My dog hurt his knee, it might be a cruciate ligament tear, what do I do now?
The problem:
The cranial cruciate ligament (the same as the ACL in the human) is an important stabilizing ligament of the knee. It guides judgement for how to walk and where to place the foot because it has nerves associated with it for proprioception. When it is damaged, the ligament will stimulate inflammatory chemistry that is destructive to the cartilage and lining of the joint. Overtime as the cranial cruciate ligament (CCL) loses strength, the knee becomes less stable and the likelihood that other structures (the meniscus) will suffer damage is also progressive.
To provide the best care in recovery, there are several issues we will need to manage:
Stability of the knee : TPLO vs Extracapsular repair
Gait re-education and muscle firing in the rest of the leg: Rehabilitation Exercise
Pain relief: NSAIDS, Amantadine, Laser and Adequan
Slow joint destruction: Platelet Rich Plasma, Stem Cell therapy, Synamid joint lubrication, and Adequan
Create strength with rehab exercises and maintain them to prevent re-injury
What you need to know:
A certain percentage of dogs have degenerative CCL disease, which means sometimes even at a young age (1-2 years old) a dog can suffer from this problem.
Up to 70% of dogs will tear the second CCL within a year of the first side being injured.
Damage in the joint secondary to a CCL tear will generate arthritis in the knee
What can we do?
We know that the ligament is likely to progressively tear over time, sometimes months, sometimes years. In addition, there are varied degrees of “tear” from 10% to 90% that we consider a partial tear. A full tear is diagnosed by laxity in the knee and is associated with more damage.
The best treatment options are pursued by gaining the most information:
Radiographs to check for fluid in the knee and evidence of laxity
Ultrasound to evaluate for ligament tear and visualize some of the meniscus if we suspect that the CCL is only partially torn.
Setting our Expectations:
Recovery from an ACL tear takes 3-6 months depending on the methods we use and amount of treatment we employ to help your dog heal.
The fastest and most complete road to recovery includes: surgery and rehabilitation and regenerative medicine. Some of my dog patients have even come back to competing in agility by 12 weeks. Dogs with average exercise requirements often recover well without the benefits of Stem Cell Therapy, however the often do benefit from this treatment for arthritis in the long-term.
Medical Management Options:
When the knee is still stable (no laxity on exam) but we suspect a partial torn CCL, we may be able to pursue some regenerative medicine options to try to put off the inevitable “complete CCL tear.”
About 50% of dogs treated by stem cells we treat have not needed surgery within the 2 years following the first appointment.
Stem cells to manage arthritis as well as IBD or allergic skin disease, which means the patients experience other great benefits, even if the CCL eventually becomes fully torn. Platelet rich plasma injections are sometimes used to treat just the knee.
Shockwave therapy to stimulate new collagen production and reduce pain
It is important to weigh the benefits of earlier surgical options to prevent tearing the meniscus at the time that the complete CCL tear happens.
Goal #1: Pain management
Goal #2: Reduce inflammation and slow destruction
Goal #3: Rebuild the body
Goal #4: Return to fun
After we discuss whether surgery is the right path for you, we also discuss the following therapies as adjunctive or instead of surgery to improve your dog’ s physical health.
Shockwave therapy:
Restore flexibility of the muscle of the knees and hips
Improve pain relief to the joints and all of those painful muscles
Stimulate new joint nutrition from the body itself
You Tube video explanation: youtu.be/yA3m_N_AHtE
Regenerative therapy options include: stemcells, Platelet Rich plasma and joint lubrication injections with Synamid. Schedule a pain management/rehab consult to discuss in detail.
Stem Cell Options:
Stem cells are one of the best anti-inflammatory and pro-healing tools we have. They will not create new ligaments and cartilage but can preserve what is there and reduce the needs for medications.
Cells can be harvested from the fat of your dog to use via injection into the knees or IV for life to help manage the arthritis we know will follow this injury.
Cells can be ordered that were harvested from another dog and used as a single treatment, SQ, and can be reordered as needed.
Some pet parents will choose to have a follow-up PRP injection instead of Stem Cell Therapy. Sometimes we want to help the joint to heal and are interested in regenerative medicine, but the cost is prohibitive, given all involved.
Platelet Rich Plasma: growth factors from blood and platelets injected into the knee at the time of surgery and potentially one month after surgery or at the time a partial CCL tear has been diagnosed. It is the least expensive option to provide immediate growth factors and modulation inflammation in the joint, but is a bit less powerful than stem cell therapy, and does not provide the benefits of lubricating the joint that synamid does.
Synamid: polyacyrlamide injection that is especially helpful if arthritis is already present
Note: Stemcells can be used with shockwave and Synamid for best outcome, either with or instead of surgery, depending on the case.
Other options:
The options above are truly the best we have to help your dog recover with the least complications.
We will of course also discuss laser and rehab therapy with supplements to help your dog rebuild the body.
There are always financial considerations and timing to weigh in this equation, we design plans that range from the best and all inclusive plan to the least effective intervention to manage symptoms and sometimes to avoid surgery in older and fragile patients.
It is our pleasure to help you navigate all the components and options.
Please schedule by calling Bree or Andrena: 303-688-3660 as soon as possible.
If your dog is very painful at the time you call, please do let them know this to try to fit you in more urgently as we are often scheduling a few weeks out.