# ACL Tears



## Katrina Kardiasmenos (Aug 5, 2007)

Hi All,

So, one of my dogs just got diagnosed with an ACL tear. On Monday, I'll be calling to make an appointment for a consult at VOSM (Veterinary Orthopedic and Sports Medicine Center) in Annapolis, Maryland.

Has anyone else ever dealt with a torn ACL? What was the outcome? Was the dog still able to work?

Any advice would be greatly appreciated!


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## Konnie Hein (Jun 14, 2006)

Hi Katrina, I have no experience with ACL tears, but I can say that VOSM must be a great place. I have a few friends who have worked there, and other friends who have taken their dogs there for various things. All gave great reviews of the place.


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## Katrina Kardiasmenos (Aug 5, 2007)

Konnie Hein said:


> Hi Katrina, I have no experience with ACL tears, but I can say that VOSM must be a great place. I have a few friends who have worked there, and other friends who have taken their dogs there for various things. All gave great reviews of the place.


I've been told that VOSM is one of the premier veterinary orthopedic clinics around...because the dog that is injured is supposed to be my next competition dog, and the future of our breeding program...and a really nice import, I want to take him to the best.

I figured if I can increase his chances for a full recover just a little bit, then that's a step in the right direction. =D>


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## James Downey (Oct 27, 2008)

So I take it an MRI was done and confirmed the tear?

either way.... ACL tear sounds horrible. It's a tendoned used for stability. Even with it torn and not repaired the dog could still work. If it was completetly torn you may lose spring in the dogs step and some lateral stability in the leg. But the dog would be able to work. Getting it repaired the biggest problem will be recovery and rehab to prevent a re-tear. 

I ask about the MRI, becasue some docs try to guess a tear...and then procees with surgery. If it's a minor tear and were talking a tiny tear, these can heal on thier own. Anything more than a minor would need surgery. But the good thing, if there is such a thing with an injury. Waiting to fix it...you would not be any worse when you got it done. That is if it is a full tear. If it's partial, and you waited, and fully tore...the treatment is the same. ACL injuries/repairs are not career ending injury. Some atheletes with a big game on the line, with a full tear...will wait to get it fixed till the post season. Out of any orthopedic injury...an ACL tear is one of the most forgiving.


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## will fernandez (May 17, 2006)

My wife's Mal had the acl surgery on both rear legs about six months apart. Not as fast as he use to be but can still run and work.(I would try water therapy when he was ready. 

A dog on my unit had it done. No difference ..just a pretty scar.


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## Katrina Kardiasmenos (Aug 5, 2007)

James Downey said:


> So I take it an MRI was done and confirmed the tear?
> 
> either way.... ACL tear sounds horrible. It's a tendoned used for stability. Even with it torn and not repaired the dog could still work. If it was completetly torn you may lose spring in the dogs step and some lateral stability in the leg. But the dog would be able to work. Getting it repaired the biggest problem will be recovery and rehab to prevent a re-tear.
> 
> I ask about the MRI, becasue some docs try to guess a tear...and then procees with surgery. If it's a minor tear and were talking a tiny tear, these can heal on thier own. Anything more than a minor would need surgery. But the good thing, if there is such a thing with an injury. Waiting to fix it...you would not be any worse when you got it done. That is if it is a full tear. If it's partial, and you waited, and fully tore...the treatment is the same. ACL injuries/repairs are not career ending injury. Some atheletes with a big game on the line, with a full tear...will wait to get it fixed till the post season. Out of any orthopedic injury...an ACL tear is one of the most forgiving.


They didn't need the MRI...he showed every hallmark symptom...

That's why I was thinking my next step would be to take him to a specialist. I know that I tore my ACL and walked around on it for months...in fact, ironically, this dog caused me to tear my ACL :roll:

I was just wondering what other people have done in this situation...



> My wife's Mal had the acl surgery on both rear legs about six months apart. Not as fast as he use to be but can still run and work.(I would try water therapy when he was ready.
> 
> A dog on my unit had it done. No difference ..just a pretty scar.


