Features February 2010 Issue

Alternatives to Canine Surgeries

Dogs suffering ligament injuries have the option of conservative management.

[Updated March 3, 2016]

Dogs go lame for all kinds of reasons. Arthritis, Lyme disease, paw injuries, muscle sprains, bee stings, interdigital dermatitis, and dislocated kneecaps can make any dog limp. But when an active dog suddenly can’t put weight on a hind leg, the most common diagnosis – for more than a million American dogs every year – is a torn cruciate ligament. In 2003, according to the Journal of the American Veterinary Medical Association, the cost of treating those injuries exceeded $1.32 billion, and the price tag keeps rising.

The most common prescription for canine knee injuries is surgery. Unfortunately, operations don’t always work and some patients, because of age or other conditions, are not good candidates. In recent years a nonsurgical approach called “conservative management” has helped thousands of dogs recover from ligament injuries, and it is growing in popularity. At the same time, conservative management is not a cure-all. It doesn’t always prevent the need for surgery, it is not necessarily less expensive, and it can require as much time and effort as post-surgical rehabilitation. At its best, conservative management improves the outcome of whatever treatment is needed for full recovery.

“Conservative management consists of any nonsurgical treatment of injuries,” says Faith Rubenstein, who founded an online forum devoted to the subject in 2004, “including physical therapy, chiropractic adjustments, acupuncture, massage, nutrition, the use of a leg brace, nonsteroidal anti-inflammatory drugs, medicinal herbs, prolotherapy, weight loss for overweight dogs, and other noninvasive treatments.”

Rubenstein, who now lives in Austin, Texas, first encountered ligament injuries when her 100-pound Briard, Dakota, then six years old, experienced a partial tear of his cranial (anterior) cruciate ligament. “When our veterinarian recommended that we see an orthopedic surgeon,” she says, “I went looking for answers.” An academic researcher who is now a private investigator, Rubenstein discovered the term “conservative management” in a veterinary textbook.

Kimber, Debbie Kazsimer's Shiloh Shepherd, recovered fully from a torn cruciate ligament with the help of a brace, physical therapy, swimming, massage, supplements, and without surgery.

The orthopedic surgeon diagnosed a partial tear in both of Dakota’s knees and recommended immediate TPLO (tibial plateau leveling osteotomy) surgery. In this procedure, the tibia is cut, then rotated and held in place with a metal plate and screws so that after the broken bone heals, weight-bearing exercise stabilizes the knee joint.

“I had misgivings about this method,” she says, “especially because surgeons at the School of Veterinary Medicine at the University of Pennsylvania don’t use it. I spoke with Gail Smith, the head of the University’s department of clinical research, and with Amy Kapatkin, a board-certified orthopedic surgeon who was then at Penn. What Dr. Kapatkin said made perfect sense to me. She asked, ‘Why break a bone to fix a ligament?’ My whole interest in conservative management was triggered by my fear of the TPLO.”

The University referred Rubenstein to an orthopedic surgeon who used other methods. He found Dakota to have so few symptoms that he agreed to write a prescription for physical therapy in hopes that it might make surgery of any kind unnecessary.

“Physical therapy and exercise made all the difference,” she says. “Dakota never needed surgery, and neither did his littermate, Aubrey, who tore his cruciate ligament a few months later. Many veterinarians believe that the only effective treatment for these injuries is surgery – either TPLO or another surgery – but that simply isn’t true. Conservative management can help most patients, including those who eventually have surgery, and then recover and lead active, happy lives.”

Understanding Ligaments

The stifle (knee) connects the femur (thigh bone) and tibia (leg bone) with a patella (kneecap) in front and fabella (a small bean-shaped bone) behind. Cartilage (the medial meniscus and lateral meniscus) cushions the bones, and ligaments hold everything in position.

Two key ligaments, the anterior (front) and posterior (back) cruciate ligaments, cross inside the knee joint. In animals, these ligaments are called cranial and caudal, respectively. The anterior or cranial cruciate ligament prevents the tibia from slipping out of position.

Veterinarians see most ligament patients immediately after their injuries, when symptoms are acute, or weeks or months later, after symptoms become chronic. If not immediately treated, most ligament injuries appear to improve but the knee remains swollen and abnormal wear between bones and meniscal cartilage creates degenerative changes that result in osteophytes (bone spurs), chronic pain, loss of motion, and arthritis. In some patients, osteophytes appear within one to three weeks of a ligament injury. Swelling on the inside of the knee, called a “medial buttress,” indicates the development of arthritis in patients with old injuries.

The main diagnostic tools for ligament injuries are X-rays, which can rule out bone cancer as a cause of leg pain, and a procedure called the “drawer test,” in which the veterinarian holds the femur with one hand and manipulates the tibia with the other. If the tibia can be moved forward, resembling a drawer being opened, the cruciate ligament has been torn or ruptured.

The drawer test is not necessarily conclusive because the tense muscles of a frightened or apprehensive dog can stabilize the knee temporarily. To produce more accurate results in such cases, patients may be sedated before being tested.

In the tibial compression test, which is another way to check for ligament damage, the femur is held steady with one hand while the other flexes the dog’s ankle. A ruptured ligament allows the tibia to move abnormally forward.

“A complete cranial cruciate ligament tear is always a surgical case,” says Stacey Hershman, DVM, of Hastings-on-Hudson, New York, “since otherwise the knee cannot function as a hinge joint.” Advocates of conservative management recommend that whenever the tear is partial, nonsurgical techniques be given an eight-week try. If symptoms improve during that time, they say, the odds favor nonsurgical recovery. If symptoms don’t improve, conservative management techniques can be used as pre- and post-operative conditioning and therapy.

