Introduction
ACL (anterior cruciate ligament) injuries are one of the most common orthopedic injuries in dogs. The ACL is a crucial ligament that helps stabilize the knee joint. When torn, it can cause severe instability, pain, and arthritis. According to research, around 1 million dogs per year suffer ACL tears in the US alone (https://journals.lww.com/clinorthop/Fulltext/2004/12000/Canine_Ovariohysterectomy_and_Orchiectomy.45.aspx). Without surgery to repair the torn ligament, dogs will be left with chronic lameness and arthritis. While some small dogs can adapt and lead relatively normal lives despite the injury, most dogs require surgery for ACL tears in order to regain normal function and quality of life.
ACL Injury Diagnosis
Veterinarians use several methods to diagnose ACL tears in dogs. The first step is a thorough physical examination of the dog’s hind legs and joints. The vet will check for swelling, pain, and instability in the knee by manipulating the joint and feeling for any looseness or clicking [1].
One of the main diagnostic tests for an ACL tear is the cranial drawer test. This involves gently pulling the tibia forward while feeling for laxity in the knee joint. Excess forward movement indicates the ACL is likely torn [2].
Veterinarians may also order imaging tests like X-rays or an MRI to confirm the diagnosis and check for any other joint damage. These images can show arthritic changes and bone bruising that often accompany ACL tears [3].
ACL Surgery
The most common surgical techniques for repairing ACL tears in dogs are extracapsular repair and tibial plateau leveling osteotomy (TPLO). Extracapsular repair is considered an intracapsular technique, while TPLO is an extracapsular technique.
In extracapsular repair, the surgeon stabilizes the knee by tightening structures on the outside of the joint capsule. This includes the lateral collateral ligament and joint capsule. Extracapsular repair aims to compensate for ACL deficiency by providing functional stability from other structures around the joint. Common extracapsular techniques include lateral suture and Tightrope procedures. These are minimally invasive options often used for smaller breed dogs.
TPLO is an extracapsular technique that involves cutting and realigning the tibia bone to eliminate instability from cruciate ligament deficiency. By changing the angle of the tibia plateau, TPLO removes the need for the ACL. This technique provides very reliable outcomes and is commonly used for larger, more active dogs. However, as an osteotomy procedure, TPLO requires a longer and more intensive recovery period compared to extracapsular techniques.
Overall, the choice between extracapsular and TPLO repair depends on factors like the size and activity level of the dog. Extracapsular options offer shorter surgery and recovery times but may have a higher failure rate in some cases. TPLO is more invasive but provides robust stabilization for an active lifestyle after healing. The surgeon will assess the specific case when recommending the optimal surgical approach.
Initial Recovery Period
The initial recovery period after ACL surgery typically lasts 10-14 days. This is an important time for your dog to allow the surgical incision to heal properly. Veterinarians usually recommend strict cage rest during this time to limit activity and prevent reinjury (Source).
While on cage rest, it’s important to perform passive range of motion exercises on the affected leg. This involves gently and slowly moving the leg through its normal range of motion to maintain flexibility. The exercises should be performed 3-4 times per day in short sessions of around 5-10 repetitions. Passive range of motion helps prevent scar tissue formation and muscle atrophy in the early stages after surgery (Source).
Following veterinary instructions for strict cage rest and performing passive range of motion exercises is vital for healing during the initial 10-14 day recovery period after ACL surgery.
Longer-Term Recovery
In the first few months after ACL surgery, your dog will transition out of rigid confinement and slowly increase their activity level. This is an important time to follow your veterinarian’s activity restrictions to protect the surgical repair and allow the new ligament to heal and strengthen. According to Emory Healthcare, most dogs are able to return to a relatively normal daily life around the 3 month mark post-surgery.
During this longer-term recovery phase from around 6 weeks onward, your dog should have increasing amounts of supervised, controlled leash walks per your veterinarian’s specifications. It’s important not to allow uncontrolled running, jumping or playing yet. Gentle leg exercises to rebuild muscle strength may be incorporated as well. HSS reports that most people and dogs are able to progress to light jogging between 12-16 weeks post-surgery.
Around 3-4 months after ACL surgery, if healing is progressing well, your veterinarian will clear your dog to gradually return to off-leash activity. But strenuous pivoting sports like agility or disk dog competitions will need to wait until at least 6 months. Full recovery takes 9-12 months for dogs to rebuild muscle mass and proprioception.
It’s crucial to follow activity restrictions during recovery, as pushing activity too soon can damage the graft or cause complications. Make sure you follow up with all recommended rechecks so your vet can fully clear your dog’s return to activity based on their progress.
