Cruciate Ligament Surgery in Dogs

March 13, 2020

​The cranial cruciate ligament is a fundamental ligament located within the knee joint of dogs. It is also referred to as the ACL, or anterior cruciate ligament. This muscle allows for stabilization of the stifle of your dog when weight is applied to it during daily activities and keeps the shin bone, or tibia, stable in relation to the femur, or thigh bone. In people, rupture of this ligament is usually due to sports related injuries where it fails immediately. In dogs, however, this ligament tends to degenerate before it ultimately becomes weak enough to fail. For this reason, treatment of a torn cranial cruciate ligament varies a lot between humans and dogs. Reasons for the rupturing of this crucial ligament are not completely understood, however, some breeds such as Labrador Retrievers, Rottweilers, Newfoundlands, Akitas, Saint Bernards, and Staffordshire Bull Terries are more predisposed to this condition. For this reason, it is important to provide your dog with joint supplements if you know they are genetically predisposed to this unfortunate condition. By taking preventative action, it can lower your dog's chances of tearing their cranial cruciate ligament.

​Rupture of the cranial cruciate ligament is often associated with osteoarthritis within the stifle and can sometimes be linked to poor confirmation and gait. These factors are usually genetic and are exacerbated by bad breeding techniques. These factors are usually associated with almost every case of cranial cruciate ligament rupture and can often be detected through X-Ray imaging. Because osteoarthritis is a conditions which progresses and worsens over time, the tearing of your dog's cranial cruciate ligament can be prevented if detected early enough. When this crucial ligament is torn, it often brings along other conditions such as cartilage rupture within the stifle and an abnormality of the shin bone, or tibia. When the cartilage ruptures, surgery is necessary to remove the damage. In addition, poor gait and confirmation in some genetically predisposed breeds can lead to an abnormality of the shin bone, in which is grows abnormally and places destructive forces on the crucial ligament. With continuing abnormal forces, the ligament weakens over time and finally fails once it ruptures.

Signs of cranial cruciate ligament rupture vary, although some symptoms include lameness in the hind legs and stiffness. This can also lead to difficulty standing up and jumping, especially when both knees are affected by this condition. Another sign to look for is a faint "clicking" noise during movement. If you notice any of these signs in your dog, it is important to have them evaluated by a licensed veterinary professional. Signs your veterinarian looks for when diagnosing complete or partial rupture of the cranial cruciate ligament include muscle atrophy in the quadricep muscles, thickening of the stifle, instability, and pain when the joint is extended. If it is determined that your dog shows signs of a possible rupture, your veterinarian will often conduct a radiograph to determine the severity or presence of osteoarthritis and the angle of the shin bone. In some cases, your veterinarian may even take a sample of synovial fluid from your dog's knee and analyze it in a lab for inflammatory changes associated with infection and arthritis. Diagnosing a canine with a cranial crucial ligament tear varies depending on the case, but this video by Colorado Canine Orthopedics & Rehab discusses some of the factors which can lead to a diagnosis. In this video, Dr. Michael Bauer, DVM, goes into depth on the complications regarding anterior crucial ligament tears.

There are several treatment options for the rupture of the cranial crucial ligament, but some of the most common options are cranial cruciate ligament replacement surgery, tibial plateau leveling osteotomy, tibial tuberosity advancement, and meniscal surgery. Cranial cruciate ligament replacement surgery often involves replacing the ligament with a graft from your dog's body or a complete replacement using an artificial ligament. According to Willows Specialist Referral Service, "the long-term stability provided by grafts and artificial ligaments in large dogs with degenerative rupture of their ligaments is questionable. As a result the use of these replacement techniques is limited to specific circumstances." Tibial plateau leveling osteotomy is usually associated with changing the angle of the shin bone (tibia) relative to the femur. This is done by cutting the bone to a specific angle, rotating it, and stabilizing it using a variety of plates and screws. Tibial tuberosity advancement involves cutting part of the shin bone off and moving it forward, again stabilizing it with plates and screws. This procedure is usually performed on young, medium to large size dogs with rupture in both cranial cruciate ligaments. Finally, meniscal surgery involved removing the damaged section of the cartilage, which is usually faster and allows for a faster recovery time. This procedure can be performed through standard surgery or arthroscopically through the use of a camera.

