Dr. Mark is a veterinarian. He has been working with dogs for more than 40 years.
First Aid for Your Dog's Knee Injury
If your dog is limping, you need to check the entire leg and try to determine what is wrong. Do not jump to any conclusions just because your dog has injured his cranial cruciate ligament (CCL) in the past.
CCL vs. ACL: What's the Difference?
In dogs, the ligament is actually called the cranial cruciate ligament (CCL), whereas in humans the corresponding tissue is called the anterior cruciate ligament (ACL). Many people refer to "ACL tears in dogs" simply because the term is more familiar.
How to Check Your Dog's Leg
- Start with the foot. Hold it in your hands and watch your dog's reaction. Is it painful? Look at the pad and see if there are any cuts, swellings, or loss of skin. When a dog licks on the pad because of pain or itching, she can take the skin right off.
- If you do not notice any cuts or swellings, check between each toe. Is there a bit of gravel, a thorn, or an injury that you cannot see when looking at the pads?
- Check the nails for cracks or swelling around the base. Sometimes, you will not see anything but your dog will react when you wiggle the nail.
- If the foot is okay, start moving up the leg. You should flex the hock and watch her reaction.
- Massage the rest of her leg gently and look for the swelling from a broken bone or another injury.
- If you still haven’t found anything, move on to the knee. A dog with a luxating patella may have been lame in the past so you might already know how to deal with it. If it does not go back into place easily, try to extend the dogs leg and gently massage the kneecap back into place.
- A damaged cranial cruciate ligament (in people it is called the anterior cruciate ligament, or ACL) is the most common cause of hind leg lameness in the dog, so if your dog is larger, a damaged cruciate ligament is more likely. (If you have a Rottie, a Lab, a Golden, or a German Shepherd, be especially suspicious.) The only way you can identify it is by the “cranial drawer” sign. Hold onto the femur, and if your dog is relaxed, she will allow you to slide her lower leg forward so that her knee is moved from front to back more than normal. If things are really bad, you might even hear a “pop." This can be painful, so not all dogs will want you to mess with their leg.
- The most important part of first aid care for a cranial cruciate ligament injury is keeping your dog calm. Do not let her jump up and down and make things even worse.
If your dog is not already on a leash, put her on one. (If she is not on a leash, she might go running off chasing something before you even have a chance to stop her. Even if she stops as soon as you tell her the damage can already be done.)
- If your dog is small or medium sized, carry her back to your house or car.
- If your dog is too large to carry, walk her very slowly.
When you get home, encourage her to lie down. If your dog jumps up and bounces up and down every time the doorbell rings, confine her to a crate or use a leash to keep her tied down to one spot.
- Anti-inflammatory drugs: When you take your dog in for an exam your vet might put her on one of the new generation non-steroidal anti-inflammatory drugs. Don’t wait around until then—you should give her something right away to decrease the swelling associated with the injury. Aspirin is the safest drug that you have at home. Give her 8-20 mg/kg and then give her another dose in about 24 hours. Give a small dose, see how she responds, and if she is still having problems you can give a larger dose the following day. (Since aspirin will upset the stomach sometimes, I always give a dose with a meal. If your dog is not eating because of the injury then give her something tasty like lunchmeat.)
- Gentle massage and an ice pack: If you are not at home and do not have an ice pack available then take some ice cubes and wrap them in a hand towel. This cold treatment is meant to reduce swelling immediately after the injury and may or may not help, depending on the extent of the damage. When you apply it to the knee leave it on at least 15 minutes while gently massaging the tissue above and below the knee. Applying an ice pack wrapped in cloth to the affected knee will allow you to observe any swelling, and may have a calming effect on your dog. (Some dogs are very upset after an injury and whine and move around excessively since they cannot understand why they are in pain. Sitting down on the ground with them for a few minutes while you apply the ice pack and massage might make a big difference.) Some practitioners recommend an ice pack post-surgery. At this time there have been no studies that show that this helps.
- Check the hips: Even if you are sure that the cruciate ligament is affected and bothering your dog you should complete the exam of his leg and check out his hips. Many people will assume it is an ACL injury even when something else is going on. A dog that has hip dysplasia and secondary arthritis can also come up lame suddenly.
When You Should Take Your Dog to a Veterinarian
If your dog is still limping after you have given him first aid and taken him home to rest, you need to take him to your vet for an exam. I cannot tell you an exact number of days to wait for recovery or watch him for changes, but I do want to emphasize that you can do a lot for your dog at home and that this is not an emergency.
The vet will perform a physical exam where he flexes the knee and checks for pain, feels the muscles on both sides to check for any difference, listens for any clicking, and feels for any crepitus (a “scratchy” feeling) that indicates things are not the way they should be inside the joint. Dogs with a damaged knee sit oddly and he will watch the dog to see if he is holding his leg out when he sits down. He will probably then perform some tests. The first, the cranial drawer test, is when he will hold the femur in one hand and try to move the knee forward by pushing the tibia back and forth.
Some vets will recommend x-rays to try and see the cranial cruciate ligament. X-rays might show swelling but cannot be used to visualize the cruciate. In some cases, your vet might even recommend the ligament be checked with a laparoscope. While your dog is under anesthesia a small incision is made above the knee and a tiny camera is pushed into the joint to look at the damage. If the tests are inconclusive but he still suspects a cruciate injury he may recommend a cranial drawer test be done while your dog is under heavy sedation.
Your vet may or may not recommend surgery at this time. The tibial plateau leveling osteotomy (TPLO) has been around several years and is the surgery that is most likely to be recommended. A 2013 study done by the American College of Veterinary Surgeons indicated that the success was better than with the TightRope (TR) or tibial tuberosity advancement (TTA). There are other alternatives but not all are available in all areas, and not all have the same chances of succeeding.
If your vet does not recommend immediate surgery, he might tell you to rest the dog and treat him medically with NSAIDS like Metacam (meloxicam, which may have fewer side effects than the aspirin you have been giving your dog after the injury). Some reports in journals like that of the AVMA (Journal of the American Veterinary Medical Association) state that medical treatment will not work and surgery is the only way to go.
If your vet recommends immediate surgery to prevent the development of arthritis, you need to wait. All dogs will develop some degree of arthritis after a knee injury, and rushing into surgery will do nothing to prevent it. No one can guarantee otherwise. Do not rush into anything.
This is the most common test to determine whether or not your dog has damaged or torn his cruciate ligament. The test may or may not need to be done under sedation.
Will Surgery Be Necessary?
If surgery did not stress out so many dogs, was successful 100% of the time, and did not cost so much, it might be worth it.
- Unfortunately surgery to fix a damaged cruciate ligament is expensive. If you ask what to do in an internet forum some self-righteous person will tell you that you are a terrible person for not having the money and you should rehome your dog. If you do decide to have the surgery, you do need to be aware that the cost to perform surgery on your dog's ripped ACL is anywhere from $2000 or more, depending on where you are. Even dog owners that care about their pets and have a special savings account for medical expenses might have trouble coming up with that much. If the expense is not a problem for you, there are other reasons to hesitate.
- It is also unfortunate that cruciate surgery is often not effective. The success rate you are told will depend on who you are talking to so it is hard to give you exact numbers. A vet that does the surgery is more likely to tell you that over 90% of dogs will have almost full recovery. Someone who managed their dog medically will tell you that even AVMA surgical studies show that non-surgical methods work at least 2/3 or the time.