After An Injury

If your dog is injured, visit your vet as soon as possible, but be an informed consumer. Many veterinarians consider cruciate ligament surgery necessary, routine, fast, easy, highly effective, and the only treatment that will help. For many dogs this has been the case, but some veterinary research places the ligament surgery success rate at well below 50 percent. If surgery is necessary, your investment in conservative management may pay dividends in faster recovery and better overall health.

Canine health and nutrition researcher Mary Straus recommends simple first-aid strategies for dogs with knee injuries. Straus learned about the benefits of such an approach when her dog, Piglet, had surgery for dysplasia on both elbows before her second birthday, followed by surgery for a ruptured cruciate at age three. “First and most importantly,” she says, “exercise must be restricted. No running, no jumping (including on and off furniture), and no stairs. Walk your dog on-leash when going outside to potty. The dog doesn’t necessarily have to be crated, which can restrict movement so much that it increases stiffness and limits flexibility, but should be confined to a small room or ex-pen, or kept on-leash while with the owner. Exercise restriction must be continued for at least six to eight weeks.”

Second, inflammation needs to be controlled. “I would use nonsteroidal anti-inflammatories (NSAIDs),” she says. “Inflammation contributes to cartilage degeneration and accelerates the development of arthritis. Don’t avoid NSAIDs in the hope that pain will keep your dog from overusing the leg. There are natural anti-inflammatories like bromelain, boswellia, quercitin, and turmeric, and I would use those as well, but they may not be strong enough alone. You could use white willow bark, which is comparable to aspirin, but it should not be combined with other NSAIDs. In addition to anti-inflammatories, I would give glucosamine-type supplements to try to protect the cartilage and slow arthritic changes. It’s questionable how much these help with cruciate injuries, but they do no harm and I would include them.”

Dr. Hershman prescribes Glycoflex, a nutritional supplement that contains freeze-dried Perna canaliculus or New Zealand Green Lipped Mussel. This product is recommended for joint and connective tissue support, for geriatric and working dogs, and as a follow-up to orthopedic surgery.

In addition, she gives subcutaneous Adequan® injections or teaches the owners to do so at home. Adequan Canine (polysulfated glycosaminoglycan) is a prescription, water-based, intramuscular, polysulfated glycosaminoglycan that helps prevent cartilage in the dog’s joint from wearing away. “I give injections twice a week for two weeks,” says Dr. Hershman, “then once a week for maintenance.”

She also recommends Wholistic Canine Complete Joint Mobility, which is a powder containing organic vitamins, minerals, digestive enzymes, hydrolized whitefish, immune-support ingredients, and pharmaceutical-grade glucosamine, chondroitin and MSM (methyl sulfonyl methane), all of which support healing, speed tissue repair, or help alleviate pain and inflammation.

Both of Faith Rubenstein’s Briards, Dakota and Aubrey, tore a cruciate ligament at different times – turning Faith into something of an expert on dealing with the injury!

Standard Process products for improved ligament health include Ligaplex, which contains organic raw bone, herbs, and minerals, and the veterinary product Canine Musculoskeletal Support, which contains anti-inflammatory herbs, Perna canaliculus, and whole-food ingredients that enhance tissue regeneration and improve joint health.

It is important to keep injured dogs from gaining weight, which can easily happen when their exercise routine is interrupted. “Overweight dogs have a harder time recovering from a cruciate ligament injury,” says Straus, “and they are more at risk for injuring the other knee. I would feed a high-protein, low-carbohydrate, reduced-fat diet. Fat is high in calories and so should be limited, but too little fat will leave the dog feeling hungry all the time. Protein helps with wound healing and also to create and preserve lean muscle, while carbs are more likely to be stored as fat. For those who feed kibble, I would cut back on the amount fed and add fresh, high-protein foods such as eggs, meat, and dairy. For seriously overweight dogs, this is one situation where I might consider using the drug Slentrol to help speed weight loss.”

Physical Therapy

Faith Rubenstein’s Dakota received physical therapy from Carol Wasmucky, PT, a licensed physical therapist for humans in Herndon, Virginia, who founded Pet Rehab Inc. and works full-time with animals by referral from veterinarians throughout Northern Virginia.

She began Dakota’s treatment by measuring his hind legs, one of which had atrophied and was smaller than the other. “Our goal,” says Rubenstein, “was to have both legs measure the same. Dakota and I worked with a holistic veterinarian, who put him on nutritional and herbal supplements, and we did acupuncture as well. I restricted his activity so he was not allowed to run off-leash for six months, and during that time he had regular physical therapy. Dakota wasn’t a swimming dog but he became one, for swimming was the perfect exercise for him. After six months, both hind legs were the same 17 inches in girth. He was in great shape, his drawer test results improved to nearly normal, and he didn’t need surgery.”

Dogs who are intermittently lame with a partial tear of the cruciate ligament are ideal physical therapy patients, says Wasmucky. In addition to providing weekly or twice-a-week ultrasound, laser, and electrical stimulation treatments, she puts patients on a home strengthening program with range-of-motion and stretching exercises. “Every program is different depending on the dog’s condition,” she says. “The owners are involved every day; I show them what to do. It’s just like working with human injuries; if you want the best results, you have to do your homework.”

Wasmucky, who has worked with thousands of canine patients over the past 10 years, encourages anyone whose dog has a partial tear to use physical therapy to build muscle so that even if surgery has to be performed, the dog goes in and comes out in better shape. “This means shorter rehab time,” she says, “and a faster recovery.”

Swimming is such effective exercise for injured dogs that many veterinary clinics have installed swimming pools. “Dogs who can’t yet do weight-bearing exercises can start in a pool,” she says, “and as they get stronger, they’re able to progress through the exercise program. I check their progress in weekly appointments and make adjustments as needed. It takes time to heal from ligament injuries and I like to be sure that dogs are completely well before they resume agility or other demanding sports.”

