Avoid the Scalpel. Alternative Treatments for Cruciate Ligament Injuries in Dogs

Introduction

Cruciate ligament injuries are a very common orthopedic problem in dogs, especially large breeds like Labrador Retrievers. The cruciate ligaments are bundles of fibrous tissue that connect the femur to the tibia inside the knee joint and provide stability. A ruptured or torn cruciate ligament leads to instability, inflammation, lameness, and arthritis. Studies estimate cruciate ligament injuries affect around 26 per 10,000 dogs per year.

Cruciate ligament ruptures are extremely painful and debilitating for dogs. They greatly impact mobility and quality of life. The standard treatment is surgical stabilization, though it is expensive and recovery can be lengthy. Nonsurgical options may be effective for some dogs but many will still require surgery. This highlights the need for alternative treatments and preventative measures for cruciate ligament injuries in dogs.

Anatomy and Function

The canine knee joint, also known as the stifle joint, is composed of the femur (thigh bone), tibia (shin bone), and patella (kneecap). The joint allows for flexion, extension, and some rotation of the hind leg (https://easy-anatomy.com/anatomy-canine-knee/).

There are several important ligaments that provide stability and allow proper motion of the stifle joint. The two cruciate ligaments, called the cranial cruciate ligament (CCL) and caudal cruciate ligament (CaCL), connect the femur to the tibia in the form of a cross. Their main function is to prevent excessive forward and backward sliding motion between the femur and tibia.

The CCL is the more frequently injured cruciate ligament in dogs. It prevents hyperextension and internal rotation of the knee joint. The CCL also provides over 90% of the restraining force against anterior tibial thrust, which is the natural tendency for the shin bone to slide forward in relation to the thigh bone during weight bearing and activity (https://easy-anatomy.com/anatomy-canine-knee/).

Causes and Risk Factors

Some common causes and risk factors for cruciate ligament injury in dogs include:

  • Obesity – Carrying excess weight puts increased stress on joints like the knee and can lead to ligament tears over time. Obese dogs are at higher risk.
  • an overweight dog wearing a knee brace

  • High activity levels – Dogs that are very active in sports like agility or that run and jump frequently have increased likelihood of cruciate tears from physical activity.
  • Genetics – Some breeds may be predisposed to cruciate ligament issues due to anatomical factors like knee alignment. This includes breeds like Labrador Retrievers, Newfoundlands, and Rottweilers.
  • Prior injury – Previous injuries to the cruciate ligament increase susceptibility to re-injury or tears in the other knee.
  • Conformation- Certain breeds with straight hind legs like Basset Hounds and Dachshunds are more prone to cruciate tears.
  • Age – Middle-aged and older dogs tend to have more wear and tear on cruciate ligaments.

Knowing the risk factors can help identify susceptible dogs and guide prevention strategies. Keeping your dog at a healthy weight, avoiding excessive jumping/pivoting, and strengthening the knee through exercise can help reduce cruciate ligament injury.

Symptoms and Diagnosis

The most common symptoms of a cruciate ligament rupture in dogs are lameness, stiffness, and pain in the affected leg. Lameness may range from mild to severe, where the dog puts little to no weight on the leg. The lameness may come and go at first but often becomes progressively worse over time as the knee joint becomes more unstable. Dogs usually avoid bearing weight on the affected limb and may show signs of pain like whimpering, especially when the knee is manipulated (1).

Veterinarians use several tests to diagnose cruciate ligament ruptures. The cranial drawer test is the most definitive – the vet will gently extend the knee joint and feel for abnormal forward sliding of the tibia. This confirms that the ligament is partially or fully torn, allowing instability in the joint. Radiographs (x-rays) can sometimes detect signs of inflammation, swelling, or arthritis that indicate cruciate damage. But x-rays may appear normal, so vets often rely more on physical examination findings (2). Advanced imaging like MRI can also be used to visualize ligament tears.

Surgery Options

There are several surgical options to repair a torn cranial cruciate ligament (CCL) in dogs, including TPLO (tibial plateau leveling osteotomy), TTA (tibial tuberosity advancement), and lateral suture techniques. The goal of CCL surgery is to stabilize the stifle (knee) joint and prevent abnormal tibial thrust that leads to inflammation and osteoarthritis.

TPLO surgery involves cutting and rotating the top of the tibia to change the angle, eliminating shear forces on the CCL and stabilizing the joint. This is one of the most common techniques with good outcomes, but requires extensive surgery and bone cutting [1]. TTA also realigns the tibia but via advancing the tibial tuberosity instead of cutting the bone. TTA has quicker recovery times and less risk of complications like infection [2]. Lateral suture techniques use sutures on the outside of the joint capsule to stabilize it, avoiding bone cutting but having a higher failure rate in larger dogs.

Comparing techniques, TTA may have faster recovery whereas TPLO has lower failure rates long-term, especially in bigger dogs. Both require extensive surgery. Lateral sutures are less invasive but may have more limited applications. Factors like the dog’s size, activity level, age, and surgeon experience should help determine the best option.

Conservative Management

Conservative management refers to non-surgical treatment options for dogs with partial or complete cranial cruciate ligament tears. The main goals of conservative management are to provide rest and restrict activity in order to stabilize the knee joint, manage pain and inflammation, promote healing of the torn ligament, and prevent further injury.

The cornerstones of conservative management include strict exercise restriction (e.g. use of a leash when going outside), anti-inflammatory medications, weight loss in overweight dogs, and physical therapy modalities such as cold laser therapy or therapeutic ultrasound to control pain and encourage healing. Restricting high impact activities like running, jumping, and playing is crucial to avoid worsening the ligament tear. Limiting exercise also rests the joint so the body can start repairing the damaged ligament tissue. Weight loss takes stress off the cranial cruciate ligament and can significantly improve mobility and function. Physical therapy provides targeted treatments to reduce inflammation, strengthen muscles, regain range of motion, and ultimately stabilize the knee.

