Adrienne is a certified dog trainer and former veterinarian assistant who partners with some of the best veterinarians worldwide.
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 crisscrossing 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 backward.
What Happens When a Ligament Is Torn?
When the crucial ligament is torn, the knee develops an abnormally limited range of motion and the dog feels pain. Affected dogs may be so sore that they are barely able to bear weight on their leg.
Signs or Symptoms of a Torn Ligament
A rear leg limping is one of the most characteristic signs of a torn ligament witnessed by the owners, but 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.
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 a Vet Diagnoses the Drawer Sign
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 backward. 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 they flex the dog's ankle with the other hand. In the case of a ruptured ligament, the tibia will once again move abnormally forward.
It should be noted that diagnosis may not be so straightforward. 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 arrive at a diagnosis while ruling out bone cancer and helping determine if secondary arthritis has set in.
What Causes Torn Ligaments?
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 rupture 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 Management in Dogs
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 leads 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 one to three 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 slow down degeneration, but it's unfortunate that the degenerative changes cannot be reversed once started.
Understanding Non-Surgical Options
If you were wondering what would happen if your dog skipped the surgery and was allowed to rest, the prognosis appears to depend in great part on how large your dog is. In a study, dogs suffering from a cruciate rupture were studied for six 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 to be more expensive over time 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, anti-inflammatory drugs, weight loss, braces, swimming, physical therapy, nutritional support, herbs and supplements. In this case, rest means no running, jumping or stairs for six to eight 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 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 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 approaches seems to be an optimal strategy.
References and Resources for Owners of Dogs With Torn Cruciate Ligaments
- Braces for dogs with torn cruciate ligaments: Orthopets and Wound Wear Inc.
- The Whole Dog Journal article on Alternatives to Canine Surgeries
- A website dedicated to ACL/CCL non-surgical recovery
Is Surgery the Only Way Out? What Some Vets Have to Say
If your dog tore 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 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 the 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
- Dog valley fever coccidiomycosis
Learn what is valley fever and how it affect your dog. Learn how this condition is treated and why it is important to have your dog seen immediately for any signs of this disease.
- Understanding the Purpose of Dewclaws in Dogs
Wondering the purpose and function of your dog's dewclaws? Learn what dog dewclaws are and when they are removed.
- Dog Health: Signs and Symptoms of Dog Hip Dysplasia
Learn the signs and symptoms of his dysplasia in dogs. Learn some effective strategies and products to make your dog's hip pain more bearable.
- Causes of Lumps on Dog Paw Pads
Wondering what may cause unusual lumps and bumps on a dog's paw pad? Learn possible causes for why your dog has lump on paw pad and why it's so important to see the vet.
- 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.
Vote and Share Your Stories to Help Others in Your Same Situation
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 Farricelli
Adrienne Farricelli (author) on June 13, 2020:
Great to hear that your English bulldogs was able to recover nicely from her ruptured cruciate ligament. I did conservative with both my Rottweilers. My vet actually suggested it surprisingly. I think the fact they were old when they ruptured played a role in her suggestion. It helped for them to lose some weight, lots of rest and good supplements.
Felipe on June 13, 2020:
My english Bulldog has complete rupture of crucial ligament in both legs. Here in Brasil It was suggested TPLO surgery for 10.000 reais. But another vet suggested conservative approach with rest and meloxicam. It was sufficient. After 4 weeks, my dog is not taking the meloxicam que she is walking normally. The vet said that the muscles and special anatomy of the english Bulldogs helps the recovery....
Missy on February 11, 2019:
Have the same problam dog with servee two acls teares
doggydancer on February 10, 2019:
I have been thru this with my own dog. Instead of buying the painful acl or ccl tplo or tta surgery, get a posh dog knee brace that will support the knee and in several months or sooner your dog will be walking normally without surgery and will no longer need the brace.
Those that buy the tplo or tta surgery have a greater chance of needing surgery on the other knee. It doesn’t matter if its a Mixed or Any Breed Dog, Huge size, or tiny size, they all can use a posh dog knee brace to start walking normally in only a few months without the pain and high risks of knee surgery, severe infections, sepsis, leg amputation, never able to walk normally again after surgery, in pain forever after surgery, bone cancer at the surgery site is common, etc.
If you need more info go to PoshDogKneeBrace .com as they have a lot of helpful info. My dog wore the posh brace for about 3 months for dog walks, and now it has been years and is still walking normally and never had to get tplo or tta surgery.
The vets will try to sell you surgery, and the vets will not tell you there are more effective solutions to healing a CCL or ACL dog knee tear like a posh dog knee brace. The tplo or tta surgery is painful knee surgery and high risks of severe infection, sepsis, screws backing out, amputation, bone cancer, and never being able to walk normally for life without pain from damage from the surgery.