Treatment for your canine companion is evaluated on a case to case basis, as there are many factors which can vary depending on your dog's unique situation. Ultimately, it is up to your veterinary professional to decide what is best for the health of your dog.

How Much Does Cruciate Ligament Dog Surgery Cost?

​Cruciate ligament surgery is very expensive, but prices can range depending on your insurance provider, your surgeon, and the extent of the damage to the ligament. According to Embrace Pet Insurance, "[tibial plateau leveling osteotomy and tibial tuberosity advancement] tends to go for about $2,000.00 USD to $3,000.00 USD per knee. Extra-capsular repairs by board-certified surgeons approximate $1,000.00 USD to $2,000.00 USD, but some general practitioners offer this latter option for as low as $750.00 USD.

After surgery, there are several post operation costs you need to consider, which tend to add up over time. In order to promote healing and prevent this unfortunate condition from happening again, your dog will most likely have to spend the rest of their life on a variety of pain relief medications and joint supplements. Certain nutraceuticals, or dietary supplements, such as glucosamine and fatty acids are commonly prescribed in order to protect the weakened cartilage within the stifle. In addition, anti inflammatories such as carprofen and meloxicam are commonly prescribed in addition to opiates such as tramadol.

For optimal recovery, it is important to factor in rehabilitation expenses as well. It is extremely important for canines to undergo weight loss and muscle building therapies in order to ensure the success of surgery. In addition to this, medicines associated with rehabilitation are often prescribed during this process. Several popular rehabilitation exercises include acupuncture and swimming, which is perfect for dogs who cannot put their whole weight on their weakened joints. Carol Wasmucky, a licensed physical therapist, says "dogs who are intermittently lame with a partial tear of the cruciate ligament are ideal physical therapy patient. In addition to providing weekly or twice-a-week ultrasound, laser, and electrical stimulation treatments, [I] put patients on a home strengthening program with range-of-motion and stretching exercises...swimming is such effective exercise for injured dogs that many veterinary clinics have installed swimming pools. Dogs who can’t yet do weight-bearing exercises can start in a pool, and as they get stronger, they’re able to progress through the exercise program. I check their progress in weekly appointments and make adjustments as needed." Joanna M. Freeman, B.Sc., P.T., C.S.C.S. says "the rehab period depends on the severity of your dog's impairments but it generally lasts at least four to six weeks. Treatment sessions range from $30 to $60, depending on the injury, rehabilitation needed, and the facility's location. Most dogs require daily therapy for a few days, followed by two to three times a week for the duration of the four to six week period. A weekly session can be enough for maintenance and weight loss."

How Long Does It Take for a Dog to Recover from Cruciate Ligament Surgery?

​The recovery of your dog depends on a variety of factors and how well you enforce your tailored treatment plan. According to Orthodog, "the effectiveness of the [treatment] methods relies heavily on several variables, including severity of tear, as well as the dog’s age and general health, activity level, current medications, and supervision level of the dog’s activity, among other factors." The owner of the animal has to dedicate several hours each day to their canine companion's recovery and rehabilitation. Healing can include complete inactivity for two to three months, with up to a year of limited activity afterwards. For the fastest recovery times, it is important to be very involved in the healing of your pet and enforce any treatment plans given to your by your licensed veterinary professional. Enforcing your treatment plan can be tough, as your dog will likely exhibit signs such as not wanting to drink, disorientation and fatigue, howling and wining, bleeding at the surgery site, and adamantly refusing to wear their neck cone. Even though we want the best for our dogs, it is important to be as strict as possible when it comes to their treatment plan so they do not injure themselves and hinder their recovery. It is always advisable to follow the instructions of your veterinary professional for optimal results and the fastest recovery time.

How Successful Is ACL Surgery in Dogs?