Studies show that with diligent conservative management for 6-8 weeks, over 90% of dogs show meaningful improvement in function and pain levels (https://www.caninefitness.com/docs/CCL-D-Protocol-2017Update.pdf). However, surgery may still be recommended if the dog has a complete cranial cruciate ligament tear or does not respond adequately to conservative treatment. Close collaboration with a veterinarian is essential to determine if and when surgery might be indicated after a trial of conservative management.

Physical Therapy

Physical therapy can be very beneficial for dogs recovering from cruciate ligament injuries and is often recommended regardless of whether surgical repair was performed. Some of the main goals of physical therapy include restoring range of motion, rebuilding muscle mass, reducing pain and inflammation, and improving proprioception (body awareness).

a vet performing physical therapy on a dog's leg

Common physical therapy modalities used for cruciate injuries include:

  • Massage – Gentle massage can help reduce muscle spasms, scar tissue formation, and swelling around the knee joint. Massage should be done carefully around the surgical site if applicable.
  • Stretching – Gently flexing and extending the knee joint through its range of motion helps maintain flexibility. Care should be taken not to over-stretch the joint.
  • Therapeutic exercises – Low impact exercises like sit-to-stand, cavalettis, and controlled leash walks help rebuild muscle strength without overstressing the joint. Exercises should be gradually increased in duration and difficulty.
  • Cold compression therapy – Applying cold packs can reduce pain and inflammation, especially after activity or therapy sessions.

In the initial recovery period, rehabilitation sessions may be needed multiple times per week. With guidance from a veterinary rehabilitation therapist, owners can also perform massage, stretching, and other exercises at home to facilitate the healing process. Consistency is key – physical therapy works best with regular, progressive application.

According to one source, simple sit-to-stand exercises done at home are an excellent way to improve strength and range of motion. Owners should start with 5 repetitions twice daily, gradually increasing over time (Source: https://www.ellicottvets.com/physical-therapy-after-cruciate-ligament-repair/). Most importantly, all therapy activities should be tailored to the individual patient based on the advice of their veterinary team.

Braces

Braces provide stability and support for dogs with cruciate ligament injuries by controlling abnormal motion in the knee joint. They help prevent further damage while allowing some mobility during the healing process (Ortho Dog, 2022).

There are two main types of dog knee braces: custom and over-the-counter (OTC). Custom braces are designed specifically for a dog’s unique anatomy and made to fit exactly. They offer the greatest stability and range of motion control. Companies like Ortho Dog take measurements and make custom braces starting at $289 (Ortho Dog, 2022).

a dog wearing a knee brace

OTC braces come in standardized sizes and are more affordable, usually $50-150. However, they may not fit as precisely and limit mobility more. Owners should measure their dog’s leg circumferences and knee width carefully when selecting an OTC brace size for the best fit. Reviews suggest the Poshard brace and Healers brand have worked for some dogs with ACL/CCL injuries (Amazon, 2022).

Veterinarians may recommend custom braces for the most control and support. But budget-friendly OTC braces can also aid recovery as part of a conservative management approach when surgery is not an option.

Nutraceuticals

Nutraceuticals, sometimes called dietary supplements, can help support joint health and provide anti-inflammatory effects in dogs with cruciate ligament tears. Some of the most common nutraceuticals used are:

Glucosamine – This building block for cartilage can help rebuild and protect joint cartilage. Studies show it may have mild anti-inflammatory effects as well.1

Chondroitin – Often combined with glucosamine, this compound is a major component of cartilage and can help inhibit inflammatory enzymes.

Omega-3 fatty acids – Omega-3s from fish oil provide anti-inflammatory effects to help ease joint pain and inflammation.2

MSM – This sulfur compound has antioxidant and anti-inflammatory properties. It may enhance the effects of other joint supplements when combined.

Anti-inflammatories like fish oil, turmeric, and CBD oil can also be given to provide pain relief by reducing inflammation. They may allow a reduction in prescription NSAIDs or steroids. It’s best to consult a veterinarian before starting any new supplements.

High quality commercial supplements formulated specifically for joint support often provide the best results. They combine several synergistic ingredients at therapeutic dosages. Finding an all-in-one joint supplement can simplify the regimen.

Lifestyle Adaptations

Making some lifestyle adaptations can help dogs with cruciate ligament injuries manage their activity and mobility while avoiding reinjury. Some key adaptations include:

Using ramps and avoiding stairs – Climbing up and down stairs puts extra strain on the knee joint and should be avoided. Placing ramps at entryways or other high-traffic areas can provide a gradual incline for the dog to move up and down without stressing the knee.

a dog using a ramp to get into a house

Providing orthopedic beds and avoiding slick floors – Dogs with cruciate injuries should have ample traction and support when moving around and laying down. Orthopedic beds with memory foam or egg-crate cushions provide stable, cushioned rest. Non-slip surfaces like yoga mats, rugs, and orthopedic booties can improve traction on floors.

Restricting jumping/rough play – Jumping up on furniture or people and rambunctious play should be avoided to prevent re-injury. Keeping the dog restricted to one level of the home is ideal. Gentle play like fetch on soft surfaces is recommended over wrestling or chasing games.

Maintaining a healthy weight – Excess weight puts more strain on joints. Keeping the dog at an optimal lean body weight recommended by a veterinarian through diet and limited treats can take pressure off the injured knee.

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