Watchful waiting for dog's ACL injury?
December 4, 2013 5:53 PM   Subscribe

Our 40 pound terrier mix injured her ACL yesterday and is badly limping. The vet's advice is ambiguous. I'd like to hear from people whose dogs have had ACL injuries, or people who know more about it than I do.

Yesterday, while chasing a squirrel in the woods, our dog somehow twisted and injured her back right leg. She can't bear weight on it.

The vet suspected an ACL injury right away, and upon examination she confirmed this is indeed the case. She recommended surgery but also said that we could use "conservative management" with pain killers to see if it heals on its own. Managing would entail keeping the dog from running, jumping, etc. for a month.

But then she gave me a printed hand-out that said the surgery had to be done within a week of the injury, and that without surgery, even if the dog seemed to get better and stopped limping, arthritis would set in and "the dog will become lame" within a few months.

Obviously it would be better to wait and manage the injury IF there was a chance the dog could heal that way. of course we'd rather not give make the dog endure this painful surgery which the vet says has a 6-8 week recovery period if it isn't absolutely necessary; it's also thousands of dollars and for a variety of reasons it would be harder for us to support the dog through her recovery over the holidays than it would be later if, it turned out, that the management hadn't worked and she needed it after all.

But, of course, if this is an emergency surgery and if the dog will never be able to walk or run again without it being done immediately we'll do it.

Because I got these two contradictory messages from the vet I would like to hear from anyone whose dog had this injury. What did you do? Did anyone's dog get better on their own? If your dog had the surgery was the recovery period like?

I don't really need answers telling me to ask the vet to clarify. I tried that and got noncommittal answers. We're getting a second opinion from another vet, but in the meantime I would like to hear from people who've been through this with their pet (or from vets or people with knowledge of animal ACL injuries).

Thank you!
posted by third rail to Pets & Animals (25 answers total) 2 users marked this as a favorite
I suspect that just like in humans, what's written on the handouts/discharge instructions can be outdated information. What your vet told you is more likely to be the best current advice for ACL injuries in dogs.

I say this in part because someone has asked a similar question here before, and I researched it and found this website, which I'd recommend you take a look at. This person has clearly done their homework to come to the conclusions as noted on the front page.
posted by treehorn+bunny at 5:59 PM on December 4, 2013 [2 favorites]

In case anyone doesn't feel like clicking through, the conclusions (which are heavily referenced) are as follows:

----That the majority of the surgeries done on dogs diagnosed with ligament injuries are unnecessary, and do not improve ultimate recovery outcome.
----That surgery is often described to clients by vets as a medical necessity in cases where it is neither necessary nor the best treatment option.
----That the reasonably expectable results of ligament-injury-related surgical procedures are often misrepresented.
----That all the ligament-injury surgeries, especially the bone-altering TPLO, TTO, and TTA, have risks which are often not disclosed to clients by surgeons.
----That non-surgical recovery, while usually the best first-choice treatment for dogs' ligament injuries, is frequently inaccurately portrayed or ignored in surgically-inclined vets' presentations to clients of the available treatment options.
----That TPLO, TTO, and TTA have become cash-cows for a number of veterinary ortho-surgeons who are making huge profits selling these questionable procedures by misrepresenting potential outcomes and risks to clients.
posted by treehorn+bunny at 6:00 PM on December 4, 2013

Response by poster: Thanks, that is a helpful website!
I will not threadsit after this, but I should clarify: the vet was definitely pushing for quick surgery before I started asking questions about waiting.
posted by third rail at 6:05 PM on December 4, 2013

My dog (a 35-pound shepherd mix) blew out both ACLs (or the dog equivalent, whatever that's called) in her back legs within a few months of each other when she was 9. We had a consult with an orthopedist, but were not that jazzed about doing the surgeries. Because of her age, they couldn't be done at the same time. It would have to be one surgery, eight weeks of recovery, then the other, then eight more weeks of recovery, and the vet emphasized that dogs can and do rupture the repair if they're not confined. Oh, and it would have cost $7,000-$9,000 (in 2009). We were also given the "if you don't do the surgery she'll get arthritis and go lame" story. We had a long chat with our regular vet, who told us after much back-and-forth "If it were my dog, I wouldn't."

