# Cruciate Ligament Torn



## missysmith

Hello, I just joined this site and I need some advice. I rescued my shepherd 6 yrs ago and we were told he was probably 4, so we estimate he is 10-11 today. He has always been healthy and we have grown so attached. He developed a perianal fistula and was put on cyclosporin. Two days later he was limping very badly. I took him back to the vet and he had an x-ray. He has torn his cruciate ligament in his left knee and TPLO surgery was suggested (xray also showed that right knee will probably need to be done as well). The vet also took him off the cyclosporin and prescribed an ointment. I have changed his diet and the fistula seems to be healing. At this age should we be putting our beloved Brixx through 2 surgeries? The price quoted was around $2700 each knee, how can I put a price on him? Even as I write this I am tearing up. Will it be selfish to do it? Any advise please, thanks


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## Jax08

I thought the same thing with our Banshee when she was 10 yrs old for a different surgery. 2 yrs later we did the surgery and she's still doing fine at almost 13 yrs old. if your dog is otherwise healthy, I would get the knee fixed that is torn (if the tear is bad enough that conservative management is not an option) and probably wait and see with the other.


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## missysmith

Thanks so much, he is so special to us.


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## Jax08

My only regret with having the major surgery done was not doing it sooner. We really believed that she wouldn't be with us that much longer. If I had to do it over again, I wouldn't hesitate to save her 2 years of discomfort.


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## GatorBytes

Did you view the x-ray, and could you see a tear? Did the vet do physical exam (drawer pull)...sometimes a partial tear becomes a full upon assessment.

Why the other? 60% of dog stear the other knee within 1 year of surgery. This is because suppportive therapy wasn't done. Was this speculative on vets part because of the 60%.

I would ask for the x-rays (if didgital they can put on disc) and go get a second opinion, in the meantime, you need to start supportive therapy. 

No jumping, running. Brace for stifile support ($500 approx.), custom made and will either manage it to heal on own and/or will be needed for therapy and healing...Animal Rehab Services in Mt. Albert - Canada...they will have your vet do measurements and custom design and ship...I haven't found a U.S. company that offers a brace like this...there are hinged rods on "both" legs to support and prevent further injury...will have better success whether you choose to do surgery or not.[/ATTACH]


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## Jax08

Just an FYI...it took my Jax almost 6 months to fully recover doing conservative management with a microtear. You can not see tears of ligaments on xrays. What you see is inflammation and possible displacement of the bone.

If the xray showed that the other knee may need to be done, what is the vet seeing? Is it inflammation from arthritis? Or inflammation from a torn ligament? If he is not showing any clinical signs, my ortho vet would refuse to do surgery. Jax's drawer was positive, her xrays showed inflammation, but she was not showing clinical signs when he examined her and at that point said he would not do surgery, which was fine with me.

He also does not do TPLO's. If you are on the east coast/NY area, I'll PM you his information. I think I read somewhere that Cornell no longer does TPLO's either. You could research that. There is also a "traditional" surgery but I've read that is not terribly successful with larger dogs.

In the meantime, get him started on fish oil, joint supplement and MSM. YOu could also use turmeric and bromelain for inflammation but remember that turmeric will work as a blood thinner so discuss with your vet when to stop using it if you decide on surgery.


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## Stosh

Our last gsd was diagnosed with the same tear in her rear leg when she was 9 yrs old and we decided to have the surgery done- but when the vet got in there he said it wasn't actually a complete tear. He was able to clean up some bone spurs and tighten up the knee. The total cost was $900 and she recovered fully to live another 2 1/2 years. My point is that the surgeon may not know how extensive the tear is until the knee is opened up. Is surgery your only option or will medication and rest help?


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## Jax08

Agreed Stosh.  Contact Diane (Jakoda) and ask her also. She had a dog that the vet was doing surgery on and he just cleaned up some bone spurs that didn't show up on the xrays. They never really know until they get in there exactly what the situation is.


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## huntergreen

jax ia VERY correct, soft tissue injuries are not seen on x rays. get the xrays and get a second opinion, even if you have used this vet for years. always want to know your options. 

something doesn't sound right that he also wants to fix the other leg, more info is needed.


