Saturday, April 17, 2010

ACL Injuries In Dogs: Xena's Story

Xena is a lovely 3 year old Shepherd/Boxer/Lab cross--very energetic and very stubborn. Well, she's a girl ;-)

Xena's mom found my blog after an unfortunate slip on ice caused a set-back in Xena's post-op recovery from her ACL surgery. She was very worried about her girl and afraid that their decision to go with an extracapsular repair was a bad one.

Our Jasmine had an extracapsular repair on both her knees and she is doing great. The post-op period is very sensitive and a mishap during that time can cause the repair to fail. While some of the newer surgeries, such as TPLO, are a little more forgiving, a trauma such as a slip on ice can bring a major set back as well.

Avoiding set-backs is as important as it is difficult.

Xena's mom agreed to share her story with us for those who might be going through this, as well as for those who were lucky enough not to have heard about ACL injuries at all. Recognizing the symptoms of an ACL injury, early diagnosis and treatment are important. Arthritis develops very quickly in an unstable joint, and then instead of one problem, you have two.

Here is Xena's story

We figure that she first hurt her leg in August of 2009. She was playing with our neighbor's dog, and the next day we noticed she was lifting her leg a bit, reluctant to bear weight on it.

It seemed to have gone away so we didn't think much of it.

During the time between August and December, she would have moments of lifting her leg,  while everything seemed fine the rest of the time.

Finally, in December of 2009, my son called me at work and told me that something was wrong with Xena. When trying to walk she would take a only a few steps and sit down, repeatedly.

We got worried so we immediately made an appointment with her vet for that night. The vet took an x-ray and informed us that Xena had ruptured a crucial ligament in her left knee.

Her vet told us that Xena will need a surgery and gave us two options. We could choose either an extracapsular repair or TPLO. We don't have a lot of money, so we decided to go with the extracapsular repair, which was about $1500 cheaper than the TPLO. The surgery was booked for January 7th 2010.

The day after her surgery we went to get her and she was very happy to see us and was acting as if nothing had ever happened to her. The vet explained how we were to lift her up if we needed to go up or down stairs, and told us that we needed to restrict her movement for at least 3 weeks—she had to be confined wherever we were, had to be on a leash to go to do her business and couldn't run or play at all. This was the hardest part.

She started putting some weight on her leg about 3 days after we brought her home—a little too soon for us—and we had a hard time keeping her occupied and keeping her still.

After the fist few weeks of her post-op there was really no change. After four weeks we took her back to the vet and he told us that she was doing ok, but should be putting more weight on the leg.

Five weeks after the surgery we were beginning to worry because she wasn't really bearing weight on her leg yet. She was lifting her leg when standing still and she was limping a lot when walking.

We were hoping that things would get much better by eighth week. Unfortunately, seven weeks after her surgery, we were taking her outside and she slipped on a bit of ice. She let out a whine and lifted her leg right away.

We called the vet and he told us to come right in. He took a new x-ray and he told us that she stretched her suture. We could either wait and see what happens, or repeat the surgery. Because the stretch was minor and the suture was still holding, he suggested to wait and see how things go. 
Those were very hard times for us, worrying that Xena would have to go through the whole ordeal again. 
Today we are at week twelve post surgery and Xena seems to be doing ok. She is still favoring the leg but when we take her for a walk it is as if she is a puppy again, even though by the end of the walk she seems a bit more sore and tired.

I am hopeful that after the six months of her post-op is over she will be the way she used to be, though I am worried that she might not. Only time will tell. I'm just hoping that her right leg will hold up, at least until her left one is healed.

As long as the knee remains stable, there is a good chance for a full recovery. Stability of the joint is extremely important. Because the stretch in the suture was minimal there is a good hope that it was just a minor set-back. I will update you on Xena's progress.

Let's keep Xena in our thoughts and wish her full recovery.