- The actual stress of the surgical procedure has to be taken into account. A dog can live with a torn or injured cruciate ligament though and old dogs and any dog with a medical problem are at increased risk during anesthesia. Not going through with surgery can be an easy decision if your dog is 15 and suffering from kidney failure. If your dog is middle aged, however, even a battery of lab tests do not guarantee that there is not a problem just below the surface.
So how do you do the right thing? You will not know if your dog needs surgery until you give him at least 8-10 weeks to recover medically. If you have one of those dogs (maybe about 1/3 or those that injure their cruciate) and:
- Your dog is not improving AT ALL with medical treatment
- Your dog is not a senior and has no obvious or underlying secondary medical problems
- Your dog is large and too active to stay still for further non-surgical recovery
- You can afford it and have a successful surgeon in your area
Then surgery may be a good idea.
When Is Surgery a Bad Idea?
- If your dog is old and has health problems that make him likely to have problems while under anesthesia for a long orthopedic procedure.
- If your dog is younger but suffering from a health problem that will make surgery especially dangerous.
- If your dog is obese then he is going to have a poor recovery prognosis. You will have to get his weight under control.
- You are being told to have the surgery quickly so that your dog does not develop arthritis.
- You are being told there is no alternative but euthanasia.
In a recent study, 24% of the dogs had serious complications and 20% of the dogs required a second surgery on the same knee. One of the dogs in the study had such significant complications that the leg had to be amputated. This is not a common occurrence, but it does happen. Your dog´s surgeon should tell you about this before he proceeds.
Medical and Non-Surgical Options
This is the most important part of healing both for alternative therapy and after a surgery. In human medicine, this may be the only treatment recommended. In veterinary medicine, we know that your dog needs strict rest to recover so he must be confined to a small room or cage; if he is allowed to walk around the house he needs to be kept on a leash so that he does not run to the door when the bell rings or run up and down the stairs.
If your dog rests too much, however, his muscles will weaken and he will have a hard time getting around even with an improved cruciate. Look into providing some exercise with hydrotherapy and provide passive motion every day through massage therapy.
Most of the dogs that are injured are overweight or morbidly obese. Their diet needs to be changed immediately whether or not a medical nonsurgical or surgical therapy is chosen. Part of his poor body condition may be due to the cheap grain filled diet he has been eating. The best dietary improvement, then, is a raw prey-type diet composed of substances high in glucosamine, like chicken legs. It is not as easy as just opening up the bag of dog food your dog may be used to but the potential advantages are important. There are several other health benefits you should learn about.
If you have investigated a raw diet and are not able to go through with it I recommend you look into a diet that you can cook at home. In the reference section you will find details of a book by Dr. Pitcairn, a holistic veterinarian, and in that book he gives details of the best diet for your dog at this time.
The medication that you give your dog will depend on whether or not he is under the care of your veterinarian. Some NSAIDs are available only by prescription, and you should follow the dosage recommended by your vet. If you are treating him at home I recommend aspirin. You can give him anywhere between 8-20 mg/kg, but it should always be with food since it can upset his stomach.
If your vet recommends that your dog be given an intra-articular steroid injection I do not think it is a good idea. An injection into the knee might lead to an infection or destruction of the cartilage, and in human medicine is never used in an instable joint for this reason.
Acupuncture might help your dog since the proper techniques can increase the blood flow to the joint and improve the ligaments ability to strengthen itself. However, I think that the stress of taking a dog out of the house and hauling him to a holistic vet for acupuncture treatments is excessive. If your dog has a torn cruciate ligament you should order an acupressure treatment chart and learn how to improve blood flow to the knee so that you can treat him while he is still resting at home.
This alternative therapy method has been proven to be effective in humans with acl injuries, but with dogs I think it should be done by the owner and may or may not be as effective.
The best form of hydrotherapy available is the underwater treadmill. Dogs are allowed to walk and meet their exercise needs during recovery but the water supports the body. There is almost no stress to the joint since the water is holding the dog up.
Since many of the dogs that damage their cruciate ligaments are also overweight, they need that exercise more than ever.
If your vet will not allow you to use the hydrotherapy facilities without surgery, the other alternative is to take your dog swimming in a lake or river. Unfortunately injured dogs can get overly excited when you finally take them out so you have to use a leash and stay with him at all times. (If it is too cold for you to get in the water with your dog it is too cold for him to go swimming too.) Dogs must wear a life jacket since they might be weaker than usual, and since the bottom of a river or lake can be muddy you have to make sure he does not slip and do more damage to his knee.
Omega 3 Fatty Acids, Antioxidants, and Herbs
A cruciate injury will affect a dog life no matter what you do so it is a good idea to try these alternative therapies.
- Omega 3 fatty acids will help lubricate the knee joint, protect against further damage to the cartilage, and may reduce inflammation. There are some reports of diarrhea and weight gain with fish oil, so it has to be started gradually and built up so that the dog can tolerate it with no problems. Since dogs with cruciate injuries often need to lose weight the calories given in fish oil have to be figured in and his food decreased to make up for the calories.
- Antioxidants can reduce the continued damage to your dog's knee from free radicals. Vitamins C and E are great for this, so if you give your dog snacks, be sure it is berries, apples, and carrot slices. Vitamin C is also needed for collagen synthesis so it may have another benefit in a cruciate injury.
- Several herbal therapies are available. If you decide to try something, do so for at least a few months, as results may take time. I have read several reports on the benefits of using yucca, a plant that has both anti-oxidant and natural steroid properties, and turmeric, a spice that has anti-oxidant and also has anti-inflammatory properties that can help your dog. If you use these products for several weeks try taking your dog off aspirin and see if he seems to still be in pain.
- Pre-packaged herbal products: If you spend a few minutes searching for non-surgical alternatives to anterior cruciate surgery you will find many sites that are selling you products. The product Agile Joints for Dogs contains turmeric, an antioxicant, sasparilla, devils claw, alfalfa, and some other herbs. Several of the herb mixtures may be valuable but when you are purchasing a mixture it is not the same as using a pure herb.
In human medicine, euthanasia is not an option so if surgery is declined an ACL injury is treated with rest and compression. Compression, via the use of a knee brace, should be a cornerstone of your dog's treatment too. (I have been pleased with this brace because the harness keeps it from sliding down and it provides good lateral support for a damaged cruciate ligament. You do have to measure your dog's leg to order the right size and order the harness separately. Other braces are available from some vet but your dog will need to be x-rayed to find the best measurement.) He will develop arthritis in his leg secondary to a cruciate injury because the femur is moving around on top of the tibia. A brace does not stop that, but then again neither does surgery.
What a brace can do is keep the knee from sliding forward or from side to side. If the ACL brace is fitted correctly it can limit the development of arthritis and give your dog time to heal.
Since many surgeons consider this a palliative only, there are few studies on the knee brace´s effectiveness. According to one recent AVMA study 98% of dog owners who went through with the TPLO surgery were happy with the results and only 86% of the knee brace owners reported the same satisfaction. Of course the people who went through with the surgery spent thousands of dollars more, so when you spend so much it is human nature to say you are satisfied with the results.
How Do I Wrap My Dog's Knee Without a Brace?
