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

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

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

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

Extracapsular Imbrication (Traditional Repair) – Duke is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

After a couple of months she was due for her needles. I mentioned this lameness to our vet, who diagnosed a partial knee ligament tear. She was extremely active, chasing balls for 30 mins every afternoon and a 5 km walk every morning. The vet suggested rest to see if it healed.

We decided to use a conservative method. She recovered very well. We started to increase her exercise levels after the 6 month mark, she was starting to play and run around off lead with no bad effects. We were very cautious when adding ball games, not allowing her to chase the ball, only to retrieve it after we had thrown it and it stopped bouncing. All was going according to plan and we were very happy.

We then made the decision to allow her playfriend over, a 12yr old jack russell. They played several times with no problems, then one day she was lame again, the feeling of depair was unbelieveable. After going back to the conservative method again, she was not recovering as she had before. The limp was there nearly every time she rose after a sleep. We decided to get her operated on. She weighs 21 kgs and the vet made the decision which method was best for her and her active lifestyle.

I am so impressed with her, she has the best nature imaginable! I got the crate 3 days before and got her used to it. No problems there.

She didn’t have any arthritic changes, which i was worried about because of the time from the first lameness. The bandage fell off on day 2, but she didn’t worry the wound at all. Some allergic reaction to the stitches, but no real problems. She has been an angel, just sleeping in her crate and chewing kong toys.

I take her out on the leash for a few hours every afternoon and sit in the backyard with her. At least she can watch the world go by. She was putting weight on it within a few days.

We are now at week 5 and she walks without pain or limping. I have started to allow her a trot now and then, very little signs of limping. I have been doing the passive range of motion from day 5, and think it has helped. Her leg is quite thin, but when the weather warms up, I have ponds near me that she can swim in. Hopefully she continues to improve. We will be sure to keep her weight down, and she will only be allowed to play ball in the pond.

I hope she never needs the 2nd leg done, but at 5yrs old i know there is a good chance it will happen. Good luck to everyone out there going thru this, it is very stressful. When tango went in for the stitches removal, my vet asked how we were and not how the dog was!

Traditional Repair After Conservative Management – Tango is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Our family pet, Jake is a 3yo Golden Retriever. We basically noticed when he was about two, when he ran or joined us hiking he would be sore. One day he was playing in the snow and he fell through and came in the house breathing heavy and it was real difficult for him to walk or put weight on his leg. You could tell he was in pain. The vet said he had torn his cruciate.

Money was a little tight so we decided on artificial ligament surgery. I am not sure of the name. He came home real sore and cried all night even with pain meds. He did not eat, drink or go to the bathroom for days. Eventually he came around and after 8-12 weeks of following drs weekly orders of short walks to eventually runs he seemed to get better but still not 100%. But he could run again and it was fun to throw tennis balls to him again and watch him run for it!

He is now scheduled for TPLO in 3 days and I am real nervous of putting him through this pain again. I hope this surgery has better results. The Dr thinks he may have torn his original torn knee again so we may have to do another TPLO. We LOVE our dog, but we always have real expensive medical issues with our pets and we have just about depleted our savings and I hope we are not making a mistake in doing all this surgery, putting Jake through pain and I hope he understands we are trying to help him and not punish him.

I hope that he can run and be pain free ASAP!! Unfortunately, it will be winter againg by the time he will be allowed to run again! Thanks for reading and I would love any advice!!!

TPLO vs. Traditional Repair in Large Dogs – Jake is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

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

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

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

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

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

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

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

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

Dog Knee Brace Experience – A-Trac Dynamic Brace

From the moment I put the brace on, Mya was putting full weight on her wounded leg. Mya wore the brace 24/7 for eight weeks, during which time I followed the rehab protocol to the tee – that is, keeping her quiet, taking her for increasingly longer walks on level ground, then moving to inclines.

The brace never seemed to bother Mya, and she left it completely alone. I took it off once to wash it and to my surprise, when I put it back on Mya did not at all object!

It has been seven months since Mya stopped wearing the brace and she is doing fantastic! Her surgeon is very impressed – she is completely healed! She is not at all lame and enjoys as much activity now as she did before her injury.

I’m sorry it didn’t work out for Tucker. I can’t really say why our experiences were so different. I feel really fortunate to have found the A-TraC Dynamic Brace and highly recommend it!

