Ask Dr. Leigh: My dog has an ACL tear. Now what?

This is Dash. An 8 week old Husky/Labrador mix available for adoption on 7/22 through www.wolftrapanimalrescue.com

Q: Hi Dr. Leigh, my lab, Bailey, just turned 8 and she has an ACL tear.  We learned from our veterinarian that it is probably due to ball retrieving so sadly we have had to put the chucker/ball away. I have a few questions…

1.     Is it best to get the surgery done?  She has been favoring her leg and our veterinarian has started her on pain medication.

2.     Once the surgery is done, I’ve heard there is a good chance it could happen to the other leg.  What are your thoughts?

3.     Once the surgery is done, is there any exercise that you would recommend? Running? Swimming?

Thanks for your help. - Ryan

A: Ryan, your question is a common one so I am dedicating this post to general education of cruciate ligament disease in dogs!  I hope the knowledge helps you make the best decision for your family and for Bailey.  I encourage you to seek out a board certified veterinary surgeon in your area for a consult.  They will gladly talk through the many options and possible outcomes with you.

Figure 1. Illustration of the anatomy of the dog’s knee: Blue = cranial cruciate ligament; Red = meniscus; Green = caudal cruciate; the insert shows a ruptured cranial cruciate ligament (also note that the shinbone is displaced forward and is crushing the meniscus)

Image from www.acvs.org

An ACL injury, also known as cranial cruciate ligament disease in our canine companions, is one of the most common hind limb injuries in dogs.  The cranial cruciate ligament (CCL) can tear slowly over time or tear completely following acute trauma (jumping up to catch a Frisbee and landing).  The CCL plays an important role in keeping the knee joint stable.  When the ligament ruptures, the joint becomes unstable creating arthritis, pain, and inflammation.  The treatment for a CCL tear in dogs is aimed at stabilizing the knee joint instead of repairing the ligament itself (as seen in human medicine).  It is important to note CCL tears are a bilateral condition, meaning there is about a 50% chance the other knee will tear (or already has).  Many options are available to treat and manage this condition which can be confusing and overwhelming when your dog is in so much pain.  Here is an overview of the modalities of treatment and management of cranial cruciate ligament disease in our canine friends:

Surgery – I know hearing the words ‘surgery’ and ‘anesthesia’ causes anxiety in many of you.  Anesthesia, although much safer than it was years ago, is definitely not without risk.  However, in the case of a torn CCL, surgery is the only option that will help to provide stability to the knee.  The type of surgery performed depends on the size, breed, and activity level of the dog.

• Osteotomy – The osteotomy procedures are designed for large and giant breed dogs (> 50lb) with moderate to intense activity level.  The goal of these surgical procedures is to stabilize the knee by changing the biomechanics of the joint.  Performing either a Tibial Plateau Leveling Osteotomy (TPLO) or a Tibial Tuberosity Advancement (TTA) depends on the preference of each individual surgeon as there is really no data to suggest one procedure is better than the other. These surgeries are to be performed only by a board certified veterinary surgeon for the best outcome.  The good news is: after your dog has recovered from surgery, most go on to remain as active as they were before they tore their ligament!  

• Suture-based stabilization techniques – These procedures can be performed by any veterinarian with experience.  They are primarily designed for medium to small breed dogs (< 50lb) with low to moderate activity level.  These dogs are usually on restricted activity even after they are healed.

Medical Management – Even if you intend to pursue surgery for your dog, you will likely need to begin medical management prior to the operation and continue until the animal gets the OK from the surgeon to begin exercising again.

• Activity Restriction – It is so hard to crate our dogs and limit their fun, isn’t it?  When your dog is diagnosed with a CCL tear, your veterinarian will likely recommend ceasing exercise and resting your dog.  This is important so as to not further increase inflammation in the joint and to help the discomfort of the animal. However, it is important to note that as long as the knee joint remains unstable, the animal will continue to have knee pain.

• Medication – Your veterinarian will likely prescribe an anti-inflammatory to help with the level of pain your dog is experiencing.  Some dogs need multi-modal management of their pain which will involve more than one medication.

• Supplements – Whether or not you choose to pursue surgery, if your dog has a partial or a complete tear, they need to be on a high quality veterinary brand joint supplement.  Ask your veterinarian about Adequan injections in addition to an oral joint supplementation.

• Rehabilitation – Have you ever visited a veterinary rehab center? If not, you should!  I am so impressed with this area of veterinary medicine and how it improves the quality of life for so many of my patients.  A rehab consult is a wonderful opportunity to learn exactly what you can do to help your animal have the best recovery after surgery.  If surgery is not the route for you, rehab can help manage pain and quality of life going forward.

As you all know by now, I am a prevention enthusiast!  While preventing a Cranial Cruciate Ligament tear is not entirely possible, you can lessen your dog’s chance by keeping her fit and trim (preventing obesity) as well as maintaining her on a high-quality diet.

– Leigh Hofmeister, DVM