Fortunately we found out just in time that a posh brace is a more effective solution for acl or ccl dog knee tears. We canceled the surgery and got the posh acl ccl custom brace and that was the best decision ever.
lauraallison on October 27, 2018:
My cross staffy lab, very active 9 years old had a torn acl, the vet said the only course of treatment was an operation costing £3000 which I did not have and I felt devastated until I read more about this invasive operation that doesn't always work, so I opted for the conservative route. I was offered an x-ray at £500 but she said it was to check for bone tumours, I said he slipped catching a ball, so wasn't sure why he needed an x-ray, however I left the surgery with a bottle of Loxicom, so he was taking that once a day for a few weeks and I was told to let him rest, weeks went by and I could see him getting more and more depressed, so I started to take him on short walks a few yards and I did this every few days and built up his walks, he was walking on 3 legs but the more I walked him he was starting to put more pressure on his back leg. He started getting back to his old self because he was getting out. It has been a long road for him but we are 8 weeks on and he can stand on both back legs, he still has a slight limp but does not seem to be in any pain,he runs up and down stairs and today was the first day I allowed him off the lead in the field, well he went berserk, enjoying his freedom and my heart was in my mouth as I thought his leg was going to give out but it didn't and by the time we got home he was still putting his weight on all 4 paws and still running around, his leg is not as strong as I would like it to be but short walks seemed to have helped the strength in his legs. I know his leg will get stronger by gentle exercise, he is used to walking up to 5 miles a day so this is a shock for him not to get out on his usual hikes. My other labrador had the same injury but she was only 4 at the time and that healed with conservative treatment too.
if this happens to your dog I would try the conservative route first, it isn't everyone who has the money for the op like myself and it isn't always the best way, don't let others make you feel any worse because you don't have the money for the op, you will feel bad enough because your dog has suffered this injury, patience and time worked for my two dogs and I hope the conservative route works for yours too.
Robb on August 28, 2018:
Doberman 7yrs old, 95lbs ACL partial tear. Vet saying surgery is the only recourse. I asked about a brace...and was told no, only the surgery. Called another local vet...surgery most likely. I asked about a brace and was told that they dont help.
When my brother tore his ACL, the brace helped. Im not sure wtf is going on with the Vets. I feel like its a car salesperson telling me that this is the only car for me. (my dog). Very disappointed, not sensing the truth. very odd predicament...my trust issues i guess.
TTA is being called for, its the end of Aug atm, they have an opening in Oct for him. after 3 days, he is putting some wt on the leg, but ive reduced his movement to minimium. no stairs, no running, no climbing etc. bought GlycoFlex3 to help. Calming aides also. damn. so frustrated. "feeling" like its all about the $5k from the vets.
im lost atm. its been 3 days...researching orthopets knee brace next.
Doberman forums have a mixture of +surgery and +conservative comments.
in short, he will relax...treating him well and hes staying put. we will see how things go over the next few weeks.
thanks for listening.
Jenny Prince on August 22, 2018:
We opted for a non-surgical approach for a torn ACL for our 70 pound dog, who was 14 years old at the time. He was not a good candidate for surgery due to his age and a history of spleen and liver cancer. Instead we opted for weekly underwater treadmill exercise seshes as well as acupuncture and laser treatment. We didn't use a brace. Additionally we used hemp and gabapentin for pain management as he could not take the usual pain meds due to his liver. He is also on a home cooked whole food diet and takes other herbs for inflammation. A year and a half later, He is fully recovered and insists on his full walk every day. If you try to con him into a half walk he will stare you down until he gets his way. He is also still climbing stairs. I agree with the article that movement is key to recovery. Surely everything we did helped. But keeping him moving daily at a slow controlled pace was crucial. Think about humans. You have a knee or hip replaced they have you up and moving right away. It was a long road to his full recovery, but our dog is a testament that it can be done without surgery. Was our choice less expensive? No. But if surgery isn't an option due to overall health or age, it's a solid choice. There's hope!
TONYA JONES, GEORGIA on August 06, 2018:
My 8 lb. Yorkie tore her right cruciate ligament recently 2018. Her left tore in 2013 and was repaired surgically by my vet using suture method for reasonable price. Now that she is almost 13, and small I've read she could heal on her own because. Now ortho vet charges $1480. How do I wrap the leg to stabilize?
Claire on December 06, 2017:
I tried your methods exactly to cure my Yorkie. He had torn crucial ligament on his back leg.
We moved our bedroom down stairs blocked off all steps and stairs, and trained him to let us lift him on and off the bed. Initially he was very quite, but now after 5 months he is full of bounce and life. He now enjoys his walks and play again, thank you so much.
richard havel on July 19, 2017:
even though I would have the surgery done ,I think about the complications of trying to keep the dog still with just walking on leash.i know he would chew a soft object on his leg to keep it from straining.he loves to run and play.he is a young adult Doberman.
