Thursday, November 24, 2011

Cruciate Ligament (ACL/CCL) Surgery Post-Op Care: Example Plan

For most dogs, the best treatment for a ruptured cruciate ligament (ACL/CCL) is surgery. When Jasmine had torn hers, I didn't want to hear this.

Cruciate Ligament (ACL/CCL) Surgery Post-Op Care: Example Plan

"Knees love being operated on," said her vet.

Today, knowing what I know now, I have to agree with that.

Making the decision of putting your dog through surgery is never easy. And you still have to decide which of the available techniques to go with.

Regardless of which surgery you choose, however, the post-operative care and physical therapy are paramount to the successful outcome. 

Cruciate Ligament (ACL/CCL) Surgery Post-Op Care: Physical Therapy

Make no mistake, this is where the real work begins. I cannot stress this enough. What you do after the surgery is what makes or breaks the recovery.

That is why I'm very disturbed by the fact that so many people I talk to have not been told this and have not received any instructions in this regard.

I remember seeing this Yellow Lab in the park, who was visibly favoring his rear left leg. When asked, the owner told me that he had a TPLO. He had the surgery a year ago and was still favoring the leg. A year after surgery, there is no such thing as still recovering. It could well be that the surgery didn't go as well as hoped, but I think it is much more likely that the poor recovery was a result of a poor (or non-existing) post-operative rehabilitation.

If your dog is having a knee surgery, do make sure your surgeon, or vet, gives you detailed post-op rehabilitation and physical therapy plan!

To give you an idea what such a plan should look like, here is the plan we got after Jasmine's knee surgery.

Cruciate Ligament Surgery Post-Operative Care: Introduction

  1. Absolutely NO OFF LEASH exercise for 20weeks. Your dog should be ON A LEASH at all times when outside, even if only in the backyard. The in-house activity should be kept to a minimum.
  2. See your veterinarian in 14 days for suture removal.
  3. Follow the physical therapy instructions, given to you by your veterinarian.
  4. See you veterinarian in 4 weeks so he/she can check the healing progress. You can expect your dog to still be lame but weight bearing at this point. If your veterinarian feels that the healing process is advancing as expected, then be sure to continue with the physical therapy
  5. See your veterinarian 8 weeks after surgery for a final re-evaluation of the knee. If your veterinarian feels that the healing process has not been completely achieved, then he/she will call. If all is well, be sure to continue to follow the physical therapy instructions. It may
     take up to 6 months before your dog is as good as he/she will be on that limb.
  6. Cruciate ligaments can tear in any type of animal, because of a misstep. However, in the large breed dogs(Labradors, Golden Retrievers, Rottweilers, Akita’s, Mastiffs) the cruciate ligaments may simply degenerate(deteriorate). 30% of these dogs will have the same problem with the other knee. Therefore monitor your dog especially during the healing process because of the extra weight carried by the other leg (ask your veterinarian about “towel walking” ). These dogs are also more likely to develop arthritis. Arthritis may or may not cause problems later in life but it is a good idea to keep your dog as lean as possible because obesity will greatly accentuate the arthritic pain.

Cruciate Ligament Surgery Post-Operative Care: Physical Therapy

The first 10 days after surgery:

  1. Apply a cold compress to the knee, 3-4 times per day for 15 minutes for the first 3 days. Apply 2-3 times per day for 15 minutes for the next 7 days. This will help decrease inflammation.
  2. Passive Range Of Motion(PROM): This activity involves moving all the joints of the limbs through a comfortable range of motion. This will promote cartilage and joint health, prevent contraction of the muscles and stimulate blood and lymphatic flow. Do be careful as this may cause discomfort in the early stages. You may wish to place a muzzle on your pet to protect yourself and to get the work done efficiently and safely. Your pet should lie on his/her side with the affected limb up. Gently and slowly extend and flex each joint (ankle, knee, and hip) 10 times 2-3 times per day. If you are unsure, ask your veterinarian to demonstrate.
  3. Massage the quadriceps and hamstring muscles (large muscle groups at the front and back of the thigh respectively). Best to massage for 2-3 minutes before and after PROM. Massaging will help stimulate blood and lymphatic flow and break down scar tissue within the muscles. Start by applying light pressure and gradually increase it over the course of the massage. Try to keep a steady rhythm. Start close to the knee and move up the muscle toward the hip.
  4. Assist your dog over slippery surfaces by placing a towel under the belly and supporting your dog (commonly referred to as towel walking).

Days 10-28

  1. Multiple short, slow, controlled, short leashed (NO FLEXI-LEADS PLEASE!) walks. Start with 5 – 10 minute walks 2-3 times per day. After 7 days, increase the frequency and length of walks gradually so that you are eventually walking for 15-20 minutes 3 times per day by day 28. Monitor your pet’s performance; do not exceed his/her limit.
  2. Continue with the massages and PROM (Before and after the walks).
  3. Use warm compress for 5 minutes before walking and use cool compress after the walk. To save time, apply the compress to the joint while you are massaging the muscles.
  4. See your veterinarian around Day 28. You can assess your dog’s progress by measuring the circumference of the thigh muscles ( it should increase with exercise) or simply compare it to the muscling on the non-operated leg. Your veterinarian will assess the knee for swelling, pain, stability and the position of the kneecap.
  5. Use a foam mat or pad 4,5, 6, 8 ft long, thin (¼ to ½ inch) then thicker as legs get stronger to encourage a higherfootfalll and increased joint use. Just have them walk back and forth on it.