It's been four years, and she's still kicking. She's slowed down with some arthritis in her hip (not related, actually), but we manage her pain with Rimadyl, and she can walk 1.5 miles daily with me. She's still got some spring in her step.

My dog's not your dog, but there's my anecdote.

Good luck with your pup!
posted by purpleclover at 6:18 PM on December 4, 2013

The vet told me let my dog rest for a few days and we also went home with a bottle of glucosamine/chondroitin chew tablets. A couple days later we couldn't tell our dog had been hurt at all.
posted by PJMoore at 6:19 PM on December 4, 2013

This happened to my smaller (20 lb) dog about 2 years ago. I decided on the lateral suture surgery because my dog was young, it was the least invasive and seemed successful enough in smaller dogs. My dog is fine now, a little slower than he was and he limps a little sometimes, but I guess I'd say it was successful.

However, I don't think there is any huge hurry to get the surgery done-If the ligament is fully torn now, its my understanding that no further damage can be done over a few weeks of waiting to see if it gets better. I wouldn't have the surgery until you are able to manage the recovery. I actually thought the recovery was pretty miserable, but a lot of that may have been because of my dog's temperament-he wasn't super in to the "no running, no jumping, no getting excited" rules so I spent 8 weeks being super nervous that he would rupture the repair.

Also, look in to glucosamine/chondroitin chew tablets. My dog still takes them every day 2 years later, and if I run out and he doesn't get them for a few weeks, I notice him slowing down a little. They really do work.

Good luck with whatever you decide and feel free to ask if you have any questions.
posted by mjcon at 6:40 PM on December 4, 2013 [1 favorite]

Our 80 pound lab had cruciate ligament surgery (TTO, I think - it involved reshaping the bone and no ligament replacement) about 2.5 years ago. The second knee went out within the week of the first. She had both knees operated on at once. While she isn't one to endure pain, she did well with this surgery.

We choose surgery because of her larger size, our multilevel house and because her past owner offered to help pay. I was a good decision for us and this particular dog. She's had a great couple of years since then and at 12-almost-13 years is just starting to have arthritis that needs treated with painkillers. I don't know that we would have/will the same decision with a smaller dog that we could carry when needed. It has make us reconsider adopting dogs over 50 pounds.

Best of luck with your pup!
posted by Agatha at 6:56 PM on December 4, 2013

My 10-lb Pomeranian tore his ACL about 11 months ago. My regular vet told me my dog would need surgery to walk normally again. She referred me to a canine orthopedic specialist (here, if you happen to be in the Chicago area) who confirmed the torn ACL diagnosis. He was also of the opinion that my dog needed surgery.

Because my dog is so small, he was a candidate for the relatively simpler type of fix (on preview, it must have been the lateral suture surgery that mjcon mentions above.) I could have opted for the more invasive type, but the surgeon figured my little dude would have a good enough outcome with the first type.

It cost about just under $2000 all together for the surgery and 48 hour hospital stay. I had to take him back there two weeks later for a follow-up, and keep him from too much running or jumping for a few weeks. (Pretty easy, as he's just a decorative carpet lump anyway.)

I was told to make sure to get him up and walking as soon as he was comfortable, and he was pretty much back to his normal self within 5-7 days or so.

I paid for this surgery using an account I opened for this purpose with CareCredit. CareCredit is an interest-free credit account for health expenses, including vet care. Not all vets take it though, so you may want to use that as one of your criteria if you decide to shop around for a vet surgeon. (Not all vets do this surgery either. My regular vet doesn't do anything more serious than spaying and tooth extractions, hence the referral.)

