I adopted Mousse, a pure bred chocolate lab, a little over 2 years ago – she was 15 months old. In the words of my vet, Mousse is exuberant. She was always ready to run, fetch, swim etc. etc.

Then, about 6 months ago, she started having problems with her back right leg. I took her to my vet several times and was told each time, she was okay. I had the vet take X-rays of her hips and her right knee. They looked OK and he said she might have strained a muscle and I was to give her Rimadyl and Tramadol. I did and it was slightly better and then … worse: she was having trouble going up the stairs and getting in and out of the car.

We went to Oradell Animal Hospital with the X-rays and the orthopedic specialist there said she had torn the CCL’s in both back legs. The good news was that it was repairable and he proceeded to show me how the TTA would work and then said it would cost $4300 … each leg!! I’m sure he saw my jaw drop to the floor, and he was decent enough to suggest that if I could go outside the NY Metro area, I might find it less costly.

I started talking to people and got numerous recommendations for veterinarians, animal hospitals, veterinary schools. I read whatever I could on the internet and became more knowledgeable about TPLO, TTA, extracapsular – traditional and Tightrope.

TPLO and TTA were scary to me on two fronts – the actual surgery where they cut the bone and then plate/screw it into a different angle, and the recovery period during which the patient cannot be active or the repaired bone could be damaged (lots of horror stories about permanent damage, lameness, even amputations!)

Knowing my Mousse, traditional suture was not a good option – she’s too active and too big … even at a svelte 67 lbs. So I started to ask about Tightrope. Although they don’t do it there, the vet at Blairstown (great place) thought Tightrope might be a good choice. Mousse and I went to Univ of Penn Vet. – very good session but they don’t do many Tightropes and they were recommending TPLO. I had also contacted Cornell Vet College, but they don’t do Tightrope.

I then emailed Dr. Cook at Univ Missouri (who came up with Tighrope) and he was kind enough to send back information and a list of facilities in NJ and NY. I researched the list via the internet and made an appt. with Dr. Henrich of Tranquility Vet Clinic (western NJ). About halfway into the appt., I felt we were in the right place and scheduled the surgery. Oh what a relief to finally be able to make the decision!

We drove (it’s about an hour west of us) back to the clinic on Monday 11-8-11 and they put a pain med (Fentanyl) patch on the back of her neck. The surgery was the next morning; I dropped her off. Dr. Henrich called me around 12 to let me know the surgery went well and I could pick her up late afternoon/ early evening. I drove back to get her around 6pm – my poor Mousse was still groggy, her entire back left end was shaved and she was wearing a giant E-collar – she looked miserable!

The incision is about 6 inches long, held together by 15 staples. (I count them regularly : )

The first few days were fraught with anxious moments but I muddled through. I have her harness on almost all the time to control her forward momentum and a beach towel knotted around her waist makes a good handle so I can keep her from putting full weight on her back legs. We only go outside to pee/poop and she sits in the sun while I rake leaves.

Sat. 11-12-11 we went back to have the patch removed and to get another laser treatment (it helps to reduce swelling and promote healing). The Dr. was pleased with how the knee looked and that Mousse is able to put it down (not putting weight on it though).

She is more active than she should be and they had given me some tranquilizers to keep her calmer which definitely help. She does not like the crate or the E-collar, but I have no choice if I have to leave the house. I still get kisses on my chin so I take that as a good sign.

Sat the 19th she is scheduled to have the staples removed … one less thing to worry about.

Follow Up: 11/16

Mousse is putting more weight on the repaired (left) leg and would love to go for a real walk. She seems more comfortable with the reduced-size cone but is getting more obstinate about going in the crate when I have to leave for work.(I didn’t crate her before the surgery.) Hopefully I can pack up the crate again after the staples come out this Sat. The knee and suture line look very good to my unprofessional eye so I’m feeling positive about the future.

Staple Removal: 11/19

Just back from staple-removal. The vet is very pleased with Mousse’s progress and we now have some physical therapy exercises.

Unfortunately, the cone is still required as there are still two small openings in her suture line. These are expected to close in the next few days … as long as she doesn’t lick and irritate them. I can also extend her walks a bit. So small steps forward … but it’s all good : )

Recheck: 12-1-11

We met with Dr. Henrich, the vet who did the Tightrope surgery and he was very pleased with Mousse’s progress. She’s walking so well that there’s even a chance he may not have to operate on the right knee.

