Can conservative, non-surgical solution work for canine cruciate ligament tears in large dogs?
The best answer to the above question is that it depends. It depends on
- the type and degree of the tear
- overall health, and condition of the dog
- the solution used
- and the ability to get your dog to cooperate
Is there any harm in trying?
The downside of unsuccessful conservative management is
- the possibility of the development of arthritis in the unstable knee
- and increased vulnerability of the other stifle
Thank you, Luanne, for sharing Sandy’s story.
Sandy’s story
Sandy is an 11-year-old Lab cross, a lovely girl who is full of life and full of beans. Her left ACL failed two years ago. At that time, Sandy got an extracapsular repair.
Quite often, particularly in older dogs, a ruptured ACL is a result of a gradual weakening of the ligament. Having the other ACL fail is just a question of time. That is what happened to Sandy.
The reasoning
Sandy’s extracapsular repair went well. And, in spite of a post-op setback, Sandy has full use of her left leg. However, there are reasons why Luanne opted for a non-surgical solution this time.
She recently lost one of her dogs on an operating table and is leery of putting Sandy under anesthesia. I can surely relate to that! Statistics mean very little when you lose your dog.
NSAIDs are not an option
It also turned out that Sandy cannot tolerate NSAIDs—she developed a bleeding ulcer after only 3 days of the treatment!
NSAIDs can be effective for managing inflammation and pain, but I frequently see cases where dogs have a bad reaction to drugs. More frequently than overall statistics would suggest. After our own experience and those I witnessed, I really recommend considering other options first. Measure twice, medicate once! (Anybody out there who had a positive experience with NSAID treatment? Let me hear from you!)
We also seriously considered non-surgical options for our Jasmine and did a lot of research. Eventually, we decided to go with a combination of extracapsular repair and stem cell therapy. Because of Jasmine’s age and activity level we felt that surgical repair was the best choice for her. We couldn’t be more pleased with the result!
For some dogs, conservative management is the way to go. The important thing with ACL injuries is to stabilize the knee long enough so scar tissue can develop to replace the function of the ligament. As long as the knee remains stabilized, whether, by means of surgical stabilization, a brace or truly controlled exercise, the final result should be the same.
Rehab management is quite similar to both surgical repair and conservative management. Restricted exercise and short controlled leashed walks … every dog’s dream (not)! But it needs to be done in order for them to be able to get back to their lives.
Stifle brace
Sandy was fitted with a bilateral knee brace made by Canadian Animal Rehab. The brace provides external joint stabilization and takes over the function of the surgical repair. Sandy was wearing her brace for her walks. The brace would likely not survive an unsupervised Sandy. Unfortunately, this led to a number of setbacks, which might not have happened if the brace was on.
We were considering a different type of brace for Jasmine. But during our conversation with the manufacturer, we learned that Jasmine would have to wear it at all times until the scar tissue developed. And it was recommended she’d wear it for long hikes even after that. That was one of the reasons we abandoned that option.
Learning from the setbacks, Sandy started wearing her brace all the time she could be supervised. Sandy is full of energy and would take advantage of every chance she had to go wild and do something silly. She is restful and calm at night so she could enjoy comfortable brace-free rest.
The additional protection of the joint seemed to have brought things around and an appointment with her physical therapist was made to assess Sandy’s progress.
A thorough examination revealed that Sandy’s leg was in good shape. However, the knee wasn’t as stable as it should have been and some arthritis seemed to have developed. An important decision needed to be made – whether to continue with conservative management or do the surgery after all.
A setback
The conservative management was going quite well until a major setback, from which little improvement could be seen. Are better control and movement restriction going to be possible with Sandy?
With that in mind, the extracapsular repair was reconsidered and scheduled. For the second time, Sandy fell ill before the surgery appointment. Would that be a sign not to go through with the surgery?
Sandy’s mom decided to continue with conservative management.
A surgery after all
While Sandy’s knee seemed to have been improving with the brace on full-time, the brace was causing trouble with Sandy’s ankle. This turned into a serious problem. It was what ultimately lead to a decision to abandon conservative management and go with surgery after all.
Sandy had her extracapsular repair done. The surgery went well and Sandy is now at home recovering.
Related articles:
Sandy”s Extracapsular Surgery
Further reading:
Conservative Treatment Options for Partial and Complete CCL Tears in Dogs