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CCL Tear - Experiences Skipping Surgery?

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  • CCL Tear - Experiences Skipping Surgery?

    Jake Puppy, our six year old field lab, is 120# of lab. He also partially tore his LH CCL playing fetch. It seems to have happened earlier this summer - we're bad dog owners and have been avoiding confronting his ongoing gimpiness - but was diagnosed today.

    We're somewhat rural and have a fantastic small animal vet willing to take a pragmatic approach with us. We're doing 2 weeks of aggressive anti-inflammatories and crate confinement except to pee, eat, and drink. After that we'll reassess to see if we continue taking a non-invasive approach or if we proceed to surgery (likely either TPLO or TTA based on his size and age).

    Keeping him crate confined for months and dealing with the surgical aftercare is/will be hard for us with our work hours (and on our budget) but we'll do it if it's the best or only option.

    Anyone have any success stories for recovering from a CCL tear without surgery in a big dog? Anyone have strong recommendations for supplement(s) we should put him on now? Anyone want to commiserate with me about our land of misfit animals (lame dog, lame horse, flat truck tire all in one weekend)?

  • #2
    About three years ago my Brittany partially tore her CCL. She was about 9 years old but a lot smaller than your dog, about 40 pounds.

    Initially we took her to the more expensive suburban small animal vet when we noticed a slight lameless and weirdness to her gait. This vet said the surgery was a must and quoted us a very high price. We took her to the rural small animal vet who like yours said to try confinement, restriction of exercise and anti-inflammatory for a period of time before doing the surgery. They also quoted us a significantly smaller amount if we did opt for the surgery.

    After about a month she looked back to normal, no lameless and typical springy energetic Brittany. We keep her on glucosamine chondroitin which seems to do a lot for her overall, especially now that she is getting older.


    • #3
      I'll see if I can stick to the important details! I have a female lab mix who's always weighed exactly 60 lbs. She grew up as a farm dog, has been on a million miles of trail rides, etc. I think she was about 8 when we first saw her limp; vet diagnosed a partial tear, not bad enough for surgery but that was the end of the long trail rides and we started her on some sort of doggy joint supplement. She bounced back well and transitioned to life as a city dog when our other lab became ever lamer than she was. Fast forward to last Christmas, right around her 14th birthday she tore the other cruciate, badly. At that age I wasn't going to do surgery. She got the max dose of anti-inflammatories plus tramadol, acupuncture, and house arrest (it's a very small house all one one floor, so we never crated her). Very, very limited exercise. Her first car trip was in February, first tiny visit to the park in March. Continued acupuncture. Was satisfied with short walks and short trips to the park but wasn't satisfied with her pain management; long story short, I had the chance to bring her for a 2-week vacation to the farm where she hung with another old lame doggy and I could watch her really closely and play with her meds. She's now on only metacam, fish oil, max dose of dog cosequin, no more tramadol, and about 200% more exercise than she was getting before and she's doing GREAT. She's almost 15 now and still moves like an old dog, but she's enjoying life. This morning we did a .75 mile loop around the neighborhood, briskly, with only one stop to poop. I never thought we'd get back to this point!

      Your challenge is going to be ramping up his exercise as winter sets in, while giving him enough time to heal, and maybe getting some of the weight off to guard against tearing the other one. Another random thought: tramadol can be sedating... use this fact to your advantage! I think it helped Kaley stay very, very mellow while she was on house arrest.


      • #4
        I have a mutt who tore his cruciate wrestling with my 100 lb lab. It was a complete tear (he was around 80 pounds at the time). We kept him confined and on a leash at all times when he wasn't confined to allow it to heal. He made quite good progress and the vets thought he was about healed and could go out in the yard with our lab again. They started wrestling and it tore again, we ended up doing surgery to repair it and he's doing fantastic now (1 year later).

        Now above lab tore her RH cruciate completely in May of 2011 (at 6 years old) playing with our mutt. We brought her in, scheduled surgery to repair it (it was obvious she was in terrible pain, our mutt remained fairly unbothered by his leg). The next night my lab fell in the yard and ended up tearing her other cruciate as well as the meniscus (LH) and destroyed her RH hip. Surgery was still an option but the quality of life wasn't there so we put her down.