Good luck. I hope your pup recovers successfully, whatever approach you choose!
posted by SuperSquirrel at 6:57 PM on December 4, 2013 [1 favorite]

mjcon: "Also, look in to glucosamine/chondroitin chew tablets. My dog still takes them every day 2 years later, and if I run out and he doesn't get them for a few weeks, I notice him slowing down a little. They really do work. "

Forgot to mention that my dog takes these too, and I agree that they do work!
posted by SuperSquirrel at 6:58 PM on December 4, 2013

My yellow lab-shepherd mix blew out both ACL's about a year apart. Had surgery for both of them, at the tune of 2K each. But it gave her back so much life and activity that I have never regretted the huge financial hits.

She passed away several years ago. We had her cremated, and when we went to spread the ashes in one of her favorite places to run, I found 2 stainless steel plates, along with 10 or so screws, from her knees. I knew that it was actually her, and I have kept this hardware ever since, as a momento.

(I used CareCredit for one of the surgeries. . .)
posted by Danf at 7:06 PM on December 4, 2013 [1 favorite]

My dog, 13+ years old, has an ACL injury on her back left leg. I took her to four vets over the past six months, two of whom pushed surgery, and one of whom recommended that I consult an area expert. The area expert, the fourth vet -- the one with the most experience with aging dogs and orthopedic injuries -- recommended against surgery given her age and ability to still walk about with a step-step-hop gait. So, my dog limps and is technically "lame" but hops along on two walks a day. She is treated medically with pain medication and monthly injections. I still feel torn about this, because it is hard to see her limp, and sometimes I imagine that people are giving me the stink eye as though I haven't gotten her treatment. So there's my anecdote. (Anyone reading this gotten the surgery for a dog older than 13 years? Would be interested to hear.)
posted by ClaudiaCenter at 7:17 PM on December 4, 2013

My 9 year old dog is going through TPLO recovery right now. Late summer I noticed she was intermittently favoring her one leg. I waited for a while and it slowly got progressively worse. Took her to the vet and he suspected a CCL/ACL tear but suggested I put her on NSAIDS and limit her activity and see how she does. I did that for a month or two with no improvement. X-rays confirmed the tear. My vet went through the options of different surgeries versus management with meds and limited activity. I also went and talked with two different orthopedic surgeons (who obviously recommended the surgery, but gave me more specifics into recovery time, outcomes, etc).

I think whether or not you go with surgery all depends on the type and age of your dog. Though my dog is getting up there in age, you would never know it by looking at her. She's a high-strung, VERY energetic pointer and is usually mistaken for a puppy. Her life expectancy may be quite long. The fact that her leg was getting worse also contributed to my decision - by the time she went in for surgery she wasn't putting any weight on her rear leg, basically hopping on 3 legs all day.

It was a hard decision for me. The surgery was quite expensive (just shy of $4,000), but fortunately my ex helped pay for it. My work hours and set-up of my house are also not conducive to containing a dog for long periods of time, but I've sort of made it work. She's probably getting more exercise/movement than she should be but I do what I can.

For me, though I dreaded paying that much money for surgery, I also couldn't bear her being in constant pain for the rest of her life (which could be a very long time), trying to manage it with pain meds which, in her case, didn't seem to help. In addition, I was worried that limping around on 3 legs would ultimately screw up her other back leg that was supporting all of her weight (I believe almost 50% of dogs that have one ACL tear end up having another one in the other leg). My surgeon did say that since the ACL was completely torn it wouldn't hurt waiting longer for the surgery, but since she was limping/hobbling so much I just didn't want her to be in pain so I opted to have it sooner rather than later (which was still months from when I first noticed her injury).

If I had a smaller dog, or a less active dog, or a dog who had a little bit mobility from the tear - I may not have gotten the surgery. And of course, if I had to cover the entire surgery (plus f/u vet bills) I may not have been able to do it.

