Does your dog need ACL surgery?

In actuality, dogs don’t have an anterior cruciate ligament (ACL) the way humans do. Dogs have a complementary ligament called a cranial cruciate ligament, or CCL. This joint is very similar to an ACL in humans, so a lot of times they’ll be used interchangeably.

The CCL connects the bone above a dog’s knee (femur) with the bone below the knee (tibia). When it’s torn, it results in the tibia sliding forward instead of backward like it’s supposed to. CCL surgery, or ACL surgery, can be performed to repair this ligament. The ligament may heal on its own, but it rarely heals to its full capacity, which could lead to limping, lameness, and further tears later in life.

Unlike humans, dogs typically tear their ACL through degradation over time (like from a lifetime of chasing squirrels and jumping frequently) rather than a single blunt injury.

Sometimes breeds and genetics can play a role in ACL tears, as they seem to be more commonly found in larger breeds such as English cream golden retrievers and labradors. Elderly dogs aren’t the only ones to have degenerative joints and the majority of ACL surgeries are performed on dogs between the ages of two and five. Some other risk factors for ACL tears include:

Obesity —Being overweight adds stress to your dog’s joints. The extra pounds can also make your dog’s exercise more strenuous, which may lead them to live a more sedentary lifestyle.

Limited exercise — If your dog doesn’t regularly exercise, their muscles grow weak which forces their joints to over-compensate for the loss of stability.

Overexertion — Overexertion isn’t good for a dog either. Finding a balance between play and rest is one of the healthiest choices you can make for your pup.

Spaying and neutering — Researchers are studying the possible relationship between spaying and neutering and ACL injuries. While the issue warrants more research, puppy owners should always consult with their vet about the best time to spay or neuter.

Common symptoms of an ACL tear

If you suspect your pet might have torn its ACL, look for these symptoms:

• Limping in the hind legs. A chronic limp is a sign of a torn ACL. There’s a risk of eventual lameness in the affected leg, so this is worth checking out if it continues for longer than a few weeks.
• Joint stiffness. Similar to limping, joint stiffness results while the torn ACL tries to heal itself.  It’ll be most noticeable when your dog is resting after physical activity.
• Difficulty jumping. It will be virtually impossible for your dog to jump in the car or climb on furniture with an ACL tear.
• Sitting awkwardly. If your dog suddenly begins to sit with one hind leg stuck out to the side, this might be a sign of an ACL tear.
• Clicking sound when walking. Clicking could be a result of your dog’s bone plates sliding against each other because their ACL is torn.

If a veterinarian determines that surgery is the best option for your dog, there are three main orthopedic operations to repair an ACL tear:

1. Lateral suture. Extracapsular lateral suture stabilization (ELSS) loops a suture through a hole made in the tibia and through the fabella (a pea-sized bone connected to the femur) and connects back to the tibia. This anchors the bones together to prevent the plate sliding that occurs in a torn CCL. Most of the time, this surgery is performed on small dogs under 35 pounds and the success rate is about 90%.
2. Tibial plateau leveling osteotomy (TPLO). A TPLO procedure is the most common of the three surgeries and isn’t dependent on your dog’s size or breed. During this surgery, your veterinarian will make a curved cut to your dog’s tibia and then turn their tibial plateau (top section) to level the tibia and femur. Your vet will then connect a metal plate to the knee to help it stabilize during recovery.
3. Tibial tuberosity advancement (TTA). If your vet chooses this surgery, they will cut inside the shin bone. They might remove some of the menisci to prevent further injury. A metal TTA plate will be attached to the tibia and a bone graft inserted to promote healing.

Alternatives to surgery

When it comes to dog ACL surgery alternatives, there are a few other options for dog owners:

Opt for a CCL brace — The tibial thrust (where your dog’s tibia goes forward instead of backward like it normally does) is one of the main problems caused by an ACL tear. A brace can help hold your dog’s joints in place so that they can heal properly.

Consider acupuncture — Acupuncture and acupressure help increase blood flow, which is great for dogs who might have degenerative muscles due to an ACL tear. Acupuncture for dogs is performed by a veterinary acupuncturist, which can come recommended by your primary vet.

Try natural supplements — Fish oil, turmeric, and joint supplements are excellent supplements known to reduce inflammation and joint stiffness.  Adequan is an excellent medicine for relieving arthritis that might be helpful for your pup.

Go for a swim — When dogs tear their ACL, they often settle for a sedentary lifestyle due to pain and limited mobility, which may lead to lameness over time. Letting Fido doggy paddle provides a relaxing way for their muscles and joints to get some movement, preventing further degeneration.

Schedule a massage — The benefits of a good massage include increased blood flow for healing and ease of stress. This article from the American Kennel Club teaches you how to become your dog’s massage therapist.

Depending on the type of operation, dog ACL surgery ranges from around $1,000 to up to $5,000. Here’s how it breaks down:

These prices will vary depending on the vet’s office, and may or may not include pre-operation procedures such as bloodwork or postoperative physical therapy. Many surgeries and post-surgical rehabilitation are covered by pet insurance.

For the first six weeks after ACL surgery, your dog will not be allowed to run, jump, or climb. We recommend setting up a staycation for them in a small space away from tempting surfaces and activities (ie., the sofa). Make them comfortable with their favorite blanket and a plush dog bed on the floor outfitted with their favorite chew toys so they don’t get bored. Short, leashed walks are allowed but don’t let them do any strenuous activity for the first few weeks. Sometimes around eight weeks after surgery, the orthopedic vet may request a post-operative X-ray. Pets may also need walking assistance with a sling while they recover. After 12-16 weeks you can gradually make their walks longer, but they probably won’t be completely back to normal for the first six months.

ACL surgery has a success rate of about 90%. Most dogs will return to a good or excellent activity level compared to their normal before the injury.

What to watch out for after surgery

Once the surgery is complete, you’ll need to keep an eye on your pet. There may be external sutures that can rip open, so you need to check their incision site daily.  Let your veterinarian know if your dog shows any of these symptoms:

• Signs of infection or inflammation. Your dog’s incision site should be clean and light pink with no swelling. If you notice any swelling, excessive redness, or fluids, call your vet.
• GI upset. While diarrhea and vomiting can be common doggy ailments, it’s best to contact your vet if GI upset lingers for more than a couple of days or if you see blood as it could be a sign of infection.
• Nursing the leg. Your pup should be able to bear weight on the leg not too long after surgery. If your dog has prolonged reluctance to put weight on the recovering leg, then you may want to contact your vet.
• Sensitivity to pain medications. If your dog is sensitive to anesthesia or meds, the allergy may manifest as mild swelling at the incision site. Be on the lookout for potentially serious symptoms, too, such as lowered pulse rate or other signs your dog might be going into anaphylactic shock.
• Loss of appetite. It’s normal for your pet not to feel the best after anesthesia, but they should feel better after a day or two. Continued loss of appetite could mean something’s wrong and should be brought up to your vet.
• Constipation. Let your vet know if your dog doesn’t have a normal bowel movement within a couple of days after surgery.
• Missing staples or stitches. If staples or stitches are missing or if your pet’s skin seems swollen or excessively red around the incision site, contact your vet immediately.