SubscribeConservative Management as a Cranial Cruciate Ligament (CCL) Treatment Option
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:
- Weight management / Diet control – Here are some weight management dog foods
- Complete restriction of movement in the beginning, along with rest
- 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.
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
- Diagnosis – How We Determined Our Dog Had A Torn/Ruptured Cranial Cruciate Ligament (CCL)
- Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial 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 [...]
I have a 7 lb chihuahua. she is 4 years old. I was told she has CCl and needs surgery. I have had her on anit-imflammatory med for 5 days. She has showed big improvements. Can I stay with conservative treatment for 4 weeks and see if she gets better. Rest, diet control and meds? Will this damage it worse.Thank you for your help
Hi Maria -
Thanks for your comment. As I’ve mentioned in other posts on this blog, I’m not a veterinarian, so I’d consult with your vet before making any decisions. In my personal experience, I’ve only heard of larger breed dogs tearing/rupturing the CCL, so conservative management of the injury may be an option for a small dog such as yours (again, consult your vet). As I mentioned in another post, I had a friend with a big yellow lab who tore its CCL and they elected not to have surgery and the dog really didn’t ever use its leg.
If the CCL is in fact torn, that will cause an unstable knee joint, and could lead to other injuries, so if I were you, I’d follow these steps:
If you’re looking to go the conservative management route, keep your dog inactive for the next couple of weeks. Maybe even penned up, like they tell you to do after a CCL surgery.Keep the dog on anti-inflammatory medicationConsult your vet at the end of the 2-3 weeks of inactivity and get a professional opinion. If you don’t like the answer, visit a 2nd or 3rd veterinarian.
I hope this helps, feel free to ask any other questions. Best of luck to you and your dog.
Have you mentioned an orthopedic brace (aka orthosis)as a method of conservative treatment of CCL tears? Our company, Tamarack Habilitation Technologies, makes orthotic components. I want to make that association clear. However, many well respected veterinarians, such as Sherman Canapp, have reported “great success” with orthotic interventions. http://www.handicappedpets.com shows different braces (i.e., orthoses). Our blog, Inside Tamarack, also discusses dog braces in a post dated May 29, 2009. We cite several independent scientific articles there that may be useful.
We have a very active 1 1/2 year old Golden Retriever named Lily and she has torn her left rear cruciate. We have been trying conservative management in an attempt to avoid surgery but she is difficult to keep down. We have seen 2 orthopedic surgeons and TPLO is their preference. But it’s not mine and I canceled her surgery. I am so afraid she will not heal well since she is so difficult to subdue. She is taking Quiet Momments right now along with periodic Deramax and she has bursts of energy that only a puppy has. She can’t help it. She has limited confined to the house and cage and only in and out on the leash to potty. I would like to try a brace if you think we could have success. I have asked the vet for a more powerful sedative but she has refused. If someone couldn’t afford the surgery what would they do. I feel since we are not given any alternatives to helping her heal without surgery that the vets are neglecting their responsibility. If we said we absolutely could not afford surgery, what would they recommend? Would they just say OH WELL. I hope not. I just want to do what is best for my hurting puppy. Please help me. We live in Orange County CA.
Hi Jenny,
Sorry to hear about your puppy Lily. I’d recommend taking her to another veterinarian in order to get a 2nd and possibly 3rd opinion. As with everything in life, people will have their preferences, as you mentioned the vets that you have seen prefer TPLO. It’s a very new procedure, but I think you might want to try looking into Tightrope Surgery (http://dogkneeligament.com/surgical-options/tightrope-surgery-in-the-treatment-of-a-dogs-torn-cranial-cruciate-ligament/), as it is a newer, less invasive procedure that is comparable to the procedure done in human ankles. The invasiveness is one of the major drawbacks of TPLO. But then again, TPLO is typically recommended for larger breed dogs.
I’d assume that living in Orange County, CA you’d have a lot of options for surgical procedures as there are many dog lovers in your area, however I do know from experience that CA has high prices for everything (we ended up paying over $3,500 in total for our dogs surgery).
Anyways, we wish you the best of luck and we hope that you’ll continue to share your stories with us as you go along.
Best of luck.
Hello, I have a four month old pointer who was kicked by my horse last week, he has seen the vet and she she has done some x-rays , these show a slight freacture at the top of the tibia and some fluid around the joint, the vet cannot tell for certain about the cruciate ligament but there is a bit of movement in the joint and has advised four weeks cage rest, as you can appreciate this is quite hard for an active puppie and when I let him out to go to the toilet he gets very excited and I am worried that he is doing more damage, I was wondering if by restricting the leg in some way it would help the healing process?. The vet has also said she is not too sure about surgery because of his age, if you could give me some advice myself and freddie would be very grateful.
Another aspect to consider when surgical intervention is not an option is physical rehabilitation. Modalities such as therapeutic exercise, massage, hydrotherapy, low-level laser therapy, transcutaneous electrical nerve stimulation, ultrasound and a host of others can all be used to minimize pain, build muscle, prevent muscle atrophy and maintain range of motion in the knee. Rehabilitation also helps with weight loss. As always, seek the advice of your veterinarian before beginning an exercise program for your pet. A qualified rehabilitation practitioner will work closely with your vet to develop a program specific to your pet’s needs.
Our 13 year old Schipperke chased a rabbit in our back yard yesterday and cannot put weight on her left hind leg.