She requires a major commitment from owners. “It’s usually an hour or so every day in twice-a-day sessions,” she says, “and this can go on for months. It’s a big investment of time and energy, and it requires a motivated dog as well as a motivated owner, but it can make a world of difference in mobility and overall health.” For more about canine rehabilitation, see “The Benefits of Canine Rehab & Conditioning,” September 2009.

Prolotherapy

Although most veterinary experts agree that there is no way to repair a damaged ligament, one alternative therapy claims to do exactly that. Prolotherapy, also known as proliferative or sclerosing therapy, has been used for over 30 years to treat musculoskeletal pain in humans, including arthritis, sports injuries, and damaged or partially torn ligaments, tendons, and cartilage.

The term “prolo” is short for proliferation, as this treatment is said to cause the proliferation (growth or formation) of new tissue in weakened areas. Ligaments have a limited blood supply, which slows healing, but in prolotherapy, injections of dextrose (sugar water) or other benign substances cause localized inflammation that increases the supply of blood and nutrients, stimulating tissue repair.

Health columnist Jane E. Brody described prolotherapy as “injections to kick-start tissue repair” in the August 7, 2007, New York Times, where she wrote that most scientifically designed controlled studies of prolotherapy have shown “a significant improvement in the patients’ level of pain and ability to move the painful joint.” In studies of human knee injuries, she said, patients with ligament laxity and instability experienced a tightening of those ligaments, including the anterior cruciate ligament. Other studies showed a significant improvement in the symptoms of arthritis in the knee one to three years after prolotherapy injections.

In Royal Oak, Michigan, John Simon, DVM, uses prolotherapy to repair damaged cruciate ligaments in dogs. He explains, “Prolotherapy is a way of tightening up loose, unstable, hyper-mobile joints by injecting a ‘sclerosing’ agent in and around the joint. The resulting thickening of the joint capsule and the ligaments surrounding it act like scar tissue and eventually contract with time. The thickening and contraction of the ligaments and joint capsule increase joint stability and relieve joint pain.”

Most canine patients receive five sessions at three-week intervals. “Although I tell caregivers not to expect any positive results until at least the third treatment,” he says, “I am occasionally surprised to see improvement after just one. Other modalities that I often recommend in conjunction with prolotherapy are soft laser therapy and pulse magnetic therapy. These treatments reduce pain and help the joint recuperate.”

According to Dr. Simon, the best candidates for prolotherapy ligament repair are dogs whose injuries do not involve torn meniscal cartilage in the joint. During the past three years, he has treated 35 dogs for cruciate ligament problems and estimates that 80 percent experienced significant improvement.

Bracing for Recovery

Debbie Kazsimer, who lives in Pennsylvania, knows a lot about cruciate ligaments. Trouble, her Shepherd/Husky mix, had TPLO surgeries at ages six and seven, and her Shepherd/Malamute mix, Fly, had a TPLO when she was two.

In 2005, the Journal of the American Veterinary Medical Association published the case of a German Shepherd Dog who developed bone cancer after her implant corroded. Two years later, Trouble was diagnosed with osteosarcoma, and when his leg was amputated, its metal implant was found to be corroded. The biopsy report linked the cancer to his 2004 TPLO surgery.

As a precaution, Kazsimer had Fly’s implant removed. “But by then five years had passed and it was too late,” she says. “The damage was already done.” Within months, both dogs died of osteosarcoma.

Four weeks after Fly’s death, Kazsimer’s six-year-old 100-pound Shiloh Shepherd, Kimber, tore a cruciate ligament. By then, Kazsimer had learned about conservative management and knew she didn’t want to put another dog through a TPLO surgery. Because of her experiences with Fly and Trouble, she was familiar with range-of-motion and physical therapy exercises, and she studied massage with her husband, Ken, an Integrated Touch Therapy canine massage therapist. She spent an hour or two daily on Kimber’s rehabilitation.

“I thought a leg brace would be a big help to her,” she says, “but my veterinarian refused to fit her for one because he was convinced it wouldn’t work. So my husband and son helped me to cast her leg with a casting kit from Orthopets. The brace supports the knee externally, just as surgery supports it internally.”

Kimber went from walking on three legs to walking on four, then swimming, then finally bearing full weight on her leg. Eight months after her injury, Kimber’s regimen of supplements, physical therapy, massage, swimming, and wearing the brace have enabled her to recover well without surgery. “She runs around like a wild girl!” says Kazsimer, who has posted videos of Kimber online, where you can see her running, swimming, and playing with and without her brace on. “It’s wonderful,” she says. “Kimber is able to do everything she did before she got hurt.”

Holistic Therapies

The most popular “hands-on” treatments for injured dogs include acupuncture, acupressure, chiropractic, and massage.

Dr. Hershman, a certified veterinary acupuncturist, treats patients with acupuncture to alleviate pain and enhance healing of the torn ligament. “I do this once or twice per week for the first two weeks,” she says, “depending on the dog’s level of pain, then once a week for five to six weeks, then once every two weeks, and finally once a month. When the dog is weight-bearing and in less pain, I stop.” Dr. Hershman is also a certified veterinary homeopath who prescribes homeopathic remedies according to the patient’s symptoms.

In the article “Post-op Acupressure” (August 2006), Nancy Zidonis and Amy Snow describe how stimulating specific acupressure points with a thumb or fingertip can help with pain management, clear the effects of anesthesia, minimize the building of scar tissue, and reduce swelling. Acupressure can be learned at home and applied whenever needed.

Veterinary chiropractors help speed the healing of injuries and surgeries by making adjustments that improve skeletal alignment and musculoskeletal function. (See “Chiropractors for Canines,” March 2008.) Chiropractic adjustments help restore normal nerve activity by gently moving bones, ligaments, and tendons back into alignment, and when ligaments are injured, adjustments help realign the body to improve balance and speed healing.

