It all started with a tiny limp. Not much to notice really. I thought she’d bruised her paw pad or twisted her ankle chasing squirrels. Nothing out of the ordinary–nothing that had not happened before. But, the next day, the limp was worse–much worse. Lady had trouble getting out of the cushioned round of her dog-bed. She kept her right back paw practically off the ground when she walked.
I took her to the vet and after a series of x-rays and a thorough examination, the doctor determined she had an Anterior Cruciate Ligament (ACL) tear. The veterinarian told me that this is an injury common to dogs and that golden retrievers and cocker spaniels, of which Lady is a mix, are especially susceptible to ACL injuries. Rottweilers and cocker spaniels are the most genetically inclined to ACL tears and ruptures. However, Labrador retrievers, German shepherds, mastiffs, golden retrievers, miniatures, and toy poodles also are more frequently affected by this injury than other breeds of dogs.
Lady was lucky. The x-rays determined no arthritis had developed in the injured leg. ACL tears left untreated develop arthritis and often (in 20% of all affected dogs) lead to tearing in the unaffected hind leg. And, while the ACL injury itself is reversible, any arthritis that occurs due to the injury is not. Lady’s vet told me there were both surgical and non-surgical options. He recommended surgery as the best course if the leg didn’t improve within a few weeks time.
Recuperation from ACL surgery takes 3-6 months and includes physical therapy for the repaired leg. Even after surgery, many dogs never regain full function in the leg. Since this injury occurs most often in sporting dogs, this means they’ll still be able to live long and happy lives, but it’s unlikely they’ll be able to resume competition trials or an active hunting schedule. For your average sedentary pet, it means he’ll have almost normal function in his or her leg, but will be more subject to injury in the future.
There are a number of surgical options available for ACL repair. The first of the two types of surgery for which Lady was a candidate, is Intracapsular Ligament Replacement (ILR). It involves transplanting either tissue from other parts of the dog’s body or using synthetic ligament in place of or to reinforce the torn muscle. This new ligament holds the tendon together and allows it to heal. This surgery is typically used on smaller dogs (under 40 pounds) and takes less recovery time than the other two surgeries.
The second surgery commonly used is Extracapsular Stabilization (ES). It stabilizes the knee joint using synthetic material that allows another ligament in the knee joint (the lateral collateral ligament) to replace the function of the injured cruciate ligagment.
The third type of surgery is used solely on larger breeds of dogs. It’s called Tibial Plateau Leveling Osteotomy (TPLO). A bone cut is made in the tibia and is then stabilized using a bone plate. By changing the anatomy of the knee joint, the TPLO eliminates the need for the cranial cruciate ligament.
Lady’s ACL tear was partial. The vet could see it on the x-ray and feel it during examination. Because this wasn’t a complete tear, there was some chance that the tear would repair itself. This is very rare and only occurs in small dogs and cats. In actuality, the tear doesn’t heal itself, rather, it builds up scar tissue allowing it to function near normally. Again, it is more subject to re-injury and a dog with any ACL injury repair, surgical or non-surgical, will need to limit his or her activities in the future. Weight loss for heavier dogs and glucosamine/chondroitin taken daily are also recommended.
Lady had been taking a low grade glucosamine/chondroitin supplement for several years, but her vet recommended she use a greater dosage. She also had a prescription for non-steroidal anti-inflammatories and bed rest. Lady didn’t seem to understand the bed rest prescription and continued to eye squirrels longingly. We decided to wait three weeks to see how Lady progressed on non-surgical treatment. Because she weighed less than 30 pounds, Lady’s vet believed the tear, which was slight, might recover on its own.
After, three weeks, Lady went in for another check-up. Her limping had stopped completely. The vet continued her prescription of glucosamine/chondroitin; but took her off of anti-inflammatories. We waited another two weeks to see if the limping would resume. It didn’t. It’s been several months since Lady first sustained her ACL injury. She’s on a regular dose of glucosamine/chondroitin and limited activity. She has to watch her weight, since extra weight aggravates this injury, as well as contributing to several other serious diseases (diabetes, heart disease, etc.). Those long 30 minute walks have become 20 minutes walks, except on weekends when we check out the dog park for a longer walk and sniff-about.
Lady is twelve years old (thirteen in August). Both the vet and I think we made the right choice for her ACL injury, given the long time for recovery, the chances of future injury, Lady’s age, and the risks that surgery involves. However, surgery is no doubt the best option for very young dogs or very active dogs. Lady, a long-time cushion-setter, seems happy enough with her limited exercise and yummy glucosamine (in vanilla and liver flavors). But, every owner needs to consider the needs of his particular dog.
Your veterinarian can give you more information about ACL injuries and several good sources can be found online for general information about ACL injuries, their symptoms, and their treatment. I was surprised that I had heard so little about this injury, which is apparently very common in dogs. Many dogs sustain an ACL injury at some point during their lives and many ACL injuries, no doubt, go diagnosed or are mistaken for arthritis. It’s very important to have ACL injuries treated early on since arthritis will develop if they are left untreated. And, arthritis, unlike ACL injuries, has no reversible treatment.
The best course for ACL injuries is, of course, to avoid them entirely. Make sure your dog stays well within his or her healthy weight limits. Dogs over the age of eight (for small dogs) and six (for large dogs) should begin taken glucosamine/chondroitin. Avoid over-exerting your dog. Dogs, like people, tend to remain sedentary throughout the week and play the weekend warrior on Saturday and Sunday. This is no healthier for your dog than it is for you. Your dog needs to be active every day, to maintain a healthy weight, and to limit his activities to his age and breed. If he or she does sustain an injury, then there are many options, including surgery. ACL treatment is making advances every day and no doubt surgery will become less stressful and invasive in the next few years, and most pet insurance covers ACL surgery and treatment (on multiple legs).
I was lucky to discover Lady’s injury early and to have a vet that made a quick and decisive diagnosis. Thanks to good information and great veterinary treatment, Lady’s doing fine. But, she’ll have to be careful in the future.