While you are waiting for your brace to arrive you need to keep your dog quiet and follow the medical recommendations in this article. In the house, however, if your dog is quiet but you are worried about further injuries since he is not confined, you can use a human elbow bandage similar to shown in this video.
An elbow bandage will not work if your dog is very small or giant. For most dogs, however, it is a good method to hold you over.
How Long Will It Take for My Dog to Recover?
If you choose alternative medical treatments and allow your dog to recover without surgery it is going to take him at least two to three months to recover. Even then, there is a good chance that he can re-injure the affected knee or injure the other cruciate ligament so you have to further restrict his activity.
If you choose to go through with one of the surgeries then recovery time after surgery will depend on what method you choose, which surgeon performs the work, the day of the week, and who you ask. Some vets will tell you that dogs start walking in a month. This does not mean that they have normal activity levels, however, so the recovery time after surgery should be as long as the recovery time after medical treatment. A good estimate would be around two to three months. The studies done of dogs that are not lame after surgery were not done until the dog was one year post surgery.
What Should I Do?
I am not a surgeon. I am a veterinarian and concerned dog owner. Since I have seen numerous failed surgeries and the dogs suffering because of the efforts, I believe that if your dog has a cruciate injury you should treat him conservatively before opting for surgery.
Surgery is not even an option for most people where I live and the dogs do fine after medical therapy. I will not tell you that surgery is always wrong though. I just would never put my own dogs through a procedure that caused pain without producing any cure.
- Surgical procedures: Tobias, K, Johnson, editors. Veterinary Surgery, Small Animal. Volume I, Section IV. Elsevier, 2012
- Is surgery necessary?: Hart JL, May KD, Kieves NR, et al. Comparison of owner satisfaction between stifle joint orthoses and tibial plateau leveling osteotomy for the management of cranial cruciate ligament disease in dogs. J Am Vet Med Assoc 2016;249(4):391-398.
- Christopher SA, Beetem J, Cook JL. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Vet Surg. 2013 Apr;42(3):329-34. doi: 10.1111/j.1532-950X.2013.12001.x. Epub 2013 Feb 21.
- Dunlap AE, Kim SE, Lewis DD, Christopher SA, Pozzi A. Outcomes and complications following surgical correction of grade IV medial patellar luxation in dogs: 24 cases (2008-2014). J Am Vet Med Assoc. 2016 Jul 15;249(2):208-13. doi: 10.2460/javma.249.2.208.
- Surgery will not prevent arthritis: Hurley CR, Hammer DL, and Shott S. Progression of radiographic evidence of osteoarthritis following tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 295 cases (2001-2005). 2007;230:1674-1675.
- Nutrition: Richard Pitcairn DVM, Natural Health for Dogs and Cats, 3rd Edition, Rodale, 2005
- Knee braces: Wucherer, KL. Conzemius, MG. Evans, R. Wilke, VL. Short-term and long-term outcomes for overweight dogs with cranial cruciate ligament rupture treated surgically or nonsurgically. Journal of the American Veterinary Medical Association 2013;242(10):1364-72.
Questions & Answers
Question: How painful is my dog's torn ACL?
Answer: It is hard for us to know just how painful an injury is for a dog. Dogs, like many other animals, tend to mask many of their symptoms even when in pain.
In humans, a torn ACL is very painful. The pain happens right away, and continues for two weeks up to about a month. Your dog should be on pain meds, but his activity needs to be limited.
Question: My American bulldog injured her knee and two vets diagnosed torn ccl. In the opinion of both vets, tplo is the best way to fix it. She's a calm dog and it's not difficult to keep her quiet. Right now it's been about 4 weeks after the injury, she's on anti-inflammatory meds and she seems to be healing well and not limping anymore, although you can feel the swelling around that knee. Would you proceed with the surgery? I'm leaning towards using a brace. Your advice?
Answer: I would give the dog more time. If she is not limping, I definitely would NOT put her through the stress of surgery. A brace seems like the best option when you take her out.
Dr Mark (author) from The Atlantic Rain Forest, Brazil on September 04, 2020:
Jo, what do you mean by supporting the leg? Do you mean tying it up? That does not help. Do you mean a brace? That might help, but the first thing would be rest, anti-inflammatories, and figure out if it is ruptured or just a sprain.
Jo fauvel on September 04, 2020:
My rescue dog had knee surgery 4 weeks after I got him he had been very neglected
The surgery went well and he had to have a prosthetic ligament attached around his knee six months later he got out and chased a cat through our woods he had been limping for 2 weeks! The vet saw him again today and he is on anti inflammatory tablets and has to go back in 2 weeks my question is why would they not Recommend supporting his leg during this rest period ? I asked them but they said no
Dr Mark (author) from The Atlantic Rain Forest, Brazil on July 12, 2020:
Sioux--for at least 6 weeks I would not want to exercise him at all, but when he is sitting in your lap just massage his knee and keep it from stiffening up. Since he is only 10kg just pick him up to go outside so that he does not have to deal with any stairs. (Always leash him outside so that he does not run off and stress the knee.)
SlOUX on July 12, 2020:
Thank you for your guidance. My vet advised urgent surgery and radiography for cruciate injury in my 10kg Jack Tzu. I'm glad i told her i wanted to go home and think it over. I have now invested in a knee brace for him and give him medicam daily. I am not sure whether he needs to use the brace while relaxing at home or how much exercise to give him, he won't go in the water at the best of times.
Sherry Hewins from Sierra Foothills, CA on May 23, 2020:
Thanks for this in-depth advice. It's so hard to get any medical advice for pets other than "take your dog to the vet." Funny since it's so easy to find home-remedies for people.
Dr Mark (author) from The Atlantic Rain Forest, Brazil on May 01, 2020:
Vicki, glad the brace arrived. Bandages are something we all struggle with, no matter how many times you have put them on.
Vicki on May 01, 2020:
Thank you for your response. I wasn't able to get that down. It wad bulky and falling, no matter what I tried. She has long thin legs, in sure that was a huge factor. Luckily, her real braces just arrived. YAY!
Dr Mark (author) from The Atlantic Rain Forest, Brazil on May 01, 2020:
Vicki, you need to wrap so that forward movement is as limited as possible. Take your dog out for a walk but just long enough to potty and only on a leash; do not let him or her run or jump up and down. Wrapping the stifle, or even a brace, is not a cure, but it can sure help things from getting worse.
VICKI Bechthold on April 30, 2020:
What is the proper way to use elbow wrap on dod while waiting for braced to come in mail?
Dr Mark (author) from The Atlantic Rain Forest, Brazil on May 24, 2019:
Tammi, medical therapy can help a lot but if your dog has an anatomical problem that is leading to the luxating patella it is not going to get better without surgery. There are a lot of things you can do to slow down the progression of the problem (like weight control) but the problem is still going to be there.
Since your dog is so young, and still a good candidate for surgery, go ahead and have it done when you have found a competent surgeon.
TammiPowers on May 23, 2019:
Hello Dr. Mark,
I have a question. Are the alternative therapies (rest, supplements, knee brace, etc) able to actually heal a ligament and luxating knee cap or does it just help them feel better and is a better option for some dogs that cant have surgery? I know you cant say for sure that my dog will be healed but is healing a possible outcome using these alternative therapies? Our puppy is only 11 mos old and active and energetic. If these options help, but wont heal, I am thinking I would prefer just doing the surgery and allowing her to recover so she can play once again. What do you think?
