Treating Dog Torn Cruciate Ligament With No Surgery—Is It Possible?
Understanding Dog Cruciate Ligament Anatomy
If you're considering non-surgical options for your dog's torn cruciate ligament, you most likely have a reason. It could be you cannot afford the very expensive surgery or you're looking for a more conservative approach for an older dog. It may also be that you are trying to learn as much as you can about this condition and want to make the best decision for your pal. The best way to understand the pros and cons of surgical versus non-surgical options is by understanding how the ligament works and what happens when it ruptures.
What is a dog's cruciate ligament?In this case, it's more correct to say cruciate "ligaments" as there are two. A ligament basically consists of fibrous tissue whose main function is to connect one bone to another so to ensure joint stabilization, while allowing a large range of motion.
In this case, the dog's two ligaments are connecting the femur and the tibia. These two ligaments are arranged like a criss-crossing letter "x" found on the dog's knee (also known as "stifle"). Hence, the term "cruciate" derives from the word "cross." To distinguish one ligament from another, veterinarians refer to these ligaments as the "anterior cruciate ligament" (ACL) or the “cranial cruciate ligament" (CCL) or "caudal". In particular, the ACL is the one dogs rupture more often and the one that keeps the tibia from slipping forward; the CCL is the one that keeps the tibia from slipping backwards.
What Happens When a Ligament Is Torn?
When the crucial ligament is torn, the knee develops an abnormal range of motion and the dog feels pain. Affected dogs may be so sore they barely are able to bear weight on the leg. While the rear leg limping is one of the most characteristic signs of a torn ligament witnessed by the owners, the most conclusive sign of a torn ligament seen by the vet is what is called a "drawer sign" which is an abnormal range of motion that would never happen if the dog's ligaments were intact.
What is exactly the drawer sign and how does the vet determine its presence? The vet will hold the femur firmly with one hand stabilizing it, while he manipulates the tibia with the other hand. As mentioned previously, the ACL keeps the tibia from slipping forward while the CCL keeps the tibia from slipping backwards. Therefore, if the tibia is able to move forward upon manipulating the joint, (just as you would open a drawer) this is proof that the ligament is torn. Further proof is obtained from the “Tibial Compression test” In this case, the vet holds the femur with one hand, while he flexes the dog's ankle with the other hand. In the case of a ruptured ligament, the tibia will once again move abnormally forward.
*Note: Diagnosis may not straightforward as thought. In some cases, dogs are quite tense at the vet and this tension temporarily stabilizes the knee joint preventing the typical drawer sign from manifesting. Also, the drawer sign may not be noticeable in dogs who have only partially ruptured their ligament. X-rays may also help diagnosis, while ruling out bone cancer and helping determine if secondary arthritis has set in.
Owners often notice their dogs are in pain because the dog will not put weight on the affected leg. In the case of partial ruptures, the limping is more intermittent. The limping tends to worsen with activity and is often more noticeable upon getting up. Some dogs may become less active. Also, owners may notice sloppy sits with dogs having trouble sitting and a predisposition to sit with the affected leg out to the side. In some cases, the joint may swell or there may atrophy of the muscles, which sometimes leads to one leg becoming shorter than the other.
How did my dog rupture his cruciate ligament? you may ask. Often, this injury may occur when a dog takes a bad step such as when his lower leg portion gets trapped in a hole and the rest of the leg keeps moving forward. In other cases, an overweight older dog may have weakened ligaments that rutpure when the dog jumps off a bed. Some large breeds are predisposed to this condition such as mastiffs, Newfoundlands, Akitas, St. Bernards, Rottweilers, Chesapeake Bay retrievers, and American Staffordshire terriers.
Conservative Management: Non-Surgical Cruciate Ligament Treatment in Dogs
The subject of surgery in torn cruciate ligaments seems to be a subject of controversy. One thing is for sure: when the ligament is torn, the knee is unstable and the bones are subject to an abnormal range of motion. This leads to a cascading effect, where the bones and the meniscus cartilage are subject to wear and tear which lead to degenerative changes. When the meniscus is affected, parts of it may need to be removed or repaired. Bone spurs, which develop in deteriorating joints, may start to form as early as 1 to 3 weeks after the rupture. A swelling just on the inside of the knee, known as a “medial buttress,” may be a sign that arthritis has set in, in cases where the tear is old. Surgery, appears to slows down degeneration, but it's unfortunate that the degenerative changes cannot be reversed once started.
Understanding Non-Surgical Treatment
If you were wondering what would happen if your dog skipped the surgery and was allowed to rest, the prognosis appears to depend on great part on how large your dog is. In a study, dogs suffering from a cruciate rupture were studied for 6 months. About 85 percent of the dogs who weighed less than 30 lbs improved or regained almost normal function. Only 19 percent of dogs weighing over 30 pounds improved or regained almost normal function.