Definitely will be doing water therapy with him...luckily, I also live near a body of water...


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## James Downey (Oct 27, 2008)

Katrina Kardiasmenos said:


> They didn't need the MRI...he showed every hallmark symptom...
> 
> That's why I was thinking my next step would be to take him to a specialist. I know that I tore my ACL and walked around on it for months...in fact, ironically, this dog caused me to tear my ACL :roll:
> 
> ...


 
You should really think about getting an MRI. I have seen 2 people try to save money and take the doc's word for it. Both did not have torn ACLs. I then had my first Malinois had a similar injury...Doc told me he was sure it was torn ACL. I got an MRI and the ACLwas fine...then he told me the knee was just sore, or bruised. But he wanted to cut my dog open to fix what he thought was a torn ACL, My wife told me not to and get an MRI. She does not like the dogs going under anesthesia if they do not have to. I did get an MRI and it was not a Torn ligament.I saw another vet after that for an x-ray and it was a chipped patella and the chip healed in perfect position. 

The only original sign for a torn ACL (for a dog) is the doctor tries to feel if there is play or instability in the joint. Not exactly a highly calibrated tool. The outward signs of a ligament tear are so general that the classic signs are classic signs to almost every other sports trauma injury. With the exception of the "play/instability" which can very from dog to dog anyway. This why we have MRI's because it's extremely hard to diagnois with any amount of accuracy. Also, the doctor cannot tell how bad it's torn. If it's minor, you could just sit on it, get no MRI or surgery keep the dog at rest, and in a few weeks it may heal, and you can save all your money. If there is no change, then I would get the MRI to make sure it's a tear in the ACL. But the risks associated with surgery are high enough where I would make sure it was necassary.


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## Katrina Kardiasmenos (Aug 5, 2007)

James Downey said:


> You should really think about getting an MRI. I have seen 2 people try to save money and take the doc's word for it. Both did not have torn ACLs. I then had my first Malinois had a similar injury...Doc told me he was sure it was torn ACL. I got an MRI and the ACLwas fine...then he told me the knee was just sore, or bruised. But he wanted to cut my dog open to fix what he thought was a torn ACL, My wife told me not to and get an MRI. She does not like the dogs going under anesthesia if they do not have to. I did get an MRI and it was not a Torn ligament.I saw another vet after that for an x-ray and it was a chipped patella and the chip healed in perfect position.
> 
> *The only original sign for a torn ACL (for a dog) is the doctor tries to feel if there is play or instability in the joint. *Not exactly a highly calibrated tool. The outward signs of a ligament tear are so general that the classic signs are classic signs to almost every other sports trauma injury. With the exception of the "play/instability" which can very from dog to dog anyway. This why we have MRI's because it's extremely hard to diagnois with any amount of accuracy. Also, the doctor cannot tell how bad it's torn. If it's minor, you could just sit on it, get no MRI or surgery keep the dog at rest, and in a few weeks it may heal, and you can save all your money. If there is no change, then I would get the MRI to make sure it's a tear in the ACL. But the risks associated with surgery are high enough where I would make sure it was necassary.


This is actually the same tool they use in humans. What they're really looking for is an "endpoint." The ligaments in your knee give it stability...but they also keep it from basically flopping around. So, the drawer test (which is what they call it in dogs) tests to see if the leg basically flops around...

They did an x-ray, and could clearly see inflammation in the knee...

In addition, MRI's aren't always conclusive when it comes to viewing structure especially in small areas of soft tissue (i.e., knees). It didn't show the tear in my ACL (and that was with a 3T machine). While they can be useful at times...they aren't an exact science - especially if the machine doesn't have a very strong magnet b/c then you end up getting more "noise" in the image...sorry...one of my specialty areas is neuroscience so I've done a lot of work with MRI and fMRI. Finally, Nemo would have to be put under for an MRI, anyway, because he would have to remain perfectly still for an extended period of time...