A vet found the knee joint had a fair amount of movement, but said the right one also was a little
loose. She has some renal problem for which we use a careful diet and she had a cancer removed from the inside of her left leg 14 months ago (no recurrence). She cannot receive preventive shots as she became very ill from both her last rabies and 3 in 1 shots. We feel me must take a conservative approach to helping her. We plan to pick up a crate and are carrying her to her food, water, outside trips etc whenever possible. The vet we saw prescribed tramadol every 8 hours for pain and we plan to pick up an anti-inflammatory at a pet store today. We would do anything for her … any alternatives to surgery that have
worked well? Will anti-inflammatory affect renal function?
Thanks for any advice….we do plan to see another vet asap
Hello,
My 2 year old golden retriever, Riley, has torn his CCL and the surgeon we meet with recommended the TPLO. I am not in a position to afford this surgery, but do not want further harm to happen to Riley’s knee. He has been taking anti-inflamm. med and is anxious to get moving again. I have been limiting his activity. Can anyone give me more information on what to do?
Tracy,
What did you end up doing? My golden has a partially torn ccl and is only 9 months. The vet didn’t say she should have surgery until the ligament tears completely, so I am stuck with a puppy who wants to run and can’t. Just wondering how things are going for your Riley?
Spleena
Hello,
We did get the TPLO surgery last week, and he is doing great. His ligament was about 90% or more torn, and I could tell he was in pain on most days. The surgeon said he will make a full recovery and will be back running and playing at dog parks in 12 weeks. My golden is over 100 lbs, he’s a blondie which are bigger, but also 10 lbs overweight, so I didn’t want him to develop severe arthritis. He has mild arthritis now, but with him being so young I didn’t want him to have to suffer his whole life. From what I understand, especially in big dogs, the surgery is necessary and the ligament does not have to be fully torn. I got several opinions and all the docs agreed to get it done sooner the better. Good luck, and keep me updated!
tracy
I have a 7 year old golden with a torn CCL. Our vet is insisting on the TPLO surgery at a cost of $2,500. We simply can’t afford that right now. Also, along with the surgery comes a very long recovery, and with a very active dog, I’m afraid she will reinjure it. Or worse, tear the other knee. I have been doing a lot of research on using a brace as an alternative, but can not find much feedback on anyone who has used them with successful results (Ican’t find feedback negative or positive). Has anyone used these with positive or negative results???
Hi Andrea -
There was someone who was trying to promote their braces on our site, but I haven’t heard of anyone who has had much success by using braces. You may want to browse through the comments on this site and see if you can find the person who commented regarding using braces for the treatment of the CCL.
Hi
Our 2 and a half year old Black Labrador recently began limping (rear right hand leg)after he’s been out for a walk….he is very active and very fit – i.e. not overweight etc. This was on the saturday evening…by sunday evening I could no longer notice any sign of a limp, but we took him to the vets to be on the safe side. The vet had a long feel and said he thought there was a very slight bit of inflammation around the cruciate but definatly not a fully torn cruciate. He reccomended 2 weeks of Rimadyl and 3 weeks of lead walks (2 x 30 mins per day) This was hard as he is a very energetic dog and is used to having 2 hours off lead every day. Still, I ensured we followed the instructions. We couldnt stop him charging around the garden though and on many occasions i was sure he would do more damage but there is still no sign of any limp and we have passed the 3 week stage. I’m just worried that if i let him go back to his old ways of charging around etc he may damage it further…the vet is well respected in our area and really loves dogs so i do trust him…could it be that it has healed up or that it wasn’t the cruciate in the begining and just a muscle strain?
I’m an Animal Health Technologist in a small animal clinic, we see many dogs big and small in with partial or complete ruptured cruciate’s. We often advise clients to try conservative treatment, one because it is a costly surgery and yes often leads to the second torn cruciate. But most often we see owners back in for the surgery, it is just not an injury that will heal it’s self. We do not do the TPLO surgery, we use nylon lead to rebuild the ligament, i have seen first hand how well 90% of dogs recover. For anyone looking to find braces you can as your vet to show you how to put on a Robert Jones bandage, it is big and bulky but it works(we use them post surgical). For anyone looking for a weight management food please look on the back of the bag at the AAFCO label if it says FOR ALL LIFE STAGES it is a puppy food in the bag. Most people think that because the bag says for weight control or weight loss on the fount of the bag mean that’s what is in the bag. You will not find a store food product that will actually cause your pet to loose weight! you need to find this in a vet clinic. Amanda
My 3 yr old Cairn Terrier was diagnosed with a partial tear in his ACL. I went with the 8 weeks of crate rest and I just have to say, DON”T LOOK AT THE DOG DURING THIS TIME! It is difficult to do, but give him chew bones for activities and put him in the main area of the house to keep him a part of the family. I only let him out about 4 times a day on a short lead. He has done so well, but my question is..how to rehab him now that it is time to let him out? He is not limping at all and thinks that he can go back to his old self. I do not want him to reinjure. I have begun to use a 20 ft lead to walk him, and am not allowing him to run. I will build up to that? I have no rehab places in my area (that I could afford anyhow!) What are your thoughts?
Our 7 yr old golden has injured both of her CCL’s. We opted to try the braces (orthotics) but they can only be left on for 10 min periods because the dog is using different muscles & they tire easily at first. Two of them cost us $950 because they were custom made. The biggest problem is finding the time to put them on her several times a day. We have two small children so they consume a lot of our time. To our suprise the knees have healed pretty good just with rest & the scar tissue will allow her to move around pretty good. If you have a young dog I would recommend surgery but if she’s older they can get around pretty good with just rest if you cant afford the surgery. She use to limp real bad but now she walks normally & can run a little even though the next day she limps a little.
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