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## JakodaCD OA

yep,,I wouldn't hesitate to do surgery on a 10 yr old dog if he's otherwise in pretty good health.

And yes, been there done that,,tears/ripping acls do not show up on an xray, you'd need an MRI for a definite diagnosis, which is VERY expensive, probably cheaper to just open them up.

For the OP, I would Seek out a board certified surgeon and go from there..IF it's a complete tear, it will not heal on it's own, if it's a partial, it can be managed but if its serious enough to affect his daily life than I would opt for surgery.

THO, they 'can' blow the other the leg because of compensation, I've had two, (not acls but OCD, arthritis, bone chips), and neither blew or damaged the other knee because of compensating.

As for the PF's, also been there done that, twice,,Desitin (baby diaper rash creme) is a wonder drug for helping clear them up as well, but dont use it with other ointments your vet has given..Did he give you tacromolis(Sp)? If you want to try desitin, use one in the am, the other in the pm,,

I would not do "both" legs at once if your vet is suggesting that,,LOADS of rehab, I would also seek out a PT for after care..


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## missysmith

Thank you all so much, I'm so glad I joined. I did condense my post a bit. Brixx started cyclosporin 07/18, limp started 07/20. Called vet to see if this was side effect, he said no keep an eye on it. By 07/23 Brixx was in so much pain couldn't walk with out assistance. He's hurt himself before, ran for a ball came back limping but I could see this was different. Back to the vet 07/25 for xray. He showed me the x-ray (which I have no knowledge about) but I could see a difference between left and right. The left looked like the bones were touching, the right had a space. He sent x-ray to another vet for second opinion. This other vet made the diagnosis about the right, said it is "thinning?" My vet said we will watch it and depending on how left heals may not need to touch it. He prescribed Metacam and Tramadol for pain and Tacrolimus for PF. My vet has an ortho that visits the area so waiting for call back on his availability. I do trust them, they have always given us multiple options to save money and call scripts into pharmacy or writtens to use online.


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## JakodaCD OA

so if I'm reading this right, the xrays showed the knee bones were "touching"? if so, that doesn't indicate an ACL tear (but of course it could have something to do with it), it could also indicate to me anyway, arthritis/bone chips, (OCD) , 

If he really blew it out (ACL) he would be 'off' that leg totally..just like an athlete when they blow their acl, they cannot walk, it's way to painful..Now if there is 'some' pressure, I would say a tear/knee joint issues.

I've used the metacam and tramadol, it does help with pain management and inflammation, just be careful that the drugs may make him feel better, and therefore, he'll feel like taking off at a sprint I'd keep him toned down EVEN if you think he feels ok , the drugs can mask what's going on..make sense?

Great that he has an ortho visit, sometimes THEY pick up things the vets don't see.

Keep us updated..


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## Rott-n-GSDs

My three year old GSD female, Luna, tore her CCL awhile back. I took her to the vet and she was diagnosed using a "drawer sign" test (basically the vet manipulates the knee and if it moves from side to side, the ligament is likely torn). It is difficult to tell just how badly the ligament is torn, however.

My vet said it was "completely blown" and recommended a TPLO. I joined a conservative management group, was convinced surgery was evil and NEVER should be done, and decided to use conservative management. 

We rehabbed her to the point where we thought she was 100% sound. She didn't limp AT ALL. Then, after a few weeks shy of a FULL YEAR of being sound, the leg blew again. The people on the conservative management list were flabbergasted that the scar tissue would give after that length of time.

This time, we immediately moved forward with a consult with an orthopedic vet. Using the Yahoo Group "orthodogs" (which I strongly suggest you join), I got a recommendation for a fantastic ortho vet a few hours from me (Dr. Levine, Inver Grove Heights, MN). We went down for the consult/potential surgery the same day. Luna's leg was SO unstable that there was no doubt in his mind that her ligament was totally torn. She had surgery (we opted for a TTA, since it is a bit less invasive, some report a quicker recovery time, and it's Dr. Levine's specialty) later that day. Her CCL was completely shredded, her meniscus was partially torn, and she had severe arthritis. I asked the vet if he felt the arthritis was due to the length of time that had passed since her original injury (over a year and a half) and he said it likely was.

