Introduction
Dogs use their anterior cruciate ligament (ACL) just as humans do, to stabilize the knee joint. The ACL is a band of fibrous tissue that connects the thigh bone to the shin bone, preventing excessive forward movement of the tibia. An ACL tear is one of the most common orthopedic injuries in dogs, often caused by sudden stops and turns while running or playing. The ACL can rupture partially or fully, causing instability, pain, and arthritis. ACL tears do not heal on their own, so most dogs require surgery to regain normal function of the joint. Surgical correction is considered imperative to alleviate pain and provide the best chance for your dog to return to normal activity levels. There are several different surgical techniques veterinarians may use to treat ACL tears in dogs.
Causes and Diagnosis
ACL injuries in dogs most often occur due to excessive force on the knee joint from sudden twisting, cutting, or jumping movements. Certain breeds like Labrador Retrievers are genetically predisposed to ACL tears. Being overweight also puts more strain on the ACL ligament. The ACL can weaken and fray over time before fully rupturing.
Symptoms of an ACL tear include limping, holding the hind leg up, swelling and pain around the knee joint, instability when walking, and reluctance to run, jump or climb stairs. Some dogs will cry out when the ACL first tears.
To diagnose an ACL injury, vets will manipulate the joint to check for instability and pain response. They may order x-rays to rule out fractures and see arthritis changes. But the gold standard is an MRI or arthroscopy to directly visualize a torn ACL ligament.
Nonsurgical Options
There are several nonsurgical treatment options for dogs with ACL injuries that may allow them to heal without surgery. These options focus on managing pain, reducing inflammation, and stabilizing the knee joint while the ligament heals. Common nonsurgical treatments include:
Rest and restricted activity – This involves strictly limiting exercise, playtime, and high-impact activities to allow the knee to rest and heal. Short leash walks are recommended for bathroom breaks only. Confinement may be needed for more exuberant dogs.
Anti-inflammatory medications – Drugs like Rimadyl, Galliprant, Metacam, and Previcox can help control pain and inflammation. However, side effects are possible with long-term use.
Cold compression therapy – Applying cold packs to the injured knee reduces swelling and discomfort. This is most beneficial in the initial post-injury period.
Physical therapy – Doing specific exercises prescribed by a veterinary physical therapist can help strengthen muscles supporting the knee and improve range of motion. Hydrotherapy may also be incorporated.
Braces or orthotics – Custom knee braces limit abnormal knee motions while allowing for use of the leg. They provide external stabilization and support healing. Correct fit is important for best results.
Alternative therapies like acupuncture, massage, and laser therapy may provide additional pain relief and promote healing for some dogs.
The success of nonsurgical treatment varies widely depending on the severity of the injury. Close monitoring and strict activity restriction are required. Surgery may still be necessary if the dog has persistent lameness or instability. Sources: https://therehabvet.com/cruciate-ligament-disease/, https://toegrips.com/dog-torn-acl-treatment-without-surgery/
Surgical Procedures
There are several surgical procedures commonly used to treat ACL tears in dogs:
Tibial Plateau Leveling Osteotomy (TPLO)
A TPLO surgery changes the angle of the top of the shin bone (tibia) to eliminate instability and abnormal forces on the knee joint that occur with ACL tears (All Animal Clinic Leighton, 2022). This procedure requires special training and is one of the most expensive ACL repair surgeries but has a high success rate.
Tibial Tuberosity Advancement (TTA)
The TTA procedure advances the tibial tuberosity, which alters forces on the knee similar to a TPLO. This surgery also has a high success rate but is technically demanding (BetterPet, 2022).
Traditional Repair Techniques
Some veterinarians may still use traditional repair techniques like sutures or tightrope methods to stabilize the knee joint after ACL tears. These tend to be less expensive options but have higher failure rates than TPLO or TTA techniques (BetterPet, 2022).
Success Rates
The overall success rate for ACL repair surgery in dogs is very high. According to the University of Florida Veterinary Hospital, the success rate with surgery is about 90%, meaning that most dogs return to good or excellent function following surgery and proper post-operative care (Source). Another source states that the success rate for TPLO surgery specifically is between 90-95% (Source). This means that the vast majority of dogs who undergo ACL repair surgery will regain normal or near-normal use of their affected leg after proper recovery.
Risk Factors
Several factors can increase a dog’s risk of sustaining an ACL injury and requiring surgery. According to research published in the National Library of Medicine, larger dog breeds are at higher risk, especially those over 22 kg. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8760802/
A dog’s weight also plays a role. Overweight and obese dogs put extra stress on their joints, making ACL tears more likely. Keeping your dog at a healthy weight is important for avoiding ACL injuries.