Canine massage therapists used to be unusual, but now they play an important role in maintaining and improving our dogs’ health. Efflurage, passive touch, kneading techniques, and stroking increase circulation, release muscle tension, reduce pain and soreness, relieve stress, and accelerate the repair process. Massage books and how-to videos make it easy for caregivers to apply these same techniques at home.

Online Support

Thanks to the Internet, anyone whose dog suffers a cruciate ligament injury can find a wealth of information about canine anatomy, surgical options, and alternative therapies online.

The conservative management forum that Faith Rubenstein founded five years ago now has more than 2,000 members around the world. Paola Ferraris, who lives in Italy, is one of its moderators. “What I would like to stress is that conservative management is not an easy (and often not cheap) alternative to surgery,” says Ferraris. “Successful conservative management requires just as much commitment as post-op care. It’s tough love and careful management. Your work is basically the same as rehabbing a dog who has had surgery; in fact, a number of our members have had surgery done on their dogs and use the list for pre-op and post-op support.”

When her own dog suffered a ligament injury, Ferraris had to make decisions with little information. “The best way to discuss treatment with your veterinarian is when you understand the available options and their pros and cons,” she says. “I had to educate myself by spending nights doing research online, after the fact. I would have appreciated having more available information, which is what we now offer.”

Co-moderator Ansley Newton of Pownal, Maine, became interested in conservative management when her chocolate Lab, Dooley, injured his second knee. “The first knee had TPLO surgery,” she says, “so I was excited to try conservative management with the second knee.

Unfortunately after four months he did not get better and I chose to have a traditional surgery, which was very successful for this 90-pound dog. Then one day my large chocolate Lab, Nutmeg, came inside with that familiar limp. I again decided to try conservative management along with a knee brace, acupuncture, massage, swimming, and some other supportive techniques. Within six months she was back to normal with very little arthritis.

“After three ligament injuries, I thought I was done. But no, two years later Nutmeg came in limping again. I again went the conservative management route and things were going fine until the second month when Nutmeg had an oops moment. She was limping again, so I decided to do surgery but had to postpone it for a couple of months because I tore my own anterior cruciate ligament and damaged my meniscus at the same time!

“So here I was running a farm by myself on crutches and wearing a knee brace with a dog in a knee brace. What a sight we both were. I wish I had taken a picture. We were forced to stay with conservative management because there was no one to take care of the farm and I couldn’t drive Nutmeg to get her surgery. We limped through several months together and lo and behold, we both healed. Nutmeg was good to go in six months and it took me closer to 10. Nutmeg recently passed away from lymphoma. She was 14 years old and despite those two ligament injuries, her legs were still fine.”

CJ Puotinen is a long-time contributor to WDJ and author of The Encyclopedia of Natural Pet Care and Natural Remedies for Dogs and Cats.

Comments (41)

Maya, we also bought the Ortocanis dog knee brace and thought it was worth every cent! Glad to see that someone else had the same good idea as we had :)

Posted by: jfrwright | April 28, 2016 12:10 PM    Report this comment

great article! lots of interesting information.. some of which is new to me! last year our dog tore her ACL - our vet was great and informed us of all the possible treatment options, including surgery. due to personal opinion and our dog already being 10 years old, we didn't want to put her through an invasive surgery and posterior recovery period. we went with the conservative treatment and completely restricted her activity for 8 weeks - no jumping, playing, walks, nothing. 5 weeks in we started to notice a difference. Our vet also recommended to us an Ortocanis dog knee brace: www.ortocanis.com/en/technical-helps-for-dogs/90-knee-brace.html

It is supposed to help stabilize the knee and increase circulation in the area while it recovers. It's been a year now and while we still have to be careful and continue to treat her (more as a preventative measure for possible future joint problems). Zola is doing great.

every now and again when she starts to limp or wake up a little stiff in the morning, we'll put on the Ortocanis knee brace and it seems to do the trick.

Posted by: maya10delmar | April 13, 2016 5:16 AM    Report this comment

great article! lots of interesting information.. some of which is new to me! last year our dog tore her ACL - our vet was great and informed us of all the possible treatment options, including surgery. due to personal opinion and our dog already being 10 years old, we didn't want to put her through an invasive surgery and posterior recovery period. we went with the conservative treatment and completely restricted her activity for 8 weeks - no jumping, playing, walks, nothing. 5 weeks in we started to notice a difference. Our vet also recommended to us an Ortocanis dog knee brace:

www.ortocanis.com/en/technical-helps-for-dogs/90-knee-brace.html

It is supposed to help stabilize the knee and increase circulation in the area while it recovers. It's been a year now and while we still have to be careful and continue to treat her (more as a preventative measure for possible future joint problems). Zola is doing great.

every now and again when she starts to limp or wake up a little stiff in the morning, we'll put on the Ortocanis knee brace and it seems to do the trick.

Posted by: maya10delmar | April 13, 2016 5:15 AM    Report this comment

Hi, found this site 14 month's ago when Bow my husky hurt his right rear knee
playing with Blitzen a rather large German Sheppard. Heard him yelp and went
out and knew he had hurt himself. Course the vet talked surgery right away
but after thinking about the way they went about it, I hoped to find out more on my own. Long story short, the conservative way was the right way. He's much
better, took almost a year of slowing him down, no long walks etc. But it worked,
and I'm so thankful. With or without surgery healing takes time, so go conservative follow the post's here, didn't need any braces or anything else but a watchful eye and time. Bow, he's running like Bow, still need to slow him down a bit, and our walks are long again. Wooooooo.

Posted by: Bill L. | January 15, 2016 1:04 PM    Report this comment

Hello,stumbled upon this thread when searching for torn ligament,my 7 yo dog was diagnosed with luxation patella but just now I noticed she was limping heavily,her vet recommend her to specialist but almost certain she torn her ligament, she recommend surgery, searching google i found many success without surgery,could someone help me with recommmending knne braces and other treatment beneficial for this kind of injury ?i would greatly appreciate it since I live in Indonesia and this kind of treatment is highly unconventional.