I will follow whatever recommendation the specialist suggests. I won't know what he suggests, however, until I see him. 

Again, my post was merely to see what people's experiences were...I honestly don't know what I'm going to do until I can figure out what my options are...but I won't know those better until later...


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## Melissa Blazak (Apr 14, 2008)

Is it a complete or partial tear? A friend with a top agility dog did stem cell therapy on her 9 year old poodle who had partial tears in both legs. The treatment was a success and she ended up being in a vet journal article, completing her MACH 4 and is still competing at 10. It is a pricey treatment though.


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## Katrina Kardiasmenos (Aug 5, 2007)

Melissa Blazak said:


> Is it a complete or partial tear? A friend with a top agility dog did stem cell therapy on her 9 year old poodle who had partial tears in both legs. The treatment was a success and she ended up being in a vet journal article, completing her MACH 4 and is still competing at 10. It is a pricey treatment though.


Funny you mention stem cell therapy...I was wondering if that was an option...the vet I'm going to take him to does stem cell therapy and I was going to ask about it...

At this point, I'm not so much worried about cost as I am about his future...he's still so young, and really has his whole "career" ahead of him...he's got insane drive, and loves to work...so I'll do what I can to ensure that he can still enjoy that which he loves...

What was the recovery like, etc?


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## Melissa Blazak (Apr 14, 2008)

I will have to ask but I think just monitored leash walking and rest for a couple of months. Gradually working up to running. If I remember correctly though she was back doing full agility courses within 4 months and got her MACH 4 shortly after that.


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## Melissa Blazak (Apr 14, 2008)

Here are a couple of links to articles.

http://archives.chicagotribune.com/2009/feb/22/health/chi-biz-dog-stem-cells-feb22

http://www.vet-stem.com/

http://www.veterinarypracticenews.com/vet-dept/small-animal-dept/musculoskeletal-miracles.aspx


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## Jim Nash (Mar 30, 2006)

I've replied to simliar dicussions on this . Last year my 10 yr old partner came up limping . They checked him out (Drawer Test[sp?] was one) and felt he had a partial ACL tear . Treatment was a few weeks off and go from there . They would only repair it if it was a complete tear . 

He's been doing great so far . Does everything he needs to do on the streets . I don't even see limping right now (cross fingers) . I take it easy on the physical stuff in training and no longer compete with him . 

We've had alot of K9's with full ACL tears over the years in our K9 unit . From what I've seen they recover from the ACL surgery well(usually) but it's a long recovery . But , usually somewhere along the line the other ACL fully tears in those same dogs . My guess is due to them favoring the stronger leg due to the first ACL injury . 

Good luck with everything .


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## Brian McQuain (Oct 21, 2009)

One of my APBTs had a complete tear of his cruciate and meniscus at 10 years old, and was told that chances are he'll blow his other leg out soon. Luckily he hasn't (year later) and besides walking a little more bow-legged, he is good as new. Full range of motion and no noticeable weakness. Unfortunately, he has just been diagnosed with Cushing's disease.


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## James Downey (Oct 27, 2008)

Katrina Kardiasmenos said:


> This is actually the same tool they use in humans. What they're really looking for is an "endpoint." The ligaments in your knee give it stability...but they also keep it from basically flopping around. So, the drawer test (which is what they call it in dogs) tests to see if the leg basically flops around...
> 
> They did an x-ray, and could clearly see inflammation in the knee...
> 
> ...


I did not know that about MRIs. I thought they were more accurate than that. 
I did not mean to be condesending or pushy, Just thought the information was pertinent to the topic. I hope everything goes well.


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## Melissa Blazak (Apr 14, 2008)

BTW the dog in question is now over 10 and is the first standard poodle to ever MACH5.

Also, my obedience instructor's dog just had a complete ACL tear and just had the surgery last week. If surgery is your option you should make sure you have a recovery program planned out. Luckily we live close to a well respected canine rehab vet clinic complete with underwater treadmill and certified massage therapists and chiropractors. It would be crappy to spend all that $$$ on treatment (whichever way you go) and not have a good facility/plan for therapy afterwards.


