Cruciate Ligament Advice

[Daphne]

Hi all,

This is my first time posting here, although I’ve referred to the dol forums many times for info for my best friend Daphne; it’s been an incredibly useful source of information so far.

I have a small 4yo dog with a suspected ACL tear. I’m in the process of educating myself about this injury, and I just have a few questions I hoped that people with experience of this injury could help with. Our vet has suggested we give it till the end of September to see if the ligament “heals itself”, and if at that point there’s been no significant improvement, to think about surgery. He advised us that waiting can be a good idea with smaller dogs that are not significantly overweight (Daphne is 9.5 kg; we’re working to get her down another 1 to 2 kg). According to what I’ve read, this “wait and see” period is to allow a stretched or partially torn ligament to heal itself. Is this correct? For the sake of clarity, I’ll list my questions:

(i) My understanding is that, even if it’s only stretched or partially torn, and she recovers on her own, she will have a higher risk of tearing or completely rupturing it again in the future. If this is the case, why isn’t surgery the preferred option from the start? In other words, what are the benefits of allowing the injury to heal on its own??

(ii) Is arthritis/joint disease more likely down the track without surgery? If so, again, why not go for surgery straight away?

(iii) Finally, and most importantly, can anyone recommend a surgeon in Melbourne for consultation/surgery? (I noted the recommendation of Dr Wing Tip Wong in another thread).

I hope my questions make some sense. I would be sincerely grateful for any help with this. I’ve promised Daphne that we’ll play soccer again

Kind regards,

Rooz.

[Charles Kuntz]

Hi, Charles Kuntz here. I am a specialist here in Melbourne. I want to start by saying that there are several specialists in Melbourne, but in a 9.5 Kg dog, many general practitioners are happy to do cruciates on small dogs. The recommendation to wait an see is based on a study by Vasseur, et al which showed that in dogs weighing less than 15 Kg, many will do well with conservative management- permanently. The ligament usually doesn't heal itself. Scar tissue forms around the joint in response to the instability. Arthritis may develop, but the clinical outcome is still often successful In small dogs, often this scar tissue is adequate. In large dogs, it is often not enough and something else has to be done.

What is usually recommended is to wait 6-8 weeks and if the outcome is less than optimal, surgery is then recommended. This is in contrast to large dogs where surgery is recommended immediately.

Please let me know if you have other questions.

Charles

[Daphne]

Charles, thankyou so much for your reply. I wasn’t at all expecting to hear from a specialist. You’ve answered many of my questions. One point I’m still not entirely clear on: can arthritis be avoided with surgery? If so, why not go ahead with surgery? Is it a matter of being conservative with surgery?

For now, we’ll give it the six to eight weeks, and see how she progresses. Finally, if we decide on surgery, are you available to do the procedure?

Thanks again,

Rooz.

[Charles Kuntz]

Arthritis cannot be definitively avoided by doing surgery. In big dogs, unrepaired cruciates result in arthritis. In little dogs, I don't think we can say that. I would wait the 6 weeks and see how he goes.

Charles

[Lablover]

Arthritis cannot be definitively avoided by doing surgery. In big dogs, unrepaired cruciates result in arthritis. In little dogs, I don't think we can say that. I would wait the 6 weeks and see how he goes.

Charles

If I may, is TPLO, the surgery of choice with active over 30 kg dogs? Do you consider tibial angulation a significant predosing injury factor?

Do you consider high incidence of CCL tears genetic?

Thankyou.

[Golden Rules]

Charles, it's very reassuring for me to read your post as that is exactly what my vet has said to me - having a 35 kilo Goldie who has had two crucite ligament ops within 8 months.

My boy had the artificial ligament done each time - I am interested to hear if the Titanium plate is the preferred option for a larger dog, and if so, why?

My boy has done well recovering from both ops but he has hip dysplasia as well which slows him down.

The conservative treatment for a smaller dog makes so much sense, but I am of the understanding that arthritis can set in after any injury no matter the size of the dog - is that correct?