Tammi on May 23, 2019:
We have an 11 month old female maltipoo. She is very active and energetic. Over a week ago she was running with a toy in her mouth and tripped and slipped on the kitchen linoleum. She immediately cried and held her leg funny, although soon after she was walking around again on both legs. Our vet diagnosed her with a luxating patella. He said she would need surgery in which he would wrap a suture around her patella to keep it in place. Since then, she has had days where she seems fine and other days where her patella comes out repeatedly over and over (we have learned how to put it back in place for her). Talking with the vet again, I was trying to see if rest and supplements and a brace would help her heal and not need sugery. He said if the patella was slipping out that frequently then the ligament had to be blown. He said surgery was the only option. So my question is this... she is young and healthy... is it possible that with rest, supplements and a brace that the ligament and patella will heal itself? Or are these options to simply help it feel better and a great alternative for dogs that cant have surgery? If these alternatives could heal her, I would like to try them first. If they will not heal her (I understand you cant say for sure, I am just wondering if its POSSIBLE to be healed using alternative methods), I would rather just go ahead with the surgery so she can recover and begin running and playing again.
Thank you for taking time to hear my story and answer my questions!
doggydancer on February 14, 2019:
My large dog had a completely torn acl or ccl and could only walk on 3 legs. Instead of buying the painful acl or ccl tplo or tta dog knee surgery, get a custom posh dog knee brace that will support the knee and in several months or sooner your dog will be walking normally without surgery. From day one, once we got the brace fitted, my dog was able to start on short dog walks, and the walks increased as the days and weeks went by. No down time like with a new injury from a painful surgery.
Those poor dogs that get the tta or tplo surgery have a high risk of needing surgery on the other knee. It doesn’t matter if its a mixed or any breed dog, huge, large, medium, small or tiny, they can use a posh dog knee brace to start walking normally in only a few months. There is no need for the pain and high risks of dog knee surgery, severe infections, sepsis, leg amputation, never able to walk normally again after surgery, in pain forever after surgery, and bone cancer at the surgery site happens frequently. I have read many nightmares of those that went thru that horrific tplo or tta surgery.
My dog wore the posh dog knee brace for about 3 months for dog walks.
Now it has been years without needing a brace anymore and is still walking normally and never had to get that painful tplo or tta surgery.
Many vets will not tell you there are more effective solutions for healing a ccl or acl dog knee tear like a posh dog knee brace. The tplo or tta surgery is painful and risky.
Fortunately we found out just in time that a posh brace is a more effective solution for acl or ccl dog knee tears so we canceled the surgery. It has been several years now and that was the best decision ever.
Hilary on January 21, 2019:
Thank you! This has been the most informative article I have read on the subject!!
Kae on December 14, 2018:
What a terrible misleading article. Total b.s. this is a typical vet tryna leach more money off of people shame on you
Dr Mark (author) from The Atlantic Rain Forest, Brazil on November 03, 2018:
Corey, the Corgi is kind of on the borderline of big and small. A lot of vets say the surgery is not needed for small, so that vet that is telling you that your dog MUST have the surgery is giving you his opinion. You might need to see someone else and get a second opinion.
I am not sure what to tell you on the knee wrap. That is a real problem in dog breeds like Corgis and Bassets. If you find a vet in your area willing to use medical treatment, not surgery, they will teach you how to wrap the knee before each time you take your dog out. Yes, it is a lot of work since it has to be done each time.
Consider looking for a holistic vet that is willing to treat things medically.
Corey on November 03, 2018:
We have a corgi who has vary small legs told he has a torn acl he will be 2 in November. I don't want to do surgery as I had a young dog that I was told would be fixed bye surgery only to be put down at the age of 2. My problem is the vet keeps saying he needs surgery and won't go any other way. How can I help stabilize his knee to help him heal.leg brace won't work as he has no legs lol.
Darla Morse on August 29, 2018:
Hi Dr. Mark, here is a update on Sassy. She had the TPLO August 1. She is doing pretty good but it has been hard keeping her calm for the last few weeks. Total recovery time is about 8 weeks.
HilaryPerry on August 13, 2018:
Exactly what we are worried about! This poor baby has been through so much already. But he is still a happy boy! At least there's that. Thanks!
Dr Mark (author) from The Atlantic Rain Forest, Brazil on August 11, 2018:
That puppy is sure going through a lot! No, I am not sure a different surgery would do any better. The vet has seen the x-rays and palpated the joints so I am not even sure if another surgeon is going to help at this point. The problem is that it might fail again, no matter what is done.
HilaryPerry on August 11, 2018:
Hi Dr. Mark,
I just got a notification that there were new comments on this thread so I was reading them. I went back and looked at my old comments and see that I wrote you back after three weeks post-op. I am sorry to tell you that three weeks after that, Wilson's left surgery failed and he is back to a grade 3 luxation! He will need surgery when his growth plates close, we are xraying him every 6 weeks to follow it as he has so much trouble walking around. Just a few days ago his rehab therapist and I thought that there is something going on with his right leg too, I think I heard the kneecap pop but maybe it was just the left. So there is a chance that he will need the groove-deepening surgery for both legs. :( Is there any other surgery I should be looking into? Also we have to decide if we want to use the same vet. I have mixed feelings about this. Do you think that it is the surgeons fault if a surgery fails after 6 weeks?
Thanks so much, HIlary
Dr Mark (author) from The Atlantic Rain Forest, Brazil on August 11, 2018:
Hi Ruthie does your poodle seem to be in pain when the knee is twitching? It sounds like you are already doing the right thing by just massaging it out and calming her down. The only thing I can suggest is that you might try a cold pack on the irritated knee if it seems to be bothering her a lot.
Try to avoid giving any NSAIDs if she is not in pain.
Ruthie Freedman on August 10, 2018:
My 15 yr old toy poodle had ACL surgery 2 years ago. Her knee is twitching when she first moves around. I massage it. What can I give her to help. I have medicam
Darla L Morse on July 16, 2018:
If it was just a tear in the ligament, I think we would hold off on the Surgery. The ER Doctor did say that when it comes to tears, he doesn't always agree with surgery to repair the tear because sometimes the end result are the same with or without Surgery.
Basically saying the same thing you did in this article but you went into more detail. However, in Sassy's case here ligament is severed and the type of Surgery she needs is going inside the knee to repair the severed ligament and any other damage they may find. Her knee joint was also partially dislocated. They sedated her to take the x ray and place the knee back in the right position. When I found Sassy and got her up on three paws her right back leg was sticking straight back. I thought she got hit by a car and broke her hip but it wasn't her hip. She still can not walk on it at all but at least it is in a better position. I was mortified when I saw her leg. The Vet did not think she got hit by a car or there would be more damage to her entire right back side. It was some form of blunt force trauma but we don't know what exactly happened.
Sassy is a very smart dog and is a Australian Shepard. Our other dog Sierra is a Husky and also very smart. They both can unlock doors, open them and apparently gate latches too. They escaped from our backyard the morning I found Sassy in the garage by figuring out how to open the latch at the top of a 6 ft fence. We now have sliding bolts on the gate.
I sure will let you know how things go for Sassy. :)
Dr Mark (author) from The Atlantic Rain Forest, Brazil on July 16, 2018:
Darla, please check in a few weeks after the surgery and let me know how Sassy is doing. As you can tell from the article, I am not a big fan of the surgery. I hope things work out for her though and that she has a speedy and uneventful recovery.