Weeks 5 to 8

  1. Continue with the slow, controlled, short leash walks. Gradually increase to 20-30 minutes 3 times per day.
  2. Add functional strengthening exercises. Walk your dog in a figure 8 pattern to the left and the right ( this will help with neuromuscular re-education as well). Start with a large figure 8 , and walk the pattern 4-5 times in one direction before switching to the other direction. As your pet improves and becomes stronger gradually (over 3-4 weeks) tighten the figure 8 (no sharp turns) and switch directions more frequently. Do “sit-to-stand” exercises: Ask your dog to sit and then ask your dog to stand several seconds later (this is not an exercise in speed). Start with 3 to 4 repetitions, 2-3 times per day. Gradually increase (over 3-4 weeks) the frequency (to 10 times 2-3 times per week) and difficulty by asking your dog to sit with the operated leg along the wall and then with his/her hind end in a corner and the operated leg along the wall and then with his/her hind end in a corner and the operated leg against the wall ( by making the space smaller, you are asking your pet for finer control over how he/she maneuvers that limb).
  3. Massages, PROM, and warm/cool compresses will still be useful and appreciated at this stage.
  4. See your veterinarian for the 8-week recheck. Your veterinarian will reevaluate the healing progress and make sure that the knee’s stability and range of motion are as they should be.

Over the next two months

  1. Continue to increase the muscling by using the figure 8 technique and sit-to-stand exercise. Do the figure 8 at a slow trot (no sharp turns).
  2. Uphill walks (slowly) will be very helpful as well as walking through deep snow, sand or water. Gradually increase the incline of the slopes and depth of the water/sand/snow.
  3. Ascend and descend stairs slowly ( a flight of 5-10 steps) 2-3 times per day.
  4. Set up a line of cones (use your creativity) and zig-zag through the line at a walk and gradually move up to a slow trot.
  5. Dancing: Hold your dog’s front paws, allowing your dog to stand only on the back limbs. Encourage your dog to take a few small steps in this position.
  6. Incorporate balance activities: have your dog walk over couch cushions (on the floor), walk across a wide board place over a low fulcrum (acts as a teeter-totter when walked over).
  7. Use leg weights. Wrap the weights around both ankles (both limbs even if only one is problematic). Velcro can be purchased from any fabric store and hardware (such as nuts or bolts) can be attached to the velcro. Be imaginative! If using weights, only use 2-3 minutes at a time, and only every second or third day. Do not overdo it.
During the second month
Allow short periods of off-leash activity (2-4 times per week). Do not encourage rapid stops or turns (i.e do not throw a ball, frisbee, stick...)

We followed this plan religiously.

No, it's not fun. But it is really important. If your dog is having a knee surgery (or any other surgery for that matter), do make sure that your surgeon/vet gives you a comprehensive, detailed post-op plan. Then, stick to it!

As much as it might seem to be taking forever, at the end of it your dog can return to the life they love, with legs they can rely on.

Disclaimer: This is an example post-op care plan. Your dog may not be able to follow this schedule. Have your surgeon provide a post-op plan tailored to your dog's case.

Related articles:
How The Oddysey Started: Jasmine's ACL Injury 
Surviving The Post-Op: After Your Dog's ACL Surgery 
Don’t Forget the Physical Therapy
Functional Strengthening Exercises: the What, Why and How
Talk To Me About ACL Injuries
ACL Injuries in Dogs: Non-Surgical Alternatives?
ACL Injuries in Dogs and Stem Cell Regenerative Therapy
Newest Surgery For Ruptured ACL In Dogs
Preventing ACL Injuries In Dogs
ACL Injuries In Dogs: Xena's Story 
ACL Injury Conservative Management: Sandy's Story
My Love Is Sleeping At My Feet: ACL Surgery Complications 
Coco's TPLO Post-Op Diary 
Small Breeds Can Hurt Their ACL Too: Star's Naughty Knee 
One Thing Leads To Another: Why The Second ACL Often Goes Too



At November 29, 2011 at 6:08 AM , Anonymous Christopher Durin, DVM said...

Nice Jana :) That is Dr James StClair in those videos by the look of it. He knows a lot about rehab. He also has his supplements, the main post-op one is called Glycanaid HA. It ticks all the boxes for a good post-op / arthritis supplement and I have had a lot of success with it. You can read about Glycanaid here: Glycanaid + Ebook

At November 29, 2011 at 2:43 PM , Blogger Jana Rade said...

Dear Dr. Chris, yes, it is. Thank you for the supplement tip! :-)

At December 21, 2011 at 10:48 AM , Anonymous physical therapy documentation said...

This is amazing, I had no idea the lengths of care that some vets provide for pets. I just wish I had heard about your site earlier, unfortunately I think my German Shepard mix is too old for any type of surgery. We'll just have to make his remaining years more comfortable. I'll be sure to come back here more often.

At December 21, 2011 at 3:02 PM , Blogger Jana Rade said...

Hi, how old is your GSD mix? Has he ruptured his knee ligament? If you're positive that he would not do well with surgery, you can consider a solution with a stifle brace

Some/any way of stabilizing the knee will allow for better functionality, less joint damage and less pain.

At January 31, 2012 at 1:05 PM , Anonymous Anonymous said...

Hi Jana...Julie here (Xena's mom)..would you happen to have a printable version of the Post-Op recovery Example plan? As you know..we weren't told alot with Xena's first leg..and I want to make sure that we do everything right this time...I would love to be able to print out this page....but nothing I do seems to work..any ideas?

At January 31, 2012 at 3:16 PM , Blogger Jana Rade said...

Hi Julie,

email me and I'll send it to you. It is best to have an individual plan but something is better than nothing. The other thing that happens with an individual plan is that it can be adjusted as you go along, depending on the dog's progress.

At February 3, 2012 at 9:43 PM , Anonymous Anonymous said...

My 9 lb Maltese (7yr old) is having both legs repaired from cruciate ligament rupture at the same time. I'm worried about handling her, carrying her, etc. with out
hurting her. Anyone been through both legs done at once?

At February 4, 2012 at 12:11 AM , Blogger Jana Rade said...

Yes, there are dogs who had both legs done at the same time. Which surgery is she having? Ideally your vet/surgeon should explain the post-op care to you.

Generally, what you don't want is too much activity a particularly no violent movements (no jumping on and off furniture, no stairs, stuff like that)

The thing is, perhaps with exception of first couple of days, you don't want to carry her too much. You want her to use her legs, though carefully. It is important for recovery.

Lightening the load is a good idea, this is a good product here'll have to look at the available sizes.

Either way, you want your vet/surgeon to go over the best post-op plan details with you.

To carry her I imagine you'd want to hold her mainly under her chest with some additional support in the belly area.