[Charles Kuntz]

Prior to about 20 years ago, all cruciate repair techniques were directed at stabilising the knee using different types of natural and synthetic materials, all with reasonable success. About 20-25 years ago, a guy named Barclay Slocumb recognised that the tibial plateau sloped backward in dogs with cruciate ligament ruptures causing the femur to "slide" backwards on the tibial plateau (like a ball rolling down a ramp). This was putting stress on the cruciate ligament and over time ultimately it would fail. He developed a technique, which he patented, which involved correcting the abnormal slope (tibial plateau leveling osteotomy). It seems to work very very well in returning dogs to fairly normal function. In one study, it was associated with a 6 fold reduction in severe arthritis compared with a traditional nylon suture technique in larger dogs. When the patent ran out about 5 years ago, there was a flurry of other tibial plateau leveling procedures and plate designs, etc, all with similar results.

We tend to use traditional nylon suture techniques in smaller dogs and tibial plateau leveling procedures in large dogs. I don't think that they have ever been compared in a small dog population.

Charles

[churchie]

Hi,

My Border Terrier strained/partial tore her cruciate ligament, approx 6 months ago and the vet advised the rest, wait and see method, and she is a small dog, under 10 kils and so far so good. She is now walking/running on it fine and my vet is very happy with her progress.

I was advised that for the 4-6 weeks, she was to be kept as quiet as possible, walking only for toileting, no stairs, jumping, walks etc. etc. Then once we got over that period, she could go for a tiny slow walk on a lead i.e. 1-2 house lengths twice a day, and then from there we very slowly built her up until I think about the 4 month mark she was allowed to go for all the walks she wanted onlead and offlead but still where possible no stairs or jumping until we get to the 6 month period.

She was also a little bit over weight so I have been trying the best to get 1-2 kilos off her to keep her as trim as I can. I also used something like 'sasha's blend' for a certain period as well during her recovery. My vet didn't believe these sorts of things do much good but I felt it couldn't hurt.

The advice I got from other people was the most important thing was to follow your vets advise exactly on what to do during the recovery period as although they might feel and look like and want to do more excercise it is better to take the slow and steady approach. We had little set backs here and there during this six month period but fingers crossed the scar tissue will hold together well.

Good luck with your girl.

[Daphne]

Thanks very much Churchie, that's very useful information. It’s also very reassuring to hear that your dog is doing well without the surgery. We’re also working on getting her weight down, and I’m currently looking into “sasha’s blend” and similar products.

Thanks again.

[Staffyluv]

I have an 11 year old male Stafford that had/has a partial tear in his left hind cruciate. This happened quite a while ago now and although the vet wanted to operate, I decided (because he has MCT and a thyroid problem from chemo) that I would not have the op done unless I had absolutely no choice.

I got a a couple of kilos off him, then we rested him with no walks for about 6 weeks and no active play either. I increased his fish oil tablets to twice a day as well as changed him from vitamin C to Ester C powder and also added chondriton and glucosamine tablets to the mix.

He can now stand comfortably on the leg and is back walking every day ( we started off walking small walks first and built back up).

I am happy that I did not do the surgery and he had his 6 month check up today and even the vet said that he is happy his leg is much better.

Don't get me wrong, he still favours it sometimes if he has a bit of rough play but for the most part it is pretty good.

Try the wait and see with regular checks with the vet and see how it goes.

good luck

Jodie

[Madeleine]

Hi

I am a physio that treats humans (although I sometimes wish it was animals....) My Mum has an Australian Silky Terrior who did his ACL 8 years ago. We went for the conservative treatment, although we did a gentle 'rehab' type program, ie instead of walking for an hour a day, he went around the block, we limited his jumping (ie on/off couch etc) and gradually built up his exercise regimen over a period of about 6 months. He started walking around the block, then walking zig-zag through cones, gently jogging first in a straight line, then the zig zag and so on. He is now 14 years old....and hasn't developed arthritis - thank goodness! I'm no animal expert - but that type of exercise is what we do with humans to gradually stress and mould the scar tissue forming in the knee.

Hope that's some help!

[Daphne]

Jodie and Madeleine, thanks so much for your advice. When she first injured the knee, I assumed that surgery was a given, and that some arthritis would be unavoidable down the track. So, it’s really reassuring to hear that this injury can heal well without resorting to surgery; our outlook is a whole lot more positive now.

We’re going to give her the 4-6 weeks rest (this is already proving quite difficult), and then gradually increase her exercise. Madeleine, your suggested rehab plan looks like a really good way of doing this.

Jodie, good luck with your boy, hope he has no more problems with the leg.

Thanks again.

[westiemum]

Hi Daphne,

Yes I too would support the 'wait and see' for 4-6 weeks and with your vet, make a call then...