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## Sarah ten Bensel (Mar 16, 2008)

My female was diagnosed with ACL tear from radiographs and manipulation under sedation. The tell-tale sign was arthritic bone spurs at the end and medial side of her tibia that showed up on the xray. No MRI was needed. She had a TPLO and made a complete recovery and went back to everything. She was not a "working" dog. However the TPLO was designed for working dogs. Her injury was from a bad fall playing fetch with a bouncing tennis ball. The ortho vet felt it was UNLIKELY to occur on the other side because the mechanism of injury wasn't from the structure of the knee but trauma. Some stifle joints are at greater risk due the angle of the tibia on the femur. He was right, she never had any problems with either stifle after that.
It was three months before she was back 100%. sWIMMING HELPED TREMEDOUSLY!
Good luck!


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## James Downey (Oct 27, 2008)

To add to the rehab plan. I am big into physical fitness and am not a physical therapist. But the big one on Ligament therapy is full range of motion. Ligaments are dumb. They will only support movement on which they are accustom to. So making sure the dog moves his leg the full range of motion is important. and the worst thing for ligament recovery is stagnation. The only way the get blood to them is when they are activated. imobilizing them makes the more susceptible to future injury.


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## Nicole Stark (Jul 22, 2009)

If it were me and stem cell is an option for you, I'd go that route particularly on on older, otherwise healthy dog. From what I understand in comparison to more invasive procedure the recovery is faster and the success rate is very high (thinking around 95-98%). The physical set back on an older dog wouldn't be something I'd want to put them up against. For the extra money the points I cited above would make it worthwhile. This would also hold true of a younger and very promising dog.


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## Sarah ten Bensel (Mar 16, 2008)

I will add another 2 cents...I agree with James. I AM a physical therapist. A painfree full ROM (range of motion) is critical. Strength building after injury needs to happen once full ROM is achieved and not before. That where the wonders of water come in. Muscles will be less inhibited when in water - without gravity the nerves that send pain messages to the brain are not activiated allowing more painfree full range of motion. Appropriate depth of the water is also very important. In the beginning water should be deep on the animal. But that is a whole nother topic.


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## Maren Bell Jones (Jun 7, 2006)

Okay, a couple things...a cranial cruciate ligament rupture can absolutely and relatively easily be diagnosed on radiographs, even by general practitioners. I did this myself for the last 6 weeks straight: first with 3 weeks of orthopaedic surgery elective with one of the top ortho vets in the country and then another 3 weeks of preceptorship with a DVM PhD former Army and SAR handler vet who is certified in canine rehab. You do NOT need an MRI (which is much much more expensive than radiographs). In fact, we never even offered an MRI to a single client.

The cranial drawer sign (same as the anterior drawer in humans) can be variable, but experienced practitioners can sometimes tell a partial versus a full tear when the dog is sedated. A full tear feels a bit mushier. There are other easy to tell signs like the medial buttress (a thickened swelling on the inside aspect of the stifle) and an occasional positive sits test (where the dog rolls over onto its good hip and its injured leg sticks out when sitting, though this is not the only reason a dog may sit this way).

According to Dr. Jimi Cook, only ~2% of CCL ruptures occur because of an actual injury like stepping in a hole while running, hit by car, etc. Unlike in humans where most of them happen because of injuries (football injuries, ski accidents, and so on), it's a degenerative process in dogs and not a spontaneous injury. And that's why 50-60% of CCL ruptures will happen on the other side. The problem with partial tears of the ligament or the menisus is that the meniscus and ligament won't really heal itself because it has such low blood flow. They've found that the ligament, if torn, is basically dead, which is one of the reasons why they remove it during the surgery.

All of the most common four ways of repairing the stifle (TPLO, TTA, TightRope, and lateral suture) each have a 90% success rate and there is no one best way for each dog. The followup rehab and care by the owner is just as important if not more so than the actual surgical approach. And the Veterinary Orthopedic Group is FABULOUS. I am going to try to get an externship there for rehab if I can manage it!


