Sunday, February 7, 2010

ACL Injuries in Dogs: Non-Surgical Alternatives?

Did your dog suffer an ACL injury? If you are anything like I was, you are searching high and low for a non-surgical solution.

Your options will depend on the severity of the injury. There is a chance that partial tears can respond to a non-surgical treatment. Once the ligament is fully torn, I believe that surgery is the only effective solution.

At the time of diagnosis, we were dealing with a partial tear in Jasmine's left knee, and a small partial tear (or stretched ligament) in her right knee.

Our motivation had nothing to do with the cost, althought the ACL surgeries are quite expensive. We just wanted our Jasmine to get well as fast as possible, with as little trauma as possible.

We found the popular TPLO and TTA surgeries very invasive and the recovery time very long. Particularly since the prognosis was that she'd have to have surgery for both knees.

We were desperately searching for another solution.

There indeed are some non-surgical options to ACL injuries. But while I don't want to shatter your hopes, I believe that the odds of successfully getting your dog's knee healed and working well without any surgery at all are rather slim.

Restricted exercise and spontaneous healing

Yes, I also read that a knee with a partial tear can heal in some dogs on its own, just with restricted exercise.

The evidence is suggesting that Jasmine already did have her knee ligaments injured in the past. But it went undiagnosed. After a long time of controlled exercise the lameness had resolved. We have been through that twice, once for each knee. Both times it took about 5 months for the lameness to resolve. That is not really any less than the post-op recovery.

She was still quite young and had the best chance of healing. However, last year her ligaments failed once more, one after another, which suggests that the healing was not adequate.

This time, armed with a firm diagnosis, we were still hoping that we might find a solution that didn't require an invasive surgery.

Braces

First thing we considered were braces. The idea was for the knees to heal while Jasmine still could enjoy her life a much as possible. But the odds were that she would have to wear them every time she would go on a longer walk or was being more active, even after the healing period was over. We felt that she was too young for that.

There are many types of knee braces available now. I don't believe it is a solution for a young active dog. But it will provide great help to an older dog, and might provide assistance if opting for prolotherapy or stem cell regenerative therapy treatments.

Prolotherapy

First promising option we learned about was prolotherapy. Prolotherapy is a possibility to consider when dealing with a partial tear, particularly if your dog is older or could not undergo anesthesia.

Stem cell regenerative therapy

Stem cell regenerative therapy is a relatively new treatment. It is successfully used to treat arthritis and other degenerative conditions, and orthopedic injuries in dogs with very exciting results. This one however does require a minor surgery to harvest the stem cells and anesthesia for both the harvesting and the injection of the stem cells.

Can stem cell regenerative therapy or prolotherapy heal ruptured ACL?

When dealing with an ACL injury, there are many variables that will determine whether the prolotheapy or stem cell treatment will be successful for your dog. It will treat the resulting arthritis. But whether or not it will actually help the knee stability depends on number of factors, most of which are hard to determine.

I believe that under some circumstances the knee can be healed using non-surgical methods, but it is a gamble whether or not it will work in your particular situation.

For best possible results it is a good idea to combine these methods with some type of stabilization (such as a knee brace) of the leg and physical therapy.

We did decide to pursue the stem cell regenerative therapy for Jasmine. But the day before her consultation her left ACL gave out completely and that ruled out non-surgical approach. We however still did combine the surgery with the stem cell injections into both knees, to assist the post-operative recovery and hoping to save the right knee. It looked very hopeful. But three months later her right ACL also failed.

To operate or not to operate?

I am a big proponent of non-invasive solutions. But after all our own research and experiences, I say operate. If you have a young dog, surgical repair is the most reliable means of dealing with an ACL injury. You don't want it to come back and haunt you. It will give your dog the best chance for a full active life.

If you have an older, less active dog, then considering non-surgical approach makes sense.

Jana

Talk to me about ACL injuries
Stem Cells for Dogs 
ACL Injuries in Dogs and Stem Cell Regenerative Therapy 
Prolotherapy: Forerunner to Stem Cell Regenerative Treatment?
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24 comments:

  1. Some injuries, such as ACL tears can happen no matter how hard you try to prevent them.

    But you're right, some people are the dogs' worst enemies. It is often mind-boggling what people are capable of.

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  2. My pup (6 y/o Maltese) had ACL surgery today. The alternative was to let her limp for the rest of her life which to me, was not an option. It wasn't cheap, but after trying to find an alternative this was really the only option do she can have a fun filled life. To anybody considering it, she was in and out of the vet and seems completely fine. Little docile right now but I think the drugs haven't totally worn off :)

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  3. Hi Gal,

    surgery, indeed, is the best option for most dogs.

    There ARE other alternative (other than letting the dog limp for the rest of their life ;-)); which depend on the extend of the injury and the individual dog. These include conservative management (best done with a brace), prolotherapy and stem cell therapy.

    Conservative management has worked for some dogs. Brace is a good solution for older dogs who wouldn't do well with surgery. Stem cell therapy can work well if the ligament.