Her surgery was on March 9th of this year. She is now at 100% activity. Watching her now... I realize that she never did fully recover after the initial injury. She was coping well with the injury and hiding the fact that she was hurting... something dogs do very, very well.

If I had it to do all over again, I would get the surgery immediately. So far, she hasn't blown her other leg and we're praying that doesn't happen, but of course it's a real possibility. If it does happen, we'll find a way to pay for another surgery. This time, we used Care Credit and are still paying it off. It doesn't matter... she's more important to us than money. (Our total cost was $3100). 

A few things to keep in mind:

1) I would consult with an ortho vet regardless of whether or not you're fully decided on surgery. An ortho vet will be in the best position to tell you whether or not your dog does indeed have a tear/ruptured ligament or if something else is going on. X-rays can definitely be an indicating factor (and they do look at the space between the bones, if I understand correctly) but usually they'll also do a drawer sign test, too. They see THOUSANDS of these kinds of injuries (by 2008, Dr. Levine had done tens of thousands of TPLOs and thousands of TTAs. The TTA had recently been introduced so I can only imagine how many he's done now!).

2) Go with a BOARD CERTIFIED SURGEON. Post your general location on here and on orthodogs to get recommendations.

3) If you do go forward with surgery, please post on here to let us know. There are a few things that happened with Luna that, had I known before hand, I would've changed how I did them.

Good luck!!!


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## Rott-n-GSDs

JakodaCD OA said:


> If he really blew it out (ACL) he would be 'off' that leg totally..just like an athlete when they blow their acl, they cannot walk, it's way to painful..Now if there is 'some' pressure, I would say a tear/knee joint issues.


Just wanted to comment on this. Luna NEVER completely went off that leg and her ligament was completely shredded. Dogs are very resilient and will hide an injury if they possibly can. There were even times when she walked almost normally.. the only one who could see something "off" with her in my family was me, and that's because I obsessed over watching her.


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## missysmith

Brixx is booked for surgery August 7. I am so nervous, however from all the support here I feel very confident we made the right choice. Spoke with vet yesterday and the ortho surgeon will call me today to answer any questions. Will update as this unfolds, thanks all.:hug:


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## lilysmom

Sending some encouragement your way... we are 5 weeks post surgery for a torn CCL. Delta had a TTA procedure and is doing great ! She too never went totally off the leg yet when all was said and done she had totally torn it. All the best to you. The first several weeks of recovery will be trying but you will be amazed how quickly they come back.
All the best,
Pam


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## GatorBytes

Also keep in mind, that it is not as easy as just some rest and short "potty" leash walks...the dog is going under anesthesia, anti-inflammatories, surgery, antibiotics afterwords...in order to have good post surgery recovery you need to nourish...
1) antibiotics kill the belly - need good bacteria (helps assimilate nutrients to they are delivered where the body needs) - probiotic
2) the muscles - they are going to atrophy - L-glutamine, and a good real Whole protein source - if you are not comfortable w/RAW...then at least scamble an egg in a touch of coconut oil or butter (nothing hydrogenated)
3a) anesthesia affects the oxygen flow to the body, spirulina (preferably) or chloraphill to oxygenate and promote red blood cells 
3b) incl. the brain, pancreas and so on, coconut oil (virgin organic - cold pressed
4) anti-inflamm. - affect the liver and conversely the kidney's - add some green leafy veggies incl. dandilion
5) NOURISH the cells that make up the joints and bone - you do not need synthetic suppliments to do this...just good old fashioned bone stock...see the link, especially include chicken frames for the type 11 collagen (from cartilage - raw), use all kinds if you wish, make a mix in a huge pot or slow cooker (preferably)...this is the most bioavailable form

Keep in mind that vets estimate 6-8 week recovery time...estimate 12-16 weeks. Your dog is a senior and doesn't have the ability to manufacture all that is req'd for a shorter successful recovery time... 