At October 30, 2012 at 6:21 AM , Blogger Shalou said...

I have taken Shylo my Pitbull in this this morning for ACL. I was told that they would be using the Securos technique. I am was so happy to find your blog with all the help with post op surgery and even happier that it is so recent and not info from the archives!! Should I buy ice packs or would ice cubes in a tea towel work as well?

At October 30, 2012 at 2:30 PM , Blogger Jana Rade said...

Hi Shalou,

ideally, your vet/surgeon should give you a detailed post-op plan. However, much too often this doesn't happen, that's why I posted this one so people would have some idea what needs to be done.

Please, keep in mind that this is an outline plan and adjustments might need to be done by your vet/surgeon depending on your dog's progress.

I can tell you that Jasmine did not like the cold compresses much at all. I find that the "softer" the cold compress was the better she tolerated it. My recommendation would be pliable gel packs type of deal. The softer and more pliable the better.

Please note that it is best to cover the pack with a layer of gauze for application.

At November 18, 2012 at 9:42 AM , Anonymous Matt Ross said...

So if my vet offered me no post-op care plan... answered each of my questions with a "dont worry about it", "Thats normal", "she'll be fine" and just dismissed my concerns..... then is that vet liable for paying for the second surgery now that my dog's need is worse than it ever was pre-surgery?

Its been about 8-9 weeks since the surgery and I was told to let her go at her own pace, but not let her loose outside on her own for about 6 weeks, but otherwise, she would be able to get about at her own pace.

Now her knee is popping and I can feel that the bones are not held in place and moving almost freely. I'm taking her back to the vet tomorrow, but I think that by not giving me instructions (other than the "let her do her thing" type instructions) the vet should be liable for having this fixed.... again.

At November 18, 2012 at 3:59 PM , Blogger Jana Rade said...

Hi Matt. That certainly does not sound good or reassuring. What surgery was that?

I can't tell you whether your vet is liable for what happened (legally anyway) and whether they would own up to it. On the other hand, though, I don't know whether I'd trust them getting things right this time.

But I don't have enough information, really. No post-op plan, though, no instructions ... red flags for me.

At November 19, 2012 at 1:03 PM , Anonymous Anonymous said...

Good Morning, My lab/boarder collie mix had his cruciate ligament done eight weeks ago, his recovery was doing better than expected said the vet then now 8 weeks out he slipped on the floor getting up and it wasnt that bad of a slip and they think he might have torn it again. Unbelieveable he was doing soo well and now hes favouring that leg again.. but still stretches it and walks on it but not all the time. Im really hoping he didnt tear the ligament again. The vet has been really great and we have been taking extra caution with on the leash and no stairs.. has anyone had the surgery fail that quick?

At November 19, 2012 at 2:48 PM , Blogger Jana Rade said...

It doesn't take much. One bad slip or jump is all that can take.

Which surgery did she have? She will need to be examine thoroughly to assess the situation. Different things can go wrong depending on which surgery she had but either of them might need to be fixed.

At March 13, 2013 at 9:12 PM , Blogger Kim Shelton said...

My female chihuahua has just had surgery to her cruciate ligament which was badly ruptured and has had a band to replace it. She also had her patella repositioned. I have found your blog very informative. I was just wondering if I should start the therepy straighaway as she had the surgery 2days ago. She is on a pain relief and a anti inflammation drug also. What would be the best eay to get her started. The vet said not to walk her as yet and just move leg in bicycle movements. She is just very small and I dont want to hurt her too much.
Thanks Kim

At March 14, 2013 at 6:41 PM , Blogger Jana Rade said...

Hi Kim, yes, "move leg in bicycle movements" is about right. Did he show you?

Yes, PROM should start right away. I hope he did show you how it's done and did give you detailed instructions?

At April 2, 2013 at 10:11 AM , Anonymous Anonymous said...

Our Lab had a full ligament replacement on the 28 November2012. He is 10 years old now. The vet gave us instructions on how to take care of him after the op. he had to be kept still for 2 months. He stayed indoors and only went out to do his business. we went with him all the time.He went for a check up and vet said he was making good progress. he was impressed with him standing on his leg after 7 days after the op when the bandages came off.He recomended we take him to therapy but there is only one place that does it here and she is fully booked. so I am looking for exercises that I can do with him. i read that the first year after the op is very critical that is when the chanches of the other leg going the same way can ocure. Is this true?

At April 3, 2013 at 7:17 AM , Blogger Jana Rade said...

Glad the surgery went well and he's improving. Above are some of the suggested exercises. Two months might be a bit too long of a rest only. Did you do any range of motion and things?

Either way, at this stage, I'd discuss with your vet some of the functional and strength exercises as described above, depending on where you're at. The foam is quite handy. Hydrotherapy is always good, swimming is always good if possible. Depending on your weather, if swimming in a pond a pool I'd recommend using a life jacket just to keep things safe.

At April 25, 2013 at 12:17 PM , Anonymous Anonymous said...

My 11 year old had surgery using the modified flow technique about 3 1/2 weeks ago. He appears to be making progress on his recovery and is using the leg more frequently... But I have noticed that I can feel his knee pop when he uses it and am not sure if that is normal or not. It doesn't pop like it did prior to surgery, but it does still pop some. I'm concerned about the range of motion exercises ... With the pop, should we still be doing these?

At April 25, 2013 at 3:09 PM , Blogger Jana Rade said...

What is a modified flow technique?

Popping would concern me, I'd take him back to the surgeon for evaluation. Last thing you want is a knee that is not stable enough or has something going on that shouldn't.

At May 23, 2013 at 3:09 PM , Anonymous Anonymous said...

I found this incredibly helpful! My 9 year old bichon frise had his surgery about 17 days ago and at his first post-op visit the vet said he needed to be using his leg more. She suggested we tape a plastic bottle cap/cover to the paw of the healthy rear leg (the left rear had the surgery) to make it undesirable to walk only on his good rear leg. Well, I can tell you he is very stubborn and hated the cap - I felt he would hurt himself by tearing at it while I was attempting to do his therapy walks with him. I found the controlled leash walk video extremely helpful and my dog began bearing weight on the bad leg while using that method. My vet never mentioned warm/cold compresses before and after exercises or the bicycle movements recommended here.