Posted by: Tat4 | December 1, 2015 9:21 AM    Report this comment

Thank you for this article. I am needing to take care of my dog Idly's ACL tear and wondering what brace is the best for long term use/wear. In February 2015 we put her in WoundWear's A-traC Dynamic Brace and it has NOT been an effective brace for the investment. The brace is poorly made, with velcro straps to hold it in place. These straps are not effective after 2-4 months due to the dog hair sticking to them. Nor can they easily be cleaned with a wash. We had to get all the straps replaced by a local seamstress. And when we needed a new rod (small 4-5 inch plastic "stick") WoundWear wanted to charge $50 USD (Idly pulled out the original one). WoundWear was not open to feedback and in my experience, not focused on my dog's best care - my impression is that they wanted their money and were focused on making money (the brace is close to $500 USD). Now held together by pins after less than 6 months of wear, I am now looking for another option. Any suggestions from someone who has treated their dog's torn ACL with alternative therapies and a brace for long term wear? Thank you. Tracy Ann & Idly

Posted by: Tracy Ann | August 2, 2015 6:54 PM    Report this comment

I had a good experience with the knee brace of Ortocanis. They are in Barcelona but ship to the US in about 4 days. 100% recomended www.ortocanis.com

Posted by: Nicki2014 | July 20, 2015 11:52 AM    Report this comment

I would also like to add I gave him those chews for hip and joint support.Glucosomine??? Not sure if thats right!! I still give it to him just because you probably should anyway.The first bag I payed $12 for. Then found the EXACT same thing at the Dollar Tree!! For a dollar!!

Posted by: krae | May 25, 2015 11:06 AM    Report this comment

I have a pitbull who was diagnosed with this torn ligament in his knee problem.Right away the Vet said he would need surgery. Suggested somebody who does the surgery 1/2 price supposedly.After coming home and reading more online and seeing what a big surgery it actually is, and how long and hard the recovery can be, I took an online Vet's advice and tried to heal it at home. Making VERY sure he did not jump or strain the knee.That was a little difficult to do since he's a very energetic active dog.It was snowing and cold out anyway, so I made him stay mostly inside for the Winter.And I've got to say, I'm so glad I opted out on the surgery.He recovered quite nicely.It is now Springtime and he's ready for the lake! Nothing holding him back! We take him on long hikes and he climbs,runs,jumps...just like he always did before the knee tear.He does not limp or favor the leg anymore at all.So,so glad I did'nt do the surgery that he would probably still be recovering from.It's hard at times keeping them from jumping and re-injuring the knee while it heals, but you will have to keep them still anyway after the surgery too.Even more so.So don't be too quick to jump into surgery.This condition CAN be healed at home.

Posted by: krae | May 25, 2015 3:08 AM    Report this comment

My sweet senior has a little tear. Has anyone tried Ortho Dog? It just velcros on and stays put with a harness. I have only read some positive things so far. My guy is 17 yr old and I just want something simple to just help assist him. I do not want the hassle of a cast/special made one. He just needs a little help with pottie breaks outside.

Posted by: Sabadoo | April 16, 2015 2:39 PM    Report this comment

s

Posted by: Sabadoo | April 16, 2015 2:34 PM    Report this comment

In response to Stephanie who was asking about Woundwear A-Trac brace costs: It depends on how big your dog is but Size 0-1 is $32, Size 2-3 is$35 and Size 4-5 is $38. They are more specifics on the website but thought I would make it easy for you to see the rough estimates! I got one for my small dog and it has been working great :)

Posted by: D_Nelson4427 | March 25, 2015 10:37 AM    Report this comment

Great article. Thank you for sharing your experience. My German Shepard recently tore his acl and has been in a lot of pain. I got him an a-trac brace from Woundwear and thankful he has been doing a lot better!

Posted by: D_Nelson4427 | March 17, 2015 1:39 PM    Report this comment

Thank you for the article. I took my Doberman into the vet for an occasional hop that was so slight I thought he might have a splinter in his paw that I couldn't find. When we went in, he could sit in good form, jump. and run for hours. When we came out, he had a severe limp and sat with his paw extended out to one side. When trying to sit, his back is arched to avoid placing pressure on the injured stifle. The physical exam performed on his leg was so brutal that now he has a more serious problem. We have opted for Conservative Management and want to share our journey and what we have learned about it with others. We have created a facebook page called "Conservative Management for Dogs." Anyone who wishes to contribute to the community is also welcome to share.

Posted by: CMforDogs | December 3, 2014 10:29 PM    Report this comment

My Siberian Husky, Bones, was referred by my vet to an ACVS Vet Surgeon. She is 3 and was a stray until May 25, 2014 when she came to us. Bones walks/runs just fine most days. Yes she favors it under certain conditions but does not limp 24/7. She will be running, yelp and then limp for about an hour then takes off running again. This happens about once every 3 or 4 weeks. We thought maybe she had an old break that didn't heal properly or was developing dysplasia so we had both legs and her hips x-rayed. The surgeon said she had a partial tear in her right rear leg and has recommended TPLO surgery. My problem is every article I read state that the dog's leg is not weight bearing. I am having problems with the theory of breaking her knee to repair this problem. Has anyone had this issue where the dog is not completely in pain and limping 24/7?

