Introduction
ACL (anterior cruciate ligament) injuries are a common issue for dogs, especially larger breeds. The ACL provides stability in the knee joint and when torn, the dog’s knee becomes unstable. This causes pain and lameness. There are two main options for treating ACL injuries in dogs – using a brace or having surgery. An ACL brace is a non-invasive option that helps stabilize the knee without surgery, while ACL surgery involves surgical repair or replacement of the torn ligament. Both braces and surgery aim to restore knee stability and relieve pain, with surgery being the traditional and more invasive treatment. This article will compare braces and surgery so dog owners can make an informed treatment decision.
ACL Injury in Dogs
The anterior cruciate ligament (ACL) is one of the major ligaments in the knee joint that provides stability and allows normal motion of the knee. ACL tears are a common orthopedic injury in dogs that often lead to instability, pain, and progressive arthritis in the knee joint.
The ACL connects the femur (thighbone) to the tibia (shin bone) and prevents excessive forward and backward sliding of the tibia. It also limits internal rotation of the knee. Dogs have a sloping angle to their knee joint which predisposes them to ACL tears, especially when pivoting, jumping, or playing.
There are two common ways dogs tear their ACL:
- Traumatic injury – sudden damage from things like jumping or slipping
- Degenerative injury – progressive weakening over time until the ligament ruptures during normal activity
Risk factors for ACL tears include obesity, genetic predisposition in certain breeds, and activities that involve sudden stops/starts or lots of pivoting. Diagnosis is made through physical exam and imaging like X-rays or MRI.
Treatment options are conservative management or surgical repair. Surgery aims to stabilize the knee while conservative treatment utilizes braces and lifestyle changes to compensate for the torn ligament.
Symptoms of ACL Injury
Owners of dogs with torn ACLs often notice common symptoms that indicate an injury. According to an article published on Timesonline, signs of ACL tear in dogs include acute, three-legged lameness, carrying a rear leg, or toe-touching (Dr. Maro: Non-surgical options for ACL tears in pets). Some dogs will avoid bearing weight on the injured leg entirely. Owners may also notice swelling and pain around the knee joint.
Additional symptoms outlined in an online article include limping or abnormal gait, stiffness, difficulty standing up or laying down, decreased activity level, and vocalizing pain with manipulation of the knee joint (untitled, n.d.). These are all indications that a dog may have a torn ACL and should be evaluated by a veterinarian.
Diagnosing ACL Injuries
ACL tears in dogs are diagnosed through a combination of a physical exam, patient history, and imaging tests. During the physical exam, the veterinarian will check for drawer sign and tibial thrust. Drawer sign refers to abnormal forward movement of the tibia bone in relation to the femur with the knee bent. Tibial thrust is when the veterinarian can feel the tibia bone shifting forward when manipulating the knee joint. These are indications that the ACL is ruptured.
The veterinarian will also perform an xray to check for any other issues like arthritis or bone fractures. Additionally, they may recommend an MRI or CT scan which allows them to directly visualize the ACL and assess the extent of the injury. As per Brisbane Pet Surgery, “A full ACL tear becomes evident when there’s any movement of the tibia relative to the femur, which is abnormal. Some veterinarians also perform a tibial compression test to confirm ACL deficiency.” (https://www.brisbanepetsurgery.com.au/cruciate-ligament-dog-surgery)
Conservative Treatment
Conservative treatment involves nonsurgical options to manage ACL injuries in dogs. This is usually the first approach taken after diagnosis. Some of the main conservative treatment methods include:
Rest – Restricting activity and exercise helps reduce inflammation and further injury. Your vet will likely recommend confining your dog to a crate or small space when unsupervised. Short, leashed walks are okay.
Medication – Nonsteroidal anti-inflammatory drugs (NSAIDs) like Rimadyl help control pain and swelling. Your vet may prescribe joint supplements as well.
Rehabilitation – Physical therapy can maintain muscle mass and strengthen the injured leg. Hydrotherapy, massage, and stretching are commonly used. Rehab is often continued after surgery too.
Weight management – Keeping your dog at an optimal weight reduces stress on the joints. Your vet may recommend a weight loss plan if needed.
While conservative treatment can help manage the injury, most dogs will eventually require surgery for long-term improvement. Talk to your vet about the best nonsurgical options for your dog.
ACL Braces
ACL braces are an alternative treatment option for dogs with ACL injuries that provides stabilization without surgery. Braces work by restricting certain motions of the knee joint while still allowing a normal range of motion. This helps stabilize the joint and prevents abnormal twisting or sliding motions that could further damage the ACL.
Some of the potential pros of ACL braces include:
- Less invasive than surgery
- Lower cost compared to surgery
- Can be effective for partial ACL tears or mild instability
- Allows dogs to bear weight and remain active
However, there are also some potential cons to consider:
- May not provide enough stabilization for full ACL tears
- Success rates are generally lower than surgery
- Dogs may require activity restrictions while wearing the brace
- Putting on/taking off the brace can be challenging
- May cause skin irritation
- Does not repair the torn ACL
According to one study, success rates for ACL braces ranged from 54-77% depending on the specific type of brace used (source). However, braces may be more appropriate for mild injuries or as a temporary treatment option. Overall, ACL surgery remains the gold standard for full ACL tears with the highest likelihood of restoring stability and function.