My westie boy, who is a rescue ex-puppy farm breeding dog, with poor back leg musculature development and arthritis (we suspect from spending most of his first 5 years in a small cage ) blew his left ACL as an overweight 7 year old (desexed late as a six year old and then I fed him too much!! ) . We did the wait and see (and diet!) approach but for us it didn't work - he would improve a bit and then bang! Overnight he would be back to hopping around and was absolutely miserable - and I think in considerable pain.

So at about the five week mark I went back to my wonderful Vet and said I thought it was time for surgery and he agreed. He did a fantastic job on the surgery, I did a fantastic job on getting his excess weight off (absolutely critical in my opinion - had to be 'cruel to be kind' - so it was a barf diet heavy on the veggies in the weight loss phase), until I got his weight down to the low side of normal - so now he's a 'lean mean westie machine' :rofl:

He's now a new dog at the age of 9, and is bouncing around like a puppy and appears to be pain free. I also use Joint Guard, Fish Oil capsules and Sylvet capsules (after a course of Cartrophen injections) with him and it appears to be making quite a difference - at least it can't hurt. And my gorgeous Weight Nazi of a Vet tells me off every time he puts on a gram - so I watch his weight like a hawk! (Its worse than going to Weight Watchers!)

So I really hope you have a lot of luck with 'wait and see'... but don't be afraid of surgery with a good experienced vet if you don't... its worked brilliantly here...

Hope that helps.

Cheers,

Westiemum

Edited September 7, 2008 by westiemum

[westiemum]

Slightly off topic, but I was just thinking... anyone know if there is any relationship between caged dogs and/or poor leg muscle development and/or ACL tears/ruptures??

I've long been suspicious that my boys history (weight difficulties aside), possibly predisposed him to a ruptured ACL and/or arthritis ... would make an interesting research project...

Just a thought...

Cheers,

Westiemum

Edited September 7, 2008 by westiemum

[Daphne]

Hi Westiemum,

Thanks so much for your advice. It’s great to hear your boy is doing so well. It’s very clear that weight is going to be a crucial factor. We’ve already adjusted her diet, adding fresh pumpkin/vegies to act as filler (I think one of your suggestions from an older thread? ). Unfortunately, we got off to a bad start with Daphne’s weight from the beginning, and she was overweight by about 2 yrs . We’ve only really been able to get her weight down significantly in the past 6 months with a change in her dry food and paying much closer attention to her daily quota; it’s been a very steep learning curve with regards to weight & diet. I feel that her weight and her enthusiasm for jumping on/off the furniture played a key role in her getting this injury.

I’ve just ordered Joint Guard; as you say, it can’t hurt. I’m looking into fish oil, etc. and other supplements as well – there’s so much to choose from, it’s hard to know what’s the most effective!

I hope surgery won’t be necessary, but your story is very encouraging if we do decide to go ahead with it.

Thankyou again,

Rooz (& Daphne).

Edited September 7, 2008 by Daphne

[westiemum]

Hi Again,

Yes I agree - I think weight control is critical in managing dogs with ACL injuries successfully - just seems common sense to me so well done getting Daphnes weight down - I'm sure that will make a big difference to her and I know what hard work that is.

Yes I let my boys weight get away from me too, early on, after I got him as a newly desexed 6 year old - and paid the price - as did he. I now have an arrangement at the vets that whenever we are passing I pop in and put both westies on the scales and they record it in their notes so we can keep a close eye on it (Which reminds me I should try and get back there next week). Back when he was on his serious weight loss diet big-time, I was expected to front up to the vet for a weekly weigh in!! But it worked - and kept me motivated and on track as the weight came off.

I have had no success whatsoever in keeping my guys from jumping on and off the furniture - although luckily, now the ACL is well healed it doesn't seem to make any difference to him - and I actually wonder given his poor leg muscles whether it may have actually helped... hmn... not sure...

Anyway welcome to DOL - and will look forward to hearing of Daphnes progress - paws crossed for you here!

Cheers

Westiemum

Hi Westiemum,

Thanks so much for your advice. It’s great to hear your boy is doing so well. It’s very clear that weight is going to be a crucial factor. We’ve already adjusted her diet, adding fresh pumpkin/vegies to act as filler (I think one of your suggestions from an older thread? ). Unfortunately, we got off to a bad start with Daphne’s weight from the beginning, and she was overweight by about 2 yrs . We’ve only really been able to get her weight down significantly in the past 6 months with a change in her dry food and paying much closer attention to her daily quota; it’s been a very steep learning curve with regards to weight & diet. I feel that her weight and her enthusiasm for jumping on/off the furniture played a key role in her getting this injury.