Question: how can I keep him from attempting to jump on/off the furniture? He loves sitting on the couch and looking out the window. I can't isolate him in another room since he gets separation anxiety and has already ruined a door in my home.

At May 23, 2013 at 5:29 PM , Blogger Jana Rade said...

Wow, bottle cap on the paw? Never heard of that before; sounds quite mean. I don't blame him for hating that.

Some of the exercises, such as sits towards a wall, figure eights, walking on mild incline etc also encourage use of the leg without freaking out the dog.

Glad you found the exercises helpful.

Well, the best way to keep him from jumping on/off furniture, particularly since he's used to being there etc, is to provide an easier access, ideally with a little ramp. That way he can get up and down all he wants and safely. If a ramp wouldn't work because of space issues, then step(s). Ideally not tall but deep enough. Dogs do respond to ramps better, though, and are more likely to use them.

At August 9, 2013 at 7:29 AM , Anonymous Anonymous said...

My 6 year old Boxer has been lame in his back leg for nearly 5 weeks, took him to vet and they suspected cruciate ligaments, looked it up on internet U Tube demo was def my dogs ailment and he would need operation. Vet has given me painkillers for 2 weeks he is still no better I think they are putting off the inevitable. He is a very active dog I am really worried as to his aftercare as I don't think he is going to get better on painkillers!!!

At August 9, 2013 at 2:57 PM , Blogger Jana Rade said...

Hi. You're right, drugs don't fix torn cruciate. They can control pain and inflammation but that's all they do. Was your vet able to get the drawer sign? If so, than that does mean it is a damaged ligament.

There is such a thing as conservative management, but it is not very likely to work for a young active dog, because it means keeping the knee stable by restricting activity. You could consider conservative management with a brace, which does provide external stabilization.

If the diagnosis is conclusive, your best option is either a brace or surgery. I myself would not wait, because indeed you're just allowing the unstable knee to develop arthritis.

So first step is confirming the diagnosis, unless that is already conclusive, and the next step is treatment, either with brace or surgery. There are several surgical options out there, you will need to determine which one is best for your dog.

At December 15, 2013 at 4:35 PM , Anonymous Anonymous said...

My deaf, arthritic 13yr old English springer spaniel bitch is already on carprofen and has (8days) ago torn her ACL. Our vet wanted to do a TTA but I felt it was too invasive for her. I`d light to do conservative management. Is this going to be ok or should I be considering a less invasive surgery e.g tightrope?

At December 15, 2013 at 6:18 PM , Blogger Jana Rade said...

Well, that depends. Where is the arthritis? What is the overall health? How active is she?

The upside about the more invasive surgeries, such as the TTA is that the recovery time is shorter. The upside of surgical repair is that it does prevent further arthritis.

If you feel uncomfortable with a surgery, do consider a stifle brace, such as from

At January 18, 2014 at 7:21 AM , Blogger lahcen aitihia said...

my german shepherd dog (7 years old ) due to have cruciate ligament surgery in 2 weeks, major problem we live upstairs have purchased a harness to carry her up and down but no way she is going to allow this to happen. desperate to find a solution. can anyone help? thanks

At January 18, 2014 at 2:55 PM , Blogger Jana Rade said...

Which harness did you get? The Help'EmUp harness? You still have time to get her used to the idea. If you take it slow with plenty of reinforcement, you might get her used to it.

The important thing is to take it slow and A LOT of reinforcement. First just at the sight of the harness, then interacting with it, then having it put on etc. Similar to this idea:

There is another type of harness which supports rear end only, a Bottoms Up leash, is she responds to it better.

You could train her to it the same way; here you'd reinforce the sight of it, having it touch the body, having it on, having the weight supported and moving while being supported. Again in small steps.

Other option, depending on your particular situation (the amount of stairs, how steep they are etc) is making a ramp for her.

At March 9, 2014 at 3:45 PM , Anonymous Anonymous said...

Wow, my Golden Retriever had CL surgery the first week of December 2013 so it's been 3 months and I was never given any physiotherapy post-op plan! I was told to keep movement to a minimum for the first few weeks and to make sure she always went out to relieve herself on-leash. She gradually worked up to short 10 minute walks. She is still holding her leg up at times and won't always put her full weight on it. She also seems lame, which could be arthritis. I would have done some post-op therapy with her at home without question! What would you suggest I do now to make the operated leg more stable?

At March 9, 2014 at 8:59 PM , Blogger Jana Rade said...

Which surgery did she have? There are things you can do to catch up on the physical rehabilitation but I would recommend finding a physical therapy vet to help you along with that. Or, at least get a second opinion, evaluation and have the new vet help you formulate a plan.

At March 30, 2014 at 11:09 PM , Blogger Valeriya Rybalko said...

Hello, Dr Jane, your article is amazing! I wish all the vets would be so responsible and caring!
My dog pit/shar pei mix just had a DFO surgery she had 2 3/4 grade patellar luxator with the angle 15%, she is 2 years old. Is there any way you can email me or post her a care plan for this type of surgery

At March 31, 2014 at 2:04 AM , Blogger Jana Rade said...

Hello Valeriya. I am not a Dr. but I'm glad you found my article helpful. Vets ought to be responsible and caring! If they're not, we ought to look for a new one.

Your surgeon is the one who should provide you with an individualized, detailed post-op plan. Please demand that they do.

Your dog should also be evaluated periodically and the plan adjusted based on your dog's individual progress.

At April 26, 2014 at 12:13 AM , Anonymous Anonymous said...

My St Bernard/Akita mix had bilateral CCL surgery in mid-February. She is 1 and half years old, tore the first CCL at 7 months and then while we were waiting for her to stop growing she tore the second one. It was a nightmare for the first few days and then improved little by little. She was walking on both legs, with us supporting her using a towel, immediately. Did passive ROM until stiches came out. We enrolled her in PT about 2 weeks after surgery and they did hydrotherapy and a few other exercises, which we did at home as well. We stopped bringing her to PT due to cost, but we kept up with the 8 week plan given to us from therapist and vet.