Good luck! There's no easy answer. FYI - so far her recovery has been great, if I didn't know any better I'd think she was never lame.
posted by canda at 7:42 PM on December 4, 2013 [1 favorite]

Also, having surgery does not mean the dog will not develop arthritis. In fact, my surgeon clearly stated she will most likely develop arthritis in that leg. Maybe not as fast as without the surgery, and there are shots that can help minimize it, but once a dog has the tear - even with surgery - they are more prone to arthritis.
posted by canda at 7:45 PM on December 4, 2013

Our Yorkie had surgery for what the vet thought was a luxating patella but turned out to be a torn ACL. It was repaired with an actual rubber band from what we were told. Recovery was uneventful but five years later she still favors that leg, sometimes not even putting it down, and has to take Rimadyl. Vet says she has arthritis in that knee now. We would still do the surgery as she could barely walk before it.
posted by tamitang at 9:38 PM on December 4, 2013

Response by poster: THese answers and personal accounts are SO helpful, thanks everyone!
I would also love to hear how long people waited between the dog's injury and the surgery, if you chose surgery, and how that time lapse seemed to affect the outcome. I'm trying to figure out if this is an emergency.
posted by third rail at 5:33 AM on December 5, 2013

My previous question on this topic.

Wilson is an 11 yr-old, 31 lb. Lhasa mix. He tore one knee and is a terrible candidate for surgery due to other issues. so that was out of the question. His pain was managed with Tramadol and though it was really awful to see him limping around for several weeks, it did get better. Our vet said dogs 30 lbs and under (not exclusively, but especially) do better recovering without surgery.

He tore his other one (very common and generally expected, unfortunately) just as the first one was finally getting back to normal. This one seems worse, as it sometimes clicks when he walks. And in the first maybe 3-4 weeks, I was really worried he was in a lot of pain, though he never complains. But we're thankfully past that stage. He does take longer to get up from sleeping now, and sometimes he limps worse than other times, but he also has plenty of episodes of crazy, running around, give-me-snacks mode, too. He is slower on walks, but loves walks, and is a happy dog.

I think the younger your dog is, the better the chance of full recovery without lingering effects, without surgery or with surgery, if you go that route). Without surgery, it will get better. If he's a bit older, well, you'll notice the limp and slowness more, but all dogs slow down. We do like to keep the Tramadol around for bad days, but there are fewer and fewer of those. (We also give him glucosamine/chondroitin tablets, though I am somewhat more skeptical about whether they work. But maybe they help, and that's worth it to us.) Good luck!
posted by Glinn at 5:39 AM on December 5, 2013

I've previously contributed to discussons on this topic, as I have a Westie who had the ACL repair surgery at 8 years old. He's 10 now and is doing great!

Here's what I originally said:

...Fergie had a repair done by our regular vet, creating a suture. The surgery went really well. Recovery entailed 8 weeks of us sleeping on the floor (because he likes to sleep on the bed with us and was forbidden from jumping), carrying him up/down the stairs, and leash-only walks and bathroom breaks. We also started him on a joint supplement at that time, and reduced his feeds so that he lost about 5 lbs. He received PT 2 times a week at the vet's for about 4 weeks, and that also included laser treatments, AND we had to ice and massage the surgical site three times a day for about 6 weeks. We did everything faithfully.

Fast forward to today. Fergie lays on his bad knee quite frequently, and it ends up being sore/stiff. But, it's nothing that bothers him. It's just like human surgery--it will never be quite the same. But he runs, jumps, and plays like he did pre-injury. It has definitely contributed to his quality of life, now that he's an old dude of 9 years. I suspect he's getting arthritis in his hips, though, and I also think that switching to a new type of senior dog food has made him put a few pounds on; we are going to try to get him to lose a few more pounds (he's at 23 now) to see if that helps. Weight management is a big part of it, especially if you have a little chunk who loves to eat.


Here are a few questions to ask yourself:

1. Are you willing to comply with a potentially complicated recovery process? What is the recovery process your vet would want you to take? We probably were extra cautious, but I wanted the best possible result.