We reviewed the exercises for physical therapy which I do at home and he gave us the okay for moderate walks. We go back on 12-15.

I’ll keep you posted.

My Decision to Pursue Tightrope Surgery – Mousse 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 discusses the importance of mastering controlled leash walking with your dog during their recovery from a cruciate ligament (CCL or ACL) injury.

Making sure your dog maintains a reasonable amount of exercise during the recovery process helps your dog to learn to use the injured leg again, and may prevent injury of the opposite leg.

Slow, Controlled Leash Walking – 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 explains the importance of post operative icing within the first 72 hours following ACL repair surgery. Icing will help constrict the blood vessels and prevent inflammatory agents from entering the knee joint. The use of ice can also help relieve pain and make your pet more comfortable.

Icing Options Following Dog ACL Surgery:

• Ice Pack (Standard) – Do not conform to body
• Gel Pack (Gel) – Great choice, conforms to body and stays cold
• Frozen Bag of Peas – Good backup, just does not stay cold very long
• Therapy Wrap – Hot and Cold therapy wrap, easily conforms to body

How to Ice Your Dog

Dogs can be very sensitive and may react. If your dog reacts to the coldness of the ice, go ahead and place a towel over the area you plan to ice in order to prepare them.

Ideally you’ll want to place the ice source so that it wraps around your dog’s injured knee – this is where having a gel ice pack therapy wrap can come in handy.

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

I am an Office Manager at an animal hospital, and I love to bring my dog with me to work every day. His name is Ben, and he is a Golden Retriever. When the story begins, he weighed 115 lbs.

In early June, I had brought Ben to work. We we playing fetch in the hospital (again, I LOVE my job), and Ben slipped on the tile floor. He had a slight limp for two days, but then he was fine. I had him on Rimadyl/Carprofen, but once the limp went away, I took him off of it. I began to worry about his weight causing problems, and I was able to get him down to 112 lbs.

On Friday, June 24th, I was in my front yard when Ben started running. He stopped very suddenly, and he couldn’t put his leg down. He couldn’t walk to the door. I immediately brought him to my hospital, and the vet was able to feel the ligament tear through the drawer test.

I spoke to 4 different veterinarians and 2 CVTs… 5 of these 6 people said to go with the TPLO. I was shocked at the prices I was being given. Even with a kind “Professional Courtesy Discount”, I was getting estimates into the $4000′s. I was worried about this high price, and I was even more worried about the lengthy recovery time, severity of the side effects, and possibly spending another $4000 on his next leg just months down the road.

I spoke to a vet who we often refer to, but his hospital can only do lateral sutures. After meeting Ben, he suggested I call Dr. Robert Cook of Animal Medic Clinic of St. Charles, IL. Dr. Cook has been performing the Tightrope surgery for some time, and he has had success with it. I set up our consultation for Wednesday, June 29th.

DAY ONE

I met with Dr. Cook at about 10:00 AM. He is extremely thorough in his exam, and he makes sure that I understand everything and all of my questions are answered. He explains the possible side effects of the surgery, and he explains why things go wrong. I feel very confident with him, even more so after he mentions he has performed over 500 of these surgeries since 2008. He explains that yes, it is a newer surgery and surgeons can make mistakes by placing the rope crooked or drilling too close to one side of the bone. After 500 of these surgeries, Dr. Cook explained that he has learned to not make these mistakes.

I also explained that I was concerned about Ben’s size, and other veterinarians did not feel the tightrope would hold. He explains that this surgery was designed for the larger dog. He has done it on dogs larger than Ben with great results. We discussed Ben’s weight, and as of today, he is down to 103. Dr. Cook wants me to get him down to the lower 90s to assist with his recovery, and he should probably be at his ideal weight then. Overweight dogs have a higher occurance of blowing their second leg.

THE TIGHTROPE SURGERY

I really recommend finding a vet as experienced in this surgery as mine. I ended up paying 2500, and while the outcome is still unknown, this is how my surgery differed from others I am reading.

The surgery was performed that day. I dropped him off at 10. They performed bloodwork, and they gave morphine, acepromazine and an epidural. They were in surgery for about an hour. They also found a tear in the meniscus, and this was trimmed. I brought Ben home THE SAME DAY at 4:00. There was no cast, and there were no bandages. There was a transparent, sticky adhesive placed over the incision which was to be removed in 3 days. The external incision was about 2 inches long, and the other small incisions were all under a centimeter. The incision was closed with staples, rather than sutures.

