Cocker Spaniel with an injured leg
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Dog With Torn ACL: What To Do

“You have a dog with torn ACL,” the veterinarian shared. “It’s a partial tear, but it could progress to a full tear.” I knew we had a long road ahead, but I wasn’t prepared for my dog to experience two ACL tears within the course of two years.

A dog with a torn ACL (also called anterior cruciate ligament or anterior cruciate ligament) is very treatable, but it’s not an easy fix. Over the course of two years, my Cocker Spaniel ruptured both of his ACLs and required surgery both times.

We tried conservative management, including a custom orthotic knee brace, cold laser therapy, limited mobility with rest, and anti-inflammatories, but nothing stopped the pain nor healed the torn ligament. Dexter had surgery twice: Once at the age of five and again at the age of 6-1/2.

There is a high likelihood that if your dog tears one of his ACLs, the other hind leg will be affected over the next 12 to 24 months.

If you’ve arrived at this article it is likely that your dog:

  1. Tore his her ACL and you are looking for options other than surgery
  2. You are curious and never heard of an ACL brace for dogs
  3. You want to know more about ACL surgery in dogs

The ACL (aka CCL) is a ligament that is commonly damaged. In fact, the surgeon who performed the two surgeries on my dog says that more than half of his patients have this injury. In fact, some dogs are more prone to ACL injury than others. However, ANY dog at any age of any breed, lineage, or mutt can tear an ACL.

What Is the ACL in Dogs and Why Does It Tear?

In both people and dogs, ligaments connect bones with bones. The ACL, or anterior cruciate ligament, connects the lower leg bone to the upper leg bone.

The ACL is connective tissue, and when it tears or ruptures, stability is compromised between the dog’s knee (femur) and the bone below the knee (called the tibia).

The anterior cruciate ligament prevents the tibia from sliding forward and out from underneath the femur. In humans, a lot of football players tear the ACL due to the pivot and hits they take to the body.

Dogs tear an ACL for a number of reasons. My dog jumped off the bed the first time he tore the left ACL. The second time, he was jumping up for a ball at the park. These are everyday occurrences for most dogs, but ACL tears are very common.

A dog can also tear the ACL as a result of trauma, slipping, falling, or pivoting, or planting a limb while his body is still moving forward. Dogs who are chasing something or running fast may suddenly turn and snap, the ACL can tear.

ACL Tear In Dogs Symptoms

You may not even notice your dog has a partial or full tear of the ACL, but most often a dog will display some level of discomfort. The most common signs of an ACL injury include, but are not limited to:

  • Limping
  • The dog favors one leg over the other
  • Difficulty jumping or climbing stairs
  • Sitting down cautiously and slowly
  • Doesn’t want to put the injured leg squarely underneath his body when sitting
  • Unable or unwilling to go for a walk
  • Holding a leg up
  • Your dog may yelp, whine, or growl in pain
  • Unable to bear weight

Many of these symptoms are also indicative of other canine health issues like arthritis, a broken leg, blood clot, infection, Lyme disease, and more. Dogs limp for many different reasons.

It is imperative to seek the help of a veterinarian who is familiar with ACL injuries and tears in dogs. Fortunately, we took our dog to a board-certified orthopedic surgeon for a proper diagnosis.

How Is An ACL Tear in Dogs Diagnosed?

There are a few ways a skilled veterinarian or orthopedic veterinarian can diagnose your dog with a torn ACL. Some of these tests may be performed under twilight anesthesia so the dog does not feel pain and so he relaxes.

Each time our dog tore his ACL, he was awake for the joint manipulation testing. The first way to diagnoses an ACL tear in dogs is the cranial drawer test.

The cranial drawer test is exactly what it sounds like. The vet holds the dog’s femur in place with one hand and tries shifting the tibia bone backward and forwards, like opening a drawer.

If the tibia slides forward, the dog is diagnosed with a positive drawer sign. A normal joint shows no or little motion, also called instability. Both times, my dog had a positive drawer sign.

A tibial compression test is something performed to diagnose a torn ACL in dogs. The vet places one hand around your dog’s femur end and then grasps the foot. He will attempt to flex the ankle. If the tibia moves forward, this might indicate an ACL tear.

X-rays of the knees and hips may also be performed to rule out any fractures, disease processes, or arthritis. In more advanced cases or for extra security, an arthroscopy can be performed. A small camera is used to look inside your dog’s joint just like it is performed on a person.

What Surgery Is Performed On Dogs With A Torn ACL?

If surgery is performed, there are three different options in most circumstances. Each procedure has its own merits. Depending on the extent of your dog’s tear, size of the dog, and other health conditions, your veterinary surgeon will recommend one of the following.