2. Are you committed to limiting food, so he can lose some weight? What is the ideal weight for him? Joint issues and osteoarthritis (which is inevitable in older dogs) are ameliorated by proper weight (and sometimes exercise--but ask your doctor).

3. What is the plan if this doesn't work? Sutures break (rarely), bone doesn't heal properly... what would be the next step?

Another thing is to get a second opinion. I am glad I did; not only did I save a bunch of money, I feel like I got the best possible service. I don't think I would have gotten the same care for Fergie had we gone to some specialist vet. Our vet was qualified to do the surgery, and it was such a non-complicated case, I felt completely comfortable that this was the right way to go.


So, the question I ask myself whenever faced with a medical or surgical issue with my dogs is: How would I feel if it were me? I would definitely want a CCL/ACL repaired. No question. This is a super painful condition for humans and it's not really reasonable to expect a dog with years ahead of it to endure daily pain, IMO.

Get that second opinion. Not all vets will treat this the same way; there are different surgical techniques out there. I am satisfied that we did the right thing with the suture with our regular vet, but had this been a different dog, like our 35 lb Goldendoodle, I'm not sure we could have done that.

There's no harm in waiting a few weeks as you explore your options--so long as your dog is not in pain. Rimadyl can help immensely.

The other thing I want to say is, don't bother with the surgery unless you are 100% committed to a full recovery. Otherwise, it'll just be money wasted, and no improvement for your pet.

Good luck... hope she feels better soon.
posted by FergieBelle at 7:34 AM on December 5, 2013 [2 favorites]

third rail: "I would also love to hear how long people waited between the dog's injury and the surgery, if you chose surgery, and how that time lapse seemed to affect the outcome. I'm trying to figure out if this is an emergency."

I asked this same question ("Is this an emergency?") to my vet and the surgeon and got similar answers from each. This all is based on my dog and his anatomy and specific injury, of course, so YMMV.

I chose to get the surgery done within 48 hours of his first injury. I chose to do it right away for several reasons, some of which were purely practical for my situation, and some were due to the advice of the vets:

+ If I waited, his chances of injuring the other back leg were much much higher, due to the extra stress being placed on it from to his awkward tripod gait. This was by far the most important reason for getting the surgery over with asap.

+ If I waited, monitoring his activity level would have been extremely difficult. Having never spent much time crated before*, crating him at this point would have been extremely stressful for him. Despite being mostly decorative, as I mentioned above, he did/still does have a daily run-around-like-his-ass-is-on-fire session, mostly in response to my other dogs wanting to play.

+ I was approved for the CareCredit account right away, so paying for the surgery was not a huge worry.

+ The surgeon was an hour away from my house, and I had already taken a personal day off work to take him in for the consult. It seemed easier to just leave him in the capable hands of the staff there right then, than to haul him home, think it over, and decide he should have the surgery anyway, arrange for another day off to take him back, etc., etc. I also don't trust my doggie nursing skills that much.

* This is one of the best reasons for crate training, even if you don't need to keep the dog confined regularly.
posted by SuperSquirrel at 8:09 AM on December 5, 2013 [1 favorite]

Both of my JRTs (one male, one female) have had to have TPLO in one rear leg. I sympathize with your situation because I didn't have 4k to devote to it (California is more expensive) and we had already made holiday travel plans in the case of the female. It's tough, because trying to keep a Jack from running, jumping or playing is well nigh impossible. We had to buy a cage for them to sleep in and stay in when we were not around, though we jiggled our schedules to minimize times we both left the house.

Anyway, both dogs are basically 100% now. We waited a month or two on the male because we had a hard time coming up with the money, and from time to time I see him limp on it... usually after he's been holed-up under the bed in a tight place, but he shakes it off. I used a 401k loan each time to pay for mine, since at least that way I could pay myself the interest. For us we couldn't bear the thought of seeing them limping, though our vet told us they wouldn't be in pain, they just wouldn't be able to use those legs.