    We too have chosen surgery after evaluating all the other options. Mind you, we were going to try the stem cell therapy, but due to other circumstances, by the time we would be able to do that her partial tear turned into a full one.

    No, it isn't cheap, but nothing good is LOL Which surgery did you go with, TPLO?

    Thank you for sharing, best luck with recovery, do make sure you get a post-op care rehabilitation plan from your veterinarian or check out the one on this blog.

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  4. Hello All!

    I still once in awhile like to research on what people are doing with their dog's injuries. My dog Zep had a full cruciate tear. An alternative to let your dog limp for the rest of their life is not right! We could not afford surgery so we went the conservative management route using a brace. Our Vet suggested the atrac brace from woundwear. There are so many options out there! and as I have been doing research I have seen more come out. I suggest people to do their research and go with what they feel comfortable with, remember its our best pal's we are trying to help! I called woundwear first to get my self comfortable with the process and fitment etc. It really worked!

    I followed a blog and also posted an article. dogkneeinjury.com

    http://dogkneeinjury.com/conservative-management-full-cruciate-tear/

    Please take a look - it may give you more insight!

    good luck!

    Ed K.

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    Replies
    1. Hi Ed, thank you for visiting and sharing. Yes, I'm familiar with dogkneeinjury.com website, I read it regularly.

      You're right, there are many options to treat cruciate injuries; from conservative management to a variety of surgeries.

      If you'd like to share your story on Dawg Business also, shoot me an email, I'd be happy to publish it.

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  5. Hi all,
    My 13-year-old shepherd mix seems to have torn his right ACL AGAIN two days ago. He had ACL surgery two years ago, and it was amazing how well he healed! Two days after the surgery, he could put weight on his leg. He is in good health but I fear putting him through surgery again. I am rather distraught that this happened again and am very worried. I will see the orthopedic vet again, but per the posts above and my research, I am wondering if I should go with the brace instead. Any thoughts?

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    1. Hi, sorry to hear about your dog's knee. Is this the original leg that had the surgery or is this the other leg? This would make a big difference in the options you have. Also which surgery did he have? TPLO? Extracapsular?

      If he became lame on the other leg that didn't have the surgery before, a brace would certainly be an option. The stifle brace I personally really like is the OrthoPets.

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    2. I'm so sorry to hear about your dog! We had the similar issue earlier this summer. Our Golden Retriever Charlie (98 lbs) had one ACL repair when she was two. About a year later she tore her opposite ACL. Because Charlie had trouble with the anesthesia with the first repair, surgery was not an option. we did a lot of research on conservative management and found Woundwear's A-Trac Dynamic Brace. Although our vet was skeptical about the effectiveness of the A-TraC, I convinced him that we should give it a go. Charlie was able to bear weight the moment we put the brace on. We got the double sided brace and only used the ROM rods in the un-repaired cruciate. Within a few moments of walking around with the brace on, Charlie actually started to run! I hadn’t seen her run in over a year- it was so great. She is from a larger than breed standard stock, with litter-mates weighing upwards of 110 ibs, and her size was a concern with having one repaired knee and one blown out knee.

      She never complained or chewed at the brace, and wore it steady for 7 months, with us following the recommendations for slowing changing, and then removing the stabilizer rods. The only change I made was putting a thicker fur pad on the webbing across her chest and the webbing under her tummy. The last time Charlie wore her braces was in June. She never had any trouble with either knee again. Our vet is sold on the A-TraC for dogs that are not surgical candidates. Every time Charlie had gone in for a vet check, he’s been amazed by the fact that there’s little range of motion difference between the knee that was surgically repaired and the knee that repaired itself via the A-TraC. I highly suggest people look into the Woundwear A-Trac Brace for a conservative management option - Charlie says “Go For It!”

      -Andrew C.

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    3. Hi Miranda! Sorry to hear about your poor dog. I agree with Andrew and should go for the brace! I ended up getting an a-trac brace for my dog from Woundwear and she seems to be healing just fine. Surgery is a scary thing and I think everybody should explore other alternatives for there dog! :)

      Delete
  6. Our little Yorkie mix needs a Knee replacement... and they want more than we can aford... do you think the brace will help...I hate to think he would have to drag his leg... behind him...

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    1. A knee replacement? What exactly happened to the knee? If what you're talking about is a ligament injury, a brace would help.

      "Total knee replacement may be necessary due to advanced osteoarthritis or traumatic injury leading to loss of mobility and high levels of pain resulting in a deteriorated quality of life for the dog. Before total knee replacement is advised, all options must be considered, from nonsurgical management involving medication and lifestyle changes, to amputation (in rare cases) or arthrodesis (a surgery that fuses the joint to relieve pain, but results in lack of joint motion) of the affected joint. An exam by a board-certified veterinary surgeon will provide a thorough physical, diagnostic, and radiographic evaluation to help you make a decision that will best serve your dog’s health."

      Please let me know what is wrong with the knee first.