Extracapsular Repair or Lateral Suture Repair

Fishing line (monofilament suture) is basically is sutured into place at the tear location, healing occurs, the scar tissue forms, the suture pops, and wha-la: New doggie (so to speak). The key to this surgery, which our dog had twice, is the formation of scar tissue within the first few months after surgery.

Our surgeon recommended extracapsular repair on Dexter based on his size. Physical therapy is recommended to help the healing process and maintain normal muscle tone. Dexter had several physical therapy sessions postoperatively at a local rehab center for dogs.

Tibial Plateau Leveling Osteotomy (TPLO)

This surgery is more popular than it was when my dog tore his ACLs. TPLO is usually recommended on larger dogs or dogs with a steep tibial slope. The ends of the ligament are removed along with any meniscal damage.

Cuts are made, the slope is leveled out, and the repositioned bone is held in place with plates and screws. Physical rehab is recommended postoperatively.

Tibial Tuberosity Advancement (TTA)

I don’t know many dogs who have undergone TTA, but it is usually performed on medium to larger-sized dogs. A cut is made in the front of the tibia, advanced forward, and the patella is realigned. Various accouterments including a bone spacer, plate, and screws secure this new position to the bone.

A bone graft from the tibial tuberosity (top of the tibia) fills in the space, new bone growth fills in, and healing is stimulated. Again, physical therapy is recommended postoperatively.

Can A Dog’s Torn ACL Heal Without Surgery?

We tried a conservative approach the first time because our dog had a partial tear. I am glad I tried the more conservative approach, but I’ve learned a lot since then.

Our conservative approach included rest, medication, a custom leg brace, and no more jumping for months on end. More about that shortly.

It is likely, but not certain, that the ligament will progress to a full tear. I’ve spoken to many pet parents who say their dogs live comfortably with a partial tear. Here are some non-surgical ways to manage a torn ACL.

A compromised joint is prone to develop arthritis. Living with a partial tear does have limitations: At any time, it can progress to a full tear, and then surgery is most likely required. Scar tissue can take the place of the damaged ligament, but it will come at a cost: Arthritis, pain, and/or limited mobility.

ACL Tear Recovery For Non-Surgical Candidates

Not all dogs are surgical candidates for a variety of reasons: Cost of surgery, other health conditions, age and risk of anesthesia, etc.

For dogs who are not undergoing surgery for one reason or another, stabilizing the knee is of utmost importance. ACL tears that are not treated at all are at very high risk for developing degenerative arthritis. Imagine the ligament is a rubber band. If you snap that rubber band in half, the knee can no longer keep stable.

knees

A torn ACL prevents subluxation of the knee joint, and maintaining its integrity is of primary concern. Since ligaments connect bones, when a tear in the ligament occurs, stability is no longer there.

A stable knee means a stable joint and scar tissue can then take the place of the tear. Ligaments cannot regenerate themselves, so scar tissue formation is crucial.

Here’s a good piece from Colorado State University Veterinary Teaching Hospital about ACL tears and repairs.

Dog in a stifle brace for ACL tear
Dexter in the moments after trying the brace for the first time.

Brace for Dog with Torn ACL

An ACL tear takes months to heal and many more months before dog parents should engage the dog in their normal activities so as to not have a recurrence or re-injury.

During that time, you want scar tissue to form for the reasons noted above. In order for scar tissue to replace the torn area, the knee joint must be stable. Stability comes in the form of rest or a stabilizing device, such as a brace.

I discovered a small business within driving distance of my home called My Pet’s Brace. They provide orthotic devices for dogs that require bracing to support hip, stifle, hock and paw injuries in the hind legs and shoulder, elbow and carpal injuries in the front legs.

Much of their primary clientele in dogs deal with ligament ruptures and tears. After a thorough examination and assessing Dexter’s somewhat hobbled gait, a stifle brace was recommended.

Dexter would wear the brace for six to nine months during “active waking hours,” which for a then nearly 5-year-old Cocker Spaniel is quite often.

Dog getting fitted for brace from torn ACL

At that time, the custom stifle brace was $625 for a dog of Dexter’s size, which is a worthwhile investment. At the time, ACL surgery clocked in at $1,800 and $2,500 in our area of Pennsylvania.

Fun fact: Our dog eventually required ACL surgery. The orthopedic surgeon asked to see the custom stifle brace to show his colleagues. He said I was his first client to ever try the custom brace. Times have changed since then.

There are many companies that sell knee and stifle braces, but they are not custom fit to your dog’s specific needs.