I’ve just ordered Joint Guard; as you say, it can’t hurt. I’m looking into fish oil, etc. and other supplements as well – there’s so much to choose from, it’s hard to know what’s the most effective!

I hope surgery won’t be necessary, but your story is very encouraging if we do decide to go ahead with it.

Thankyou again,

Rooz (& Daphne).

[Turkey Trip]

Very interesting to read all the responses. Our first experience with a medial cruciate ligament problem occurred over 20 years ago when one small dog suddenly stopped after a full-speed play gallop and hopped around on 3 legs, holding one hind leg off the ground.

The Vet advice at the time was that surgery was essential, and a (very expensive) repair job followed which entailed a piece of plastic inserted and attached somewhere... Recovery was gradual over about two or so months and the leg was always a bit stiff as the dog aged.

Interestingly, a series of 5 cruciate ligament damage incidents ensued over the next few years, all related to some extent (by family) to this first one. That said, there has not been a single occurrence for the last 11 years.

After the first case which entailed surgery, we thought about it a lot and weighed up the treatment vs the outcome. Thus in the latter cases, we went against current vet advice at the time and virtually confined the dog to kennels for the first 4 weeks thus lots of rest time, no running or jumping but room to move around at leisure. Then as the dog in each case started placing a little weight on the leg, we graduated to walks on lead at first, then supervised outside time (no play with other dogs allowed) and ultimately built the activity level slowly up to 'normal life'. Every single case recovered completely with full mobility and notably, without the stiffness of the first dog which had the surgery.

Lesson learned. I guess it is worth x-raying the joint (what do our experts think?) to get a proper diagnosis though as if there is such damage to the joint that the bones are totally displaced, surgery to re-set the joint might be required and simple rest and gradual rehabilitation might not be the solution. BTW all these dogs would have been 12-15kg.

I think Madeleine's comment about stressing and moulding the injury site during recovery is very, very pertinent. A more recent experience with this factor in relation to elbow dysplasia due to a growth plate injury has taught us a lot . A happy eventual outcome there and also, no surgery. Again it was a little experimental but after much "Googling" on research; (Hurrah for arrival of the computer age!) we took little steps, building up activity and slowly and carefully monitoring the results. I felt that after the initial rest and repair period, nature would compensate for the injury as bone is after all, a living thing and young growing joints a work in progress. With good nutrition and careful exercise an apparent full and total recovery and an absence of symptoms has occurred. The elbow xrays planned in a few months (18 mths of age) will be most interesting to compare to those of 6 months of age after the growth plate injury, radius/ulna dysplasia and foreleg lameness first occurred.

Again, common sense suggests this would not work for all elbow problems. In this case it worked for elbow dysplasia caused by a growth plate injury disrupting growth of the long bones in the foreleg.

[poodlefan]

Slightly off topic, but I was just thinking... anyone know if there is any relationship between caged dogs and/or poor leg muscle development and/or ACL tears/ruptures??

I've long been suspicious that my boys history (weight difficulties aside), possibly predisposed him to a ruptured ACL and/or arthritis ... would make an interesting research project...

Just a thought...

Cheers,

Westiemum

There is a definite link between obesity and ACL rupture. I'll defer to the experts but I'd have thought lack of muscle bulk/tone would place additonal stress on the ligament.

Edited September 8, 2008 by poodlefan

[PepitoVFR]

Wow, I came to the forum this morning to create an identical thread, but already done for me , thanks Daphne

About two weeks ago our 8 yo Maltese/Shi Tzu X (this is her

after a short run around in the backyard suddenly started walking with one rear leg raised. And she has ever since

A vet who took a look at her suspects an ACL rupture and has suggested an x-ray and if the rupture is confirmed to go with surgery straight away.

I'd already planned to get a second opinion but after reading through this thread, particularly from Charles (great to see specialists taking time to contribute to forums like this!) I most definately will.

Thanks all

Edited September 9, 2008 by morita

[Daphne]

Hi Morita,

Glad this thread’s been useful to you; it’s certainly been a big help to me. It’s interesting that your vet recommended surgery straight away, given the input/advice given so far on this thread. Anyway, good luck with your little one’s recovery, hope she's back to full strength in no time.

Rooz.

Edited September 9, 2008 by Daphne