NIGHT ONE AFTER TIGHTROPE SURGERY

Ben was in a lot of pain. I was able to get him to eat a little and drink a little. He held his leg in the air the entire time. He would not stand on his own. He was so depressed, like he had lost the will to live.

DAY TWO

I take Ben outside at 730 AM. We have four stairs at my house, and I have to basically hold his back end while he walks down the stairs. He peed and laid down. I COULD NOT get him to stand up. I’m so happy I had called off of work… I wasn’t able to get Ben back into the house until after 9:00AM. Ben was still very painful, even after medication, and he would growl at me if I would pet him. He has never growled at me in his life, so I found this concerning. He laid around for the rest of the day. When he would stand later in the day, he would begin to toe-touch. His appetite was normal, and he was drinking. My brother was able to carry him outside in the early evening, and again, he wouldn’t walk to the door to come in.

DAY THREE

Ben is starting to walk and follow-me around. He is putting weight on his paw. His pain seems to be going away.

DAY FOUR

I leave Ben alone for the first time since his surgery. He stayed in my room all day. When I got home, he began to run in the house. I had to stop him from moving so quickly. His function appeared to be back to about 50-60%.

DAY FIVE

This injury came at a bad time. Ben is crazy afraid of fireworks, and this was the 3rd of July. I made a hiding spot for him in my room with a lot of blankets. I had given him 100mg of Tramadol and 75mg of Benadryl, but he does not seem to calm down whatsoever. At one point, I walked out to my car. I came in about 5 minutes later, and Ben was in the bathroom with a blanket attached to him. I’m assuming he heard a loud firework, and he ran out of my room and tripped over the blanket, because he was holding his leg high in the air again. I was concerned that he did something to reinjure himself or screw up the surgery. I got him to go back in my room and I blasted classical music. I was able to get him to fall asleep.

DAY SIX

The Fourth of July!

I brought Ben with me to work. I know he was supposed to be bed resting for two weeks, but I wanted my vet to see his progress. He was walking around a little too much for my liking, but my vet thinks he is healing well. The incision looks healthy and normal, and no swelling is present. I cut his Deramaxx from 100mg once daily to 75mg once daily.

That night, I gave him 25mg Acepromazine. He hid the whole time without any pacing. Thank goodness!

DAY NINE

Ben is at about 70 to 80% percent function during the day, but he drops back to 50% at night. I wonder if it is because his Deramaxx is wearing off.

I am slightly concerned that initially, he was showing steady signs of progress, and now it is slowing down. The other problem is that he is getting sick of sitting in this house. He is being way too active when I get home, and he runs to the door if someone gets here. He’s pretty good about stopping when he is told to do so, but I’m worried that these small instances can cause big damage.

Ben is able to completely go down stairs quickly, without assistance (just the 4, as approved by my vet), but he shows a little difficulty when going up. I am lifting up his rear to get him to climb.

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

I’m not sure exactly how it happened, but I know she has very bad hips and the right hip is the worse so my vet thinks that she was over compensating on the left leg because of her bad right hip. She is doing well, but I have major concerns about re-injury and also injury to the other leg.

The Swivel Lock is a fairly new procedure, but it is available where I live in Florida. The Swivel Lock system is a extracapsular repair that is very similar to the tight rope procedure. We chose to use this system seeing as she was such and big dog, and with this system, all parts if the implant are buried so it does not disturb the muscle as much as some of the other systems.

Right after surgery she was toe touching with the leg and within one week she was using the leg but only putting about 25% of her weight on it. We have been doing a lot of physical therapy with her since surgery.

Week two we started going on short walks and using physical therapy tools to help her use the affected leg. We are now on week four and she is already weight bearing about 80% on the affected leg. We are doing water physical therapy with a under water treadmill weekly. She does have some muscle atrophy that we are working on rebuilding. I had major concerns about the high probability or her tearing the other ACL so we are working hard on getting her repaired knee back to 100% working order and I must say she is doing great!!! I must say with a dog her age the hardest part of after care is keeping her quiet and making sur ethat she does not re-injure her leg.

Josie is now about four weeks post surgery and is doing great!!! I feel that the extracapsular repair was a great choice for Josie and I. I love that it is a less invasive surgery and with the correct post operative care, correct joint support supplements to help prevent arthritis and physical therapy it can have excellent results. Our recovery has gone very smooth.

