotics in either the cephalosporin or penicillin family. The antibiotic course will be anywhere from 5-14 days. Again, go with your veterinarian’s recommendations and do not stop the dosage before all of the pills have been taken.

You may also be given a tranquilizer or other calming agent to keep your pet quiet while they recover. We were given Acepromazine for our dog during his recovery process.

Pain medications may also be given to help your dog through the first few days following the procedure. If it is at all possible, it is advisable to keep your dog overnight at the facility where they are having the TTO done – as long as the facility is constantly staffed throughout the night. This way your dog can be monitored all evening after the procedure and can continue to receive pain medications via IV.

Exercise

Post Op to 6 Weeks

Your veterinarian will recommend your pet have very minimal exercise for the first 6 weeks following the TTO surgery. It is recommended that you set up a confined, carpeted area in the home where the dog can stay. It is optimal if this area is located close to where your dog will need to go to use the bathroom. 10 minutes of any type of exercise/movement is the absolute maximum during this crucial time following the TTO.

Many people get creative with ways to help out their pet during the recovery process. You can fashion a sling out of a towel to help your dog get up and down. Other people install ramps if their dog needs to navigate steps in order to go outside. The best thing you can do to ensure your dog has the best recovery possible is to plan as far ahead of the surgery as possible, making sure that the home is safe, quiet and secure to allow them the best chance at an optimal recovery.

After 6 Weeks

If the healing process is taking place as planned, leashed walking can typically begin around the 6 week mark. It is important to start off slow with the walks as your dog will have experienced a significant amount of muscle atrophy as a result of the extended resting period. The best way to begin incorporating walks is to go for a few walks of short duration. On the first day maybe take three to four, 4 minute walks, and work your way up gradually over the next two weeks. By 8 weeks it is ok (as long as your dog is doing well) to increase the walks to a maximum of two, 20 minute walks per day.

If at all possible, this is also a good time to do swimming (in water deeper than they are able to stand) or walking up slight inclines. Both of these types of exercises will help to rebuild lost muscle mass.

Unsupervised play, as well as jumping, stairs or other types of roughhousing should continue to be avoided until about the 12-16 week period. At 12-16 weeks after the TTO surgery your dog should be almost back to normal. If not, make an appointment to go in and see your veterinarian for a recheck.

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

Well I am happy to report that Taylor is doing great and is now 5 weeks post surgery. It has been a long 5 weeks. At approximately 1 week after surgery Taylor was no longer limping and was ready to go! It has been difficult to keep her at rest. We have enrolled in a cranial cruciate study and has had 4 rehab sessions. These sessions include water treadmill, and appropriate therapeutic exercises to facilitate neuromuscular re-education and to improve flexibility, strength, balance and gait patterning.

Taylor remains quiet and activity is limited to controlled exercises and short leash walks. She can also walk stairs slowly one at a time while supervised on a leash. I will post more pictures soon including post op pics and of course some rehab pics. She now walks without a limp and other than her shaved leg and some mild muscle atrophy she is doing great……I know there is still a possibility of complications including infection and rejection of the implanted screws and plates but all looks great at this point in time.

TPLO Post Op Update – Taylor 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