Just got checked this morning and both legs are doing great. She will be at 10 weeks Monday and I have been looking for a rehab plan for 10 weeks and longer. I really like the example plan you posted and will start to slowly incorporate the 8 to 12 week exercises. She is doing great and glad I did both at same time rather than do one and then have to repeat with other leg a couple months later.

Anyway, greatly appreciate you posting this sample plan.

At April 26, 2014 at 1:16 PM , Blogger Jana Rade said...

Great to hear she's recovering well! Glad you worked on her physical therapy, it's so important. And I'm glad this example post-op plan is useful to you :-)

At May 24, 2014 at 10:54 PM , Anonymous Anonymous said...

Our son's large dog had surgery 1 week ago...She had no bandages or dressing...We have just had the first cartrophen injection and was checked by the vet. She is well rested ( in large crate) and toileted on lead. However I notice a " clicking" sound at the kneecap and the vet physically stretched the joint but could find no click. It is still there when I walk her. She is using the leg well and squats to toilet with no difficulty. Should I be concerned ???

At May 25, 2014 at 12:42 AM , Blogger Jana Rade said...

Clicking sound in the joint can have various causes from joint laxity, damaged meniscus or simply from sudden release of air bubbles in a joint space (as when people are cracking their knuckles)

So it might be something or it might be nothing. If she's using the leg well and without problems, I'd think that it might be nothing serious. (My knees clicked when I squatted since I was about 15. Jasmine's knees clicked sometimes) Personally, I'd go by other signs to see whether or not there is significance to the click if your vet isn't concerned, and your dog isn't showing lameness or pain.

At August 25, 2014 at 1:03 PM , Blogger Steve Carter said...

I have a dog named Buchanan and he ruptured his cranial cruciate ligament last year. I had no idea this was a problem, but apparently it's the most common knee injury for dogs. The rupture was totally repaired by the surgery, and Buck is up and about again. Good luck to your dog in his recovery too!

Steve Carter |

At October 9, 2014 at 4:52 PM , Anonymous Anonymous said...

My little dog named Freddie tore his ACL about a week ago. I didn't want to put him through surgery so I started to look for other options. I ended up getting him a A-Trac brace from Woundwear. At first he didn't like it but once he got used to wearing it he could walk around the house without a limp! Soon I hope he will be able to go on walks with me again :) I like reading stories about dog owners who are going through a similar situation. I hope your dog continues to get better and I wish you well!

At February 24, 2015 at 4:33 PM , Blogger Jesse Neimann said...

I got a brace from Woundwear as well. It's good to know the brace is working for you! My dog Bella recently tore her acl and I have been hearing good things about Woundwear thats why I decided to get her an a-trac brace before resorting to surgery...hopefully it will do the trick :)

At March 16, 2015 at 10:44 PM , Anonymous Anonymous said...

my dog is suppose to have acl surgery in 10 days,,,,,think she hurt it a few months ago as was limping and not using much weight.....she now is using her leg well and doesn't appear to be favoring it and run and walks well.....does surgery always need to be done on a ACL hate to do it when doing well

At March 17, 2015 at 9:39 AM , Blogger Jana Rade said...

Well, that is the question, isn't it?

First important question is whether it was diagnosed correctly and it is indeed a damaged ligament in the knee. Who and how diagnosed it? Did they do "drawer sign" and did it come positive?

The second thing to consider is that you likely limit her activity which would decrease the load on the knee and could make it feel that much better. If the ligament is damaged, the first time she gets to run and goof around the pain might come right back.

Best thing to do is to talk to the surgeon, tell them about the improvement and have them re-evaluate the leg.

In general, though, yes, I feel that it is best to repair the knee once the ligament is damaged if that's indeed the case.

At April 20, 2015 at 7:00 PM , Blogger Courtney Klocke said...

I have a 3 year old petite Golden Doodle named Hank. He is 12 days post Medial Patellar Luxation Surgery. I am very knowledgeable with human physical therapy and have been diligent with Hank's rehab. I printed off the pamphlet from Top Dog Health and have been following it to the T. I also purchased Glycanaide Joint Health Supplements. I am very confident with the rehab process and I will admit a bit Type A with it. But everything in life can not be controlled :) Today I had two clients at my house. My back was turned to the front door with one client as my other client decided to let Hank out of the kitchen which is blocked off by a gate. Next thing I knew, out of the corner of my eye, Hank had jumped up on my couch! I almost died! Seriously! Everything by the book until today! Day 12 and he jumped up on the sofa. He didn't yelp. I picked him up and set him back down in the kitchen and he walked back to his bed. Any advice would be great, as I am hyperventilating right now :) I can't believe this happened.

At April 20, 2015 at 7:39 PM , Blogger Jana Rade said...

Courtney, not every unexpected event results in a set-back. Unless you see that he started favoring the leg more than before this happened, everything is likely fine. One cannot control everything and stuff like this does happen. As long as it doesn't result in re-injury, all is good.

I hope all is well.

I know how you feel. We were babying Jasmine's knees - one operated on and one just holding up. Then she goes potty and meets a little dog who barks right into her face. She lunged just ever so little to give the little dog heck - it was all it took for the other ligament to get busted.

Other times she'd pull crazy stunts and nothing happened.

At April 20, 2015 at 9:04 PM , Blogger Courtney Klocke said...

Jana. Thank you so much for your quick reply! Wow! And thank you for putting me at ease. Poor Jasmine! I just feel for our little fuzzy buddies. They bring so much joy to human life :) Thanks again!

At April 21, 2015 at 8:14 AM , Blogger Jana Rade said...

Sounds like everything is ok then? Stuff happens. And while you do want to prevent jumping on things and so on, not every time it happens it means a disaster. Fortunately :-)

At April 21, 2015 at 2:25 PM , Blogger Courtney Klocke said...