Physical Rehabilitation
A key part of the recovery process after ACL surgery is physical rehabilitation. The main goals of rehab are to restore range of motion, build muscle strength, retrain proper gait mechanics, and prevent future injuries 1. Common rehab modalities include:
- Range of motion exercises – Gentle bending, extending, and rotating of the knee joint to improve flexibility. This may include passive ROM from a therapist, or active exercises like sit-to-stand.
- Massage – Helpful for reducing swelling, pain, and muscle tension around the surgery site.
- Hydrotherapy – Water exercises and swimming allow low-impact conditioning to rebuild muscle. The water’s warmth and buoyancy aid recovery.
- Balance and proprioception exercises – Wobble boards, balancing on unstable surfaces, and other exercises retrain proper joint positioning.
- Gait training – Walking over cavalettis or low rails helps rebuild normal limb mechanics.
Consistent rehab under the guidance of a veterinary therapist is key to ensuring the best possible functional outcome after ACL repair surgery.
Recuperation Timeline
The recuperation timeline after ACL surgery in dogs depends on a variety of factors, but here is a general guideline on when you can expect to see improvements in limping and lameness:
In the first 2 weeks after surgery, your dog will likely still have significant lameness and limping. They are in the initial healing phase and the knee joint is still inflamed. You will need to restrict their activity to very short leash walks for potty breaks during this time.
From 2-6 weeks post-op, you should notice gradual improvements in lameness. Your vet may allow short 5-10 minute leash walks at this stage. Swelling should reduce and your dog may start using the leg more.
From 6-12 weeks, lameness and limping should continue getting better. Your dog may walk close to normal at a walk, but still limp after activity. Physical therapy and hydrotherapy can help maximize healing.
3-6 months is often cited as the timeframe for full recovery after ACL surgery in dogs. However, it can take up to a year for complete healing of the ACL graft. Your dog will regain muscle mass and stamina during this period.
With strict rest and physical rehab, most dogs are able to discontinue limping within 3-4 months post-op. But your vet will examine the knee stability throughout healing to determine when your dog can return to normal activity.
Complications
While most dogs recover well from ACL surgery, there are some potential complications to be aware of. According to Top Dog Health, one of the most common risks is a post-operative infection, which can occur if the dog excessively licks the surgical wound. Keeping the incision clean and using an Elizabethan collar can help prevent infections.
Back Mountain Veterinary Center notes that other issues like implant failure or arthritis can also arise after surgery. Using high-quality surgical implants and closely following post-op care instructions can minimize these risks. They report the success rate for ACL surgery recovery is 85-90% currently.
Veterinarians of the Rockies point out that if complications like infections or secondary injuries do occur, dogs can still eventually heal to an excellent long-term outcome with proper treatment and rehabilitation. However, issues like arthritis may be lifelong conditions to manage.
Prognosis
The overall prognosis for ACL surgery in dogs is very good, with 85-90% of dogs recovering fully to resume normal activity levels. However, it’s important to follow post-op protocols and allow adequate healing time. According to one source, https://www.petmd.com/dog/general-health/recovery-dog-acl-surgery, the main factors influencing prognosis include the dog’s age, weight, breed predispositions, overall health, and severity of injury. Younger, lighter dogs tend to recover better. Certain breeds like Labradors and Rottweilers are prone to ACL injuries and may be at higher risk for reinjury. Overall health impacts the ability to heal, so dogs with other orthopedic issues or obesity may have slower recovery. With proper rest and rehabilitation, the vast majority of dogs can return to normal function and active lifestyles after ACL repair.
Preventing Re-injury
Preventing re-injury after ACL surgery is crucial for your dog’s long-term mobility and quality of life. The best ways to avoid another ACL tear include:
Completing the full rehabilitation program. Physical therapy should continue for 8-12 weeks after surgery. This helps rebuild muscle strength and proprioception. Skipping rehab can lead to chronic instability and increased re-injury risk.
Maintaining a healthy weight. Extra pounds put more stress on the knee joint. Keep your dog lean through portion control and exercise. A 2020 study showed overweight dogs have 4x higher ACL tear rates.
Avoiding high-impact activities. No jumping, running, or rough play. Walk leash-only walks for the first 8 weeks. Then introduce low-impact exercise like swimming. Avoiding reinjury is more important than high activity levels.
With vet guidance, lifestyle changes, rehab, and weight control, most dogs fully recover after ACL repair and can avoid another tear long-term. Be patient during the recovery process to ensure the best outcomes.