But you absolutely should get some other opinions. Your local SPCA may be more affordable as well.
posted by jeffamaphone at 9:54 AM on December 5, 2013

My SIL's Rottie blew out an ACL about a year ago. She paid for the surgery, did all the follow up care and the dogs leg healed with no worries. The strain of favouring the injured leg, damaged the other ACL. As my SIL has had major financial/life changes since then she could't afford to have it repaired so the vet managed it with rest, the dog is now able to go for walks, but not for as long as it used to be able to or it's leg starts bothering her (she used to run for miles, now it just gets gentle strolls along the beach) the dog seems as happy as it used to be, is not in pain unless it pushes itself too far and seems to know when it's time to stop and rest. My SIL still talks about getting the ligament "fixed" when she gets the money, because I think she feels guilty.
posted by wwax at 10:10 AM on December 5, 2013

FWIW, there are no peer-reviewed, evidence-based studies that indicate glucosamine and chondroitin are effective in reducing joint pain or osteoarthritis.

I have worked with a veterinary orthopedic specialist and have seen many of these procedures first-hand from initial consult to final check up. My advice:

Get a second or third opinion. It is expensive surgery, and some surgeons are more skilled than others.

Commit to reducing your dog's activity level so that it can heal, whether or not you decide to go forward with surgery. We see many recurring orthopedic conditions in pets whose owners let them run or jump or climb stairs because they don't want to restrict their freedoms. Many times, we see pets returned injured months after a successful surgery because their activity was not restricted. It ends up being expensive for the owners, frustrating for everyone, and an unpleasant experience for the pet.

Bear in mind that NSAIDs are expensive, and not without detrimental side effects when used long-term. They can help make your dog more comfortable, but talk with your veterinarian about how they would work with your pet, and for how long he or she would be comfortable prescribing them.

How did your vet diagnose the CCL rupture? Radiographs? Cranial drawer sign under sedation? How experienced is he or she with the condition and the surgery?

If your dog is overweight at all, reduce its weight to reduce the strain on his or her joints.
posted by Seppaku at 1:56 PM on December 5, 2013 [1 favorite]

My 7 pound mystery dog had a luxating patella which caused his ACL to tear last year (he was 9 at the time). He was in a tremendous amount of pain, so there was really no decision to be made regarding the surgery. I took him to a orthopedic surgeon and a $1200 and a couple months later, we was like new. He is so much happier now that his tiny drumstick is fixed!

Good luck to your furry friend whatever you decide!
posted by couchtater at 12:02 AM on December 7, 2013 [1 favorite]

My young, 40-lb dog had the same problem and we did not do the surgery. She's absolutely fine now a few years later.
posted by thatone at 3:26 PM on December 7, 2013

I wanted to update with an anecdatum. (Background from above: My 13+ year old 40 pound dog has an ACL tear, and at this point (after consulting with four vets) I have decided not to do the surgery.) Between the first and the fourth vet, I was prescribed for my dog various medications for pain (metacam, gabapentin, and tramadol), and was conscientiously spending a lot of time getting the medication into my dog because I was of course so concerned that she not experience pain. (And, in fact, the tramadol prescription permitted me to give her even more than I was giving her.) At the same time, her appetite was crap, and she was lethargic and unhappy; I thought she was heading toward the end of life. BUT -- it turned out my dog was overmedicated. The fourth and most experienced vet cut the medication way way down -- I am now giving my dog twice a day a small dose of tramadol and a regular dose of gabapentin, no metacam, plus injections weekly and then monthly. My dog has come "back to life" -- her energy and appetite are great, her mobility is good (although of course she does a step step hop with the busted knee), and just overall she is way way way happier on less pain medication. I am so glad I kept looking for the right doctor for my dog's situation.
posted by ClaudiaCenter at 10:49 AM on January 14, 2014 [1 favorite]

Hey, everyone in this thread, thank you. Left alone on the internet with a dog in pain is no place to be. Finding a level headed thread on Ask was *very* welcome.
posted by DigDoug at 1:59 PM on April 5, 2014 [2 favorites]

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