I think he is ok. I am watching him closely. He's a little sore today. Hopping a bit more, but after a few hops he finds it in him to set all four paws down and walk normal (normal for post surgery :) Thanks again for being so kind. I really appreciate your time. You are doing a great thing by being here for people with questions & concerns. I love your picture at the top of this site. Jasmine's eyes just speak to me! I bet you miss her terribly.

At April 22, 2015 at 9:02 AM , Blogger Jana Rade said...

You're welcome, Courtney, having been there I know how it feels. For Jasmine, it was normal to favor her leg a bit more some days. She too would walk out of it. Which surgery did you do? I'd imagine that luxating patella surgery is a bit more forgiving overall than a cruciate repair.

At April 22, 2015 at 9:03 AM , Blogger Jana Rade said...

Jasmine will always be with us. But I do miss her physical presence, yes. Her eyes were as expressive as human eyes.

At May 5, 2015 at 5:06 PM , Anonymous Anonymous said...

Our 8 yro Blue Heeler tore her CCL and menisus and just had TTA surgery last week. We did a ton or research pre-surgery, got more than one opinion, are are very comfotable that this surgery was necessary. Even the holistic vet, one specializing in non-surgical alternatives, agreed we needed to do it. Although I think we have a good rehab plan and she is doing well so far, I really, really appreciate the additional information here. Hearing of the experiences of others makes me feel less alone in this. Many thanks for the quality information, we will use the additional rehab tips!

At June 5, 2015 at 12:29 AM , Anonymous Anonymous said...

Hi Jana,
Our 5 year small breed dog was just diagnosed with ACL on Wednesday and she will have surgery on her left back leg next week. I am trying to prepare and study but I am not quite sure what I should do now before the surgery. I am keeping her calm, using the leash, a diet to loose some extra pounds, and applying cold compress. Should I do the PROM exercise now? Should I try the towel to help her walking? Will you happen to know a good brand of orthopedic beds which are only 1 or 2 inch height? Your information is really really important. I have already asked my vet to provide the postoperative plan and schedule in detail. I got a little worried as her feedback was very brief, but she promised to give me one. I am so glad I found your blog on line. It is helping a lot.

At June 5, 2015 at 8:43 AM , Blogger Jana Rade said...

Hi Marie,

glad you found my article helpful. Here is one that includes some things that can be done prior surgery
Surviving The Post-Op: After Your Dog's ACL Surgery

You can definitely work on the environmental changes now, such as rugs on the floor (or, these days you could use ToeGrips instead), getting/making a ramp, getting her used to the toweling (though I don't know how this might work with a small dog). If you were getting her used to being supported, do it as a new "trick" with clicker training. Though Jasmine did not like that and preferred just using the ramp (took to that right away). You likely don't need one going in and out the house because you can carry a small dog. But if she's used to getting on the couch with you, having one so she can do it safely is probably a good plan.

Your vet OUGHT TO give you a detailed post-op plan and teach you how to do the PROM.

No, no PROM until after the surgery.

At June 16, 2015 at 8:55 AM , Anonymous Kelly said...

Thank you for sharing! This is a great tutorial and has helped me a lot with my dog, Lucy. Instead of surgery I ended up getting her an a-trac brace from Woundwear which has been helping her walk around the yard again.

At June 27, 2015 at 9:53 AM , Blogger Courtney Klocke said...

Hi Jana. Thank you for creating this site for doggie parents such as myself. By the looks of it, you have assured many worried pup parents. I am grateful I stumbled upon it. My dog Hank is now 12 weeks post Tibial Tuberosity Transposition Surgery (TTT/TTA). He had a medially luxated patella. I thought I had done all of my research pre surgery and was ready for what was to come. Boy was I too confident :-) I wish I would have known more of what to expect post surgery, so I committed to posting weekly videos to my youtube channel of Hank's full recovery. I have 11 videos posted from day 1 to week 12 of Hank's recovery and rehab in hopes of helping out other people considering this surgery. If you are interested in sharing my youtube channel link with the videos, feel free.
Thanks again!

At June 27, 2015 at 10:43 AM , Blogger Courtney Klocke said...

Wondering if anyone has had experience with implant (pins & wire) removal following TTT/TTA knee surgery? Hank's surgeon thinks his implants (pins & wire) are loose and migrating out of his bone, irritating his soft tissue. Any advice or experience with this? Thanks!

At June 27, 2015 at 8:16 PM , Blogger Jana Rade said...

No direct experience but once the knee is healed, the implants don't need to be there. They are left in to avoid additional procedure but they are not needed any more. Sometimes they can cause issues such as you describe or other reactions or infections.

At August 4, 2015 at 9:52 PM , Blogger donna ostrowski said...

My pitbull had ACL surgery 8 weeks agao and still is not walking on her leg. The vet says everything looks good and has given me more pain medication and an anti inflammatory for her. I'm concerned. What can I do to help her want to walk on her leg again.

At August 5, 2015 at 8:47 AM , Blogger Jana Rade said...

Which surgery did she have? Is she not using the leg at all?

At August 5, 2015 at 11:12 AM , Blogger donna ostrowski said...

She had ACL surgery to repair a tear to her leg. And no, she is not trying to walk on it.

At August 5, 2015 at 5:29 PM , Blogger Jana Rade said...

Donna, there are a number surgeries to do this: lateral suture, tightrope, TPLO, TTA, TTO ...

On any account, she should have been using the leg. Is your vet the one who did the surgery? Have your surgeon evaluate the leg and if they don't come up with a good answer, get a second opinion.

At October 25, 2015 at 7:33 PM , Anonymous cindy d said...

Hi getting ready to have the TPLO surgery on my Pit/Queensland mix. She is 50lbs now. Her first injury was 6 months ago, we put her on a diet she lost 10lbs since then.. We bought the a -track brace for her and she was in it constantly, she was doing very well after about 4 months of wearing it, even bearing full weight on the injured knee. We went on a camping trip and did several stairs to and from the beach for 3 days, and she still seemed strong, then about a week later was outside without the brace on and came back holding her leg up again. As you can imagine it broke my heart. The vet suggested the TPLO surgery and said it was the best one for her due to her size and weight. Can you tell me if this surgery is usually the best one to go with. Our vet already told us that the physical therapy was going to be a long road but it would be well worth it, he did give us detailed intructions so this part makes me feel positive. I also had a full knee replacement on my right knee 4 years ago so I am well aware of how important the physical therapy is. I just want to be sure that the TPLO surgery is in fact a good surgery to have. Can you please let me know your thoughts on this type of surgery, as it is fairly expensive, but for my baby girl i'd do anything. thanks for you comments

At October 26, 2015 at 8:25 AM , Blogger Jana Rade said...