ACL braces typically range from $80-$300. While less expensive than surgery initially, they require ongoing use so costs can add up over time. Consulting with your veterinarian is important to determine if a brace is the right choice for your dog’s specific injury.
ACL Surgery
There are a few different surgical techniques that can be used to treat ACL tears in dogs:
Tibial Plateau Leveling Osteotomy (TPLO)
The TPLO surgery involves cutting and realigning the tibia bone to change the angle of the top of the tibia, which helps stabilize the knee joint. This is one of the most common and successful ACL repair surgeries for dogs. According to one study, dogs who underwent TPLO surgery had a success rate of over 90% (source). Some pros of TPLO surgery are the high success rate and fast recovery time. Cons include the extensive bone cutting and use of metal implants, as well as the high cost, often $3,000-$5,000.
Lateral Suture Technique
The lateral suture technique uses sutures instead of bone cutting to tighten and stabilize the outside of the knee joint. This less invasive technique has a lower cost than TPLO, often $1,500-$2,500. According to one source, the lateral suture has a success rate of around 75-80% (source). While the success rate is lower than TPLO, the lateral suture causes less trauma and has a quicker recovery time of 6-8 weeks.
Tibial Tuberosity Advancement (TTA)
The TTA surgery advances the tibial tuberosity bone to change the angle of the patellar tendon, stabilizing the knee similar to the TPLO. Success rates are comparable to the TPLO, over 90%. The TTA is less invasive than the TPLO and maintains more natural knee biomechanics. However, the cost is high, similar to the TPLO surgery.
When deciding on ACL surgery, owners should consider factors like invasiveness, recovery time, success rates, and cost. Consulting with a veterinary orthopedic surgeon is important to determine the best surgical option for an individual dog.
Recovery
Recovery timelines can vary significantly depending on whether a dog undergoes surgical or non-surgical treatment for an ACL injury.
For non-surgical treatment like using an ACL brace, recovery usually takes at least 8-12 weeks. The dog will need to avoid strenuous activity and wear the brace continuously during this time. Range of motion and strength exercises are gradually added over the weeks. Even with brace treatment, some dogs may take up to 6 months to return to normal activity levels.[1]
With surgical treatment, recovery is longer but provides more stabilization for the injured knee. After surgery, dogs usually need to be strictly rested for 2 weeks. Stitches are removed at 3-4 weeks, and controlled leash walks can start. At 6-8 weeks post-op, physical therapy begins to improve range of motion and strength. It typically takes at least 12-16 weeks before dogs can return to full activity following ACL surgery.[1]
Regardless of treatment type, recovery focuses on protecting the ACL, reducing inflammation and swelling, improving joint mobility, and slowly strengthening the knee. Close monitoring by a veterinarian is important to ensure the knee heals properly. Recovery times are estimated, and each dog may progress at a different pace depending on factors like age, health, and injury severity.
Lifestyle Changes
After ACL surgery or bracing treatment, some lifestyle changes will be necessary during your dog’s recovery process to prevent re-injury. According to PetMD, the overall recovery time can take 4-6 weeks, with gradual reintroduction of activity over 3-4 months.
Your vet will likely recommend restricting your dog’s activity for at least 2 weeks after surgery. This means keeping them crated or confined when unattended, allowing only short leash walks for potty breaks. Jumping, running, and playing should be avoided. You may need to block off stairs and furniture to limit mobility.
After 2 weeks, you can begin short 5-10 minute leash walks, avoiding rough terrain. Your dog should not be allowed off-leash for the first 6-8 weeks. Swimming and other low-impact exercise can be introduced after 4 weeks. But running, jumping, and playing fetch should wait until at least 8 weeks post-op.
Some lifestyle changes will be long-term. Your dog may need to lose weight to reduce pressure on the knees. Ramps can help avoid stress from jumping on and off furniture. Daily joint supplements and medications may be prescribed. And you’ll need to monitor activity levels and avoid overexertion going forward.
Prevention
There are several ways to help prevent ACL injuries in dogs:
Exercise dogs regularly to maintain muscle mass and joint health, but avoid excessive exercise like jumping or sharp turns which can stress the ACL. Low-impact exercise like swimming is ideal. See: How To Massage A Dog With Torn ACL
Keep dogs at a healthy weight to reduce stress on joints. Overweight dogs are more prone to ACL tears.
Use joint supplements containing glucosamine, chondroitin, and omega-3 fatty acids to support joint health.
Avoid slippery floors that could cause dogs to twist their legs abruptly.
Consider protective knee braces or wraps to stabilize the knee joint during high risk activities.
Have a veterinarian examine any early signs of ACL injury like limping or stiffness to potentially diagnose and treat issues before a full tear occurs.
Some dogs may be genetically prone to ACL tears, so selective breeding can potentially reduce this risk over generations.