Mary Wills on April 25, 2017:
I have a Jack Russell and his ligaments have collapsed he is 12 years old and my said he can either have surgery which at his age she did not recommend, he walk sort of flat footed and I was hoping that there is a product to build up his front ligaments please help will this Ligaflex help
Adrienne Farricelli (author) on April 17, 2017:
Mark, glad to hear that braces worked for your dog and that surgery was not needed. Sounds like a dog conservative treatment success story!
mark on April 17, 2017:
This article has the missing link that really worked. My dog was walking on 3 legs, vets said it was a complete worst case tear and the vets said only tplo surgery, but after researching the pain and the expense and high failure rates, I went with a dog knee brace and it healed in just a few months with no surgery.
Adrienne Farricelli (author) on May 09, 2016:
We did conservative treatment when my female teared her left and then later right ACL and didn't use a knee brace both times. Whether it's good to use one or not seems to be a subject of controversy. I would consult with an orthopedic specialists before considering one just to be on the safe side. Many people get a brace and think that because it's there, their dogs can do things they should not which can cause more problems down the road. I see that the last 2 user names above share the same IP addresses, which makes me believe that they are trying to advertise their products, so I warn people to do their homework before falling into biased marketing traps.
Alison on May 09, 2016:
I'm in a similar situation, I'm going to check out the Ortocanis dog knee brace and ask my vet about it..less than $50 seems like a great deal, and if people say it works, than it seems like a great product to invest in while my dogs recovers from this injury. Thanks for sharing your experience.
Jennifer on April 29, 2016:
Maya, we also used an Ortocanis hip brace on my dog when she was diagnosed with hip dysplasia. I'm glad to see that other people are finding their products as useful as we are!
I hope my lab never tears her ACL, but if she does this article has definitely opened my eyes to the different treatment alternatives.. I try to avoid surgery as a general rule of thumb and it's great to see there are other successful options out there!
Adrienne Farricelli (author) on April 22, 2016:
Glad to hear your dog got better with conservative treatment. We went through it with my female Rottweiler twice, first her left leg, then her right, we put her on a diet and rest, and she did well both times.
Maya from Connecticut, USA on April 21, 2016:
Wow 18% went with the conservative treatment and it worked! More than the people voting for having had successful surgery. We are one of those conservative treatment cases that worked. My dog was 10 at the time the tear happened.. we didn't want to put her through a stressful surgery and post-rehabilitation period. We also weren't so keen on dishing out thousands and thousands of dollars on a procedure that wasn't even guaranteed to work. So, with all of this in mind and with the advice of our vet, we went down the conservative road.
We also found the Ortocanis dog knee brace online to help stabilize the knee while it recovered. While the Ortocanis knee brace provides moderate support, our dog was on complete bed rest anyways so it was enough support for her, and the best part is that she didn't seem bothered by it or try to take it off. A year later of on again off again wear, the brace has held up and is still in great condition. All for less than $50!!
Obviously some dogs have a tear that is so serious that surgery is their only option, but for many of us the conservative treatment can be successful! It's something everyone needs to consider.
Adrienne Farricelli (author) on July 23, 2013:
Thanks for sharing bcplace, rupturing the other one is unfortunately a common happening. Great to hear though you have been successful both times! I am currently doing it with my Rottweiler and so far she is improving, we are 3 months into the process.
bcplace on July 21, 2013:
My border collie ruptured her right ACL when she was only 6 months old. Vet said she was too young for the surgery so I did conservative management. It worked. At 15 months she ruptured the left one. I tried conservative management again and it worked. She is now 26 months old and doing great - no limping at all and doing normal dog activities.
Adrienne Farricelli (author) on March 30, 2013:
Thanks for the tip! Will check that out when I have a moment, thanks for stopping by!
page1articles from California on March 30, 2013:
Alexadry: Your article has a lot of valuable information in it. I found the title to be confusing to read and almost didn't bother reading this little gym. You might want to run this through the title tuner tool that they offer here at hubpages because correcting your title might help your reach more readers and that would benefit dogs everywhere...
Eiddwen from Wales on March 29, 2013:
Another great hub by you to pass over to my fanily.
Thank you for sharing another great hub.
Adrienne Farricelli (author) on March 29, 2013:
It's good to do research and get different vet opinions when dealing with conditions that can wait a little bit. Some vets offer more conservative approaches at times.
Michelle Liew from Singapore on March 28, 2013:
Alexadry, keeping this for reference because like many, I would rather my dog not go through surgery if possible. Thanks for the alternative suggestion of conservative management!