I did come to believe that surgical repair of busted knee is the best option for most dogs, particularly young and/or active dogs. Conservative management may or may not work - works for SOME dogs but most end up having to have a surgery at the end.

TPLO is one of the surgeries that are most often used. It's relatively forgiving during post-op and the post-op is shorter than with traditional suture method. For Jasmine we chose the suture method but for a younger dog I'd opt for either TPLO or one of the similar surgeries.

There are three types in total TPLO, TTA and TTO. TTA isn't done very often and TTO is rather new. Personally I'd be more partial to TTO; this one is a combination of the other two (TPLO and TTA). It does seem to have some theoretical advantages over the TPLO. However, one important aspect is to go with the type the surgeon is most comfortable with, which in most cases is TPLO.

Some specialty hospitals or orthopedic surgeons might offer TPLO, TTA, or all three. There are different indicator which of the surgeries would be best for each individual dog, depending on their knee anatomy and a surgeon who does both or all three should be able to recommend which one would work best for your dog.

Most places, though, seem to do TPLO only. The surgeons experience and being comfortable with the surgery is an important aspect to consider. You don't want to turn your dog into a guniea pig.

If you want to be certain which one is best, try finding places that does more than that one and consult with them on their recommendations.

At October 26, 2015 at 3:30 PM , Blogger Unknown said...

Thank you very much for your information. My girl is 8 years old, and yes i agree the surgeons experience in a paticular surgery is very important. We had consulted with another vet previously and he was going to do the suture type surgery, but I did not get a good feel from him and the whole time my dog who is normally very chill was completly nervous around that office. So we moved on to this other pet hospital and it has so far been a really good, my girl was so relaxed there, and went with the doctor, nurse and technician without hesitation. Either she felt comfortable or they have some great treats behind the door. haha!

At October 27, 2015 at 9:04 AM , Blogger Jana Rade said...

I agree, if the vet has a wrong vibe and dog who normally isn't fearful at the vets is, it's time to move on.

We did the suture repair and it worked perfectly well even though Jasmine was a big girl but the rehab is longer, more sensitive and more demanding.

At November 21, 2015 at 8:52 PM , Blogger Unknown said...

Hi Jana, great compilation of information for pup and family to help all get through this injury/rehab successfully. Thank you. My 8 yr old 20lb westie just had cruciate ligament surgery 4 days ago (extracapsular) and has seemingly been doing well since discharge, unfortunately I left the room for a moment today without blocking the couch and returned to find him sitting on it. He didn't seem to be in any pain or discomfort and hasn't shown any glaring signs of reinjury as of yet(increase swelling/limping). How much damage do you think he may of incurred and how possible is rupturing his repair with this jump. Thanks.

At November 22, 2015 at 10:26 AM , Blogger Jana Rade said...

Thank you.

Sorry about your pups knee; glad it's been treated and things seem to be going well.

Here is the thing about mishaps. Not every jump on or off a couch results in a setback. It is quite possible he got away clean. Unless there are any signs of more favoring or other signs of damage, he should be fine. It's the "unfortunate" jumps that can be disastrous. The only thing is that nobody can no before hand which one will be harmless and which one will not and that's why the "no jumps" policy.

Sounds like your pup is fine; keep watching for signs of a setback. And do your best to prevent jumps in the future. Consider a large step type of deal or a ramp if you want your dog to be able to get on the couch safely.

At December 8, 2015 at 11:48 PM , Anonymous Anonymous said...

Thanks again for ur prompt reply and ur commitment to helping those in the animal community, I carry the same love for my buddy as you seem to have and had for Jasmine, the amount of time and depth of info u've given is much appreciated. Great site Jana, thank you

At April 29, 2016 at 10:38 AM , Anonymous Judith said...

This is a fantastic article, it's hard to come by such in depth material on the subject. Often we forget that many physical therapy activities we can perform ourselves on our own pets.. no need to always pay for expensive rehab sessions. Another treatment option that really helped my dog in her recovery process from a torn ACL and subsequent surgery, was using a dog knee brace before and after the surgery to help support the knee. We purchased the Ortocanis dog knee brace ( after lots of extensive research and never regretted our decision.

Over 6 months later and the brace is in great condition and it continues to help my dog with her mobility each and every day.

At January 30, 2017 at 2:43 AM , Blogger DeeLee said...

Hi Jana,
I don't know if you still read these but if you do I would love your answer to this question.
I have a 10year old Boxer who was extremely active before she tore her CCL and is meant to have the MMP operation which they do in Australia
but as I work all day, I cant watch her and do the physio on her back right leg like you are meant to. She skips around on three legs and of course I'm so concerned her other back leg CCL will tear because it is doing the work of two legs. She did this injury about 4 weeks ago, but she is still recovering from having her left ear amputated, from what two different vets diagnosed as possible aggressive cancer in the pinna and suggested either a biopsy or amputation, but also suggesting amputation of the ear would be the way to go as it would only be one anaesthetic rather than two if a biopsy was taken first and came back positive so we went for the removal of the ear BUT the Histopathology came back with the diagnosis of Canine Leproid Granuloma syndrome NOT cancer and the tumour would have dissipated over time. Poor girl. She lost her ear for nothing so what I am saying is, she needs another operation now on her leg, but i am hesitant to do this because no one will be home to nurse her, and give her physio and her meds, but she is in discomfort and I do have her on anti inflammatories and painkillers for the time being. Can you please advise me what to do in this situation. If I wasn't working (but I have to) I would be home all day to nurse her and give her all the support she needs. I have seen the other responses here and I will buy her a knee brace for starters and she is such a stoic boxer but although I know she must be in pain, she still wants to play with her ball and go for walks, all I which I have stopped. I value your opinion. Many thanks

At January 30, 2017 at 11:34 AM , Blogger Jana Rade said...