​The success of your dog's surgery varies depending on a variety of factors, such as your dog's breed, age, type of surgery, extent of the injury, and how well you enforce your treatment plan. According to Metropolitan Veterinary Associates, "the success rate of either surgery is between 85-90%. This means your pet should get back to normal or near normal activity over a 2-4 month period. There are a small percentage of dogs and that do not do well following cruciate ligament injury, no matter how they are treated."

There are several complications which may arise as a result of surgery which can complicate the healing process and affect its success rate. Some of these complications include anesthesia, infection, implant failure, isolated meniscal injury, fabella pain, tibial tuberosity fracture, and patellar tendon inflammation.

With anesthesia, there is always a risk, however, it is rare that there are significant problems. When put under an anesthetic, your dog will be monitored by a veterinary nurse, who will keep track of their heart rate, respiratory rate, blood pressure, and intravenous fluids. Normally, your dog will also be placed on a circulating warm water blanket so they can better maintain a healthy body temperature. Infection is always a real possibility following any surgical operation. Although infection rates are generally low, there are a lot of factors which can increase the chances of infection. In most cases, infection occurs when post operative treatment is not enforced and the dog is allowed to lick or chew at the surgical site. However, in rarer cases, it can also be due to improper or unsterile surgical technique. Another complication is implant failure, as it can prematurely break down due to broken sutures or unrestricted activity. This is more common in large, active, or obese dogs. Implant failure can also be due to failure of the plates or screws used to stabilize the joint. If these were to fail, further surgery is most definitely required at an extra expense, and is commonly more difficult to treat. Isolated meniscal injury can occur to any dog, and is a problem associated with the cartilage within the stifle. It is not possible to predict what dogs will be affected but proper post operative treatment will lower your dog's chances of developing this condition. Fabella pain is a complication due to several surgical techniques, and affects a small bone behind the dog's knee. This is rare, but this can cause dogs a lot of pain and can easily be removed in a simple surgery. Tibial tuberosity fracture could also occur, and causes a fracture through the top part of the shin bone, or tibia. Surgery is often required to fix this issue, with extra stabilizing plates and screws often necessary. Finally, patellar tendon inflammation is an uncommon complication which can make the recovery process even longer. Fortunately, this condition does not require any additional surgery, however, activity will need to be restricted for a longer amount of time.

Can a Dog Live With a Torn ACL?

​Although it is possible for a dog to live with a torn ACL, it brings about several consequences which may be worse than the original condition. According to Dr. Phil Zeltzman, DVM, DACVS, CVJ, "from a surgeon’s standpoint, an ACL tear is a very fixable problem. Sure, it is possible to survive with a torn ACL. Sadly, it may be the only option if you absolutely cannot afford surgery. However, if you can afford surgery, it will dramatically improve your dog’s quality of life. Several vicious cycles set in after the ACL tears. For example, pain leads to lameness, which leads to poor use of the leg, which leads to muscle atrophy. Inactivity leads to weight gain, which leads to more pressure on the joints, which leads to pain." If not fixed early enough, several other conditions can set in which will make your dog's quality of life extremely bad, not to mention the fact that they will constantly be in pain.

There are many consequences of not repairing a torn crucial cruciate ligament. First, your dog will constantly be in pain, and will most likely require many pain medications. Although they can help manage the pain and stop the limping, they will never truly fix the problem. In addition, the longer the injury persists, the more arthritis is seen in the joint. Unfortunately, there is no "arthritis medication" and it is a life long condition. This can truly exacerbate your dog's pain. To treat this, your dog will most likely have to go on a variety of joint supplements. Also, when the torn cranial cruciate ligament is not repaired, your dog's body will try and repair it using scar tissue. This is hardly ever strong enough to keep the stifle stable and will limit your dog's range of motion. With a stiffer joint, your dog will be unable to bend or extend their knee to its full range. This can lead to misuse of the leg, which, in turn, can lead to various levels of muscle atrophy. Not using the leg can lead to exercise intolerance, worsening your dog's already terrible condition. Finally, when the cranial cruciate ligament tears within one knee, your dog will often be forced to shift his weight to the opposite leg, which may lead to a tear in that leg as well. In addition to another tear, your dog will also suffer from a change of posture and gait which can affect all other limbs and their spine.

