An Introduction to Dog ACL Surgery
As a pet owner, you have a lot to think about when it comes to your dog’s health and physical well-being. When you have received a diagnosis for your dog of an ACL tear or if you’re noticing symptoms of an injury or chronic pain, Veterinary Specialists of the Rockies can be your biggest resource. We are here to help manage veterinary emergencies as well as to provide specialty veterinary support, like surgery, when you and your family veterinarian suspect that dog ACL surgery is needed.
Learning that your dog needs ACL surgery can be scary and there are several things you might like to know.
- For a quick introduction, did you know that dogs do not have ACLs (anterior cruciate ligaments) as people do? In dogs, the connective tissue of the knee is called the CCL or cranial cruciate ligament. It is the CCL that connects the bone above a dog’s knee (the femur) to the bone below their knee (the tibia). Because many people call a dog’s ligament an ACL, for this article we will use the terms ACL and CCL interchangeably.
- ACL surgery has been performed by highly-skilled, veterinary surgeons like our surgeon specialists here at Veterinary Specialists of the Rockies for over 20 years.
What Happens During Dog ACL Surgery?
To help you consider if dog ACL surgery is the best approach for your pet, it may help to know the basics of this common surgery. Dog ACL surgery requires making a small cut at the top of the tibia bone, which includes the weight-bearing part of the tibia, the tibial plateau. This is called an osteotomy, with the entire procedure known as tibial plateau leveling osteotomy (TPLO). The cut portion of the bone is rotated, reducing the slope of the tibial plateau. During the surgery, we also stabilize the parts of the bone using a plate and screws while the bone heals. You may be able to better picture this as a small, forced break that is used to reposition and stabilize the bone, which will help to stabilize the knee.
Injury or Chronic Conditions that Can Lead to Dog ACL Surgery
Above we mentioned that the CCL or cranial cruciate ligament in dogs is the same as the ACL in people. It is responsible for limiting things like over-extending and over-rotating the knee. When an injury or chronic condition leads to a tear, it is known as a cranial cruciate ligament rupture (CCLR), which is the most common cause of lameness in the hind legs of dogs.
Why this usually occurs is a little different in dogs than in people, too. Though a traumatic injury is the most common reason for ACL tears in people, CCLR (ruptures or tears in the ligament) in dogs most often happens because of degeneration.
Potential factors for CCL injuries in dogs may include:
- Genetic predisposition
- Obesity and poor fitness
- Early neutering
- Excessive slope of the tibia plateau (tibial plateau slope or TPS)
- Immune-mediated disease
- Bacteria within the joint
Large breed dogs are at the greatest risk for tearing their CCL, with most of these dogs being young to middle-aged females.
However, it is possible for any size, age, sex, and breed of dog to develop a CCLR. And just like in ACL tears for people, acute traumatic ruptures can happen.
Changes that take place in the joint can lead to a loss of healthy cartilage early in a dog’s life, resulting in arthritis. For most dogs, if there is a degenerative condition of the CCL, it will eventually lead to a complete tear.
Diagnosis – How Do I Know if My Pet Needs Dog ACL Surgery?
If your dog exhibits hind leg lameness after light activity, which partially improves with time and then is followed by stiffness after getting up, or if your dog exhibits mild-to-moderate lameness (limping or non-use of the leg) following heavy activity, then they may have partially or completely torn their CCL. Even with a partial tear, the disease will likely advance, with the ligament progressively tearing. Lameness (limping, loss of use of the leg) may become more consistent. An acute, complete tear can begin with lameness where your dog does not use their leg at all, or your dog may sometimes use their leg. The joint instability that is associated with CCLR may also injure the meniscus cartilage in the knee. Injury of the meniscus may cause extreme pain for your dog and can also lead to lameness.
Your family veterinarian or our surgeons can test to diagnose a CCL tear, including:
- The Cranial Drawer Test – Your veterinarian will test to see how much the tibia can be moved forward in relation to the femur
- The Tibial Thrust Test – Your veterinarian will help your dog to mimic weight bearing to see how the front of the tibia is pushing forward in relation to the femur.
Other diagnostic techniques may include examination for loss of muscle mass or atrophy, swelling within a joint, or the formation of scar tissue around the knee, known as buttress. This kind of scar tissue is a dog’s body’s natural response to attempt to stabilize an unstable joint, leading to decreased range of knee motion. In a small percentage of dogs with meniscal tears, there may also be some noise that sounds like a click in the knee joint.
