Conservative management for dog knee injury is something dog owners may wish to pursue for their dogs, but it's important to consider that not all dogs are good candidates. To better understand how conservative management works, it helps to gain a closer insight into what happens when dogs tear their cranial cruciate ligament (CCL) and how it impacts their knee. Veterinarian Dr. Ivana Crnec discusses conservative management for dog knee injury and provides details on what it entails.
Dog Knee Injuries
The most common cause of hind limb lameness in dogs is cranial cruciate ligament (CCL) injury or insufficiency. The CCL is the most important stabilizer of the stifle joint or knee. It is estimated that in 2003, dog parents in USA spent more than 1.3 billion dollars on treating CCL issues.
Unlike humans, dogs rarely suffer from traumatic CCL rupture. More often than not, the rupture is caused by a combination of several factors such as: degeneration or aging of the ligament, poor physical condition, obesity, conformation and breed.
The CCL degeneration is a subtle and slow process (occurs over several months or even years) that usually lacks clinical manifestation. That is why, in most cases, a small and acute trauma can easily cause rupture of what it appeared to be a healthy ligament.
Based on the degree, CCL ruptures can be classified as either partial or complete. However, in dogs, partial tears almost always eventually progress to full tears. This happens as a result of continued physical activity – quick movements that aggravate an already bad situation. Dogs whose knee injuries are already managed can experience flare-ups – exacerbation of the clinical signs due to new traumatic events or inappropriate exercise.
What dog breeds are predisposed? The incidence of CCL issues is higher in certain dog breeds such as Rottweilers, Newfoundlands, Staffordshire Terriers, Mastiffs, Akitas, Saint Bernards, Labrador Retrievers and Chesapeake Bay Retrievers. Also, statistics show that female dogs and neutered dogs are at higher risk of developing CCL issues.
On the flip side, the incidence is particularly low in dog breeds such as Greyhounds, Dachshunds, Basset Hounds and
Old English Sheepdogs.
What signs are seen in dogs suffering from CCL? A torn CCL is clinically manifested with: chronic and progressive lameness and favoring of the non-injured leg.
Treatment Options For Dog Knee Injury
There are two treatment approaches to knee injuries: surgical approach and non-surgical approach (also called conservative).
Generally speaking, when it comes to torn CCL ligaments, the surgical approach is the official treatment of choice. However, the surgical approach is more expensive and riskier (since it requires anesthetizing the patient).
When deciding which approach is the best, several factors need to be considered: concurrent medical issues, dog owner financial concerns, type of CCL injury (partial vs. complete, unilateral vs. bilateral), surgical approach.
Knee injuries can be fixed with three different surgical procedures:
1. Lateral suture technique or extracapsular repair, which entails replacing the torn ligament with an artificial fiber plastic ligament and costs $1100-2500
2. Tibial plateau leveling osteotomy (TPLO) which entails cutting and rotating the tibia in a more flat position thus eliminating the need of a CCL. It costs $2400-4500
3. Tibial tuberosity advancement (TTA) which entails changing the knee’s dynamics stabilizing the joint by implanting a stainless steel metal plate. It costs $3500-4500.
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Surgically treated patients require complete inactivity for 8 to 12 weeks, close supervision during the post-operative recovery period and rehabilitation.
Conservative Management For Dog Knee Injury
The conservative approach is mostly suitable for dogs weighing less than 30 Ibs. The conservative approach is multi-modal and includes:
• Physical inactivity or rest – it is advisable to restrict the patient’s physical activity for at least 6 weeks. Sometimes the rest should last for as much as 2 months.
• Controlling the effects of inflammation – this can be achieved by using non-steroid anti-inflammatory drugs (NSAIDs), ice therapy and laser therapy. NSAIDs are useful because they control the pain and decrease the inflammation (responsible for the further degeneration of the knee structures).
• Gentle exercise regimen or rehabilitation (physiotherapy) – the goal is to strengthen the quadriceps and hamstrings so they can support the increased limp loading and eventually regain the normal movement patterns. The rehabilitation regimen usually includes hydrotherapy (swimming pool or underwater treadmill) and light exercises.
• Weight loss – obesity is both a risk factor and an aggravating factor.
• Wearing a knee brace – this is a cost-effective alternative to knee surgery. Knee braces are non-rigid braces that promote stabilization and support the knee joint. The brace stabilizes the knee by limiting its flexion and extension motions. That way, the scar tissue can grow and eventually form a callus over the torn region. Generally speaking, all soft tissue injuries tend to heal in 6-8 weeks. Theoretically, a torn CCL can heal in this timeframe with or without the brace. However, the brace is beneficial since it promotes the natural healing thus ensuring positive outcome.
• Prolotherapy – the term "prolo" stands for proliferation. Namely, ligaments heal slowly because of their poor blood supply. Prolotherapy means injecting sugar water (dextrose) or other harmless substances into the ligament. The goal is to cause local inflammation and consequently increase the supply of blood and nutrients. Once the blood and nutrients supply is increased, the ligament is more likely to heal. Usually, the patient needs to receive five injections at three-week intervals.
• Holistic alternatives – acupuncture, acupressure, massages and chiropractic. Acupuncture relieves pain and promotes faster healing. Acupressure reduces swelling and minimizes the scar tissue build-up. Plus, it can be learned at home and used whenever needed. Massages reduces pain and soreness, increase circulation, decrease muscle tension and accelerate the overall healing process. Chiropractic adjustments align the bones, ligaments and tendons back into their normal balance.
Dogs receiving conservative treatment are usually put on an 8-week trial. If the condition improves during this trial period, the treatment is considered successful. If the condition remains the same or worsens, it is advisable to look into the surgical approaches.
At least half of the dogs with CCL issue in one knee will eventually develop a similar problem in the other knee. Over time, partial CCL tears progress to full tears and invariably lead to arthritis and limited range of motion.
CCL injuries are quite common and require prompt veterinary attention. They can be fixed surgically or conservatively. Both approaches have their pros and cons. It should be noted that not all dogs are good candidates for surgical treatment. On the other hand, not all dogs respond to conservative therapy. Each case is different and each patient requires an individually tailored treatment plan.
About the Author
Dr. Ivana Crnec is a graduate of the University Sv. Kliment Ohridski’s Faculty of Veterinary Medicine in Bitola, Republic of Macedonia. She is a certified nutritionist and is certified in HAACP food safety system implementation.
She currently practices as a veterinarian in Bitola and is completing her postgraduate studies in the Pathology of Domestic Carnivores at the Faculty of Veterinary Medicine in Zagreb, Croatia.
Ivana’s research has been published in international journals, and she regularly attends international veterinary conferences.