The Healing Power of Bone Broth Transition Now (note: do not use onions in recipe at the bottom, strain the bones, refridgerate and skim off the fat)

Good luck, and give your baby a scratch on the head from me
G


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## Rott-n-GSDs

Here are a couple of things I wish I'd known prior to Luna's surgery:

First of all, she came home with a full wrap on her leg, including the toes. It actually REALLY hindered her and caused her more pain. I ended up cutting it off the next day, as she had started actually dragging the leg behind her. We HAD to do stairs for her to go out to potty and getting up and down those stairs with a big ol' wrap on the leg was nearly impossible. Additionally, a full wrap, including the toes, can be very dangerous because there is the potential of the inner bandage twisting and cutting off the circulation.

Next, MANY dogs have trouble with the Fentanyl patch. My regular vet said he wishes that surgeons wouldn't even use it. Luna was really "out of it" and it scared her a lot. Her eyes were odd, she was constantly whining, and just could not get comfortable. I ended up taking that off early, too, and her pain seemed to be managed quite well between the Tramadol and the Metacam.

We actually ended up working with a rehab therapist (certified vet tech) and she was AMAZING. She really helped me with the passive range of motion in the beginning, and was invaluable with helping me determine what Luna's activity level and exercises should be. Every dog is different, and dogs recover differently. We actually weren't doing enough initially, which left the injured leg in such a weak state that the good leg was straining to compensate. I believe if I hadn't gotten assistance, the other leg might've blown just based on having to overcompensate. 

Luna is now back in obedience training, starting tracking, and will be starting back up again in agility and skijoring soon.


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## JakodaCD OA

rott'n,,Luna sounds like a very stoic girl My female wasn't totally off the leg either, but then again hers was OCD vs a tear/blown..

Sami didn't come home with any bandages, quite a site just the same


I totally agree with Rottn about seeking out some PT for him after surgery,,it helps TREMENDOUSLY..I actually had Sami at a vet who was certified in acupuncture and Chinese meds, which also did wonders as well as PT..


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## lilysmom

What type of procedure are you having done ?


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## kindofabigdealsmom

*ACL injury and acupuncture*

Jakoda mentioned acupuncture and Chinese meds. My GSD Chloe was diagnosed as having an injured ACL in June. Vet said drawer test and xrays did not indicate complete tear, plus she puts weight on it, but has been favoring that left leg ever since. Tried Metacam and rest; no improvement. Have been taking her to acupuncture for 6 weeks, doing PROM exercises and giving her the TCVM herbs recommended. Still do not see much improvement. The acupuncture vet is supposed to be one of the best--has a clinic here in FL where people come from all over the country to learn. He keeps telling me I must be patient. This way is better than surgery. he thinks. What do you guys think?
Also, I will be sending Brixx good vibes on August 7th--eager to hear how it comes out and how he does. 
You all are so great with so much helpful advice. My other dog is a sturdy little mutt who has had virtually no health problems. Chloe was dropped off by some jerk at the local convenience store--my little village's version of the humane society, I guess.


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## missysmith

Brixx is doing great! He came home the same day quite stoned and slept through the night. Ortho said surgery went great and result was the TPLO procedure. Next day a lot of bruising but no swelling. They didn't, bandage his leg and surprise Brixx did not go for the stitch. Probably due to the fact they are on the interior of the knee and harder to reach with a sore leg. Thank goodness we have a ground level walkout basement that we have quarantined B to. Icing has helped and he is eating fairly well, am's he's not too hungry. Along with Metacam he is on tramadol and I have added a vitamin C and glutamine supplement. One thing he seems to have a lot of ear wax build up, any ideas here. Called vet, as it has no yeast odor maybe stress. I don't want to take him in for a minor issue so just going to monitor. My husband thinks it might be his way to keep me close as he Loves! when I clean them lol. Thanks all and will post some pics soon.


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## Jax08

Great news!!!!!


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## CujoGSD

MissySmith,
Your story is a real confidence builder, I’m dealing with the same thing as we speak, my 10 ½ year old GSD will be going for his consultation today and if he has a torn ACL he is booked tomorrow for the surgery. 
I wish I had the same house layout as you , I’m having a carpenter come out this afternoon to build a walk way for my GSD so there is less of a grade on the ramp we already built going from the house through the garage to the back door where he can do his stuff. No parking in the garage for me . And setup shop in our dining room for the recovery period. But all worth it if I get a few more good year out of my boy.


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