Update on Xena
May 10, 2010

Xena was showing good gradual progress in her post-op recovery She would still favor the leg when standing, but her gait was looking very good. She wasn't showing as much progress as Jasmine did, but Jasmine had her stem cell treatment together with both of her ACL surgeries and that made a huge difference.

Recently they had a big scare when Xena suddenly became substantially more lame. A thorough exam and new set of x-rays showed that her knee is indeed very stable and scar tissue well developed and the lameness was caused by a muscle injury. This is interesting, because we had exactly the same scare with Jasmine.

The fact that the knee is perfectly stable is the most important thing at this point. Only a little bit longer before Xena's post-op should be done!

Update on Xena
August 8th, 2010

Xena is doing very well. She can now run and walk with no sign of anything ever being wrong with her knee. She does favor her leg a bit after a long day, but it seems that it gets sore from arthritis that has developed, rather than the injury.

Very glad that Xena has her life back!


Do you have an ACL injury story to share? Do you have a comment or a question? Leave a comment.

Related articles:
Talk To Me About ACL Injuries
Preventing ACL Injuries In Dogs
ACL Injuries in Dogs: Non-Surgical Alternatives? 
ACL Injury Conservative Management: Sandy's Story
Surviving The Post-Op: After Your Dog's ACL Surgery


  1. Hoping that Xena continues to heal and improve every day and that Jasmine continues to do well also!

    Out of the six Rottweilers that I've owned, only Heidi ever had ACL problems, but like many others, she did end up eventually having surgery on both knees. This was quite some time ago and the only options offered to us at the time were TPLO or tuna line (extracapsular). Heidi was not participating in any dog sports, so we went with the extracapsular repair at a significantly lesser cost. Both surgeries went well, as did the post-op (and yes, what you do in that period is so important). There was a minor issue with the second surgery with some swelling and fluid buildup, apparently caused by one of the suture knots. I do not remember exactly what they did, other than draining it, but all was well within a few weeks.

  2. Jasmine's legs are doing great. And we are hoping that Xena's knee heels and becomes stable and reliable.

    Not all large dogs injure their ACL. It depends on a number of things. Jasmine had everything going against her: malabsorption of nutrients due to IBD, immune issue, hypothyroid ... all added together resulted with bi-lateral ACL surgery.

    Glad the extracapsular repairs worked out for Heidi. It's a perfectly good option, though many sources would have us believe otherwise. The only problem is that the post-op period is more sensitive and somewhat longer. On the other hand this surgery is substantially less invasive.

    Some minor issues can arise with any surgery, glad yours was minor and it resolved!

    Thank you for sharing your story!

  3. Wow! I remember this ACL stuff with my dog, Oliver, who passed on a few years ago. He had ACL repair and it's not an easy thing, by any means. I built a hydrotherapy pool in the backyard. It was 16 X 8 X 4! He did beautifully. Unfortunately, tho, he died of cancer less than a year later. :( @turtlelady81

  4. Wow, you built a hydrotherapy pool, that's awesome! Hydrotherapy is definitely a great rehab. Jasmine was going for underwater treadmill exercise (we have that available in our area) with her muscle injury. It's great stuff!

    Sorry to hear about his passing ... but at least he had a loving mom and got to enjoy the years he was given.

  5. I am glad Xena made it through. My 1 year 6 month old doggie, 110 lbs Boerboel breed (similar to mastiff) ,Tequila, has been diagnosed with an ACL tear and I am currently researching the different surgical options. I feel very reluctant to have her go under the knife and am looking for some positive outcome stories like Xena's to justify such invasive procedures. The invasiveness of the TPLO greatly bothers me specially cuz i think it radically changes the structure of the knee joint and sounds like it would be quite an ordeal for my baby.So I am leaning more towards the extra-capsular option. I am hoping to find a surgeon with experience in extra-capsular repair in large breed dogs. Jasmine's story also motivates me. I am keen to know how she is doing now?( I mean the long-term outcome of the surgery)Did she lose the limp completely ? Although Jasmine is similar in size to Tequila and it motivates me to have her undergo this procedure I not sure my doggie is a good candidate cuz she is so very active and am worried she might undo the surgery in the first critical weeks. I would love if the author of this blog or anyone who has faced a similar situation would share their experiences during the recovery phase. My email:

  6. Dear Mabel. Sorry to hear about Tequila's knee! That is a young age too.

    There are quite a few surgical options, TPLO, TTA, TTO, Tightrope and Extracapsular repair.