Posted by: mara1007 | November 30, 2014 6:55 AM    Report this comment

Hi,
I went to the orthopedic vet yesterday, my dog (Maltese) had some x-ray's done, only to confirm he has a patellar luxation (knee cap) grade 3. The vet said that grades 1 and 2 don't need surgery but that a grade 3 and 4 do need surgery because if left untreated it could result in rupture of the ACL, or cause arthritis at an early age.
He said that it wasn't an emergency but he suggested I did the surgery within the next 12 months. Although the surgery is expensive, that is not really my concern, I'll see where I get the money from as my dog is precious to me and he is a very important part of my life, I'm willing to give him the best vet care possible. However, I was told the recovery time is about 8 weeks of confinement, and this really worries me. My husband and I both work a 9-5 job and do not work close to home. My dog has never been crated before let alone for 8 hours + in a row. Unfortunately, I don't have anyone who could care for him while I'm gone, unless I start considering boarding or doggy day care $$$
He hasn't really stopped limping, his leg is down but you can tell he is not putting any weight on it. I'm keeping him in the kitchen while I'm gone and I've been having to leave my cat in the room as they like to play a little rough and the cat can easily get in the kitchen because we only put a little doggy fence to close it up. (So my cat is also paying for this when the poor baby has no idea why he can't play with his friend anymore).

My vet had told me a long time ago that he had this and that he was born with this, but since he never limped or never showed to be in any pain, I was not too concerned. This all started on Sunday when he jumped off the bed and landed wrong, he whined and started limping immediately.
My question is, once the inflammation is gone, and he gets a little better (prior surgery) should I get another x-ray to see if he really has a grade 3 luxation? I'm just trying to avoid such painful surgery if there are other alternatives, but I also don't want to be guilty if it gets worse over time, I have read so many opinions that I really don't know what to do. I appreciate any insight you might have on this.

Posted by: rclavy | October 23, 2014 4:01 PM    Report this comment

Hello, thanks a lot for all your information on personal experiences. My 9lbs 2 year old Maltese jumped off the bed (as he always does without a problem and yes I have doggies stairs that rarely chooses to use) and unfortunately landed the wrong way and injured his left hind leg. A trip to my vet indicated that he might have a torn ligament and I was referred to an orthopedic vet who is is highly recommended. I'll have an x ray done tomorrow hopefully and see exactly what the problem is and the surgery (if any) recommended before proceeding with it.
My dog has been limping on and off since Sunday and I have tried keeping him from jumping and walking as much, unfortunately I have a cat that loves to play with the dog while we are gone and now it seems I'm gonna have to crate the dog while I'm gone to work, he has never been crated before so I don't know if he could take 8 hours in a crate.
I don't trust my dog to any vet, I love mine, but I don't know this orthopedic vet, and I went online and the reviews of the clinic weren't all that good, I don't want to start freaking out, but hopefully I get an honest opinion. Wish me luck, I'll be back to post what the vet says tomorrow.

Posted by: rclavy | October 21, 2014 10:37 AM    Report this comment

Great comments as my German Shorthair, Koda, was hit by a car. The Dr. took x-rays and said he needed surgery. The hit and run happened 9/28/14. I've seen improvement but Dr. is still pushing for surgery. This gives me food for thought and some ideas as to what I can do to help him. Thank you all! I will contact the brace manufacturer as that is what I received with a severe ankle injury. Blessings to you all. Faith

Posted by: Faith Rothlisberger | October 12, 2014 4:28 PM    Report this comment

I have had great success with conservative management with my 10 year old lab with what we think was a partial tear. It takes patience and there are setbacks but it can work. Here is a story of a vet that rehabbed a 100 lb lab that had a full rupture on one leg and a partial tear on the other. Most vets will say this dog 100% needed surgery but he recovered without it.
I can't put the link to the full story and treatments here but Google "Payton lab cruciate" and the 1st site that come us has detailed info

Posted by: Ed | October 9, 2014 7:43 PM    Report this comment

My dog recently got diagnosed with a slight tear in his acl. He now will not put his foot down at all. I need to know how effective the dog brace is . I do not want to put my dog to sleep every three weeks for injections nor do I have the money for surgery. He is a pit /mastiff mix and weighs about 75lbs. He doesn't do good at the vet. They have to sedate him to even trim his nails. Help me. I live in taylorsville kentucky. O can't stand.to see him suffer like this and I hate giving him pain meds..

Posted by: tricia | October 1, 2014 9:02 PM    Report this comment

I loved this article! My dog Rudy tore his ACL about a month ago and it was awful see him in pain. I didn't want to put him through surgery so I started to explore other options. I ended up getting him an A-Trac brace from Wound Wear and he is already walking without a limp :)

Posted by: Kimberly | September 23, 2014 3:59 PM    Report this comment

My dog is a 5 year old male Havanese. He's been amazingly healthy and good natured but recently began to limp after extended and hearty play with another small dog. The vet diagnosed a torn ligament and prescribed restricted activity, and pills for pain and inflammation. He seemed to be on the mend but today turned around after eating and flopped on the kitchen floor, unable to get up and move for some time. Finally he hobbled into the dining room and is resting on the rug. He doesn't want to be held and he is not whimpering. What could have caused this latest symptom?

Posted by: Molly B. | September 21, 2014 4:43 PM    Report this comment

my boy has been diagnosed with a possible/probable torn cruciate tear they did the drawer test outside of the exam room, understood all that was explained as far as surgery, however now really reading up my baby has addison's and epilepsy and now this, most possible needs the surgery, but the alternative should be much better.

Posted by: Cd | August 25, 2014 9:41 PM    Report this comment

@ CynthiaandLuna: Would you mind posting a status soon about the brace? I know you said you would, but just wanted to let you know that interest is there. My dog's 9, 107 lbs, and he has the same issue.

Posted by: strea | August 15, 2014 9:04 PM    Report this comment

If you are looking for a brace you need to check out the A-Trac Dynamic Brace by Dr Joel Spatt at woundwear.com
Not only is it a great product at a fantasic price, but the people there genuinely care about what they are doing.
I made a mistake on a measurement and they caught it and stopped the order to confirm it for me - saving me time and money on return & exchange fees, but most important, it got the right brace to my dog ASAP and I can not thank them enough for that act of kindness!!
I will be back every couple weeks to let everyone know how the brace is working. My dog is an 85 lb terrier/greyhound mix and currently she is not putting weight on her left hind leg due to an acl injury. She is 8 yrs old and I am hoping the brace will help us avoid surgery. Woundwear.com has posted videos on YouTube and it looks like they have gotten some incredible results so I'm excited to share our experience with you all!