A custom brace is most effective because, like a custom brace for a person, it conforms to the exact specifications of your dog’s anatomy. Not all knees, legs, or dogs are the size same and with the same structures. Two Cocker Spaniels, for example, side by side, still do not have the same anatomical measurements.

There are a variety of non-custom braces available, but none could guarantee the precise custom molding to my dog’s knee as that from a facility that makes them with your dog’s specifications in mind.

The folks at the orthotic center cast my dog’s leg to build the brace. It is important to understand the process that goes into crafting a custom device for your dog versus purchasing one that is designed for most any dog to wear.

There are cheaper options, but I wanted the security and peace of mind that my dog received precision accuracy and proper sizing. I also loved having the staff on hand to answer questions and consult with at follow-up appointments.

Custom Knee Brace Step by Step

The four steps in the simple process of creating a custom device for your pet are:

  1. Taking a cast of the leg or other body part
  2. Fabricating or building the device,
  3. Fitting the device on the dog
  4. Modifications and adjustments, if necessary. (Steps 3 and 4 are usually accomplished at the same time.)

It sounds more complicated than it actually is, so here’s a visual and video guide of what happens, and in our case, for a custom stifle joint for ACL stability:

You and your dog’s veterinarian discuss options and if it is determined that a leg brace would best serve your dog, find a brace business that actually can see and touch your dog for custom molding.

If there is not a clinic near you to do this, many times a kit is sent to the veterinarian and they perform the casting, then return it for custom molding to the orthotic manufacturers.

We opted to drive to the facility for the process. After meeting with the folks at My Pet’s Brace, the process began. My biggest concerns were pain during the process and if my dog would adjust to the end product.

There was no pain, the process was easy, and Dexter adjusted to the brace in about 60 seconds. It takes most dogs a day or so (or less) to adjust, so we were very fortunate.

The entire process took about five minutes to actually take an exact replica of Dexter’s stifle area. This is best left up to the experts, and the business we dealt with works with veterinarians all over the country.

They send the kit to your vet’s office, your vet can do the casting and then send it back to them for custom creation.  Spending the time necessary to take a good cast in the proper final alignment is critical in obtaining a well-fitting functional device.

Here are some images of the actual process that occurs once the client leaves and the casting begins:

dog brace

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My Dog’s Experience With A Custom Stifle Brace

My dog wore the brace for 90 days, except for sleeping or while lounging around in the house. Though the brace did help to stabilize the knee, his light running with it on did more to put stress on the already fragile ACL and snap, one day it just gave out.

Once the ACL fully ruptured, this meant bone-on-bone contact. Dexter underwent extracapsular repair surgery for his fully torn ACL.

dog limping after tearing ACL

ACL Surgery The Second Time Around

A little over a year later, Dexter tore the ACL in the other hind leg. The same doctor, same surgery, and same recovery process ensued. Here’s what happened during my dog’s second ACL surgery.

dog after ACL surgery
This is the moment Dexter was released from the hospital.

ACL Tear Costs

The costs vary from vet to vet, surgeon to surgeon, and city to city. Here’s a breakdown of some of the costs we incurred when my dog tore his ACLs:

Custom orthotic brace for left stifle:  $625

Six cold laser therapy treatments: $250

Extracapsular surgery with same-day release from veterinary hospital: $2,000

My dog’s love and devotion coupled with good health: Priceless.

I highly recommend some kind of high-quality pet insurance like the one we have had for nearly 30 years. Pet insurance isn’t created equal, and make sure you get the top-tier plan that will meet your needs. About 90 percent of all of the above was covered under our policy, which has a very reasonable cost per month.

Are Some Dogs are More Prone to ACL Tears Than Others?

In his book, Advances in the Canine Cranial Cruciate Ligament, author Peter Muir, shares that the Newfoundland (“Newfie”) breed of dog has a high incidence (as high as almost 23 percent) of ACL (sometimes referred to as CrCL) rupture trait. Further, specific breeds of dogs have an increased risk of ACL rupture, which suggests a genetic predisposition.

These breeds include, but are not limited to, the Labrador Retriever, Rottweiler, Bichon Frise, St. Bernard, and others. Many dogs with a degenerating ACL will have the condition in both knees, and this is the case with both our Cocker Spaniel and his littermate. Knee cap issues can also predispose a dog to rupture their ACL. These knee cap issues include a luxating patella.

ANY dog at any age of any breed, lineage, or mutt can tear an ACL.

Do ACL Tears In Dogs Have A Genetic Component?

