Part I: Symptoms and Diagonosis | Part II: Treatment and Management
Canine ACL tears are debilitating to a dog. Oftentimes, full tears to a dog's ACL will require surgical repair to avoid severe, progressive osteoarthritis. Surgical repairs to ACL tears have a high success rate (usually around 95% for all the procedures), but as with all surgical procedures there is always risks involved. For partial tears, non-surgical treatment may be the better, less invasive option, with surgery as a back-up if the injury does not heal properly.
There are several cruciate surgical techniques used to treat ACL injuries in dogs. However, there is no clear research that points to one technique having better success and outcome than another. That said, some surgeries are more complicated than others and therefore risks of complications may be higher and the surgery more costly. Some techniques may be better at preventing osteoporisis (arthritis) and others better suited for certain-sized dogs and to individual cases.
Your veterinarian will recommend treatment for your dog based on his/her size and age and the severity of the injury. It is important to discuss with your veterinarian what is the most suitable treatment options with your veterinarian.
Non-surgical, or conservative, treatment may be effective in treating dogs with partial ACL tears. Conservative treatment can be especially effective in dogs who are less than 30 pounds (13.5).
Conservative treatment includes strict confinement/rest for 6 weeks to 2 months. During this time gentle physical therapy and anti-inflammatory medications (NSAIDs) are prescribed. Other non-invasive treatments include acupuncture, massage, nutrition, aqua therapy, the use of a leg brace, nonsteroidal anti-inflammatory drugs (such as glucosamine and Perna canaliculus/New Zealand Green Lipped Mussel), weight loss for overweight dogs.
If conservative therapy does not result in improvement, then surgery should be considered.
With surgery, the aim is to repair cranial cruciate ligament ruptures and stabilize the injured joint, returning the joint motion to normal, while reducing the forces that put undue pressure on the knee. Depending on which surgery is performed the cost can range between $900 to $3500.
ACL surgeries include:
Lateral fabellotibial suture (or lateral suture or the de Angelis suture). This surgery has been performed for over 30 years and is considered quick, affordable, and safe. The procedure appears to be most effective for smaller dogs (less than 40 lbs/20 kg) as near normal function of the leg is returned. Larger more athletic dogs appear to only have fair outcomes. It also has been observed that this surgery results in thickening and swelling around the joint that may suggest arthritis or more scar tissue.
Tibial plateau leveling osteotomies (TPLO) - This surgery has been around for 10 years. TPLO changes the angle of the knee joint by cutting the bone (an osteotomy) so there is less force acting on the cruciate ligament. A line cut across the shaft of the tibia is made. it is then rotated and held in place with a metal plate and screws.
Dogs who get TPLO surgery are usually back on their feet faster and with less arthritis than with lateral suture. However, as it is a more complicated surgery, there is a higher complication rate. TPLO is recommended for large, athletic dogs.
Tibial tuberosity advancement (TTA) and Triple tibial osteotomy - TTA changes the relationship of the patellar tendon and tibial plateau angle via an osteotomy (bone cut). Both of these procedures attempt to stabilize knee joint by using existing tendons as well as cuts in the tibia. They are like variations of the TPLO procedure.
Veterinary surgeons recommend these procedures for large dogs as well. Dogs who get TTA usually begin using the leg more quickly than patients having a TPLO procedure, because with the TTA procedure, the tibia is cut only in a non-weight bearing area. The femur sits on top of the uncut portion of the tibia, not through a line cut across the shaft of the tibia, as in the TPLO procedure.
Overall, newer surgical techniques are better at addressing the progression of osteoarthritis and appear to have a higher success rate in larger dogs than lateral suture.
Rehabilitation after Surgery
Care of the incision: During the first 2 weeks after surgery, special attention needs to be paid to the surgical incision. Your vet should outline what to look for and how to care for the wound. Swelling around the incision should go down over a 2-week period. Your veterinarian will remove the sutures usually 14 days following surgery.
Limit Activity: After surgery a dog will need to stay off the injured leg for several weeks (usually between 8 to 12 weeks). If excessive activity is allowed too soon after surgery, stabilization of the knee can be lost and a dog may require additional surgery. Damage can cause problems with the incision, deep tissue, cut bone, implants and create scar tissue. It is therefore critical your dog rest and stay off his/her leg while it heals.
After the initial 48 hours, a routine of light phyiscal therapy should begin.
Physical Therapy Regimine. Physical therapy is a criticall part of the process towards healing ACL injuries. By making time to take your dog to a registered physical therapist, and adhering to your vet's prescribed physical therapy plan, you will give your dog the best chance of healing properly and returning to normal activity.
Keeping to a daily regimine may be difficult to achieve with life's hectic schedule. Therefore, it is better to do less than do more when it comes to physical therapy. It will not do your dog any good to rush therapy and try to push the healing with aggressive or infrequent therapy. However, physical therapy should not be ignored if you wish your dog to get back to normal activity and regain normal range of motion in his/her knee joint. Always consult with professionals when undertaking a physical therapy regimine for treating ACL injuries.
Therapy will include:
Once healed, dogs can go back to doing virtually any activity, including running, jumping, playing with other dogs and playing ball.
Previous: Part I: Symptoms and Diagnosis
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