Barbara Fitzgerald is an AKC Breeder of Merit and author of the column "Conversations with Champions" for the BCSA magazine, Borderlines.
All Dogs Are Predisposed to ACL Injuries
The ACL (anterior crucial ligament) tear or rupture is a relatively common canine injury affecting almost one million dogs a year in the USA.
Currently, national costs to treat this injury in dogs are over $1.5 billion dollars a year, and treating a dog surgically costs on average between $3,000-$3,500.
Additionally, dogs receiving surgical intervention can expect a substantial rehabilitation time of up to three months for successful surgeries. Approximately 5% of surgical interventions are unsuccessful.
Today, the standard of care typically involves one of two surgeries; TPLO (tibial-plateau-leveling osteotomy) or LFS (lateral fabellotibial surgery). However, a new and much less expensive and non-invasive treatment option, platelet rich plasma (PRP), is being tested with good results.
Why Are ACL Tears and Ruptures Common Injuries for Dogs?
The physical dynamics of a dog’s hind leg predispose him to ACL tears and ruptures. Because the dog stands on his toes, unlike humans who stand flat-footed, there is constant pressure to thrust the tibia (the main lower leg bone) forward and out from under the femur (the main upper leg or thigh bone).
Dogs can experience a tear or rupture as a result of intense physical activity or even just by walking to the mailbox.
The Anatomy of a Dog's Leg
The femur and tibia are held in place by two ligaments, the cranial or anterior crucial ligament (ACL) and the caudal or posterior crucial ligament. These two ligaments join the femur to the tibia by crossing each other inside the knee joint from front to back. The ACL prevents the tibia from slipping out of position.
What Happens When the ACL Is Injured
When the ACL tears partially or ruptures completely, it causes instability in the joint. Without the restraint of the ACL, the tibia is now more free to move to the front of the femur, potentially causing damage to the medial and lateral meniscus (the protective pads between the two bones).
Additionally, the instability causes joint inflammation, pain, and ultimately arthritic changes to both the tibia and femur, resulting in long-term damage when left untreated.
Symptoms of an Injury
Generally, dogs with ACL tears or ruptures avoid putting weight on the affected leg when standing. As they move or increase the speed of their gait, they may appear normal. However, when returned to a standing position, they will remove weight from the affected leg.
This condition may wax and wane. Dogs may have worse days than others and may “warm” out of the condition as they exercise. However, the knee joint remains swollen and abnormal wear between the femur and tibia and on the meniscal pads causes a loss of range of motion as a result of arthritic changes. Bone spurs may begin to develop as well.
ACL tears are diagnosed by a combination of a physical exam and x-rays. X-rays will not show the actual ligament. However, they can show secondary symptoms of a torn ligament.
These include excess fluid in the knee both in front of and behind the knee joint. Granulation of the bone (remodeling) and osteophytes (bone spurs) can be seen as well, and may begin to develop within three to four weeks of the injury.
Physically Examining for an ACL Injury
The physical exam involves a procedure known as the “drawer test.” In this exam, the dog’s femur is immobilized, while the examiner attempts to move the tibia out in front of the femur. If it moves in front of the femur like a drawer opening, then it indicates a torn ACL.
Dogs may be able to stabilize their knees by tensing their other muscles against the action. An especially nervous dog may need to be slightly anesthetized to determine the true range of motion in the drawer test.
In a second physical test, the femur is held in place while the ankle is flexed. If the tibia moves forward abnormally, a ruptured ligament is suspected.
Additionally, the veterinarian should examine the knee joints of the healthy leg and affected leg to determine the degree of swelling. Swelling on the inside of the knee, called a “medial buttress,” will indicate the development of arthritis in dogs with old ACL injuries.
Dr. Michael Bauer Discusses Clinical Signs of ACL Symptoms
Treatment of ACL Tears and Ruptures
In instances where the ACL is completely torn, surgery is the only option to stabilize the joint.
When the ACL is partially torn, it is inevitable that it will fully rupture without some type of intervention, as the remaining weaker ligament must fully restrain the tibia.
The knee joint has a relatively low blood supply, and the torn pieces of the ligament are resorbed by the body. To generate new tissue, a growth factor must be introduced or replacement ligament must be surgically introduced.
Herbs and Supplements
Until recently, nonsurgical treatment has been largely holistic. Herbs and supplements such as turmeric, glucosamine, Omega 3’s and Glycoflex are administered to reduce inflammation and further damage to the joint. Nonsteroidal anti-inflammatories and NSAIDs may be given as well.
Adequan vs. Polyglycan
Adequan, frequently used for horses, may be injected as it can help prevent cartilage in the dog’s joint from wearing away. Another drug frequently used, Polyglycan, a less expensive substitute for Adequan, has been shown to be less effective than Adequan in reducing swelling in horses.
