The following story and questions came from reader Nina through our Contact Page. I haven’t had any experience with these problems, so I’m hoping that some of our readers can help answer some of Nina’s questions.

My Boxer mix had tight rope surgery on his knee April 2010. I did all the slow rehabilitation like the vet requested. His knee still gave him problems and after several more vet visits has been placed on anti-inflammatory and antibiotic medications which do not seem to help. Recently a digital x-ray showed that two things may be the problem:

1. The hardware is causing an infection that will not go away unless the hardware is taken out
2. The cushioning in between the joints is damaged

Either way I was told the hardware must come out. Then the possibility of repairing the knee with the top of the line hardware with all the metal may be needed. How can the hardware cause an infection that no antibiotic will help and if its the hardware causing the infection how can another piece of hardware be different? Also is there anything else I can do to help this poor dogs knee besides another costly surgery and more hardware?

My guesses were as follows: the only way that the hardware could cause an infection is if the hardware that was placed inside the knee during surgery was not sterile. If that were the case, then the veterinarian would be responsible for cost/replacement/etc. Other than surgery, the typical options are conservative management, weight management, drugs and medications, and/or dietary supplements.

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• Surgical Procedure for a Ruptured CCL in Doberman Pinschers
• Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)
• Cost of TTA Surgery for Cranial Cruciate Ligament – Cost of Knee Surgery for Dogs

Dealing with a torn cranial crucial ligament in your dog is never an easy thing, and when you add in the high cost of dog knee surgery, it can become a very stressful situation for both the dog and the dog owner. When you begin to research the type of surgeries available to treat the injury, you’ll find the following primary surgery types which can range anywhere from $750-$3,000 depending on the type of surgery, the size of the dog, etc. Common surgery types used to treat a torn cranial crucial ligament in a dogs knee:

• Traditional Repair / Extracapsular Fixation
• TPLO
• TTA
• TightRope

Each of the above types of surgeries is great in its own application, however the size and weight of your dog may disqualify it from receiving one or more of the particular types of surgeries. For instance, a large dog, such as a Rottweiler probably will not be eligible to receive a Traditional knee surgery strictly due to its size and weight. Most vets will probably recommend TPLO or TTA surgery for a dog this size, and unfortunately, TPLO and TTA are two of the more costly surgery types due to the fact that they are more invasive and involve cutting of the bone in the knee joint to create a new angle of the knee joint in order to reduce the amount of stress on both the joint itself and the surrounding ligaments.

Cost Reducing Options

At the end of the day, if your dog needs surgery, there really isn’t a way around it, though I have heard of some dog owners who have just not had the ways or means to cover the cost of dog knee surgery so they simply chose to use conservative management as their way of “treating” the injury. The reason that I put “treating” in quotes is because choosing not to repair a torn knee ligament will leave the knee unstable and it will really reduce the dogs quality of life in most cases – especially if the dog is overweight. Should you elect to avoid the cost of surgery by going the conservative management route, here are some things that may help you:

• Limit the dogs activity
  This may seem like a no-brainer, but you’d be surprised at how many dog owners will just forget about the injury all together after time. The dog may seem to be better, but chances are the injury is still there and the dog has just found a way to cope with it. Make sure you restrict or limit the dogs activity after it suffers a torn cranial cruciate ligament.
• Manage the dogs diet
  If the dog was overweight when the injury occurred, chances are the weight was a contributing factor in the torn/ruptured knee ligament in the first place. Putting the dog on a weight management diet can drastically improve the dogs quality of life (though many dogs will seem miserable when their food intake is limited) weight loss can definitely help improve mobility and recovery because the knee joint will have less force on it.
• Anti-Inflammatory medications
  Though this may be an option, it’s not recommended in cases where the dog owner has elected not to get a knee surgery for the dog. Giving anti-inflammatory medication to a dog with an untreated torn knee ligament may give the dog the false sense that the knee is actually better and more stable than it actually is, causing the potential for more injury.

Though most wouldn’t consider not treating a torn knee ligament as a treatment option, it is in fact the only option for some people out there, strictly due to the cost. If you ever find yourself in this circumstance, you could always try to negotiate with your veterinarian – they may be able to work with you on the price.

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• Cost of TTA Surgery for Cranial Cruciate Ligament – Cost of Knee Surgery for Dogs
• Cost of TPLO Surgery – Cost to Repair Torn Cruciate Ligament in Dogs
• Cruciate Ligament Injury In Dogs – Cost & Repair Options

As with ACL tears in humans, CCL tears in dogs can be sudden and very noticeable, or they can develop slowly over time. When a person injures their knee and suffers a torn ACL, it is normally going to be very painful and the joint will feel very unstable and in most cases, will not be able to be used. The same will hold true for dogs when they injure their CCL. When our dog tore her CCL, she immediately stopped bearing weight on the leg.

Our dogs CCL was torn while at the beach, our other dog was playing and ran into her at full speed while she had her feet set in the sand and was digging. The impact caused an awkward twisting of her rear leg that was planted in the sand and it caused the CCL to give way. After the impact, she immediately held her leg up and began hopping/skipping and only using one rear leg.

This was an extreme situation, and it was obvious when it happened that our dog had suffered some sort of an injury. Whenever anything like this happens, the dog should be taken to the vet immediately, though I’m not sure I’d recommend the emergency vet anymore. If you’re unable to get your dog into the vet within a few days from the injury, the emergency vet may be your best option, but chances are, they’ll have you take your dog to your primary car veterinarian.

