The Best Torn Dog ACL Treatment (for the fastest recovery)
One of the most common injuries in dogs that results in long term lameness and joint damage is a torn ACL. This is especially true in larger breed dogs, although breeds large and small can all suffer cruciate ligament damage.
In fact, it’s so common that vets have a saying that “ a hind limb lameness if due to damage to the cruciate ligament until proven otherwise”.
If your dog has torn their ACL then this is what you need to know to make sure you are giving them the most appropriate treatment to help them recover as quickly as possible.
What's the best way to treat cruciate ligament rupture? Surgery is way too expensive and the lower priced places have long waiting periods - Karen
Cruciate Ligament Rupture
Cruciate ligament rupture is one of the most common causes of persistent lameness in dogs, especially in larger breed dogs.
There are some breeds that are more likely to damage their cruciate ligament, although we do see it in every breed from small to large. There is a reasonable chance that your dog may become affected by a cruciate ligament rupture.
Partial vs Complete
Cruciate ligament tears can come in a couple of different varieties.
Dogs can get a partial rupture, where there is just a little bit of damage but the ligament as a whole is still intact. Think of it like a rope that is starting to fray but has not yet snapped.
Dogs can also develop a complete rupture, where there's no ligament left intact. In these cases there is a lot of instability in the joint, and so the joint moves in ways that it should not. It is really painful and a really significant problem.
Rather than being the result of a traumatic event, which is really what happens in ACL (anterior cruciate ligament ) rupture in people, the ligament in dogs tend to actually weaken over time. Much like a frayed rope that eventually snaps.
We do see cases of cruciate rupture in a dog jumping over a fence and getting their leg trapped. Other cases where dogs have fallen falling from a height. Or if they get knocked over on the road. These situations can all result in a sudden traumatic rupture.
By and large however, most cases tend to be the result of a gradual weakening of the ligament over time which one day simply decides to snap completely with an incident that is not particularly severe. It is not a big traumatic event. The cruciate ligament will just fray and then completely rupture.
What about the other knee?
The reason that this is important is because around 30% to 50% of dogs will rupture that other cruciate ligament within about 12 months of the first cruciate ligament snapping.
You need to know this is a real risk. I’ll discuss surgery in a minute, but you need to be prepared that your dog may require 2 expensive surgeries within a 12 month period. Some dogs are super unlucky and only have a few weeks between each cruciate ligament being irreparably damaged.
Treating a Torn ACL in Dogs
There are a couple of different ways that we can manage cruciate ligament rupture in dogs.
Conservatively and surgically.
For dogs that are under 15kg (33lb), about 85% will have a good outcome with conservative management. I'll go into what that means in just a second.
For dogs over 15 kilos, the success with conservative management falls to around 20%.
You can see then that if we are not doing surgery in our larger dogs (dogs over 15kg), we can expect only about one in five to have a really successful outcome. Meaning, they will have little lameness and they will be able to return to normal function.
This is compared to 9 out of 10 dogs having a good outcome after surgery.
That is a strong argument that bigger, larger dog breeds really do need to have surgery for this disease.
Surgical management will almost always result in a better outcome.
With surgery, over 90% of dogs will have a good outcome as I’ve just discussed. This means that they will have minimal lameness and can return to their normal function. That is really encouraging.
Surgery will result in a faster recovery as well as less arthritis and pain going forward.
There may be less of a difference in small breed dogs and those with just a partial rupture.
Which cruciate surgery is best?
There have been a number of different surgical techniques over the years. This is where we start to get into the expensive nature of cruciate ligament surgery. Broadly speaking, there are 2 types of surgery used to treat cruciate ligament rupture in dogs.
The first group are ligament replacement surgeries. In these techniques, a false replacement ligament is created to stabilise the knee in the same way the cruciate ligament used to.
The second group of cruciate ligament surgery techniques are those involving osteotomies. These surgeries involve cutting the bone and changing the angles within a dog’s knee joint. This creates a stable environment within the knee.
The cost difference between these techniques can be significant. These differences are a reflection of the technical aspects of the surgery being performed, the equipment needed, the training that needs to be undertaken, as well as the cost of implants that are being used. These include surgical plates, screws, and titanium wedges or cages.