        I think it's much harder for a cruciate tear to be repaired without surgery in a large dog because there is so much more weight on their legs and the possibility of having a problem in another leg is a good possibility. If you can keep your dog comfortable on some pain meds and keep him quiet it probably can be done, and it helps that it's not a complete tear. My mutt has been on Cosequin to try and aid with his joints and I think it makes a bit of difference.


        • Original Poster

          Thanks to both of you. Good to know that it can be done. He's at his ideal weight at about 115# (yes, really, he's a hugely tall lab) so we will be taking a few pounds off of him. So far, so good. Crate and leash training him as a puppy is paying off. Now to figure out which supplements to put him on.


          • #6
            My vet/chiro recommended I use Standard Process Ligaplex II (supplement)on my shepherd after he tore his CCL. I opted for the surgery (TPLO) since he's such an active dog and his was a complete tear.

            Just in case you do decide to do the surgery, you might want to know that while I was researching my options, I e-mailed the chairman of small animal surgery at MSU and he said if I had the TPLO done, to make sure it was done by a very experienced surgeon. It is a very complicated surgery and experience counts. My horse trainer's golden was done by a local vet. 2 surgeries later and she's still not doing all that well. My dog was done at a veterinary specialty clinic. Dennis was the vet's 1000th TPLO. After only 8 months, you can't even tell which leg was operated on. After care an physical therapy afterwards are very important.

            Goog luck!


            • #7
              Here are the cons of not doing surgery:
              - The tibial plateau is likely unstable, chances for a second rupture are high.
              - Arthritis sets in faster
              - The other leg will likely take a lot of strain while leg #1 is healing
              - Fast recovery (with TPLO), usually back to full weight bearing in 1 - 3 days.
              - Very high rate of success (specialty practice).

              Here are the pros of not doing surgery:
              - Much cheaper
              - No chance of infection
              - No chance of anesthesia or surgery complications
              - Fair rate of success with strict rest and rehab protocol.

              If your dog isnt in severe pain or distress, why not try the conservative route for a while? Surgery is always an option down the road if there is no success with conservative management.

              Personally, I would go straight to a TPLO (over conservative treatment or lateral suture) just because we do on average 2-3 daily and I see the success rate. However, its not cheap and I totally understand that its not fiesable for everyone!


              • Original Poster

                Squish - thanks for the pros/cons. At this point I think we're going to try the conservative route for 3-4 weeks just to see where it gets us. We're not ruling out surgery, but leaning against it if we think we can manage without. As I mentioned in the OP, both the cost and managing a 6-8 week recovery are BIG issues for us.


                • #9
                  My Springer (43 lb.) partially damaged a cruciate and was intermittently lame on it for several years; it would bother her for a couple hours after hard exercise. Then one day she was running around my friend's farm, I heard a loud "YIPE," and I just knew she'd really done it. Sure enough, 3-legged lame. I never even considered conservative non-surgical treatment because she was completely non-weight bearing. We opted for a traditional repair, based on cost (even that was a stretch) and it's just as well, because when my excellent vet got in there she found Sunny had bilateral tears - both ligaments were totally ripped. Knee was trashed. Vet said even if we'd gone for the TPLO they would have had to put in a ligature. Complete recovery took a good six months but she's now 9 1/2 (the repair was 3 1/2 years ago) and you'd never know she had a thing done. I give her GlycoFlex III every day and I assume it's helped, but I've had her on that since before the surgery so can't say for sure.

                  OP, I think your plan is just fine in your case - as several have said, you can always opt for surgery later. My .02 on that is if Traditional repair is what's in your budget, don't let anybody make you feel bad or guilty - in our case it was literally half the price and we had excellent results. I was concerned she'd do the other knee, for one thing! I do agree it's important to use a vet who's done many of whatever kind of repair you opt for. My regular vet has done hundreds of Trads, but would have sent us to the surgical specialty center for TPLO.