I was looking into getting her the A-trac brace but wanted to do a little more research. I don’t mind spending the money if it will help and hopefully prevent the other ligament from tearing as well because I know the statistics of injury to the opposite leg. I would lover to know how people felt about it and if any one has any suggestion before I order. I just would love her to have that extra support to help her recover and learn how to use that injured leg properly again. I would love to hear the pros and cons. Any insight would be greatly appreciated!

13 Weeks Post Op

We are about 13 weeks post op and are doing AWESOME. Josie is 100% back to normal.

I could not be more happy with her surgery and recovery! TTA was a great choice for her! I am super happy. She is doing so well that we are adding another addition to our family in the end of Feb. I am very happy! It was a long haul but we finally made it! Yay!

Extracapsular Repair with Swivel Lock System – Josie is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Grayson’s Tightrope Procedure for her CCL/Meniscus Repair

Grayson’s Background:

Breed: Weimaraner

Sex: Female/Spayed

Age at surgery: 4 years old

We were given three options for surgery (TPLO, Nylon repair, or Tightrope) We chose the tightrope, but it was not recommended unless the dog had a FULL CCL tear and our Grayson had a partial. We ended up taking her home with Rimadyl and Hip/Joint supplements. Over the next few months she did WONDERFUL…I actually thought that it may have healed. Then, on mother’s day she must have torn it the rest of the way because she began carrying her leg and showing signs of extreme pain. We immediately scheduled the surgery for the next week.

Day 1-Surgery Day:

My nerves were shot on the drive to the vet. I was so worried about our sweet Grayson. Mostly because I had to leave her overnight. I trusted the vet whole heartedly and knew she was in good hands. I just hated to be away from her and I hated that she had to go thru this invasive surgery. When we got to the clinic he did a quick exam of the knee and walked me thru what was going to happen. The tech’s took her back to do pre-surgical blood work and run an EKG on her to make sure she was ready for the anesthesia. After all her test came back normal they prepped her for surgery. I left her at the clinic around 8:30am and she was set for surgery at 10:00am.

So began the waiting game….I am not good at the waiting game. I received a text about an hour into surgery from the Surgeons wife (who is also a vet and close friend). Her text said that the surgeon had opened the knee to find a completely shredded CCL and Meniscus. She said the surgery was going to take longer then normal because of the meniscus tear.

About 2 hours later the surgeon called. He said she was doing good and was waking up. He explained to me that not only did she have a CCL tear but her meniscus was torn as well. He also informed me that she had a genetic/birth defect that prevented her knee from being aligned properly (more then likely contributing to her injury at such a young age). He had some trouble getting the knee realigned but eventually was able to get her all fixed up. He assured me she was in good hands and told me I could pick her up the next day. Thru the night she would be placed on IV antibiotics and receive  pain meds to keep her comfortable.

Day 2-Bringing her home

The anticipation was killing me. I don’t think I could get to her fast enough. I had not slept much because I was so anxious. When we arrived at the clinic he informed me that she had not yet bared weight on her leg. This was a bit of a shocker for me because everything I had read said with the tight rope procedure they will usually began using the leg within 24 hours. He assured me not to worry that she was not only in pain but a little nervous as well. We were given strict pill dosing instructions for her Deramaxx (anti inflammatory) and Clavamox (antibiotics). He told us not to let her go up and down steps of jump up and down off of furniture. He said that we could start short walks after a couple of days.

We carried her out to the car and placed her in the back seat. She cried out a couple of times while trying to get comfortable. She had also urinated on herself in the night and they were not able to bathe her because of her sutures. I was in shock at the site of her incision. I counted 18 sutures. I will attach pictures. It was pretty ugly.

Once we arrived home we placed her in the grass and see if she would potty. She would still not use her leg or potty. We brought her in and got her to eat and drink a little and had her lay down in her dog bed. This is where she stayed for the next 5 hours. She slept and slept…Finally that evening she woke up and ate a full bowl of food. We took her out into the grass and noticed that she was beginning to lightly use her leg. She also peed and pooped (which I was worried she would not be able to do). She took her medicine pretty easily. I bought the Greenies brand “pill pocket” treats at Pets Mart and placed her pills inside. I would recommend these because they come home with lot of meds and its VERY important that they get each dose.