Darla L Morse on July 16, 2018:
Hi Dr. Mark,
Thank you for responding. I was very confused/shocked when they responded with those answers. I have never been to that specific place, it was on the list the ER Vet gave us of places that do the ACL repair surgery. Our regular Vet is on vacation and does not do that kind of surgery. I called them anyway after I sent you the first message and asked if they new why to the questions I asked you. The receptionist I talked to was shocked. She said if the ER Vet gave you pain meds for Sassy give them to her as instructed. They gave me two other places that actually do this type of surgery and specialize in it. One of the problems I was having with the list of places the ER Vets gave me is most are not taking new patients right now. I have contacted one of the recommended places and will be taking Sassy in tomorrow for some test to make sure she is healthy enough for the surgery and for them to review her x ray's. Then we will schedule her surgery if all comes back good.
How I found you is I was googling for information on ACL repair surgery so I could get a better understanding of what Sassy will be going through. Your article really explained a lot for me. I greatly appreciate it!
I so wish Sassy did not have to have this surgery but being the extent of the damage to her ligament it is our only option. It breaks my heart to see my fur baby hurt or suffering but I also want to make sure she is in good hands when it comes to Veterinary care or even surgery. The price for the Surgery at the place we are taking her is $3500 to $4500 so we activated our Care Credit so that we can cover the costs immediately so she can get the Surgery. The place I told you about in my first message only charges $700 to $1200, the price difference explains a lot all on its own. However, both my husband and I are not taking her there. We will get it done by a Vet that specializes in this type of Surgery and pay the higher price.
Thank you again so much! Darla Morse.
Dr Mark (author) from The Atlantic Rain Forest, Brazil on July 16, 2018:
Darla, it is hard to say how painful something is for a dog, but in humans the pain has been described as intense, and it lasts anywhere from 2 weeks to a month.
I cannot understand why the vet would tell you that it would take a week to evaluate your dog. Do they always put off appointments for a week? If your dog has a laceration and is bleeding, or has bloat, do they say "wait until next week"?
Darla L Morse on July 16, 2018:
Hi, my dog Sassy has severed her right ACL, we were told by the ER Vet that took the x rays that she would need Surgery with in the next four days, then gave us a list of Vets that do the Surgery. The Vet's office we contacted said they could not evaluate Sassy for a week and it would be another week after that before they can get her in to do surgery. Then when asked about her pain medicine running out we were told not to give her pain meds because the dog is not in pain with this type of injury. My Questions are: 1.Why are we being told to different things concerning how long of time Sassy should have surgery? 2. Is she in pain with this type of injury like the ER vet told us? The ER vet gave us pain meds and told us to keep her calm and not let her run around outside. I am really reluctant to even go to this Vet!
Dr Mark (author) from The Atlantic Rain Forest, Brazil on May 02, 2018:
Hillary, great news. Thanks for the update on Wilson.
HilaryPerry on May 02, 2018:
Hi Dr. Mark,
I wanted to let you know what ended up happening with my Newfie puppy, Wilson. We found a surgeon who did a "Stifle Arthroscopy Bilateral + Tibial Crest Transposition" three weeks ago. Wilson had casts on both legs for 10 days and then 10 more days of rest. He can now stand and walk! He still has trouble getting up, He didn't get up before, in fact the last time we remember him doing this was when he was around 16 weeks. So now he is 6 months. He weighs about 71 pounds! We have three more weeks of controlled leash walking and then the plan is to re-xray and possibly take out the pins. The vet expects him to have a full recovery! We are very hopeful and taking it slowly. Thanks again for your support!
Robert Kostuch on March 26, 2018:
Thanks for useful article!
HilaryPerry on March 21, 2018:
Thank you! That is really nice!
Dr Mark (author) from The Atlantic Rain Forest, Brazil on March 21, 2018:
Hilary, keep in touch. I really want to hear how he does.
HilaryPerry on March 21, 2018:
Dr. Mark,Thank you for your quick response! I was not able to reply from my phone because it kept going to an advertisement but I finally am on my computer. I didn't even think about the potential for him never walking normally! omg Well, I do have an appointment with the surgeon soon. Also my breeder said that she would complete the surgeries he would need. But who knows really.
Your detailed comments really helped me as I do have a terrible decision ahead. Whatever we do, it is a heartbreak.
Dr Mark (author) from The Atlantic Rain Forest, Brazil on March 19, 2018:
That poor dog! If you do wait, which is probably in his best interest, he may never walk normally because of the psychological effects of being lame at such a young age. (Patricia McConnell describes a similar problem with her Great Pyrenees in one of her books. Even after surgery corrected the problem the dog was not able to walk.) I cannot tell you if it would be okay to take him back because that is a very personal decision. I know how hard that choice is.
Would the breeder put the puppy through those surgeries, or would she just put him down? You probably know the answer to this already. I had a client that bred Shar Peis and paid for several eye surgeries on one of her dogs, but eventually the eye had to be removed. She was an exception, however, as most breeders are not able to handle those expenses.
Hilary, there is no easy answer to your question. Ask the orthopedic surgeon if he thinks the puppy will be able to walk after surgery. An adult Newfie that cannot walk around is going to be a burden that most people cannot handle.
HilaryPerry on March 19, 2018:
Hello, thank you for your articles on patellar luxation and ccl injuries. I have a 20 week old newfoundland puppy who had bilateral lateral luxation and do not know what to do! He also came to me at 11 weeks with a UTI, then got an upper respiratory infection and had an infection on the tip of his penis. A couple of weeks ago he came down with a cherry eye, during the surgery they discovered the patellas. Now, he is about a week out of surgery and the eye looks great. But he can barely walk! I do have an appointment with an orthopedic surgeon. The breeder has refunded my purchase price and has offered to take him back. There are so many people telling me their opinions and I am very worried! Do you think that with all his issues he is going to have more? Like, is this a sick dog? He has been in the vet more often than any other place since I got him. And he has never been like the other puppies, he is calm and quiet. But now that he can barely walk I am not sure how to take care of him. Also, do the surgeries need to wait until he is fully grown? That is a long time with not being able to walk around and play. Thank you for any insight or opinions!
Bob Bamberg on March 15, 2018:
And she wanted it NOW! Dogs will patiently wait by your side until you're ready.
Dr Mark (author) from The Atlantic Rain Forest, Brazil on March 15, 2018:
Yes I am sure this is the longest one I have written. There is so much evidence to tell people that they should not rush, but...
I laughed about the camera and developing comment. A few years ago I gave a neighbor kid one of my old cameras since she liked photography and I was willing to help her learn. When I explained that she would have to buy film and develop the photos, she said "I dont want THAT!" I think she just wanted an iphone.
Dogs are SO less complicated!
Bob Bamberg on March 15, 2018:
The detail is terrific on this one, Doc. I especially like your point about proceeding conservatively. The thoroughness with which you address the topic should also be reassuring to pet owners who otherwise would consider it an urgent matter. The conservative approach may be a tough choice for some folks, though, because in this digital age we live in, people expect instant results.
I find myself being subject to that impatience sometimes, and I'm from the demographic that used to wait two weeks for our photos to be processed and returned to us! If it only took a week and a half, we thought, man, that was quick! Now I find myself getting aggravated if the first car at the red light is distracted and takes 6 or 8 seconds to move! I don't know what I'm going to do when I get old.