At this time, an ACL tear is considered binary; that is, dogs are either affected or unaffected. When it comes to littermates, our dog is from a litter of five; two of the five have had ACL tears with eventual surgical repair. The dogs were five years old when the first injury occurred, close to six when the second injury occurred, and they are both neutered, healthy, active males from a reputable breeder.

Incidentally, ACL rupture has a variable age of rupture. This makes genetic predisposition screening to determine the propensity to tear an ACL important since all dogs of all ages are affected.

Littermates, therefore, can be affected, as evidenced in our case. Both dogs are of a healthy weight and both are from the same litter. Is this the case across the board? There is not enough evidence nor scientific study to point to this, but in our own personal journey, I have encountered several littermates with ruptured ACLs. My dog and one of his littermates both have had ruptured ACLs

Can A Dog’s Torn ACL Heal Without Surgery?

I asked my dog’s board-certified orthopedic surgeon this question all those years ago. His answer was a firm no. The dog would suffer in some capacity in most cases.

Some of the more conservative options for a canine torn ACL include:

  • Physical therapy
  • Chiropractic treatments
  • Stifle brace
  • Acupuncture
  • Weight loss for overweight dogs
  • Limited heavy activity
  • NSAIDs (non-steroidal anti-inflammatories)
  • Cold laser at the vet or from home
  • Massage

I’ve talked to many pet parents who tell me their dogs could not have ACL repair. Sometimes the dog is too old, surgery is too risky, or there are other pre-existing conditions. It can also be costly and some pet parents cannot afford the surgery from a financial standpoint.

Our dog’s orthopedic surgeon performed thousands of ACL repairs at that time. He shared surgery with conservative treatments, such as physical therapy postoperatively, gives most dogs the best chance at ACL tear recovery.

Your dog’s veterinarian can better counsel you on this topic, but be aware of one important aspect. If you choose conservative management and not surgery, your dog’s activity must be totally restricted for an extended period of time.

A realistic time frame should be defined if you go the conservative route. For example, if your dog doesn’t show signs of improvement after four weeks, your veterinarian or surgeon may recommend other options.

Dogs with a torn ACL who don’t have surgery are more prone to develop bone spurs, arthritis, pain, and decreased range of motion in the affected leg. Without surgery, a dog is more prone to degenerative joint diseases like osteoarthritis.

Diary of A Dog With Two Torn ACLs

Throughout my dog’s two torn ACL ordeals, treatment, and surgeries, I blogged all about it. The links below will off you some more assistance in helping your dog feel better.

How to Entertain Your Dog After Surgery

Safe Options To The Cone of Shame

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49 Comments

  1. Thank you for such an in-depth look at Dexter’s ACL injuries and treatment. Haley had a stretched ACL injury a few years ago and it’s always in the back of my mind that she could re-injure or tear it. It was interesting to learn that the development of scar tissue is a good thing when there’s a tear to take the place of the torn ligament. I never would have guessed that. Also, the information about the brace was really helpful. I hope it doesn’t happen, but I feel so much more prepared now if Haley ever tears her ACL. Thanks!

  2. Wow! Great info. I also have VPI for our three dogs so was happy to see you comment that they helped offset some of the cost of treatment. Thanks for such a thorough article.

  3. Yep, we know all about busted knees too. Never actually tried the brace, though considered and researched it. Decided for surgery. Hopefully Cookie’s and JD’s knees will hold up through their entire lives.

  4. This is extremely helpful thanks Carol. Finn has a luxating patella on his right rear leg so we are set for a similar experience some time in the future.
    Am sharing to the WherePetsAreFound.com Community across all social media, thanks,
    Annette x

  5. It amazes how our dogs can have so many similar injuries and illnesses that we can get too. I am sorry you and Dexter had to go through this not one but twice with his ACL. I am glad he is doing better now. Thank you for writing this informative article for other pet parents to read when dealing with ACL injuries to their dogs.

  6. Dexter is a cutie! So glad he’s all healed now. This is a VERY informative post and I’m going to recommend to all my dog owning friends that they check out your blog.

  7. I admit I know nothing about ACL injuries because I’ve never had experience with it first hand (crosses fingers). It’s nice to know someone with such expertise!

  8. What an interesting and informative blog post, thank you! I love seeing how much detail you put into your writing, this is going to help a lot of pet owners down the road. It also helps that Dexter is seriously adorable! 🙂

  9. That injury seem so painful. Poor Dexter! I’m glad that he has you for a mom, Carol. Not everyone would have the patience and persistence to properly care for such a complicated injury.

  10. Wow, what an ordeal for your poor baby. I’m sorry you two have had to go through all of this. It is incredibly difficult to see your baby sick or injured. I’m really glad that he is better now, though, and it’s really amazing that your insurance picked up most of the cost!