    We did extracapsular repair for our Jasmine and it worked great for her. She is over two years post-op now and doing great, has no problems with her knees. Yes, she lost the limp completely.

    During the post-op and it is really important to prevent any mishaps. (it is almost as important with the other surgeries too, they are just somewhat more forgiving). But busted plate isn't a good thing either and all it needs is one unfortunate jump off the couch.

    The upside with the extracapsular repair is, that even when things go wrong, at least you're back where you're started and nowhere worse.

    We didn't like the TPLO either, for the same reasons. It is, however, quite clever way of fixing it. From the actual bone surgeries I personally like the newest one best, the TTO (there is an article here on my blog about it).

    The extracapsular repair is the least invasive and studies are showing that 18 months post-op there is no difference between the stability of a knee repaired this way or with the TPLO.

    You are more likely to find an expert in extracapsular repair among old time practitioners than actual orthopedic surgeons. The reason for that is that at school they all do TPLO now, as certain number of procedures is needed for accreditation.

    Jasmine's knees were done by our new vet, he's a small town, small clinic old-timer, he's done many of these repairs on large dogs successfully.

    There are some more stories here on my blog under ACL Injuries in the TOC, and there are a bunch of stories on

  7. Thank you Jana, for all the valuable information. I truly believe that there isnt a better resource out there than someone whose been in the same boat as you.
    I am in the process of looking for the old-school surgeons who can do the extra-capsular repair in large dogs.

    Cannot thank you enough for helping me reach a decision on what surgical option to opt for.

  8. Dear Mabel, yes, we've been there, done that, including a lot of research and sleepless nights trying to make the right decision.

    I started blogging so people could benefit from our hard-earned experience.

    Please keep me posted on Tequila.

  9. Hi Jana, I have been ringing up vet surgeons all day and one of them explained to me that there is extracapsular repair techniques of all sorts, which differ in the way they suture or use of suture material. Now I am not sure which one of them is suitable for large dogs. I did not dare ask the surgeon cuz he sounded very pro-TTO surgery!! Do you have any idea what sort of extracapsular repair was done for Jasmine?

    Sorry, for dogging you!!

  10. Dear Mabel. Many different kinds? Interesting. Here is what Jasmine's surgeon did:

    100 lb line and crimped hole in tibia crest and anchored at flabella medial and lateral sutures. Medial arthrotomy removed frayed CCL and verified menisci intact, flushed marcaine and cepahlexin flush , 2/0 monocrylto closure and jt and sq,

  11. Thanks so much for all your help Jana- I mean even the sharing Jasmine's surgical notes. Sorry, I could not reply earlier. After several phone calls to different specialist vets I shortlisted two of whom I have an appointment with tommorro. Unfortunately I did not find any vets who felt confident of using the extracapsular repair with my large dog.

    So the vets I am seeing tommorro are those specialising in Tightrope and TTO. Will see how the consultation goes and will take it from there.

  12. Hi Mabel, glad I could be of assistance. It is true that majority of surgeons believe that TPLO is the only solution for large dogs. I think it would need to be one who's done a lot of them, like our vet.

    The Tightrope is quite similar to the extracapsular repair, the idea being that the line should not break.

    Interestingly, when discussing this, our vet voiced concern about the line making its way through the bone. But I heard a few stories of dogs who had it and they seem to be doing fine.