However, it's true that there are also stories of dog owners trying the non-surgical route. It's an unfortunate fact that not all dog owners can afford the hefty price tag that comes with this type of surgery which often amounts to $3,000. Those who cannot afford it, or owners of dogs who due to age or other conditions cannot go the surgical route, often do loads of research and decide to try to help their dogs through what is known as "conservative management." Those who decide to go this route though have a rough road ahead with lots of uncertainties about the outcome. Also, at times this route may turn out being more expensive overtime than the actual surgery.
Generally, the best candidates for conservative management are dogs who have just a partial tear. In this case, these dogs can be given an 8-week trial through conservative management. If the dog seems to improve during this time, it's a good sign. Dogs who have a complete tear are instead always a surgical case, explains veterinarian Stacey Hershman in an article for the Whole Dog Journal. The reason for that is that in the case of a complete rupture, the knee cannot function as a "hinge joint." If you are interested in trying the non-surgical route, you will need to first have a vet determine if the tear is partial or complete.
So what is conservative management when it comes to a dog's torn cruciate ligament? It consists of rest, ant-inflammatory drugs, weight loss, braces, swimming, physical therapy, nutritional support, herbs and supplements. In this case, rest means no running, jumping or stairs for 6 to 8 weeks. The dog will need to be sent on-leash to potty. However, it appears that too much rest won't work either. A dog crated all day may get get stiff. Better off being confined in a small room or an ex-pen.
Anti-inflammatory drugs are not only needed for pain control but also to reduce inflammation which is a culprit for cartilage degeneration, which in turn leads to arthritis. Glucosamine supplements such as Glycoflex, Adequan injections and natural anti-inflammatory products may help as well, but discuss about them with your vet as some may interact with anti-inflammatory drugs.
Weight loss is important as those extra pounds can play a detrimental role. Extra pounds may also put more strain on the other healthy knee. Also, when a dog is on restricted activity for a long period of time, weight gain is very likely. A healthy diet with high protein, low-carbohydrates and reduced-fat may help. Cutting down on kibble, but adding high-protein foods such as eggs, meat, and dairy is not a bad idea, according to dog health and nutrition researcher Mary Straus.
Acupuncture, acupressure physical therapy, massage therapy, swimming and prolotherapy are forms of therapy used for partial tears. All these require great time and commitment. Braces may also turn out helpful in supporting the knee externally. In most cases, a combination of different treatments seems to be an optimal strategy.
References and Resources for Owners of Dogs With Torn Cruciate Ligaments
Is Surgery the Only Way Out? What Some Vets Have to Say
If your dog teared his cruciate ligament, most likely the vet told you that it's either surgery or a life of disabling, often warranting euthanasia. Veterinarian Narda Robinson in an article on the Veterinary Practice News, debunks some myths on the subject. For starters, she claims that evidence suggests that TPLO surgery (Tibial Plateau Leveling Osteotomy) doesn't halt the progression of arthritis. Interestingly, she claims that several studies show quite the contrary; indeed, it appears that arthritis actually worsens after TPLO.
Narda Robinson adds: "Most injuries do not require surgery for their successful resolution. Rest and wrap, massage, acupuncture, laser therapy and proprioceptive retraining may produce a full recovery for many problems whereas cruciate surgery never restores the limb to normal function. Who pays for the diagnostic error when the surgeon finds an intact ligament? The dog and the client."
Also, Narda Robinson claims that it's not true that dogs will be as good as new after a TPLO surgery or other surgical approaches for cranial cruciate ligament. Post-surgery, dogs will be lame for the first two weeks. Then, four to six weeks afterward, they lose muscle mass and the circumference of their thighs decrease. Also, the dog won't recover fully, with stiffness in the stifle lasting five or more years, and possibly, persistent lameness.
Veterinarian Shawn Messonnier further notes in an article on Dog Channel that upon having a dog diagnosed with a torn ACL, dog owners don't have to rush their dogs on the surgery table on an emergency basis. A second opinion is often helpful so to determine if surgery is really necessary. He also explains how alternate therapies may help dogs recover without surgery. Such therapies include homeopathic remedies, herbs, nutritional supplements, such as bromelain and glucosamine and chondroitin.
If you're considering conservative management it's important to evaluate what is best for the dog. Veterinarian Dr. James St.Clair, Director of Veterinary Medicine cautions that while conservative management may work, it works for some dogs and not necessarily all. It also comes with risks. If the dog is not rested properly, he may risk compromising the opposite hind leg; which can ultimately have a devastating outcome. As mentioned, this topic is quite a subject of controversy and it's not a bad idea to listen to both sides of the story so to make an informed decision. This article by veterinarian Phil Zeltzman focuses on the possible complications from untreated ACLs.
For Further Reading
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- Causes of Limping in Dogs
Learn about some of the most common causes of dog limping. Find out how to palpate the leg to pin-point problems and potential causes for front leg limping and rear leg limping in dogs.
A Success Story Post-ACL Tear Without Surgery
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What happened after your dog teared his cruciate ligament?
This article is accurate and true to the best of the author’s knowledge. It is not meant to substitute for diagnosis, prognosis, treatment, prescription, or formal and individualized advice from a veterinary medical professional. Animals exhibiting signs and symptoms of distress should be seen by a veterinarian immediately.
© 2013 Adrienne Janet Farricelli