There will be cases where the injury slowly develops over time, and ligament will eventually give way, tearing/rupturing partially or completely. In this circumstance, you may notice your dog limping on occasion (not all the time), probably particularly after heavy activity, strenuous activity or prolonged activity. Some breeds of dogs have knee joints that aren’t physiologically great at bearing weight, and any of the above mentioned conditions can aggravate the CCL, and over time it can eventually deteriorate enough to the point where the ligament gives way. In this case, you’ll want to take your pet to the vet to get an opinion as you begin to notice the symptoms – limping, stiffness, sluggishness, less playful, etc. As the owner, you’ll know when your dog isn’t acting normally. If your dog is developing a slowly forming knee injury, it can often be treated by conservative management, weight management, and sometimes even change in diet. Your veterinarian will be able to give you treatment options and recommendations, but hopefully seeing the signs early will be able to prevent a full tear or rupture of the CCL.

Related Posts

• Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)
• Diagnosing a Torn/Ruptured Cranial Cruciate Ligament in Dogs
• How Our Dog Ruptured Her Cranial Cruciate Ligament

The cranial cruciate ligament in dogs provides stability to the knee (stifle) joint. Any strain, tearing or rupture of the cranial cruciate ligament can, and will, result in knee (stifle) instability. A strained cranial cruciate ligament can, in many cases, be repaired or heal itself without surgery. Strains should be treated with conservative management. Tears and ruptures of the cranial cruciate ligament require more drastic treatments such as orthopedic surgery. When it comes to surgical repair of the CCL, there are multiple CCL surgery options available and it is always best to consult with your veterinarian prior to deciding which option is best for your dog.

The necessity of the cranial crucial ligament (CCL) can be compared to the necessity of the anterior cruciate ligament (ACL) that is found in humans. While there are people who have bypassed having surgery with a torn ACL, their knees are typically less stable for the remainder of their lives and their activity has to be severly limited. The same holds true for canines – should a torn or ruptured CCL be left untreated, the dog will survive, but may display lameness in the limb with the torn ligament, and the dogs activity level will not be the same as that of what it was prior to damaging the ligament.

Related Posts

• Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)
• Tightrope Surgery in the Treatment of a Dogs Torn Cranial Cruciate Ligament
• Diagnosing a Torn/Ruptured Cranial Cruciate Ligament in Dogs

Though this wasn’t our first choice when dealing with our dogs ruptured cranial cruciate ligament, Conservative Management (or Conservative Treatment) is a non-surgical option of CCL treatment that should be considered by all dog owners prior to surgery.

Consider the human knee for example, you’ve all probably heard of torn or ruptured ACL’s (meaning the ligament is entirely severed), and you’ve also heard of partially torn ACL’s (meaning the ligament is still intact, but has definiate damage. Now, let’s consider a pro athlete, surgery will be necessary for either case – torn ACL or partially torn ACL. However, let’s say we have a 40 year old man with a desk job who doesn’t do too much physical activity. Surgery would be the best bet for a torn ACL, however he could probably get through the rest of his life with a partially torn ACL, and using a brace and conservative management in situations where any further damage to the ligament could occur.

The same hold true for dogs, however, the unfortunate thing is that we don’t have the option of giving a dog an MRI, which will actually show the extent of ligament damage. With dogs, we can have an x-ray, and we can have veterinarians check for instability (drawer movement), but we will not not for sure if the ligament is completely torn, or just partially torn. This is where conservative management comes in. Depending on the size of your dog (conservative management is typically not an option for large dogs – 40+ lbs), the amount of instability (drawer movement) in the stifle (knee) joint and the amount of lameness your dog displays in the injured limb, your veterinarian may recommend conservative management rather than a surgical procedure.

For conservative management, these principles must be strictly adhered to, otherwise the stifle joint will be unable to recover naturally:

1. Weight management / Diet control – Here are some weight management dog foods
2. Complete restriction of movement in the beginning, along with rest
3. Use of anti-inflammatory medications

Weight Management is not only something that will be recommended in the case of conservative management, but it will often be recommended following surgical procedures as well. Our dog dropped 1/3 of her body weight after surgery through diet control and weight management.

Rest & Restriction is required to allow the knee joint to heal in any way if its going to. This process can take 4-8 weeks, and at the end of this period, if the dog is still exhibiting lameness in the limb, surgery might be the best option. During this period, it’s a good idea to keep your dog in a crate or pen. We actually ordered these two plastic pens for Roxy during her recovery.

Anti-Inflammatory Medications can be used in combination with weight management and rest & restriction to help remove the swelling in the limb and let it recover. Here are some natural and over the counter anti-inflammatories that can aid in conservative management.

Before beginning a conservative management regimen, it is always best to contact your veterinarian and have the CCL injury professionaly diagnosed. After seeing a friend of mine try conservative management with a Labrador, I’d recommend seeing a vet ASAP after the injury.

Related Posts

• The Use of Supplements for Conservative Management Rather Than Medications
• Cruciate Ligament in Dogs, Canine Cranial Cruciate Ligament (Crucial)
• Tightrope Surgery in the Treatment of a Dogs Torn Cranial Cruciate Ligament