To read about Tucker’s experience with the ATraC dog knee brace click here.

A-Trac Dynamic Brace After Two Failed Extracapsular Surgeries – Mya is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

At over 8 months post op, I can safely say that the surgery was a success and worth the cost and trouble. Beau (a Golden Retriever) plays as much as any healthy dog and we have had; he is completely healed.

We have learned many things from this experience, and the highlights are:

1. Keep the dog’s weight in check. Probably the most important thing we have learned. Those joints are stressed enough and just can’t handle the extra weight. Keep ’em lean for their own good.

2. Follow the vet’s post surgery directions to the letter. The post surgery dog is a baby/puppy all over again and the house needs to be safe, safe, safe! Exercise as prescribed to re-build the muscles, and so that the non-injured side is strong enough to handle the extra weight it must bear while the bad leg is recuperating.

3. Our dog is banned from jumping on the bed forever. That activity didn’t cause the injury, but it will never help it and it can only make it worse. A nice doggy bed in the bedroom corner is just fine.

4. The surgery was expensive, and the recovery was really difficult to manage – particularly since recovery was in the deep winter months of Ohio. But if you take it just one day at a time, each week after the first two gets a little bit easier.

It is all worth it to have a happy dog again!

Modified Traditional ACL Surgery – Beau is a post from: Dog Knee and Leg Injury, Canine Cruciate Ligament Recovery, TPLO Surgery, CCL Injury Diagnosis, Dog Knee Brace Information

Jake had traditional repair 7/28/10. This was Jake’s second surgery, as he had TTA (Tibial Tuberosity Advancement) in February of 2009. Prior to both surgeries we tried conservative management, but needed surgery both times.

Traditional Repair – Post Op

We are currently Day 4 after the Traditional Repair, and it has been remarkably smooth. Jake is a large mini poodle (32 lbs.) and was always on the large side of his breed and is more of a small standard size. He is almost 13 y.o. so I was concerned about going into surgery, since the anesthesia seemed to escalate his aging after the first surgery, the TTA.

Honestly, I have read so many horror stories about the recovery period, etc., I was skeptical. Jake had surgery Wednesday, he came home Wednesday night with a soft cast, some Tramadol and Previcox.  He was a little uncomfortable that night, but slept. Day 2 was similar, and although the cast was cumbersome he was putting weight on the leg. Cast came off 2 days after surgery and he has been walking on the leg. Pain meds continue (but 1/2 tablet Tramadol 3X day) and he is doing great.

TTA – Post Op

Comparing to the TTA, which I decided to do after about 6 weeks of conservative management, this was a piece of cake. Jake did, however, stay overnight with the TTA, and came home the following day, with cast and meds, and was putting weight on it (also) almost immediately, but lots of toe-touching.

TTA vs. TPLO

I did extensive research and interviewed various surgeons prior to the first surgery, and opted for the TTA over the TPLO once I heard if there was a complication with a TPLO, it was not able to be “fixed”, but the TTA could be re-done, if needed. I believe it has to do with how the joint is re stabilized — the TTA uses a non-weight bearing bone, and the TPLO reconstructs the angle on the weight bearing leg, so if there is a problem, there is a real problem. One vet confidentially told me that sometimes the leg needs to be amputated (now, this vet preferred a TTA, but upon some checking, it may be true). IF you decide to go with a TPLO procedure, be sure to ask the vet the “what if’s” in case there is a problem a few weeks out and you need to have a “redo”.

Recovery

In any event, Jake is doing well, and at almost 13, he should be as good as new.

I will add that his cruciate ligament was fully ruptured on the first leg (meniscus was ok), and the partially ruptured on the second leg — although he could not put any weight on the 2nd leg, so I had no option. We believe it is a genetic predisposition in Jake’s case, as opposed to an “injury” due to his age. Also, there was no real accident, just normal dog stuff. I am happy to share any of my knowledge I have gained over the last 2 years.

TTA and Traditional Repair Cost

By the way, the TTA cost was around $2400, plus physical therapy, x-rays etc. (another $1,000 or so); the traditional repair which I opted for this time due to the fact it would be easier on him, was around $1300. I reside in the Chicago area.