Hi Dee,

your girly seems to have quite a bit on her plate too <3

You have quite a predicament. If she's an active girl, surgery would be a good option for her. I suppose you guys don't have any pet sitter options where you are? It's quite a big thing in the US; pet sitters often have the dogs at their home, or come to the home of the dog. That might be one option to consider if available.

As for pain management, there are pain patches which work well and don't need changing as often as one would have to give medications; so perhaps a pain patch would be a way to go when it comes to pain management, at least at first. (They also seem to work better)

So I think the needed medications could be organized to fit within your schedule.

During the initial period, it is generally recommended that the dogs are crated to prevent them doing something silly. So you might want to look into confinement options.

Another option, one we used for Cookie's post-injury recovery is "chemical restraint", we used Trazodone; more and more surgeons use it now around here. Worked well though I recommend starting that over the weekend when you are at home because initially it made Cookie quite wobbly after each dose before it leveled out in her system.

As for physical therapy, I think doing it 3x daily while you are at home (in the morning, when you come home, and before bedtime) would be enough.

A brace works for some dogs; would not use it together with surgery though, because each of these things work differently and don't really mix well. If I were to use a brace I'd use Orthopets.

Another pointer, if available, adding PRP together with the surgery assists pain relief as well as healing.

Feel free to have questions.

At May 1, 2017 at 2:45 PM , Blogger Unknown said...

Hi. My 2 year old lab mix tore two ligaments in his knee this past March. He had surgery and everything went well. I'm reading a lot of stuff online saying how important it is to begin physical therapy really soon after surgery, but my dog was in a cast for almost 6 weeks. He actually just got it taken off last week. And the earliest appointment I could get with a rehab center is two weeks from now. Should I be concerned that he was in the cast for so long? Is there anything I should start doing now to help get his leg back to normal? Thank you!

At May 2, 2017 at 11:39 AM , Blogger Jana Rade said...

It's quite unusual that dogs get a cast. It has its pros and cons. Physical therapy is important to restore muscle function and strength. I'm sorry you have a long wait before you can start the physio.

Which surgery was it that cast was used?

Either way, there is no point dwelling on whether or not the cast was there too long, this is in the past. What matters now is what happens from now on. I recommend that you talk to the surgeon about starting some light physical therapy before your appointment. Massage, stretching (active and passive) walking, figure eights, walking on slight incline (up, down, sideways), sit-to-stand, walking in grass or sand ... there are a number of things that can be done in the interim. I suggest you work with your surgeon to formulate an individual plan for your baby.

At July 26, 2017 at 2:08 AM , Blogger Debbie T said...

Hi My dog is having her Crucial Ligament repaired next week. We live up 1 flight of stairs. Is there any advice on taking her up and down the stairs post op?

At July 26, 2017 at 11:18 AM , Blogger Jana Rade said...

What breed/size is your dog? Small dog can be carried; for a larger one you want something like Help 'Em Up Harness (spelling?). There are a few brands making those now.

At July 30, 2017 at 8:55 AM , Blogger Debbie T said...

She is a corgi\lab cross, short legs long body about 50 pounds in weight

At July 30, 2017 at 11:03 AM , Blogger Jana Rade said...

Is that your house or an apartment building of sorts? A ramp would be ideal but impossible depending. Will likely need one of the full support harnesses to take as much weight off her legs as possible when going up and down.

At January 26, 2018 at 7:55 PM , Anonymous Anonymous said...

The cost sadly puts Woundwear out of my reach. Is there a cheaper brace?

At January 27, 2018 at 11:02 AM , Blogger Jana Rade said...

Here is the thing; the rule of thumb - the cheaper the brace, the less effective. If you buy one that doesn't provide proper support your might as well not waste your money. Providing proper support for the stifle is tricky and if it's not done properly might not bother.

At August 12, 2018 at 3:19 PM , Blogger Unknown said...

Hi, My Maltipoo tore his right, back ACL and then 3 days later he tore his left one. His vet decided to do surgery on the right one first, since it was the worse tear. It's been 6 weeks since his surgery, he's actually walking fine on the non-surgery leg, but not so good on the surgery one. My question is, would these exercises be fine for him? I'm so afraid of re-injuring his left leg before I can get him into surgery. In fact, I'm not so sure I even want to have the surgery now, the way he's wobbling around on the surgery leg. Seems like the non-surgery leg is way better off. I'm so confused/disappointed. Thank you!

At August 12, 2018 at 5:26 PM , Blogger Jana Rade said...

Which surgery was it? What is the pain management? Has it been evaluated?

Any rehab needs to be individualized and your vet should have given you instructions what to do. Passive range of motion and massages likely good for any situation. The rest is an individual thing. If stitches already out (should be?) underwater treadmill is fantastic because helps mobility and muscle strength without impact on the joints.

Need evaluation of the surgical leg and may need a second opinion.

At January 24, 2019 at 4:35 PM , Blogger Unknown said...

Hello! My miniature poodle had an ACL Surgery 17 days ago. We tried our best to keep him contained and controlled and tried our best to follow instructions. He did jump up and down the furniture a couple of times. He just did his X-rays and the surgeon responded with this comment: "It appears that the implants are slightly bent. However not fractured. There is some healing that has been established but not very much at this point yet. The patient does have some patellar tendinitis as well as some joint inflammation. This is most likely from over activity. We do need to ensure that the patient becomes more controlled as this implant could potential he break."

Does this mean that we have time to salvage the damage that was created? How bad is "plates bent"? I really would like a second opinion on this. Thank you so much in advance.

At January 24, 2019 at 9:11 PM , Blogger Jana Rade said...

If you want a second opinion you need to see it with somebody who can take a look at your baby and the x-rays. Doesn't sound like a huge problem yet but could turn into one. I highly recommend you ask the surgeon about "chemical restraint" with Trazodone. It works well to facilitate calm during recovery.


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