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## Harry Keely (Aug 26, 2009)

Not ever a good injury, my 9 year old rotti had a ACL tear about a year ago. It cost me almost 3 grand to get it fixed by a orthopedic vet. Then was a long recovery and alot of control of his day to day movement to keep him from bouncing around like a dam jack rabbit. Its been a year now but still isn't himself. I mean gets around alright and stuff. But as far as his suit work and hidden sleeve stuff he is finished. To afraid of a re-injury. So hes now here for the long haul as a dog that kinda of just lays around the house thats gets fed / water and loving. Sad too he was a rare rotti. But it is what it is I guess. Anyways very sorry to hear about your dog and a ACL injury. I wish you the best of luck with the surgery.


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## Katrina Kardiasmenos (Aug 5, 2007)

Hi Everyone...

I did get an appt with VOSM...they have a phenomenal reputation...so I will 100% trust what they recommend. 

I am glad to hear everyone's stories...successful or not so successful...

I appreciate everyone's words of wisdom...

Now, how do I keep my dog quiet? :?:


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## Maren Bell Jones (Jun 7, 2006)

Good! Let me know how you like them and what technique they decide to go with!  They'll likely recommend that you towel walk your dog for the first week afterwards. Your dog likely won't need it except perhaps the day or two after surgery, but it's just an insurance policy in case they take a spill. They make fancy custom made slings, but what is even cheaper (especially for just a few days) is if you take one of those cloth reuseable grocery shopping bags they are selling every where nowadays for like $1 or 2 and cut it down the sides. The wide part of the fabric will make the sling and the handles of the bag do really nicely as the handle and are less uncomfortable than the towel. It also helps because typically by 2-3 days after the surgery, the dog is feeling pretty good on the pain meds and wants to just go go go. The handles help for holding the dog back from hurting itself and the implant. They'll want the dog on strict cage rest and short leashed potty walks only for probably 6-8 weeks, so you can probably try on leash tracking over short grass and VERY short distances (like 50 ft max), simple in the house low key retrieve games, or shaping simple new behaviors or tricks to keep their mind exercised.


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## Katrina Kardiasmenos (Aug 5, 2007)

Maren Bell Jones said:


> Good! Let me know how you like them and what technique they decide to go with!  They'll likely recommend that you towel walk your dog for the first week afterwards. Your dog likely won't need it except perhaps the day or two after surgery, but it's just an insurance policy in case they take a spill. They make fancy custom made slings, but what is even cheaper (especially for just a few days) is if you take one of those cloth reuseable grocery shopping bags they are selling every where nowadays for like $1 or 2 and cut it down the sides. The wide part of the fabric will make the sling and the handles of the bag do really nicely as the handle and are less uncomfortable than the towel. It also helps because typically by 2-3 days after the surgery, the dog is feeling pretty good on the pain meds and wants to just go go go. The handles help for holding the dog back from hurting itself and the implant. They'll want the dog on strict cage rest and short leashed potty walks only for probably 6-8 weeks, so you can probably try on leash tracking over short grass and VERY short distances (like 50 ft max), simple in the house low key retrieve games, or shaping simple new behaviors or tricks to keep their mind exercised.


I LOVE that suggestion for the sling! Thank you!!!

I was thinking of trying to do some low-key tricks to keep his mind occupied...mostly clicker stuff...I gotta do something b/c he's not happy sitting in a crate...

Thank you so much for your help! I will definitely let you know what happens and how it goes!


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## Maren Bell Jones (Jun 7, 2006)

No problem! This is exactly what I want to do when I graduate vet school in a little over a year and I'm looking into getting the Certified Canine Rehabilitation Therapist certification, so I'm glad to offer a few pointers, since I've towel and sling walked quite a number of big dogs post cruciate repair by now.  Even though the bulk of cruciate tears are overweight couch potato labs, I think it will help my future working dog clients since I understand the mental needs of the working dogs, which are different than just pets.


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