Additionally, it has side effects that may include sterility with prolonged use. Owners can be taught to administer Adequan themselves at home. Injections are given twice a week until symptoms improve, and then once a week for maintenance.
Rest and limited exercise while avoiding weight gain are also critical in the management of joint disease and damage.
What Is PRP?
Platelet rich plasma therapy has been used with success to treat arthritis in joints, muscle, tendon, and ligament damage.
In this process, the blood is drawn from the patient and then centrifuged to concentrate the platelets as well as remove the majority of white and red blood cells. Then, the plasma is injected back into the patient at the site of the injury. Its injection may be peppered along the site of the injury to maximize its beneficial effects.
How Can It Help?
The rationale behind this treatment is twofold.
- Inflammation must be removed from the site for the healing process to begin, and growth factors must be introduced to aid the healing process and to encourage new tissue growth. Platelet rich plasma, or PRP, accomplishes both of these tasks. When tissue is initially injured, the inflammation that is triggered stops the spread of infection and clears away damaged tissue. But healing of the tissues will not begin until the inflammation process is turned off. Platelets introduced to the site of the injury attract white blood cells to the injured area that will clear away the remains of the dead and injured cells.
- Additionally, the blood platelets release growth factors that are directly responsible for tissue regeneration. Known as cytokins, they include a series of growth factors including epithelial growth factor, transforming growth factor, insulin growth factor, and other important growth factors. Because it comes from the patient, there is no risk of rejection. It is for these two reasons PRP treatment is being promoted and tested for ligament, muscle, tendon, joint, and bone injuries, which are normally slow to heal.
Other Benefits and Uses
PRP can be used as a treatment of the injury or to aid in healing following surgical intervention. Additionally, PRP is substantially less expensive than surgery. The typical TPLO surgery ranges from $3,000-$3,500, while PRP is approximately $500 per treatment with a recovery time of about six weeks of leash walking.
Dogs may need to be retreated with PRP in order to continue the growth of new ligament tissues.
The long-term benefits of PRP therapy have not yet been fully determined.
Stem cells have also been researched in conjunction with new tissue generation. Just as in PRP therapy, stem cells bring growth factors to the site of the injury.
However, within 24 hours of injection as many as 95% of the stem cells have already died. Given that stem cell treatments cost $3,000 on average per treatment, PRP seems to be the better alternative for experimental nonsurgical treatment for canines.
Your Dog Might Still Need Surgery
At this point in time, neither PRP nor stem cell treatment will guarantee that your dog will never require surgery. Long-term case studies will be required to understand the benefits of PRP and how long they can be expected to last.
However, a study on Standardbred race horses with severe ligament injuries did show that PRP treatment allowed them to return to racing. With a shorter recovery period and a much lower cost compared with surgery, PRP is worth exploring with your orthopedic veterinarian.
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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.
Debbie Cooper on June 03, 2018:
My Australian Shepard has a tear in his cruciate ligament. After x-rays and physical exam it showed some inflammation but no other changes. I have had great success injecting my horses with PRP so I thought it could be an option for my dog. My son ( a veterinarian ) injected both knees 3 weeks ago. It is unbelievable how much better he is already! He was clearly in obvious pain which is no longer visible. Not only is this treatment a lot less expensive but a lot less invasive. I’m sure that not everyone might not get the same positive results that I have so far, but it is sure worth a try!
Erin on February 28, 2017:
My sister's pit bull had a partial torn CCL. He was given the PRP treatment and in a few months was back to his old self. He injured it at a year old. He also took daily glucosamine and was on strict crate rest for a few week. He does have signs of arthritis now at 5 because of the injury. He is still an active dog and walks daily.
Barbara Fitzgerald (author) from Georgia on July 05, 2016:
Hey SmartandFun: The PRP therapy in Atlanta was $500 per treatment. I don't know if that is in your budget. Non-steroidal anti-inflammatories would be your least expensive goto - but they are a lifelong commitment. They have helped racehorse get back in the game. Each case is its own diagnosis and outcome. You may want to see if you can find used knee braces on Ebay.
SmartAndFun from Texas on July 01, 2016:
I have been reading all I can find about dog ACL injuries on the internet for about a week now, and this is the first I have heard about PCP. Is it difficult to find a vet who will perform this treatment? Can anyone who has used it report back on how it worked?
My dog has injured both her ACLs at the same time, so the price for surgery is doubled so I am looking at $8000. I love my dog but... would love to find a more affordable treatment. Plus she is 9 years old, so I worry about her undergoing two surgeries.
I am looking now at the Posh Dog Knee Brace, which for two of them adds up to more than I'd like to pay, but it is much less than two surgeries.