Use of Radiography Before Dog ACL Surgery
Radiographs can also help us to confirm the diagnosis of a CCLR. At Veterinary Specialists of the Rockies, we have an in-house diagnostic imaging specialty department, which can help us to detect the kinds of joint changes that can follow a CCL injury. Changes can include excess fluid or effusion, arthritis, or the tibia bone’s forward movement relative to the femur bone. Radiographs are also helpful to your surgeon in ruling out other injuries.
Dog ACL Surgery is Invasive – Is it Worth Doing?
Any time your adored pet needs surgery, it is a serious situation. The invasive nature of dog ACL surgery is something to consider. The good news is that after dog ACL surgery, most dogs can start using their repaired leg within just days of surgery. This fast return to both comfort and function is one of the reasons we perform the kind of surgery (TPLO) that we do at Veterinary Specialists of the Rockies, especially on larger dogs.
For about eight weeks following surgery, the implanted plate and screws are stabilizing your dog’s knee at the surgery site. After the bone heals, the plate and screws aren’t needed. However, unless an infection or irritation develops, we suggest leaving them in place. Fewer than 5% of dog patients who have a TPLO surgery ever need to have the implanted hardware removed.
For dogs under 30 pounds, there are other surgical techniques like lateral suture that can help return your pet to health. Today, even in small breed dogs, TPLO is becoming the preferred surgical approach, due to reported improved outcomes with TPLO over other common procedures.
Also, with TPLO, the veterinary industry reports a 90-95% good-to-excellent outcome for dog ACL surgery. “Excellent” means that your pet can play normally, including running and jumping. You would not know that your dog ever had an injury. “Good” means that your pet might temporarily exhibit signs of soreness after heavy play, running and jumping. If this is the case, your surgeon at Veterinary Specialists of the Rockies, or your family veterinarian, may prescribe the brief use of anti-inflammatory medication. Unfortunately, there are approximately 5-10% of pet patients who do not return the functional joint use that you hope for. If your pet suffers a complication after dog ACL surgery, such as an infection or another injury, they may still eventually heal to a good or excellent long-term condition. There may just be a few additional challenges on their way to complete recovery of function.
Other Dog ACL Injury Treatment Options
If for some reason you cannot proceed with dog ACL surgery for your pet, there are some things that you can do to help your pet. Talk to your veterinarian about non-surgical approaches that may include:
- Pain Management
Talk to your veterinarian about using anti-inflammatories or pain relief medications.
- Weight Management
Weight loss is one of the most helpful things that you can do for your dog if they have suffered an ACL injury. Obesity greatly increases the risk of CCLR, and weight loss can improve health and may reduce the need for surgery.
- Modified Exercise
Talk to your veterinarian about modified exercise. Dogs may benefit from gentle stretching, walking, and swimming. Physical therapy may further improve motion. Physical activity can also positively affect weight management, help with range of motion, building muscle, and providing comfort. You may be able to gradually increase the activity. Many short walks are often advised over one long walk, and you may want to avoid extreme weekend bursts of activity after little activity during the week. Take it gradually and use warm-ups of walks before more strenuous activity.
While the broad use of joint supplements is not indicated in veterinary science, there is evidence that diets supplemented with Omega-3 fatty acids and administration of polysulfated glycosaminoglycans may have a positive impact. Omega-3 fatty acids from fish contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). There is evidence that dogs who get 69mg EPA+DHA/kg daily may experience improvement in discomfort, lameness, and severity of joint disease. Unfortunately, Omega-3 supplements are not regulated by the FDA, so review the ingredients for high doses of EPA and DHA (at least 20mg per pound) from a trusted brand.
My Dog Needs ACL Surgery – Now What?
If you suspect that your pet needs dog ACL surgery, give us a call. Our veterinary surgeons will work with your family veterinarian to understand your dog’s overall health and whether surgery is the best option. If you agree that dog ACL surgery is the best approach to restoring your adored pet to their best health and pain-free motion, we will discuss the entire process with you and schedule an examination before surgery. Once you understand the procedures and costs, we will schedule surgery and communicate with you throughout the process to help you understand everything to help your dog make the fullest recovery possible, to get them back to their regular, playful self.
If you have questions, or to book a pre-surgical examination, we invite you to call us at 303.660.1027.