I'll leave the diet thing alone, only to comment that you seem to lump all pet foods into the Ol' Roy category. Today's high end holistic foods are a far cry from that. While still a small part of the total pet food market, raw commercial diets continue to enjoy modest growth. Veterinarians might want to put the dog on prescription or therapeutic diets.
I'm wondering what the chances are of a dog reacting to manipulation with a bite if the handling causes sudden pain. If an owner inflicts pain more than a couple of times, can it result in the loss of the dog's trust?
You put a lot of time into crafting this one, but it is a very helpful hub that underscores the effort.
ACL Surgery Cost for Dogs – 3 Easy Ways to Get the Best Price
ACL surgery costs for dogs can be high, but there are ways to help reduce overall price.
Variables that affect the cost of acl surgery include the severity of the injury, the type of surgery chosen, geographical area (rural vs urban clinics) and whether there are underlying conditions affecting the dog.
This post is designed to help you understand the types of surgical options, their prices, and the options you may have in keeping those costs as low as possible.
ACL Injuries can happen quickly
We limited Sydney’s exercise, curbing her zoomies around the yard. I walked with her (mommy and me time) while J played with Rodrigo, Scout, and Zoey. This was the easy part because Sydney is like me, she’s a couch potato.
The diet part was harder and this is where I made one crucial mistake. I did reduce the amount of food she was eating, but I did it by sight. She was still eating too much for her decreased activity level and she gained 10 pounds over the year – that’s a lot for a dog.
J purchased a new digital scale that’s more accurate than the one I was using and I weigh all of our dogs’ meals. This and light exercise is helping Sydney finally losing weight, however, she didn't keep it off. My girl's sedentary ways kept bringing the weight back and I had to find a right balance of food to help her lose – I learned a lot about calories, fat, and fasting, which I will discuss below.
Canine Knee Injury? Brace Yourself
Custom-made braces can help your dog after knee surgery - and can sometimes be used in place of surgery.Penny, an 83 -pound Newfoundland who lives in Maine, recovered from a torn cruciate ligament with a brace from My Pet's Brace.
Ten years have passed since WDJ explored “conservative management” – the nonsurgical treatment – of knee ligament injuries (see “Saying ‘No’ to Surgery,” February 2010). Since then, although surgery remains by far the most widely used knee injury treatment, consumer demand for complementary therapies, including the use of custom-designed knee braces, has grown.
Nearly all veterinarians have experience with canine ligament injuries because they are so common. Depending on the injury’s severity, a dog may have a hint of hind-leg lameness, an obvious limp, or be unable to bear weight on the leg at all. The injury may be a partial or total ligament tear.
“Most veterinarians recommend surgery as soon as they diagnose a ligament injury,” says Jim Alaimo, a board-certified Prosthetist Orthotist, “but that’s because surgery is their most familiar option.”
Alaimo, who founded My Pet’s Brace in 2010, made the transition to veterinary braces after designing human prosthetics and orthotics for 25 years. Prosthetics are artificial replacements for body parts such as arms, legs, and joints, while orthotics are devices such as splints or braces that support, immobilize, or treat weak or injured muscles, bones, or joints.
“Surgery is often the best treatment for canine cruciate ligament tears,” he explains, “but in some cases a dog’s age, medical history, activity level, home environment, or the cost of surgery makes it unsuitable. A well-designed custom-fitted knee brace can help a dog recover from a torn cranial cruciate ligament by supporting the joint while scar tissue builds stability.”
Knee braces can also be used for arthritis and post-surgical cruciate support. Like tendons, ligaments have a poor blood supply and, as a result, heal very slowly. According to Alaimo, it’s the development of scar tissue that stabilizes the knee and helps an injured leg move normally.
An online search will bring up dozens of knee brace designs, but most veterinarians familiar with bracing recommend custom-built braces that are made for a specific dog’s injured leg using modern technologies. The key to success is the brace’s ability to hold the leg in a correctly aligned stable position while allowing the dog to move naturally.
“Torn ACLs” and “bad knees” are familiar phrases in the world of dogs. Understanding what these terms mean can help if your dog suffers a knee injury that requires medical attention.
In this article the term “canine cruciate ligament disease” describes various injuries that can affect the dog’s knee. In generic use, the term accurately employs the word “disease,” because even though it’s often a traumatic injury that causes an acute tear or rupture of the ligaments in a dog’s knee, the majority of ligament ruptures occur under normal activity.
Also, according to an article published in the 2011 World Small Animal Veterinary Association World Congress Proceedings (“Review of Cranial Cruciate Ligament Disease in Dogs”), a number of studies suggest that the majority of knee ligament injuries are the result of chronic degenerative changes within the ligament.
DEFINITIONS OF RELEVANT TERMS
Ligaments are bands of fibrous tissue that connect bones and cartilage while supporting and strengthening joints.
The stifle (knee) connects the femur (thigh bone) and tibia (leg bone) with a patella (kneecap) in front and fabella (a small bean-shaped bone) behind. Cartilage (the medial meniscus and lateral meniscus) cushions the bones, and ligaments hold everything in position.
The cranial (front) and caudal (back) cruciate ligaments cross inside the knee joint. The cranial cruciate ligament prevents the tibia from slipping out of position beneath the femur. The term “anterior cruciate ligament” (ACL) is used in human medicine and “cranial cruciate ligament” (CCL) is a veterinary term, but both terms refer to the same ligament and both are used to describe knee injuries in dogs.
Radiographs (x-rays) are commonly used to check for cruciate ligament disease even though they do not display soft tissue and cannot be used to diagnose a cruciate injury or differentiate between a partial and complete tear. They can, however, rule out bone cancer or other conditions that may be a cause of leg pain. Advanced imaging studies, such as an MRI, do display torn ligaments but are expensive and require anesthesia, so they are not usually used in dogs.
The main diagnostic tool for CCL tears is a procedure called the “drawer test,” in which a veterinarian holds the femur with one hand and manipulates the tibia with the other. If the tibia can be moved forward, resembling a drawer being opened, the cruciate ligament has been torn or ruptured. The drawer test can be inconclusive if an apprehensive dog’s tense muscles stabilize the knee temporarily, so anxious patients may be sedated before being tested.
In the tibial compression test, which is another way to check for ligament damage, the femur is held steady with one hand while the other hand flexes the dog’s ankle. A ruptured ligament allows the tibia to move abnormally forward.
A recent estimate quoted by several veterinary websites is that more than 600,000 dogs in the United States have cruciate ligament surgery every year.
According to the American College of Veterinary Surgeons (acvs.org) canine cruciate ligament disease risk factors include aging of the ligament (degeneration), obesity, poor physical condition, genetics, conformation (skeletal shape and configuration), and breed. Most ligaments rupture as a result of subtle, slow degeneration that has taken place over months or even years rather than because of an acute trauma to an otherwise healthy ligament. An estimated 40% to 60% of dogs with cruciate ligament damage in one knee eventually injure the other knee. The ACVS advises that, left untreated, partial tearing of the cruciate ligament is likely to progress to a full tear over time.
The ACVS states that CCL injuries can affect dogs of all sizes, breeds, and ages, with the Rottweiler, Newfoundland, Staffordshire Terrier, Mastiff, Akita, Saint Bernard, Chesapeake Bay Retriever, and Labrador Retriever commonly affected.