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  7. We just got the xrays back on our 35 lb Australian Cattle Dog and she had acl tears in BOTH knees. We were prepared to go ahead with the surgury on the one knee, but now with this diagnosis I'm not sure what to do. Any one had this experience?? She is 6 years old

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    1. There are dogs who had surgery done on both knees at the same time and did well. Those dogs had full tears. You'd need to talk to your surgeon what they think. The TPLO type surgery would likely be best for this (TPLO or TTO)

      Other dogs, including Jasmine, who had a partial tear in one and full in the other, had a surgery on one knee first, then on the other.

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    2. Hello-Xrays cannot determine if a ACL is torn. The only true way to see this would be with an MRI. It is amazing to me that so many vets tell people that an xray shows this.

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    3. Well, to a trained eye, apparently, the x-rays can show secondary damage, fluid build-up etc. Won't show the ligaments but might show the outcome. Jasmine went to a orthopedic specialist and they did and use the x-rays as part of the diagnosis also.

      Delete
  8. One other thing to consider, Rehab after surgery is a VERY important part of getting the dog back on track. One of the lastest Therapy's to be used is the Game Ready cold and compression unit, the same unit that all the human athletes use!

    They may be a good chance that yourvet may have the system, which is great, but what about once the dog goes home he still needs to be getting this treatment.

    Elite Vet Products now offers a at home rental program for these dogs so they can get the best treatment avil.

    Ask your vet about this or go to:
    www.elitevetproducts.com

    hope everyone finds this helpful

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  9. My dog, Cookie, tore her acl about month ago and I was so worried that surgery was going to be my only option. She is an older dog so I really didn't want to go through with it. After doing some research I ended up buying an a-trac brace from Woundwear and now Cookie doesn't have a limp anymore :) I like hearing about other people who have gone through similar experiences with their dog. Thank you for sharing.

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    Replies
    1. Hi Jesse; glad you found a solution that works for you and your dog. Surgery certainly isn't the only option and a brace can work well. For a younger dog, I'd consider surgery but for an older dog a brace just might do the trick.

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    2. Okay, thanks for the response! Cookie is doing a lot better already :)

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  10. Thanks for sharing this article! I have an older dog who tore her acl about a month. I had to look for other options other than surgery because I didn't want to put her through surgery. Like Jesse, I got a brace from Woundwear. Although it was uncomfortable at first...she got used to it and it is helping her in the long run. ACL tears are scary when they happen to your beloved pet but I'm glad there are solutions out there :)

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    Replies
    1. Glad the brace is working for her. ACL tears are quite a common injury and there are many options out there.

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  11. Has anyone seen any dog w/an ACL tear that doesn't limp or pull up the leg? I was told that my dog had a torn ACL because of a positive drawer test. It was end of October when I got the diagnosis. It was decided that we would have the surgery right before Christmas so people would be home for break and could be with our lab. It took over a thousand dollars just to figure out what was wrong w/him because there was no obvious symptom. He was just wanting to lay in his crate and appeared sad. As we restricted activity waiting for the surgery date, many people-including his vet-were shocked to see that by mid December, there was no evidence that anything was wrong with him. It was NOT fun restricting him, especially since we have another dog and all they wanted to do was play. We went ahead with the surgery (TPLO) and recovery was pretty brutal, but he became whole again. That surgery was in Dec of 2013. Today, I believe he has another injury to his ACL because he is acting in the same manner as he did 1.5 years ago. But again, NO limping...no pulling up of the leg, no toe touching. I took him to the vet last night and he did cry when pressure was placed on his knee-but still acted like a goof at the vet. I asked the vet if he had ever seen a dog w/a torn or fully ruptured ACL that didn't at the very least limp, and he said no. In fact, he said he would not refer my dog for surgery at this time. We're going to try the restricted activity route. There is so much confusing info out there! Plus, I'm not even 100% sure he tore his ACL the first time-knowing all I do now. Let's face it, there is good and bad in every profession. TPLO cost me $4800.00 and it is a money maker for a surgery that, in most cases, takes less than one hour to perform. This time, I'm trying my dog's good ol fashioned body to see if it can repair itself. IF he does have a tear, it just can't be that serious of one for him to not even limp, not to mention that he was interested in playing w/the other dog today-2 days on restriction. It's so darn hard to know the right thing to do. I'm going to look into the braces I've read about here. :) Julie

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    1. Hi Julie,

      well, that is kind of strange, though I'd say that positive drawer test does mean unstable knee. Did anybody measure leg circumference at any point? Measuring the thigh muscles etc - it will show whether or not a leg is being favored (favored leg will have less muscle on it); up to about 25% of favoring of the leg isn't visible to human eye.

      Just wanting to lay around does mean there is SOME kind of a problem. Doesn't really tell what the problem is.

      What other diagnostics were done? Thyroid function? Tick-borne diseases?

      Detecting problems at the vet's office can be difficult because the excitement covers up most of the pain etc.

      Which knee is the problem? The one that had the TPLO or the other one?

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