Is there a way to treat your dog’s torn cruciate ligament without surgery?
The best treatment option for your dog’s CCL injury depends on several factors such as:
- age/activity level
- overall health/other medical conditions
- degree of damage
I always give serious consideration to non-invasive options before making any treatment decision for my dog. Why put your dog through surgery if another treatment might do the job?
So the question remains, can conservative management do the job when it comes to canine cruciate injuries? Sometimes. Though I feel I ought to warn you that I know enough people who spent a great deal of time trying and ended up having to resort to surgery at the end.
Is it worth of try?
Of course, it’s worth of try. Do keep in mind, however, that the longer the knee remains unstable, the more damage it sustains in the form of worsening arthritis.
Example story: CCL Injury Conservative Management: Tucker’s Story
The main reasons people choose conservative management (CM)
- preference for less invasive treatment
- risks involved with surgery
- risks involved with anesthesia
- fear of post-op restrictions
Don’t judge people who have to include cost in their treatment decisions. Depending on the type of surgery, it can come to anywhere from two to five thousand dollars. And that is without calculating any post-operative care.
On the other hand, though, intensive care which includes various therapies such as laser therapy, hydrotherapy, and physical therapy, can add up over time too.
Note: If you fear you won’t be able to keep your dog subdued during the post-op recovery, what makes you think you’ll be successful in keeping them subdued to allow healing without stabilization of the joint?
The good news is that you can talk to your veterinarian about “chemical restraint” in either case. Trazodone was a life-saver for us with Cookie.
When has CM the best chance to work?
If you have a young, active dog, you can forget the idea. The odds of success are low. As well as the larger is your dog, the lower are the odds of a good outcome.
In other words, the best candidates for conservative management are dogs who are:
- less than 30 pounds
- less active
Partial CCL tears are generally better candidates for conservative approach than full tears. That doesn’t mean you cannot try that for full tears, not it means it is a sure-fire solution for partially torn ligaments.
Further information: Nonsurgical treatment of CCL tears
What is the optimal outcome of CM?
The goal of any therapy for cruciate ligament tears is to achieve a stable knee joint. Ultimately, the body accomplishes that by surrounding the joint with enough scar tissue to prevent it from instability.
A tight envelope of scar issue stabilizing the stifle is the optimal outcome of the CM. With too much excess movement in the joint, though, the approach fails to accomplish that.
What does conservative management entail?
The core strategies in conservative management of CCL tears in dogs include:
- exercise/activity restrictions
- anti-inflammatory medications/pain management
- adjunct therapies such as laser therapy
- physical therapy
- braces or wraps
When the CCL gets damaged, the knee joint becomes unstable–the bones in the stifle move in ways they are not supposed to. That leads to inflammation, pain, and further tissue damage and arthritis.
The best way to facilitate healing is by preventing the unwanted movement–stabilizing the joint. That is what surgery or external stabilization with braces or wraps accomplishes.
Without these measures, your dogs activity needs to be minimal if the knee is to heal.
The most common medications prescribed for pain management for dogs with CCL tears are anti-inflammatory medications (NSAIDs).
They control pain by reducing inflammation. While some degree of inflammation is an integral part of the healing process, too much is detrimental.
Further information: Understanding Chronic Inflammation In Dogs
Laser therapy can be used along with or instead of NSAIDs if your dog cannot tolerate them. It facilitates healing and relieves pain and inflammation as well.
Laser therapy helps the formation of the scar tissue needed to achieve joint stability.
Further information: Laser Therapy for Dogs: Can Photon Power Help Your Dog?
Physical therapy is a cornerstone of recovery from injury or surgery.
The goals of physical therapy in CM for cruciate ligament tears include:
- increase of blood flow
- maintaining range of motion
- promoting functional strength
Further information: Dog CCL Injury Grading: Cruciate Tears “All or None, or Partial?”
Braces or wraps
The purpose of braces or wraps is to provide external stabilization of the knee during the healing process.
Couldn’t braces or wraps replace surgery altogether?
While surgical repairs have their risks and challenges, braces and wraps sound like the ideal solution. However, the way they stabilize the knee is different and not as effective. They provide some stability but don’t prevent unwanted laxity completely. In other words, they do an imperfect job.
As well as to work properly, they’d have to remain on at all times. One of the common setbacks people run into with these devices is when they put them on only when they figure the knee needs support. Do you think that if your dog is in their crate, they cannot mess up their healing knee?
Some dogs won’t tolerate a brace and will simply shred it to pieces. As well as braces can cause new issues, such as at the hock.
If you are going to use a brace, make sure it is custom brace molded to fit your dog’s limb perfectly. An example of what I consider a perfect device is the OrthoPets stifle brace. I talked to the founder extensively, and I was highly impressed by how much thought and consideration they put into the product. Even though we abandoned that solution, I did get to hold one of the braces in my hands, and it is surprisingly light–it looks like it would be much heavier when you look at the construction.
Further information: Canine Full CCL Tears: Treatment Options for Full Cruciate Ligament Tears
Prolotherapy is an underdog in mainstream veterinary medicine but some practitioners do use it in the treatment of CCL injuries.
Prolotherapy has been around for decades, and it involves injections of various substances into the joint. The veterinarian might select different solutions based on the goal of treatment. For dogs with CCL injuries, it helps tighten the joint and facilitates the healing process.
Small to medium dogs or dogs with partial tears can do quite well with this additional help.
Naturally, activity restrictions and physical therapy are still essential. No matter what treatment you choose, you cannot get around that.
When Jasmine was diagnosed with partial CCL tears in both knees, we considered the full gamut of treatment options.
When I looked up the TPLO which was the sole recommendation from her veterinarian, I did not like that at all. I was willing to try anything but that. I wanted Jasmine fixed but I found the surgery crazy invasive.
Could conservative management work for Jasmine? She was an active dog, and both of her ligaments were in bad shape. Further, the evidence at the time suggested that Jasmine already injured her CCL in the past–it went undiagnosed. Her lameness resolved with exercise restrictions, but it returned. Clearly, the problem wasn’t solved.
Each time it took about five months for her lameness to resolve–so not much difference in terms of shorter recovery time.
The next thing we considered was braces.
The idea was for the knees to heal while Jasmine still could enjoy her life a much as possible. But the odds were that she would have to wear them every time she would go on a long walk or was being more active, even after the healing period was over. We felt that she was too young for that.
To operate or not to operate?
We looked into regenerative therapy, and I liked that idea very much. Unfortunately, Jasmine busted her CCL entirely in the meantime, and that approach no longer made sense.
To get Jasmine back on her feet and back to her active lifestyle, we opted for surgery at the end. For Jasmine, we selected the least invasive option at the time, the extracapsular repair. It worked for Jasmine and after the recovery period her knees were as good as new. That said, I don’t believe it would have worked for any other of our Rotties.
If your dog is less active or easy to control, older or unable to undergo surgery, conservative management is a viable option. And it is definitely better than doing nothing.
If I were to try CM for my dog, I would incorporate a stifle brace to try and provide some additional stabilization of the joint.
Talk To Me About Dog ACL/CCL Injuries
Dog CCL Injury Grading: Cruciate Tears “All or None, or Partial?”
Preventing CCL/ACL Tears in Dogs: How to Keep Your Dog from Busting Their Cruciate Ligament
Canine Full CCL Tears: Treatment Options for Full Cruciate Ligament Tears
Physical Therapy for Full CCL Tears
Nonsurgical treatment of CCL tears