Neutering before the age of 1 year has been statistically linked to torn cruciate ligaments. On July 7, 2020, the journal Frontiers of Veterinary Science published “Assisting Decision-Making on Age of Neutering for 35 Breeds of Dogs: Associated Joint Disorders, Cancers, and Urinary Incontinence” (Benjamin Hart, et al,) that showed significant increases in cruciate ligament risk related to the early neutering of male Bernese Mountain Dogs, Cocker Spaniels, and Miniature Poodles male and female German Shepherd Dogs, Golden Retrievers, Labrador Retrievers, and Rottweilers and female Saint Bernards and Australian Cattle Dogs.
The study concluded, “A likely mechanism by which early neutering may lead to a joint disorder is related to disturbance of the closure of the long-bone growth plates by gonadal hormone secretion as the animal approaches maturity. We have proposed that neutering much before the closure of growth plates allows the long bones to grow a little longer than normal, and may sufficiently disturb joint alignments in some neutered dogs to lead to a clinically apparent joint disorder.”
A related study, “Assisting Decision-Making on Age of Neutering for Mixed Breed Dogs of Five Weight Categories: Associated Joint Disorders and Cancers” (Frontiers of Veterinary Science, July 31, 2020, Benjamin Hart, et al), showed similar results in mixed breeds, especially for dogs weighing 44 pounds or more and neutered before one year of age.
Owners can’t change the status of dogs who are already neutered, but there is much we can do to protect the knees of our at-risk companions. As the ACVS website explains, “Poor physical body condition and excessive body weight are risk factors for the development of canine cruciate ligament disease. Both of these factors can be influenced by pet owners. Consistent physical conditioning with regular activity and close monitoring of food intake to maintain a lean body mass is advisable.”
HOW KNEE BRACES ARE MADE
Different manufacturers use different materials and methods to create custom braces, which may be called knee, stifle, ACL, or CCL braces. Braces are also designed for canine wrists, ankles, hocks, and hips.
The first step in custom brace design is a review of the patient’s size, breed, medical history, activity level, and environment to determine how strong the brace has to be to support the dog’s weight and activities as well as what special features the brace may require.
Next, casts or detailed measurements create a model of the dog’s knee. Jim Alaimo at My Pet’s Brace uses fiberglass to create a cast of the dog’s affected leg.
Alaimo describes, “We fill the cast with plaster, and that gives us a positive model of the leg. Then we remove plaster from some areas and add it to others in order to increase or relieve pressure as needed. We add knee joints, foam, and any needed reinforcements. Then we take polypropoline (a thermoplastic polymer), heat it, and vacuum-form it over the modified model of the dog’s leg. After it hardens, we cut it off, take it to the machine room, smooth out the edges, add joints and straps, and we have a finished brace. We use closed-cell foam and stainless-steel fasteners to make the brace fully waterproof.”
The final step is a fitting appointment during which any necessary adjustments are made along with videos and photos of the dog walking and moving in the brace. “During the eight or nine months that the dog wears a brace,” says Alaimo, “we schedule follow-up appointments to measure progress.”
After a break-in period, the dog wears his or her brace during waking hours. “Most dogs put it on in the morning and take it off in the evening before bed,” he says.
Penny, a lively 83-pound Newfoundland living with Regina Helfer in Maine, injured her right hind leg in September 2019, shortly before her ninth birthday. “She tore her ACL,” says Helfer, “and the vet on duty recommended immediate surgery.” Instead, Helfer asked Penny’s breeder (as well as the breeder of her other dog) for advice. Both breeders recommended My Pet’s Brace.
“We received the brace in September,” says Helfer, “and Penny did really well with it. She didn’t have any challenges at all. Penny is a therapy dog and a Reading Education Assistance Dog. She loves going to the library, working with kids, going for walks, and going for swims. We got her a hot pink brace and whenever we put it on her, she would stick her leg out to help.
“Penny wore her brace every day for nine months, by which time she had fully recovered. It’s here in case she needs it, such as if she goes on a long or challenging hike just to keep the leg stabilized, but so far she’s doing fine without it.”
At just 5 years old, June was diagnosed with arthritis and a torn cruciate ligament, with surgery recommended for the torn CCL. Her owners opted for a Hero Brace instead, and June recovered well. Her owners still use the brace when taking June on long hikes.
Ben Blecha has a personal as well as professional interest in leg braces. An osteosarcoma survivor whose leg amputation at age 21 inspired him to help others, Blecha became a board-certified Prosthetist Orthotist. Until 2005, when he was asked to help create a brace for a dog, all of his patients were human. He went on to partner with Wayne Watkins, DVM, to create Hero Braces for dogs.
Last year, June, a 5-year-old 100-pound German Shepherd Dog belonging to Ben Elsen of Dallas, Texas, began favoring her left hind leg. “June lives with her sister and littermate, Shiner,” says Elsen, “and they have always played hard every day. Starting two years ago, my wife and I were warned that June’s knee was beginning to show signs of wear and tear.”
Despite a reduced exercise schedule, June stopped jumping onto the bed and sofa. In October 2019, she was diagnosed with arthritis and a torn knee ligament. “Our veterinarian recommended immediate surgery,” says Elsen, “but we had misgivings, both about the cost and because June and her sister are always together, so weeks of rehabilitation would be stressful for both of them. When we asked about braces, our vet said he didn’t recommend them. But when he referred us to a surgical center, we met a rehabilitation specialist who thought highly of braces and recommended the Hero Brace.”
The specialist made a cast of June’s leg and 10 days later she was fitted with her brace. “She was fine with it from the start,” says Elsen. “We kept it on her at home and on walks, and her knee responded just as expected. We still use it while hiking, but otherwise, June is doing well without it. She’s back to jumping onto the bed and sofa, and she doesn’t favor her left side at all.”
TO CAST OR NOT TO CAST
Australian Cattle Dog Howdy, seen here in his Posh brace, was born with spinal bifida and suffered a cruciate ligament injury shortly after he was adopted at the age of 6 months.
Most custom braces are designed around models of legs that were cast in a veterinary clinic or at the client’s home with materials provided by the brace manufacturer. The resulting cast is submitted with supporting measurements so that the brace can be designed to fit. In some cases casting has to be repeated because of damage to the cast during shipment or because the cast was incorrectly made. If done in a veterinary clinic, the appointment adds to the brace’s cost.
The Posh Dog Knee Brace was developed seven years ago after Pasha, an 11-year-old, 77-pound Golden Retriever, injured her left hind leg. Pasha’s veterinarian diagnosed a ruptured cranial cruciate ligament and torn meniscus for which he recommended immediate surgery, warning that if left untreated, the strain would cause a similar injury to the right leg, result in severe arthritis, and prevent Pasha from ever living an active life.
Pasha’s owners, Florida residents Jim Morison and Beth Scanlon, could afford the $5,000 surgery, but they worried about Pasha’s age and medical history, which included an adverse reaction to anesthesia. Instead of scheduling surgery, they ordered a custom-made knee brace, and Pasha’s recovery began.
While delighted with Pasha’s progress, Morison thought that several features of the brace could be improved. He began designing adjustments and in the process launched his own knee brace company, which he named Posh, one of Pasha’s nicknames. Within six months of wearing her improved brace, Pasha was running through tide pools and swimming at the beach, and within nine months she had completely recovered.