Day 3

I actually let her sleep in the bed with me last night. I just kept a hand on her to make sure she didn’t try to get off the bed (but she slept soundly all night). She woke up in good spirits this morning, and is back to her normal self–minus the hurt knee/limp part. She still is only barely putting her toe down every now and then, but is fully using the leg when its time to go potty.

We let her lay in the shade in the grass while we did some minor yard work. She seemed to really enjoy herself and we thought the fresh air and change of scenery would be good for her. I noticed some bruising and swelling on the inside of her leg. I text a picture to our surgeon and he assured me that it was normal and that gravity will cause some swelling inside her leg. He told me to begin checking her temp daily and call him if it is ever above 103. I checked it and thankfully it was 101. He also assured me that she would show small improvements each day. I am happy with her progress today, but looking forward to even more improvements and time goes on.  She also ate her normal breakfast this morning and easily took her medications. She is a pretty good patient.

Day 4

Today she did not seem to have much of an appetite. I added a small amount of canned food to her normal dry food and was able to get her to eat. She also is not drinking water on her own unless I bring it to her and coax her a little. She is also not interested in treats at all (which is not like her at all). I have heard from others that this is normal and is probably a combo of her not feeling well and the meds upsetting her tummy. I also checked her temp again today and it was normal. I left her today for the longest time period yet (around 4 hours) and when I came home she greeted me with a bone in her mouth. This made me so happy because they is what she typically does but has yet to do since her surgery. We got a wire dog play-pen and placed it in our living room. It covers about an 8×8 foot area. In the play pen with her we place her dog bed, water, and bones. We are making small improvements everyday and I am looking forward to seeing where we are at the 1 week mark.

Tightrope Repair for CCL and Meniscus Tear – Grayson is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

I have an Olde English Bulldogge named Wilson, he is 4 and very active, with re-active personality. I had the tight rope procedure done last year and nothing has changed for Wilson as far as chasing, running, and jumping.

Tight rope is much less invasive than TPLO, because with TPLO they actually take out some bone and recovery is much longer. Tight rope uses a fishing like leader (metal wire) along with some key points in the joint so it can be laced up again. Eventually, the leader will break a while after the cartilage has been reformed.

Remember – your dog will probably have arthritis due to a torn ACL, but it’s ok, there are plenty of things for that. I live in Minnesota, even when walking Wilson in cold temps his leg does not bother him much, as matter of fact, bullys are famous for not showing pain even if it hurts or (dogs in general). Wilson still has a tire hanging from a tree that he swings and falls from, his recovery or a recovery in general is not as bad as you may think if you have not had it done yet. If you do get tight rope done remember to give Glucosamine, Chondrointin pills daily for life. I have a friend that is a vet and the ones you buy at Walmart for human consumption are perfectly fine, even ask your vet.

I paid $683 dollars for tight rope procedure at a vet I highly recommend…he had done plenty of tight ropes, and my total bill was in the $1100 range. There are advantages and disadvantages to any procedure. Mine was extremely wonderful; to see Wilson happy and back at ‘em. I would be grateful to help or give opinions to anyone who needs some assistance with my resources.

Tightrope Surgery and Large Dogs – Wilson is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Charlie, our 83lb German Shorthaired Pointer, age 7, had tightrope surgery on his back right leg on Wednesday, January 25. 2011.

Initially he started shaking on his right back leg when standing, our Vet shook his head and said he could not say what was wrong. 6 months later the leg had progressed from shaking to being held off the ground at all times, and 3 Vets later we finally got a diagnosis of a cruciate ligament break requiring surgery. The surgery was performed 2 days later. The Surgeon recommended the Tightrope method as it was less invasive, has a good recovery time and Charlie is a large dog.

After an overnight stay at the clinic, we brought him home noon the next day, with a bright green stocking right up to his poor shaved bum! We were given antibiotics to be given twice a day, and a painkiller, once a day.

He cried all night and my husband slept with him on the cot mattress we had laid out for him in living room floor. Next morning he had no trouble peeing and pooing and had no problem eating. Very restless all day, wanted to walk and run when out on the leash to do his business.

Friday and Saturday more restless nights and days – how do you keep a good dog down….he was walking around going to the door to get out and walking over to the water bowl. He is not putting any weight on his operated leg, and I am trying to get him to lay down as much as possible to protect both legs. We have the largest size Vari Kennel but even that does not give him much room and he positively refuses to enter it. He wants to walk about and go to the window. etc. He does not appear to be putting any weight on his operated leg, but does touch it to the ground, and I am worried about his good back leg.