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

Jasmine’s Bilateral ACL Injury
By Jana Rade

When Jasmine started limping in the summer of 2008 we didn’t think too much of it. It wasn’t the first time it happened and it wasn’t the worst either. Jasmine had injured her hind legs three times before and, each time, after an exam and x-rays, we were told it’s probably just soft tissue injury and sent home with recommendation of restricted exercise. Each time it did seem to have resolved on its own eventually.

With passing weeks I started to feel that perhaps we should take her to the vet again after all. It wasn’t getting worse, but it wasn’t getting better either, and Jasmine was showing less enthusiasm for exercise, which hasn’t happened before and wasn’t like her at all.

At the beginning of September we took her to her vet at the time. He didn’t really find anything and couldn’t elicit the drawer sign but suggested an appointment with an orthopedic specialist just to be sure. He mentioned the words ACL injury and that was the first time ever we heard about such thing.

After I researched what an ACL tear was I really didn’t want it to be it. Jasmine was putting some weight on the leg even though she was limping heavily, particularly after rest following exercise. She wasn’t holding her knee up as would be typical, so I was being hopeful.

However, after her visit with the specialist, and a set of x-rays, the diagnosis was in and it was breaking my heart. Yes, Jasmine did indeed have a partial ACL tear in her left leg, and if that wasn’t enough, her right knee didn’t look so great either. The recommendation was to do a TPLO surgery on the left knee immediately, with a prospect of another surgery once that heals. When I’ve learned what TPLO was I didn’t like it the least bit.

To Jasmine, her legs are the most important part of her body! They take her places! Such an invasive surgery and six months recovery … taking almost a whole year out of her life … I really didn’t want to do that if I could help it.

I spent endless hours researching and looking high and low for other options. We considered conservative management with knee brace. But Jasmine was only 5 years at the time and she is a very active dog. Brace didn’t sound like a good solution for her.

I was talking to many people and many vets and one vet from Australia mentioned that prolotherapy might be a solution for a partial ACL tear. I researched that and it sounded hopeful, and certainly better than a surgery. I found a vet in our region and discussed that with her. She said that it could be an option. Before we booked a consultation with her I brought it up to Jasmine’s vet. He didn’t know much about it, looked it up quickly and figured it was a terrible idea. There he was saying things such as bone infection and amputation … scared the living daylights out of me.

I did talk to a number of vets who successfully used this technique prior that conversation, but the word amputation eclipsed all the positive things I read and heard. I called the consulting vet immediately and told her what Jasmine’s vet thought. She was trying to explain that while there is some degree of risk they take precautions and it is very safe. As she noticed I wasn’t really hearing that suddenly she suggested something else:

“Well, we could also try stem cell regenerative therapy. It really is a shortcut to what the prolotherapy is designed to achieve.”

Stem cell therapy? Ok, a new word that didn’t have the word amputation tied to it. I asked her how it worked and she gave me the skinny. This certainly sounded interesting!

So back to research. The more I was reading about what stem cells were, the more exciting the whole idea sounded. We discussed it with my husband and he also felt good about it. So back on the phone with Jasmine’s vet.

“Stem cells? From bone marrow?” he asked. “And what about rejection issues?”

“No,” I said, “stem cells from Jasmine’s own fat tissue”.

This time he didn’t even bother looking it up. “Sounds like a scam,” he said.

Well, it didn’t sound like a scam to us. I went back online to see if i could find any testimonials about this treatment in dogs. Didn’t find many, but found some. And more importantly, this felt right. I found a website of the company who is behind this treatment, VetStem. There they had additional information and a list of vets certified for the procedure.

I made a list of those who were the closest and starting calling them. Ideally we wanted to find one who already had experience with this. It turned out that nobody in Canada, or in Ontario anyway, had actually done it yet. As we’d really prefer somebody who did, we decided to call around south of the border. Couldn’t find anybody either. Ok, this was pretty new stuff, huh?

Still though, it did feel right. So back to calling vets near by. The first one who was actually available to talk to me also turned out to be the best vet of them all. He spent at least forty minutes discussing things with me on the phone. He did feel that surgery might be the best option, but was open to the idea. “Knees love being operated on,” he said. “Well, knees might … but what about the dog?” I was thinking.