A dog’s activity level impacts their ACL risk too. Highly active dogs that run, jump, and play roughly have a higher chance of tearing their ACL. Limiting intense activities like fetching and Frisbee can help reduce risk.
Underlying health issues like hip or bone problems can also predispose a dog to ACL tears by altering their gait and joint stability. Getting these other conditions treated may lower their chances of an ACL injury. Overall, older, larger, and more active dogs tend to be most at risk for ACL tears requiring surgery.
Complication Rates
According to a 2016 study, complication rates for incisions and implants were 3.9% and 2.8% respectively, based on lameness/swelling of the surgical site. Another research found that severe postoperative complications occurred in 31% of dogs after TPLO surgery, 22% after LFS surgery, and 25% after TTA surgery.
One of the most concerning potential complications is infection. According to one source, rates of infection after ACL surgery range from 5-15%, with higher rates after more invasive procedures like TPLO. Signs of infection include pain, swelling, redness, warmth, drainage, and fever. Infections are treated with antibiotics, flushing the surgical site, and sometimes additional surgery.
Re-tear of the ACL graft is another complication, occurring in around 5% of cases. This leads to recurrence of lameness and instability. Retears are often treated with revision surgery.
While death is a rare complication, the mortality rate after ACL surgery is estimated to be around 0.2%. Other complications like bleeding, implant failure, fractures, and nerve damage occur in less than 5% of surgeries.
Recovery Process
The recovery process for ACL surgery in dogs can take several months and requires strict limitations on activity to allow the knee to heal properly. According to Lick Sleeve, the typical recovery timeline is as follows:
– Week 1: Your dog will need to be strictly confined and prevented from running or jumping during the initial week after surgery. Pain medication and anti-inflammatories will be prescribed.
– Weeks 2-4: Your dog can start going on short, leash-only walks, but running and jumping are still prohibited. Range of motion and strengthening exercises will gradually be introduced by your vet.
– Weeks 4-6: Your dog may be allowed to go on longer walks, but running and jumping are still not permitted. More intensive physical therapy will continue.
– Weeks 6-8: Your dog may be allowed to start going up and down stairs on a leash and can do light running for short periods. Jumping is still restricted.
– Months 3-4: Your dog will be able to gradually return to normal activity levels and freedom of movement.
Strictly following activity restrictions and physical therapy under the guidance of your vet is crucial for a successful ACL repair and to prevent reinjury, according to Hill’s Pet Nutrition. This allows the knee ligament to progressively heal and regain strength over time.
Costs
The cost of ACL surgery in dogs can vary greatly depending on a number of factors. According to MarketWatch, cruciate ligament surgery for dogs typically costs between $2,000-$6,000 per knee. The average cost is often cited as $3,000-$4,000 per knee.
Some of the main factors affecting the price of ACL surgery include:
- Which surgical technique is used – TPLO is often more expensive than extracapsular repair
- Whether one or both knees require surgery
- The size/weight of the dog – larger breeds often have higher surgical costs
- Geographic location and vet clinic fees
- Additional medications, x-rays, physical therapy etc.
According to Forbes, other factors like the experience of the surgeon, complexity of the procedure, and length of hospitalization can also impact the total ACL surgery expenses. Owners should prepare for costs in the range of $1,500-$4,000+ per knee on average.
Conclusion
ACL tears are a common injury in dogs that can significantly impact their quality of life if left untreated. While nonsurgical management is sometimes an option, most dogs will benefit from surgical repair to stabilize the knee and prevent ongoing arthritis. Surgeries like TPLO and TTA offer high success rates, but do carry risks of complications like infection and implant failure. Recovery involves weeks of restricted activity, and costs can range from $2,000-$5,000 on average.
The decision of how to manage an ACL tear is highly personal. Owners should have a thorough discussion with their veterinarian about their dog’s age, activity level, and other health factors to determine the best treatment plan. Be prepared for an intensive recovery process if opting for surgery. With proper rehabilitation and management, most dogs go on to live active, happy lives after ACL repair. Stay vigilant in aftercare and follow all discharge instructions closely to support your dog’s healing process.
ACL injuries can happen to any dog, but are not a death sentence for an active lifestyle. While the recovery process is daunting, the long-term prognosis is very good. With patience and partnership between pet owners and veterinarians, dogs can return to full function and resume the activities they love after recovering from ACL surgery.