It is important to consult your licensed veterinary professional about any decision you make regarding your canine companion's health. They are almost guaranteed to be your best resource when it comes to managing the health of your pet, and can most likely find a treatment plan that works best for you and your beloved pet.

Health Insurance for Dogs

Does Dog Insurance Cover ACL Surgery?

​Having a dog is a lot of fun and a blessing in many people's lives, however, they can be quite expensive to care for. This is why many pet owners resort to purchasing a pet insurance plan, which covers them should an unfortunate injury such as a cranial cruciate ligament tear were to occur. According to 365 Pet Insurance, "cruciate or ACL (Anterior Cruciate Ligament) injuries are probably one of the most serious injuries that can happen to your pet, and they can be very expensive to repair. Pet owners spend approximately $1.3 billion every year on ACL surgeries just for dogs alone. Although most pet insurance companies will pay for ACL surgeries and treatment, most insurance companies have some sort of exclusions or limitations for ACLs. Pet insurance is a great way to cover ACL injuries, provided you have signed up your pet prior to an injury presenting itself."

Most pet insurance companies will cover a torn cranial cruciate ligament surgery on either leg given that the dog has no previous history of cruciate ligament problems, and sometimes, a history of limping. In addition, some companies will only cover your dog after they have had a full year of insurance coverage. This can be waived for some companies, given your veterinarian certifies that your dog's knees were in an otherwise healthy condition beforehand.

Some of the top pet insurance companies which cover cranial cruciate ligament surgery include Nationwide Pet Insurance, Healthy Paws, Embrace, PetFirst, Hartville, and Figo. If you want to make sure your dog will be protected in the event of a disastrous condition such as a cranial cruciate ligament tear, it would be wise to look into coverage under a pet insurance company. Although it may be expensive at first, it will give you peace of mind about the health of your pet and might even save you on veterinary bills in the future.

Can a Dog Recover from a Torn ACL Without Surgery?

​Although it is possible for your dog to recover from a torn ACL in some cases, it is not true for all situations. There are a variety of factors which can affect your dog's healing process, and there are several non surgical alternatives. According to OrthoDog, "the answer isn’t black and white. While it is possible for a dog to recover from an ACL tear using surgery alternatives, it is not true for all dogs. In some cases yes, and in other cases, no. As with any dog health concerns, it is always recommended that dog owners get an expert opinion. Once a licensed veterinarian diagnoses your dog with a torn cranial cruciate ligament, the next step is for you to look into all available options in order to support your pup’s health. Treatment modalities can include invasive surgery or a conservative management, such as a dog brace to stabilize the knee joint or supplements to support joint health."

When it comes to surgical alternatives, many dog owners look into purchasing a canine cranial cruciate ligament brace for an easy, cost effective solution. Knee braces allow the stifle to be stabilized and supported bu limiting flexion and extension so that scar tissue can be formed over the tear. This can help your dog with healing naturally, although, it is not always effective. Using this method depends on the extent of the tear and how well using the brace is enforced. When wearing a brace, a soft tissue injury in your dog can be expected to heal within six to eight weeks. There are also a range of other alternatives, such as acupuncture, swimming, and massage. These can aid in your dog's recovery, but are commonly used a post operative therapy treatments. Other supplements such as fish oil, turmeric, glucosamine, and fatty acids can aid in the recovery of your dog and are often given pre and post operatively to promote healing.

Final Remarks

​When it comes to the health of your canine companion, it is important to get any medical advice from a license veterinary professional. Even if you do not have the facilities to go with surgical options, it is possible that your veterinarian will be able to come up with a treatment plan that works best for you and your canine companion. As with anything health related, it is recommended you go over the pros and cons of each option, whether they are surgical or not. It is hoped that your dog will be able to get the treatment they need and return to themselves in no time.

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