We are surprised how good our other dog, Penny, has been. She is a 4 year old GSP and very active. When Charlie first came home she gave him a lick on the cheek and a muzzle nuzzle, and has left him alone ever since.

How are we going to keep him quiet for the next 9 weeks??

He visits the Vet next Wednesday for a check of the wound and re-bandage.

Will let you know how we are all surviving!!!

2 Week Post Op Tightrope Update

Charlie had his stitches removed on day 14 (yesterday). Unfortunately, the bandage cause his foot to swell hugely, and so we had it re-bandaged on day 7. He had it re-bandaged again on day 10, but the swelling continued.. I eventually cut the bandage at the foot to allow a bit of relief.

3.5 Week Post Op Tightrope Update

Charlie is now 3 and 1/2 weeks after tightrope surgery. He puts his foot down very seldom, and when he does it shakes and shakes – same as when I first noticed he had a problem. Vet gave him an Cartophen injection to help build cartilage, he has to have another Cartophen injection in 4 weeks, some more happy pills, and assured us it just takes time. We are gently stretching his leg (12 x 2) 3 times a day and have been given permission to take him for short walks 3 times a day on a short leash, no running or jumping . But he is ready to run, run run, but he is hop, hop, hopping, I am so worried what that is doing to his other leg…. he pulls on his leash and when we take him outside for business, he really wants the freedom to run with Penny, our other GSP, and sniff all his boundaries once again!

To all who are facing the same recovery, it is so wonderful to hear from you and to realize everyone is anxious for their dog and hoping all will turn out well. Keep in touch please, it is very encouraging and useful to hear from you all. One day we will be romping in the park, all of us!!

Tightrope Surgery Recovery – Charlie the GSP 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

We found a vet (Dr. Kelly) in Byron MN, near Rochester who has done about 90 Tightrope repairs. He also does TTA and TPLO. The name of his clinic is Meadow View.

Why Tightrope ACL Surgery?

We decided on Tightrope as it is much much less invasive and has about the same failure/complication rate as the other options, BUT if anything goes wrong it can be fixed (which is most times not the case with the other options).

We chose to do both legs at the same time for numerous reasons:

• He will only have to go through recovery and rehab once
• He will not have to put all of his rear weight on one rear leg that is painful and susceptible to further damage
• We are able to take time off of work to be home with him

What is the cost of tightrope surgery?

The surgery took about three and a half hours. Total for both legs including pre-surgery blood work, 3 meds, food to hide the pills in, wound cleaner, and joint supplement pills for 2 months was $3500. There will not be a charge for the post exam or removal of the staples.

Recovery after Tightrope surgery

When we picked Edgar up he was doped up. He was all but asleep while being carried out to the car and lost control of his bladder just before getting in. He slept the entire hour and a half home. We carried him in and laid him on puppy pads and cleaned the pee off his leg. He slept until we took him outside (took two of us, a sling and a harness with a handle) he did go pee. We laid him on his opposite leg and applied ice (peas) for about 5 mins.

The incisions are 6″ long, there is about 2-3″ of slight bruising around the wound that looks dark red. Swelling is not very noticeable. There is a reddish-clear fluid we are noticing on the puppy pads and this is normal. He was shivering quite a bit (normal as the surgery meds lower body temp); we covered him with a blanket to keep him warm. He also was sort of cough/huffing every so often and a grayish brown mucus was present. This is normal due to the tube that was in his airway. This stopped altogether by evening.

I suppose I should add that Edgar is a very large (125lbs) 2 year old American Bulldog. He is neutered. I think he first injured his right leg about 6 months ago, and the left a few months after that. Since conservative management worked so well with Emma (our 42 lb pitty) we tried it with him also, but due to his size – no dice.

I put his favorite toys near him and towards the end of the night he pawed at them. He also pawed at us which he does all the time (demands attention) so we viewed this as good.

The last time we took him out for the night he actually put some weight on his back legs and walked (in the sling) and did go pee.

My husband slept next to him on a sleeping bag as Edgar adores him and always wants to be by him. We also put an E collar on him just in case. He is so out of it I am justifying the spoiling today…

Bilateral Tightrope Surgery, Day 1 – Edgar is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information