Posted by: CynthiaandLuna | August 10, 2014 1:56 PM    Report this comment

Dogdancer. Could you please tell me where in Florida that you purchased your dog's leg brace? Thank you.

Posted by: pkunnath | July 30, 2014 12:30 PM    Report this comment

Wanted to share our experience. Our 10 year old active 68 pound Aussie/sheepdog mix recently tore his CCL. It was a traumatic injury, that happened when he came down in a hole while playing fetch. We were really torn on what to do and got opinions from three vets. 2/3 recommended TPLO, one said there were pros and cons to each. We waited 2 months (with extreme activity limits) to see if our dog would heal up on his own, but at 2 months there was almost no improvement, he could only toe touch with the bad leg. At that point we decided to go with the old fashioned ex cap surgery. We did this for several reasons. First, the TPLO procedure just seemed extremely invasive. Second, our dog is incredibly active and we just didn't think we could keep him crate bound for a full month. With the ex cap he could begin all activity (gradually) even stares. Surgery showed a complete CCL tear as well as a torn meniscus. The first 3 days were terrible after surgery, but since then he has had a wonderful recovery. At 3 months he is about 80 percent weight bearing, almost has normal muscle back, and can run at a full tear (scaring me to death in the process, my recovery may be longer than his). Anyway, I would just recommend you talk to several vets and feel really comfortable with the one you choose. And take your time, we almost rushed in to TPLO and I'm glad we didn't.

Posted by: Treeclimber | June 19, 2014 2:39 AM    Report this comment

I can understand the apprehension in having TPLO surgery, but we had a great outcome after this procedure. Perhaps my dog was one of the lucky ones. He has done amazingly well 2.5 yrs after his first TPLO surgery. But, he blew out his other knee a couple months ago, another fully torn ligament and torn meniscus, after a rowdy bike ride. No doubt he needed another surgery but I struggled with TPLO based on the horror stories I've read. But then I realized that I have to base it on my own experience and his previous good outcome (and the fact that, generally, people don't post positive outcomes on the internet, just bad ones). Charlie had his second TPLO surgery on the other leg today. Now my dog's hind legs are worth a small car =). If it keeps him active and happy, then it's money well spent. He is a 95 pound bull mastiff/pit mix and is the best doggy doodle in the whole world. I am praying he recovers as well as he did last time. It does seem like an unnatural thing to do to a dog's legs. I hope I made the right decision which was largely based on my experience and my vet who I completely trust. (He does not perform these surgeries but refers out to other board certified surgeons.) Just my experience...they aren't all bad.

Posted by: iheartkarma | May 29, 2014 6:54 PM    Report this comment

Want to thank you for this article. After my 2yr old lab suffered a tear I struggled with with moving to surgery too quickly after finding out how invasive it was. After seeing your article started researching. The second vet agreed that we could take it slow, but we needed to keep this crazy girl on a short leash (literally) and keep her super skinny. We put her on weight management food, gave her 1100mg of glucosamine condroitin MSM a day, after a couple months did regular swimming in a local pond, and limited her play. It took a year, but happy to report there is no clicking or looseness in her knee, and no surgery in her near future! Vet says this is very unusual case, but congratulated us on the progress we made.

Posted by: KD | February 27, 2014 7:00 PM    Report this comment

Thank you! My giant breed dog has a torn ligament and the vet was very fast (too fast!) in recommending the TPLO surgery on both knees and he is only a year old and suspected that there might be other alternatives to surgery for him. Your article prompted me to find a holistic vet in Asheville to give us a second opinion and recommendations on alternative therapies before we make a decision and this article gave us a nice base of information to work from so far. Fingers crossed!

Posted by: Jo Hannah | February 18, 2014 10:29 AM    Report this comment

Thanks for writing this article. My big older dog tore her ACL CCL Cruciate Ligament tendon. The vet said the gold standard was tplo surgery. Absolutely no risks. And to have money available to do the other knee too. Said we would need about $4,000 for the TPLO and $1,000 for pre and post surgery checkups and NSAIDs and pain meds. Then save another $5,000 because the other knee joint will tear in a few months anyway. And read that to save another $5,000 to pay for the complications that will happen in 1 in 3 dogs that get CCL surgery. I was told to have $15,000 set aside for tplo surgery. Then I read so many forums about those who had the surgery and the nightmare that followed from infections, bad surgeries, resurgeris, dying from the NSAIDS like rimidyl and previcox, bone cancer at the implant site, corrosion of the implant, etc. Too scary to risk surgery on my dog. I am very thankful for those that posted their experience with TPLO, TTA, tightrope, fishing line surgeries, etc. I read many many articles on pros and cons of CCL surgery. Apparently ccl tplo surgery is a fad and high profits for tplo surgeons. One thinks if they buy the most expensive surgery that their vet recommends plus the vet may get a referral fee or gift of some 10% of the $4,000, they are doing the best thing for their dog. Nothing can be further from the truth. After much research, I started looking into dog knee braces. I tried several dog knee braces that had severe slippage issues and the velcro was impossible getting all tangled in the long hair. But kept searching. I finally found a local posh dog knee brace in Florida. It was much improved dog knee brace with buckles on the outside of the leg, so easy to attach, no velcro on the upper leg, but straps and easy click buckles instead. It was easy to put on quickly. And it stayed in position. My big dog with a full tear has been wearing the posh dog knee brace for several months during the day, and out on dog walks. She can walk comfortably for longer and longer dog walks, and I can see the knee is healing. It is a slow process but she is happy now and is fine with wearing the posh dog knee brace with conservative management I am happy after many months of trying to find a safe solution for our dog. Thanks again for all those who shared their nightmare experience with CCL surgeries. Because of you, you saved my dog from going through a nightmare of pain. With research of articles and reading forums of experiences, we made the right decision to avoid surgery. I am very happy knowing I did make the right decision for my dog and did the safer alternative with the more affordable posh dog knee brace. I hope my experience will help others make the right decision for their dog and hopefully avoid ccl type surgeries, and the nightmare that may come with ccl type surgeries.