“Posh started with the type of brace that requires a casting mold, but we now use a different design,” says Nikki Bickmore, who as lead veterinary technician at Posh, answers questions from clients, supervises the service department, and oversees production.
“In order to eliminate casting, Posh hired a team of orthotists and veterinarians to design a new system,” Bickmore explains. “The result is a semi-rigid brace instead of hard plastic, with multiple padding layers, so the brace works with the dog’s muscles as they move and contract. Ours is the only brace that uses Tamarack brand double-reinforced hinges mounted on two layers of plastic to improve the brace’s strength at critical stress points. The brace fits without any rubbing, irritation, or slipping and attaches with quick-release micro buckles found in high-end snow sports and water sports equipment.”
Using measurements instead of casting to provide a model of the dog’s leg both speeds up and slows down the ordering process. Once accurate measurements are provided, most braces arrive within a week, but because clients must study video instructions and take measurements with two people under the supervision of a veterinary technician during a live video conference, ordering takes longer. Before a Posh brace can be worn, it must be fitted in another video conference, again under the supervision of a Posh vet tech.
“What people most like about our braces,” says Bickman, “is that they are easy to use and fit well. They like our system of straps and buckles so there’s no need for Velcro, which can get tangled in a dog’s hair. The brace is comfortable because we use a soft rather than hard shell, and it allows for more freedom of movement, plus it’s durable and super easy to clean.”
Howdy, a 3-year-old Australian Cattle dog, was born with spina bifida and nerve damage in his hind end, as well as incontinence. “He’s a favorite of the Posh staff,” says Bickman. “Alicia McLaughlin adopted him at 6 months, and soon after that he injured his CCL, plus he had a luxating patella concurrent with the CCL tear. Many people thought he should be euthanized, but with bracing, and lots of love and patience, he now lives a happy country life in New York with Alicia.”
KNEE BRACES AND REHAB
The author’s active and athletic Labrador, Blue Sapphire (seen here), wore a brace for a month to recover from a sprain of her right knee the author says the brace not only helped her dog heal from the injury but supported the weakened soft tissues and prevented an exuberant Blue from making the injury worse.
All of the manufacturers mentioned here provide detailed instructions for owners and caregivers regarding exercise, recommended activities, do’s and don’ts, and other guidelines.
“The success of a dog’s recovery depends on an educated owner,” says Jim Alaimo. “Owners have to be good observers and also use the brace consistently. Our goal is to provide a conservative treatment modality for owners so their dogs can resume a full, active lifestyle as quickly and comfortably as possible.”
Paul Brumett, DVM, is a Colorado veterinarian and Certified Canine Rehabilitation Practitioner. Since 2018, as a representative and consultant for Hero Braces, he has presented educational seminars about braces to veterinarians. “Over the past 10 years,” he explains, “veterinarians have become more interested in learning about braces, partly because so many of their clients ask about them. Braces are not a cure-all, but not every dog is a good candidate for surgery, and I help veterinarians like myself understand the proper use and benefits of custom bracing.”
Dr. Brumett estimates that 25% of his dog patients suffer from cruciate ligament disease, and for 5% to 10% of them he prescribes a custom made knee brace.
“During the healing process,” he says, “dogs are helped by complementary therapies such as acupuncture, laser therapy, nutritional support, chiropractic adjustments, pulsed electromagnetic field (PEMF) therapy, massage, stretching, and rehabilitation exercises that improve core strength and balance. The braces are waterproof, allowing dogs to exercise on underwater treadmills or swim while wearing their brace, and they can walk in the rain and enjoy snow as well.”
Dr. Brumett recommends a gradual break-in period that introduces the dog to his or her custom brace over a week to 10 days. Leash walks are kept short, such as 15 to 20 minutes in the beginning, and the pet wears the brace for longer periods each day.
“Many dogs need time for the muscles around the knee to get strong enough to support longer walks,” he says, “which is why it’s important to work with the prescribing veterinarian or physical therapist. Wearing the brace protects the knee from abnormal movement such as when the dog stands suddenly because the doorbell rings. We want the custom brace to be in place so it can do its job. Gradually, pets work up to eight to 12 hours of wear each day.”
“The main challenge owners have is actually using the product consistently and planning appropriate activities for their dogs,” says Nikki Bickmore. “It breaks my heart when someone forgets and lets a dog who’s been using a brace for two months run outside without the brace. That can result in a major setback. I know it’s hard, but keeping dogs in a conservative management program while their knees strengthen and the muscles come back is so important.”
MORE BRACING CONSIDERATIONS
If your dog begins to favor a hind leg, don’t assume the problem will go away on its own. It might, but it could be a symptom of cruciate ligament disease. Schedule an appointment with your veterinarian to be sure.
Surgery requires careful consideration, but so does the use of a brace. The custom-fitted braces described here are not inexpensive, and their successful use depends on commitments of time and attention. Not every dog is a good match to bracing and neither is every owner. The key to making informed decisions is gathering information and having a realistic understanding of what’s involved.
To explore custom knee braces, visit the websites of companies listed here. Consider how the brace is manufactured, who makes it and what their qualifications are, what warranties the company provides, how customer support works, the cost of replacement braces, the company’s experience with dogs like yours, and brace color or decorative design choices.
Where available, read customer comments and watch videos that demonstrate brace fitting and use. Custom braces are made to last a lifetime. Some companies offer discounts if two braces are needed (one for each hind leg) or to convert a brace for use on the opposite leg at a later date.
Several of the manufacturers listed in the table on page 17 create braces or prosthetics for animals other than dogs as well as braces for other body parts. This list refers only to custom-made canine knee braces. For best results, consult with your veterinarian, Certified Canine Rehabilitation Specialist, or other expert for advice and recommendations.
Montana resident CJ Puotinen is a long-time contributor to WDJ and the author of The Encyclopedia of Natural Pet Care and other books.
How to Treat Anterior Cruciate Ligament (ACL) Tears
Last Updated: March 29, 2019 References
This article was medically reviewed by Jonathan Frank, MD. Dr. Jonathan Frank is an Orthopedic Surgeon based in Beverly Hills, California, specializing in sports medicine and joint preservation. Dr. Frank's practice focuses on minimally invasive, arthroscopic surgery of the knee, shoulder, hip, and elbow. Dr. Frank holds an MD from the University of California, Los Angeles School of Medicine. He completed an orthopedic residency at Rush University Medical Center in Chicago and a fellowship in Orthopedic Sports Medicine and Hip Preservation at the Steadman Clinic in Vail, Colorado. He is a staff team physician for the US Ski and Snowboard Team. Dr. Frank is currently a scientific reviewer for top peer-reviewed scientific journals, and his research has been presented at regional, national, and international orthopedic conferences, winning several awards including the prestigious Mark Coventry and William A Grana awards.
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The anterior cruciate ligament (ACL) is one of the four main ligaments in your knee that connects your femur to your tibia. Your ACL provides rotational stability for your knee and keeps the joints in your knee in place. You can tear your ACL by twisting your knee as well as landing too hard on your knee on a constant basis. ACL tears are a common injury among athletes and people who do contact sports.  X Research source If you tear your ACL, you should do immediate care to protect the injury. You can then try rehabilitation treatments to treat the injury or get surgery on your ACL to correct the problem.