  13. Hi Jana,
    The specialist vet doing Tightrope did say that infection of the fibre-tape is a complication we might have to watch out for. I also read a few stories of other tightropes gone bad on the orthodogs yahoo group discussions. They cited problems of the line burrowing through the bone too and even breakage of the fibretape before the scar tissue was formed.

    So the tightrope is a no-no for me! Our consultation with the other vet doing the Triple Tibial Osteotomy (TTO) convinced me to book in for surgery next wednesday. I thought the TTO was a new procedure but the vet assured me its been around 4 years or so. He told us he's done 'hundreds' of TTO's and about 10% of his cases had fracture of the tibial tuberosity( which is vertically cut during surgery), but he said its easily fixable with a screw and 2% had bone infection. I even saw a dog of the same breed as ours at his clinic, who had undergone TTO 4 weeks ago, come in for a check-up and she was already bearing weight on her leg and limping only slightly. The owner was quite happy with the surgery too and recommended it to us.

    So we taking the plunge, just praying that all goes well for Tequila.

  14. Hi Mabel.

    Yeah, our vet has very mixed feelings about the tightrope.

    If I had to pick one of the bone surgeries, the TTO would be what I'd pick. Wishing you smooth sailing with no complications! Keep me updated. (((hugs))) to Tequila


  15. Tequila's in for her surgery today. Will let you know how she's doing. A big thanks from Tequila n me for helping us out.

  16. I'm sure things will go great. Best of luck and hugs to Tequila. Please do let me know how she's doing :-)

  17. Hi Jana, I am facing the same dicission with my 7 1/2 year old Husky and was wondering how Tequilar went with her surgery and recovery. We are leaning towards the TTO from everything we have read but our first consultation with the specialist had said that TPLO was the best option and TTO wasn't offered so we have an appointment for another opinion this Tuesday.

    1. Hi Donna, I haven't actually heard back from Mabel, so I don't know how it went for Tequila.

      I would agree with you, from the modern surgeries I like the TTO the best, for a number of reasons. The problem with this one is that it is still rather new, and as you say, it might be hard finding a surgeon who can do this one.

      TPLO is the oldest from the three (TPLO, TTA, TTO), widely taught and done.

      You might get lucky and find a surgeon who can do the TTO, but it might take some looking.

      The other point is, that regardless of advantages or disadvantages of the particular procedure itself, having a surgeon doing a surgery that they are comfortable with and experienced doing makes up toward extra points towards that option. You don't really want a surgeon to learn or experiment on your dog.

      All that said, a fourth option is a "traditional" extracapsular repair. This option is least invasive and it is an option with went with for Jasmine. It is generally not recommended for large dogs, but Jasmine is a Rottweiler and worked for her just fine. Our vet has done it for many large dogs successfully. Disqualifying parameters would be steep tibial plateau slope and a very active dog you wouldn't be able to control during the post-op period.

      This option is usually not offered at orthopedic hospitals, but by regular, usually old-timer vets.

      While the downside of this option is a sensitive post-op period, the upside is that it is much less invasive, if it goes wrong (sutures tear) it is not a major disaster such as it can be with the other surgeries, and meniscus, unless damaged, can be preserved.

      Most orthopedic surgeons will indeed tell you that TPLO is the best option, and for a number reasons it is. For another number of reasons the other options can be better (I have an article on TTO on the blog also).

      Ideally, you can choose an option which both your surgeon and yourself feel comfortable with. It is indeed important that your surgeon is comfortable with the surgery they'll be doing.

  18. Glad to hear Xena is doing well! Who doesn't love a success story?

    Our story was similar but we went with a different treatment route. The tear in the ACL was only partial so our vet suggested the conservative treatment route, which ended up working for us.

    Luckily we didn't have a vet pushing surgery down our throats, although I do understand that in some cases it's the very best option.

    She also recommended getting the Ortocanis dog knee brace from the online store

    It was hard to do the conservative treatment but in our case the combination of rest, the knee brace, joint protector supplements and rehabilitation gave my dog back her active, happy life!