CCL Tears Conservative Management: My Two Cents on Non-Surgical Treatment of Cruciate Ligament Tears in Dogs

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:

• size/weight
• 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
• cost

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.

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
• older

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

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

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.

Further information: Prolotherapy

Jasmine’s story

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.

Braces

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.

Further details: CCL/ACL Injury in a Rottweiler: How The Odyssey Started—Jasmine’s ACL Injury

In closing

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.

Related articles:
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

Further reading:
Nonsurgical treatment of CCL tears