We booked a consultation. He asked to see the x-rays taken by the orthopedic surgeon but didn’t seem happy that there were only x-rays of her knees. He wanted to see her shoulders and hips also.

We discussed it all again with my husband and figured that we do want to see where the stem cell route might take us. So we booked a consultation with this new vet. We agreed that he’d take his own set. When we brought Jasmine in, he started examining her head to toes.

“Hey, doc, the knees are over here in case you can’t find them,” we thought. But he started explaining how the bad knees would affect other things.

“I want to treat the whole dog,” he said.

Our jaws dropped. “Wow, now there is a novel concept!”

Skipping through a series of events that stemmed from an additional abdominal exam he did while he had Jasmine under to take the x-rays, a cancer scare, and an exploratory surgery, several weeks later we were all set to go ahead with the treatment.

As destiny would have it though, a week before the planned treatment Jasmine came home and was limping really badly, not using her left leg at all. We took her in immediately and our fear was confirmed, her ligament was now totally gone.

So there we were, back to the drawing board. Do we have to do the TPLO after all? (Personally I’d liked the TTA better, but there was no surgeon in Ontario doing that.) Her new vet brought up the option of an extracapsular repair as less invasive. That confused things further, because we have already discarded this option at the beginning, after reading many articles on how bad this option is for large breed dogs.

However, this new vet already got a lot of our trust in the meantime and he has done this surgery successfully on large dogs many times in the past. I asked him the main question: “Is this what you would do if it was your dog?” He said that all things considered yes, he would. I was still a bit uneasy about potential failure of the repair, but it was substantially less invasive…

With that decided we didn’t feel like abandoning the stem cell therapy idea though. Perhaps it could save her other knee? And while at it, it could maybe help the operated knee heal better?

And so it was all set. The first day her vet did the extracapsular repair and extracted a bit of Jasmine’s fat tissue and sent it to VetStem to be processed. Two days later he injected the stem cells into both of her knees, shoulders (which developed arthritis as she was compensating for her bad hind legs) and gave her one IV dose of stem cells also to help our areas that couldn’t be injected).

The first month post treatment he seemed rather disappointed, as he couldn’t see any difference the stem cell treatment would have been making. By the second month though, he started to get really excited. We couldn’t really tell, because we had nothing to compare it with. All along we were just praying that her right leg would hold up through all that. At the end of the second month Jasmine was hardly limping at all, and the third month she was getting the bounce back into her gait. Now it started to get really exciting!

So of course, as a number of times before, just when we were so happy how well things were going, three months after the first surgery, Jasmine’s right knee just went. She didn’t do anything crazy or out of the ordinary. Just boom and there it was. That was really disappointing.

So back on the operating table. However, what the stem cells did for healing from the first surgery was incentive enough that we decided to use it again with the second operation. Her operated leg was strong and in good enough shape to get Jasmine through without a glitch.

Today, about two years after her knee surgeries and stem cell treatments, Jasmine’s legs are as good as new. Her knees are strong and no arthritis is bothering her at all. Her shoulders, which were very broad before, are now in the right proportion again. She has full range of motion and perfect muscle mass. She can run and jump as if nothing ever happened. It’s us who keep slowing her down, still so worried about her.

If we could go back in time, we wouldn’t have done anything differently.

Yes, the stem cells didn’t save her right knee. This treatment can be successful in treating ligament injuries, but it depends on the type and degree of the injury, and of course hopping on the treated leg as she had to do with the left knee surgery, wasn’t the ideal scenario. We are thankful that the right leg held up as long as it did. Normally it is recommended that the stem cell treatment for ACL injury is combined with rest, restricted exercise and external stabilization of the knee (brace). That was not an option in Jasmine’s case.

We are however big advocates of both extracapsular repair and stem cell regenerative therapy. We are happy that Jasmine has her life back!

- Guest Post by Jana Rade of Dawg Business
I have gone to the dogs! Graphic designer by profession, I became a dog mama by design. My first puppy, Jasmine, changed my life completely, and now everything I do revolves around her. Her lovely face made me learn about dogs, dog behavior and needs. The unfortunate hand she’s been dealt made me learn a lot about dog health issues. Jasmine has her own ranch, her own dog and a crew of vets helping me take care of her. I couldn’t love her more if she was my own flesh and blood.

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