Posted by: dogdancer | September 26, 2013 9:59 AM    Report this comment

Although the author evaluated the results of surgery vs no surgery I did not see any mention of the use of prolotherapy for treating dogs with torn cruciates. I would like pet owners to know that prolotherapy is a viable third alternative to surgery or no surgery and in my hands it has been extremely effective. I have been performing proliferative therapy (prolotherapy) on both small and large breeds of dogs with torn cruciates for 10 years and would estimate it to be at least 80% effective in significantly reducing lameness and enhancing the quality of the pets life. Cold laser therapy can be used with prolotherapy to hasten the formation of fibrosis and the relief of pain. For those who have never heard of prolotherapy it involves injecting a specially prepared solution around and into the affected joint. Repeated injections are given every three weeks for approximately 5 visits. The injections are given under either sedation or light anesthetic. What prolotherapy does is stimulate fibrosis and the thickening of the joint capsule and other supporting ligaments around the damaged joint. Over a period of time the newly formed fibrosis contracts and tightens the joint. The procedures is very safe in experienced hands. Prolotherapy was orginally developed for use on humans and was first introduced in the mid 1950′s. For more information on prolotherapy visit either of my websites: myholisticpetvet.com or doc4pets.com .

To find out about prolotherapy for humans visit "caringmedical.com".

Posted by: woodside27452 | November 19, 2012 9:07 AM    Report this comment

Do you know anyone in Australia that works with the braces for dogs torn ACL, as we are going thru homeopathic injections, and thought the brace would also be very supportive.

Posted by: debc | September 30, 2012 11:07 PM    Report this comment

Hi, those of you who used the wound wear brace, can you give an indication of how much it cost?

Posted by: stephanie r | September 3, 2012 4:02 PM    Report this comment

Hi, those of you who used the wound wear brace, can you give an indication of how much it cost?

Posted by: stephanie r | September 3, 2012 4:02 PM    Report this comment

Thanks for the great article! I was doing some research and found that even with surgery a successful recovery is not guaranteed (only 85% success rate). My 13 year old husky mix had a full cruciate tear a little while back, and my vet said the surgery would be around $4000. Thankfully I found a surgery alternative brace at Woundwear while doing some research online. I felt comfortable contacting Woundwear to learn more about the product, and they were very helpful and easy to work with. I went to my vet to get the brace sized correctly, and now my dog is able to put weight on her leg while wearing the Woundwear A-Trac brace. I highly suggest the brace to others interested in a brace! Again great article!

Kelly B.

Posted by: KellyBrown | July 31, 2012 2:37 PM    Report this comment

Great article, thank you! My lab had a tplo surgery 2 years ago for a partial tear and I've regretted that decision terribly. She has never recovered and has had pain and limping ever since. Now I'm reading about how ineffective the surgery is and it's really upsetting because I went to one of the best hospitals and surgeons in the country (head of surgery at Angell Memorial in Boston) and they said this was the **only** choice. The implication was that nothing whatsoever could be done except surgery and no one ever said anything about the risks and possibility of failure.

At any rate, looking forward, does anyone have any thoughts about the therapies described above applied to a failed tplo situation?

Thank you!

Posted by: Unknown | July 28, 2012 8:17 AM    Report this comment

Great Article! My dog Zep had a full cruciate tear, it was not fun at all! Our vet recommended surgery, but we were not ready for the plunge. I did research and found articles such as this one and did not even know a brace could be used! After much research we went with the atrac dynamic brace by Woundwear. Dr. Spatt was very helpfull and had me get the right measurements etc. Zep is doing great! I suggest people looking into braces! Once again, great article!

Ed K.

Posted by: EdKawalsky | July 10, 2012 1:10 PM    Report this comment

When my Golden, Sammie partially tore his CL, his vet immediately put him on an anti-inflammatory and told me he needed total rest! Miraculously, he cooperated and was on the mend relatively quickly.
I spoke to his acupuncture vet and we started treatments which also helped immensely. She recommended swimming therapy too, so after 4 or 6 weeks (I forget which), he started swimming. He LOVES swimming and fortunately made a full recovery within months. He still swims once a week for fun!
Naturally, he has arthritis now which bothers him once in awhile. He is going to have stem cell therapy this summer to help alleviate the pain from arthritis before it slows him down.

I was fortunate to have the guidance of a great conservative vet AND a great holistic vet. Surgery was the last option, but neither of them ever recommended it throughout Sammie's recovery.

Posted by: Cindy G | May 30, 2012 9:33 AM    Report this comment

In Quebec, you can find orthotic-prosthetic devices and other rehabilitation products (harnesses, ramps, wheelchairs, etc) for animals at www.orthodesign.ca (they do business also with Canada, USA and Europe)

Posted by: OrthoDesign.ca | April 13, 2012 3:46 PM    Report this comment

thank you so much for this article! Yesterday I took my Great Pyrenees to the specialist who told me that she absolutely had to have an operation on BOTH knees for ruptured ligaments in the knees that would cost us a total of 6600$. I decided to look for alternative ways and found your article and I am so grateful. I've taken notes and hopefully won't have problems finding these products here in Quebec,Canada, but then there's alwyas internet! Thank you again for giving me hope.

Posted by: andree | April 12, 2012 10:37 AM    Report this comment

New to Whole Dog Journal? Register for Free!

Already Registered?
Log In