There is a lot of complexity with these advanced osteotomies compared to the ligament replacement techniques where we are putting nylon or a replacement of fake ligament on the outside of the joint. This is technically less demanding and the cost of implants and equipment is also less.
So why choose one technique over the other?
In general osteotomy surgeries, the more advanced procedures, are felt to produce better results. They seem to produce faster recovery. Dogs are using their legs much more quickly than with the lateral suture techniques.
However, there is not completely clear data to back this up irrefutably. It is often the case that when there are multiple techniques or treatment options for a particular condition, there is no clear winner as to the best option for every individual patient.
By and large however, the general feeling among the profession is that the newer osteotomy surgeries to treat cruciate ligament disease in dogs are the best option is you can afford them.
Now, one thing I would caution against is using conservative management in the first instance and then surgery if your dog is not improving as well as you would like. Especially if you’re monitoring them for more than just a couple of weeks.
By this stage, there is going to be a lot of damage within the joint already and you are not going to get the full benefits of surgery. I think that if there is a possibility or a likelihood that you can afford surgery and you are thinking that it will be the better thing for your dog, then go for it sooner rather than later.
Don't wait until you have got a lot of joint damage and the conservative management isn't really working before jumping to surgery. Surgery will still help, but you are not going to get the best bang for your buck.
Rest and Confinement
Regardless of surgery type, your dog still needs to go through the period of rest and confinement to make sure that there's no extra strain that could cause problems with the surgical site while everything is healing.
If you cannot afford surgery, especially for smaller dogs, conservative management is absolutely appropriate.
What this involves is complete rest for about a six to eight week period. Rest means just that. Confining your dog so that they cannot jump anywhere. They are not running around. They are not doing the wall of death in a pen outside. They do not have a really big garden where they can exercise themselves.
You need to confine your dog to a small room, or to a crate, for six to eight weeks. They should only go out to the toilet, and should be on a lead at all times. This allows as little as possible forces going through that knee, allowing the body to for scar tissue which ultimately stabilizes the knee.
Physiotherapy, hydrotherapy and other exercises may also improve your dog’s recovery. Maintaining the muscle within the leg, as well as ensuring the joint doesn’t seize up are important considerations that will help ensure the best recovery possible. These options should be discussed with your veterinarian.
If your dog is not having surgery, you may also be considering buying a knee brace as well. I'm uncertain how much benefit these actually are, and they can also be very expensive. I discussed that in the Dr. Alex Answers Episode Number Five if you want to learn more about knee braces after cruciate ligament rupture.
Cruciate ligament rupture is painful, and so painkillers are absolutely essential.
Some people still suggest that leaving their dog in pain will make them less likely to use their leg, and so help protect the joint while it heals. This is completely unacceptable. You should be keeping your dog as comfortable and pain-free as possible, while managing them appropriately to limit their activity.
There are several different painkiller options. Non-steroidal Antiinflammatory Drugs (NSAIDs) are the most common, which I discuss in more detail in my post all you need to know about NSAIDs in pets.
Other techniques for improving comfort might include having soft conforming bedding (a memory foam dog bed would be ideal!), and using cold or hot packs, depending on how long it has been since the cruciate injury.
Reducing Arthritis Risk
Once a dog has improved, be that through the conservative management or after surgery, and they've gone through their immediate postoperative care instructions that your vet has given you, then your dog is going to need ongoing care to help keep arthritis to a minimum.
No matter what treatment plan is carried out, arthritis will develop. We can though impact how quickly it progresses.
Weight management is critical! Make sure that your dog is lean rather than overweight, which is a very common problem.
Consider using a ramp for the car or for the stairs
Consider a joint diet or joint supplements
Avoid slippery floors so that your dog is not slipping over and hurting themselves.
Stop ball chasing and other activities involving rapid acceleration, changing directions, and stopping.
If your dog has had cruciate ligament rupture, then I'd encourage you to sign up to my free arthritis mini course. This will take you through some of the things that we can be doing to help keep our dogs as comfortable as possible and minimizing the effects of any arthritis that they are suffering from.
Helping your dog continue to live a healthy, happy, and comfortable life!
The above is a transcript taken from “The Dr Alex Answers Show”.
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