What is an ACL injury?
The anterior cruciate ligament (ACL) or cranial cruciate ligament (CCL) is one of the most main stabilizing structures of the knee (stifle) joint in the hindlimbs of dogs. The ACL is a rope-like structure inside the joint that acts as a static (constant) stabilizer of the knee, preventing abnormal “slipping” of the two bones of the knee joint, the femur and tibia. Its main job is to hold the femur and tibia in proper alignment during all forms of activity.
Deficiency of the ACL is the most common orthopedic problem in dogs and inevitably results in degenerative joint disease (arthritis) in the knee joint. It is often referred to as a disease because it is typically the result of a degenerative process in dogs, rather than the from athletic injury or trauma. Although it is often noticed after running, playing, or jumping, the disease process has usually already been present for weeks to months when symptoms occur. Illustrating this point, 50 – 70% of dogs that rupture an ACL will rupture the ACL on the other leg.
One of the most important issues with ACL injury has to do with the medial meniscus. The medial and lateral menisci are “cushions” of cartilage positioned on top of the tibia, cushioning the force from the femur. When the ACL ruptures, a large amount of stress is placed on the medial meniscus, and it is often damaged. The damaged and unstable meniscus is particularly uncomfortable, and cleaning the damaged part of the meniscus is an important part of ACL surgery. It is possible for meniscus damage to progress even after surgery. As many as 9% of dogs have continued meniscus problems after surgery.
What are my treatment options?
ACL injury is not life threatening, and surgery is not absolutely necessary. Occasional dogs, especially very small dogs, can do OK with rest, pain medication, and physical therapy. In general, conventional wisdom is that dogs will have more significant arthritis without surgery. Success can be particularly slower if there is meniscal injury. Even with surgery, dogs will still develop arthritis, but less significant arthritis than without surgery. While there are many surgical options, there are 3 more common surgeries. There are no definitive studies showing one surgery to be better than another. Each surgery has its own set of pros and cons.
Tibial Plateau Leveling Osteotomy (TPLO) is generally considered to be the best “state of the art” surgery addressing the underlying reason why ACL injury is so common in dogs. This has to do with the alignment of the femur and tibia, changing the anatomy of the top of the tibia so that it no longer “slips” with pressure from the femur. It does not replace the function of the ACL, but instead makes the ACL unnecessary. A semicircular cut is made at the top of the tibia with a curved saw so that the tibial joint surface is “leveled out” to prevent forward slipping of the joint. A plate and screws are applied to stabilize the cut bone during healing. The cost of the TPLO can vary, but is typically around $5600. There is a variation of the TPLO called Tibial Tuberosity Advancement (TTA). The TTA is similar in concept, but the cut made in the tibia is different.
Lateral Suture Stabilization is historically the most common technique used to treat ACL injury in dogs. It is one of the “extracapsular” techniques which means the function of the ACL, which is inside the joint, is replaced by placing a suture outside the joint. The suture is placed around the fabella and through either the tibia or patellar ligament, providing a mostly soft tissue anchor for joint stabilization. The cost of the Lateral Suture can vary, but is typically around $3600.
The anterior cruciate ligament (ACL) or cranial cruciate ligament (CCL) is one of the most main stabilizing structures of the knee (stifle) joint in the hindlimbs of dogs. The ACL is a rope-like structure inside the joint that acts as a static (constant) stabilizer of the knee, preventing abnormal “slipping” of the two bones of the knee joint, the femur and tibia. Its main job is to hold the femur and tibia in proper alignment during all forms of activity.
Deficiency of the ACL is the most common orthopedic problem in dogs and inevitably results in degenerative joint disease (arthritis) in the knee joint. It is often referred to as a disease because it is typically the result of a degenerative process in dogs, rather than the from athletic injury or trauma. Although it is often noticed after running, playing, or jumping, the disease process has usually already been present for weeks to months when symptoms occur. Illustrating this point, 50 – 70% of dogs that rupture an ACL will rupture the ACL on the other leg.
One of the most important issues with ACL injury has to do with the medial meniscus. The medial and lateral menisci are “cushions” of cartilage positioned on top of the tibia, cushioning the force from the femur. When the ACL ruptures, a large amount of stress is placed on the medial meniscus, and it is often damaged. The damaged and unstable meniscus is particularly uncomfortable, and cleaning the damaged part of the meniscus is an important part of ACL surgery. It is possible for meniscus damage to progress even after surgery. As many as 9% of dogs have continued meniscus problems after surgery.
What are my treatment options?
ACL injury is not life threatening, and surgery is not absolutely necessary. Occasional dogs, especially very small dogs, can do OK with rest, pain medication, and physical therapy. In general, conventional wisdom is that dogs will have more significant arthritis without surgery. Success can be particularly slower if there is meniscal injury. Even with surgery, dogs will still develop arthritis, but less significant arthritis than without surgery. While there are many surgical options, there are 3 more common surgeries. There are no definitive studies showing one surgery to be better than another. Each surgery has its own set of pros and cons.
Tibial Plateau Leveling Osteotomy (TPLO) is generally considered to be the best “state of the art” surgery addressing the underlying reason why ACL injury is so common in dogs. This has to do with the alignment of the femur and tibia, changing the anatomy of the top of the tibia so that it no longer “slips” with pressure from the femur. It does not replace the function of the ACL, but instead makes the ACL unnecessary. A semicircular cut is made at the top of the tibia with a curved saw so that the tibial joint surface is “leveled out” to prevent forward slipping of the joint. A plate and screws are applied to stabilize the cut bone during healing. The cost of the TPLO can vary, but is typically around $5600. There is a variation of the TPLO called Tibial Tuberosity Advancement (TTA). The TTA is similar in concept, but the cut made in the tibia is different.
Lateral Suture Stabilization is historically the most common technique used to treat ACL injury in dogs. It is one of the “extracapsular” techniques which means the function of the ACL, which is inside the joint, is replaced by placing a suture outside the joint. The suture is placed around the fabella and through either the tibia or patellar ligament, providing a mostly soft tissue anchor for joint stabilization. The cost of the Lateral Suture can vary, but is typically around $3600.