                  (P.S. I just had Sunny x-rayed - dingbat ate a couple of socks - and her knee looked awesome. The vet was very pleased with herself. :-) And the sock pieces were passing, thank God!)
                  "Horses lend us the wings we lack." ~ Pam Brown


                  • #10
                    Originally posted by UrbanHennery View Post
                    Squish - thanks for the pros/cons. At this point I think we're going to try the conservative route for 3-4 weeks just to see where it gets us. We're not ruling out surgery, but leaning against it if we think we can manage without. As I mentioned in the OP, both the cost and managing a 6-8 week recovery are BIG issues for us.

                    Cost I can see, but to be perfectly honest surgery is a MUCH faster recovery than conservative management. You are likely looking at months of kenneling and on-leash only activity with conservative management if you want it to work. With surgery, they are often fully weight bearing within a few days. We dont suggest kenneling, but suggest baracading stairs for 6 weeks to prevent running up/down. Short leash walks start immediately after surgery.

                    Again, nothing wrong with trying conservative! Just dont want you to think it will be "easier", its actually a much longer and more difficult in terms of confinement and careful management.


                    • #11
                      Having been through TPLOs on both of my now deceased dogs- I think you are damned if you do, damned if you don't.

                      In my experience, both of my dogs developed severe arthritis in the knees that they had the TPLO in, as compared to the normal knee (they each had one knee done). I know they would have developed arthirtis anyway with out the sx.

                      In retrospect, I think the surgery was more beneficial than not for my larger dog (120lb Rottie). The benefit of having a stable, relatively pain free knee for a few years before it got severely arthritic was worth dealing with the problems later on. She had a TPLO as a 2 yr old, but then again, she only lived to be 9. (Non-TPLO related bone cancer).

                      For my 55 lb coliie/ shepX - I should have skipped it. She really was ok (very functional) with the pre-surgery instability in the knee. She had hers done as an 7-8 yr old, and she lived to be 15. The last 3 years of her life, that knee bothered her tremendously. Her poor leg would tremble with pain from the arthritis. And, I had the plate taken out 4 months after sx because it was bugging her.

                      So, (sorry so long!!!!) I think I would do it again with a large active dog, but not with a midsized or smaller dog. Big dog had real hard time getting around on three legs.
                      Unrepentant carb eater


                      • #12
                        My "crazy" anxiety dog (yes, she is still with us and doing great with some changes and help from 3 vets, one being the behaviorist at OSU.) Anyway, she ruptured hers this past winter. She is leggy and not over weight. I spoke to the surgeons at work (I work at a larger specialty clinic.) I was told she did not need to be crate rested. We do live in a ranch and I stopped letting her use the big back yard for a while. She was put on Carprofen and has always been on fish oil and a joint supplement. He said she would have good days and bad days (some days she was toe touching lame). On good days he said to add a little more activity and on bad days to rest her...increase her meds over needed. I added in Duralactin and eventually Adequan and acupunture. He said over time the good days would out number the bad days, and that was exactly what happened. He just said she would heal faster with surgery. (She was 10 at the time and cannot be crated.) By the summer you couldn't tell and she is fine. She will always be on the glucosamine and Adequan, but I can handle that. I would have considered sx on a younger, less crazy dog, but for us, this worked out fine.


                        • #13
                          My corgi boy came back in from the yard 3 legged lame. Vet couldn't confirm a tear but it sure seemed like it. I had decided against surgery for a few reasons, cost and injury to the opposite leg mostly.

                          My boy was kept in a play pen with his crate and a "front porch". I left his crate door open with a big blanket hanging out the front. He had enough room to lay in his crate or on the blanket. He hung out in his corral for 4-6 weeks. I lost track of it to be honest. Saw small improvements at 3 weeks. He could hobble to potty then went to lay down. Then a few weeks later he took off running after something in the yard and I realized he was better. Totally back to himself. He still layed on his "porch" a lot but I took the corral down. Eventually he started getting around on the laminate flooring again too. Total time to heal about 8 weeks.

                          I know someone with a lab who had the same injury. They made a tie out cable that was long enough for dog to lay in crate or on blanket just outside crate. Time can heal. The trick is keeping them quiet. Luckily my boy adjusted to keeping quiet.
                          "You are a child of the universe, no less than the trees and the stars;
                          you have a right to be here." ~ Desiderata by Max Ehrmann