  11. So much great information – luckily this is something I haven’t had any first hand experience with. Now I certainly know where to look if it comes up with any of my friends’ pets. That’s amazing that they make the brace that way; I guess I hadn’t considered how custom ones were made before. Good to know Dex is all healed up now.

  12. Oh poor Dex, what an ordeal for a little dog to go through – and a worried dogmom too! This is such great information, definitely sharing. Thanks for such a thorough report.

  13. This is a fantastic article – thanks so much for such a detailed write-up of an important health issue for our canine friends! I’m sharing b/c this info is so important!

  14. I’m sorry that happened to Dexter! We just got a puppy and would hate for an injury like this to happen to him. Glad you were able to find something to help him though. He’s lucky to have you.

  15. I’ve seen a lot of these in the past few years. Just from friends dogs at the park, to a few pups that boarded at the kennel I worked at, and now one of my own dogs! Its not a fun process!

  16. This is an AMAZING post. I often think about this with how active Charlie is. Bookmarking and saving for the future ( I hope I wont need it). I am so glad that Dex is doing so well.

  17. Very informative blog! I’ve been going through it for an hour or so now because our 2 year old German Shep hurt her knee and we’re in the beginning stages of what we believe is an ACL tear. In October we took her out to play fetch, she slipped on the wet leaves but continued on, we didn’t think much of it. Then a few days later she began to whine while going up the stairs (we live on the third floor of a three family house).

    She just had the X-Ray done actually today and the vet couldn’t find anything visibly wrong on it. But she still whines (screams practically ugh) when going up the stairs. She can walk just fine, run a bit but no stairs. Which makes it VERY problematic for us to take her out, she’s been apartment bound for at least two months. Thankfully we have a small porch where she can go out and potty.

    Long story short, I’d love to try the brace at first but do you have any idea how she would be able to handle stairs with the brace?

    1. So an ACL tear will not often show on xray. Can the vet do a drawer test? This is pretty definitive for ACL tear. Also I would recommend seeing a specialist. The brace was great for a while and a great option for dogs who can’t have the surgery. In your German’s case, she may need TPLO procedure. I would definitely seek a board certified specialist in the surgery. Unfortunately, a dog with a brace has mobility but should not do stairs. You want the leg stable so that scar tissue can form if a tear exists. It is so hard to keep active dogs still. Keep me posted on how your dog does. I am very curious, okay? I appreciate knowing that these resources have helped.

  18. I was told by our vet that for my Zola’s torn ACL, the best thing to do was to restrict her activity as much as possible during 8 weeks, and see if there was any improvement. We also bought her a custom knee brace from Ortocanis.com to help stabilize her knee while she recovered. If she showed improvement it meant that her knee was healing on its own and that she probably could do fine without surgery. It was definitely tough to not be able to go on walks or play with her for such a long time, but in the end it was definitely worth it! We made sure to buy her an orthopedic bed and put it on the ground, and keep her in an enclosed area every time we left home so that she wouldn’t be jumping on and off any of the sofas or beds or going up and down the stairs. She was already 10 years old when this happened and a year later she’s doing great! I really believe that for both people and dogs, avoiding surgery whenever possible is the best option.

    1. I am so happy to hear that the brace worked for you and it has provided the needed stability. Though that isn’t always the outcome for every dog, you are proof that it can and does help. Way to go!

    2. Dogs sure can be expensive sometimes.. but boy is the love they give worth it! I’m recently going through a similar situation but the tear is partial so we’re also going to try avoiding surgery. I’m going to look into the Ortocanis dog knee brace you mentioned.. it’d be great to find an alternative that works without having to shell out hundreds and hundreds of dollars (don’t get me wrong, if I have to I will but first I want to learn more about some of these promising alternatives!) Crossing our fingers….

  19. This was great! So full of good information! Loved all the pictures, gave me a idea of what the process is all about.
    Thank you for posting your adorable dog. Well done and helpful!

  20. I have a large Aussie. His left leg blew first and a month later his right leg blew. He had surgery on both legs, cortisone shots in each knee but is not getting any better. He is on long term antibiotics because of an issue of autoimmune inflammation. I have to carry him outside and hold him up to urinate. He weighs 61 lbs. so this is no easy task. He is such a trooper and trusts me so much. Do you think maybe a brace on each knee/leg would help him get mobile? My vet is in Middleburg Fl. and is proficient in orthopedics.

    1. I would definitely see a board certified orthopedic veterinary surgeon and get a reason why this is happening. it should not be happening. After that, yes braces can help but they can also hurt if they are not custom and not necessarily needed.

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