I looked at the Ortocanis brace Maya used, but my dog cannot walk at all at this point. The Ortocanis brace just doesn't seem rigid enough to support my dog's weight/knees. Plus, the company is in Spain. If Maya sees this, I'd love to learn more as Ortocanis braces are much less expensive than the Posh Dog braces.
Sorry for the long message and thanks in advance to anyone who can chime in with more information on leg braces or PCP.
Barbara Fitzgerald (author) from Georgia on April 29, 2016:
A knee brace is an excellent idea to help prevent further damage and injury to the joint while the inflammation clears out.
Leslie on April 29, 2016:
I had never heard of the PRP treatment before... seems like a really interesting treatment option for this common disorder. When my dog tore her ACL my friend recommended trying the Ortocanis dog knee brace to help stabilize and support her knee.. I truly think it made all the difference in her successful recovery.
Maya from Connecticut, USA on April 18, 2016:
My vet just recommended we use an Ortocanis dog knee brace to help stabilize her knee during recovery and it also helps to keep the area warmer.. reducing pain.
going to try mixing this into our conservative treatment plan!
Maya from Connecticut, USA on April 08, 2016:
And what about using a dog knee brace to help stabilize the knee while it repairs itself?
Barbara Fitzgerald (author) from Georgia on December 31, 2015:
Hi surgLVT - Thanks for visiting. You seem to know a lot about veterinary medicine. You should, therefore, know that the ACL (Anterior Cruciate Ligament) is the same as the Cranial Crutiate Ligament. I offer this quote from PetMD.com - "Cranial cruciate ligament disease , also referred to as the anterior cruciate ligament (ACL), is the sudden (acute) or progressive failure of the cranial cruciate ligament, which results in partial to complete instability of the stifle joint." We chose to use the ACL as it is most commonly used by laypersons seeking treatment options for their dogs. The information in this article comes from discussions and interviews with the top veterinary orthopedic surgeon in the Southeast of the United States, Dr. Matt Corse, DVM, MS. This is a new technology that is still being tested for efficacy in treating partial crutiate tears. The article will be updated as new studies emerge.
surgLVT on December 30, 2015:
Dogs will most commonly tear their CCL (cranial cruciate ligament), not their ACL...that's a big mistake to be in an article giving veterinary medical advise. Try speaking with a boarded surgeon to get your information on surgical vs non-surgical repair options. They went to school and through residency for a reason and are your best bet for helping you choose the best care plan for your pet...be careful where you get information online, you never know the real qualifications of the writer and where their information (or misinformation) is coming from.
Barbara Fitzgerald (author) from Georgia on June 27, 2014:
Hi Peg: That is great you found a surgeon that did a top notch job. I know that surgery is very expensive these days; this treatment when it works can provide substantial relief at 1/5 the cost of surgery. But it is not guaranteed to work in all situations.
Peg Cole from Northeast of Dallas, Texas on June 27, 2014:
These are interesting new developments in the medical treatment for torn ACL injuries. Our large flat-coated retriever tore his ACL and had surgery nearly 20 years ago. The injury was extremely painful. He couldn't walk at all. We were extremely lucky to find a top notch surgeon who repaired his leg as good as new. Thanks for this enlightening look into the latest techniques available.
Jane Wilson from Geogia on March 04, 2014:
Hi Bella's owner: Let me know how she does with the treatment. Is there a followup treatment recommended at a certain interval?
Best wishes for a full recovery for Bella!!
Bella on March 03, 2014:
My wife and I just had our American Bulldog named Bella at the Midwest Animal Hospital in Orland Park, IL for the PRP Injections (both knees) today. Dr. Woodside did the procedure and is extremely knowledgeable about the entire process. The PRP Injections are being done vs. the TPLO Surgery (not even recommended; TTA Surgery for the ACL Tear is the best Surgery if this is ). Price is reasonable and it's non-invasive!!!
Barbara Fitzgerald (author) from Georgia on November 25, 2013:
A friend of mine did the PRP treatment on her border collie about 3 weeks ago. I will keep you posted on his progress.
Adrienne Farricelli on November 24, 2013:
This article was very helpful to me, as my girl has a torn ACL. Took quite a while for the vets to diagnose it, I had to see 3 different ones! One told me her limping was due to a small lump she had on her foot and needed surgery, I didn't believe it, and did well, as the lump disappeared on its own 2 months later. Saw another vet, did drawer test and didn't find anything. Third vet, did drawer test, but told me drawer test must be done with sedative as dogs are tense upon examination and may hinder diagnosis. So under sedatives, the drawer test was finally declared positive. I have been doing conservative management for 6 months and so far so good. I wasn't aware of PRP therapy, I 'll consider it as an other non -surgical option, voted up!