Opinions on CCL Tear Conservative Management

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Opinions on CCL Tear Conservative Management

This is a discussion on Opinions on CCL Tear Conservative Management within the Dog Health forums, part of the Keeping and Caring for Dogs category; Hello, My dog recently became 3 legged lame, so I brought her to the vets for x-rays which suggested she has a partial CCL tear ...

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Old 01-16-2018, 03:38 PM
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Lightbulb Opinions on CCL Tear Conservative Management

Hello,

My dog recently became 3 legged lame, so I brought her to the vets for x-rays which suggested she has a partial CCL tear and other arthritic changes. My vet advised that he thinks it is likely this will lead to a complete rupture at some point, at which point it will require surgery- but I am leaning towards conservative management in the meantime and hoping surgery can be avoided altogether.

Has anyone done conservative management successfully and avoided surgery?

As per the vet, I plan on keeping her quiet, as best I can, for the first 2 weeks- just walking out to pee on a leash basically.
Then hopefully incorporating some short, leashed walks for a few more weeks- progressively getting longer.

One of my concerns is that because we're still in the middle of winter, I am worried about walking her on the roads due to the ice/snow we've had this year. I don't want her slipping, and vet advised the 'falling' through snow with each footfall is not ideal.

Would a treadmill work to provide safe and consistent ground for her to be worked on do you think? Or is it likely that the surface may too jarring for her, even at a walk?
My thought is that the treadmill would be a consistent surface to work her on- no holes, no slipping. Obviously I'd be attentive and interacting with her to make sure she is using it safely and not falling off.

This is a normally very hyper, very active dog so I know keeping her quiet will be difficult- so I think structured exercise will probably be necessary for her own sanity...and I hope, if subdued enough, help heal the knee.

Dog currently on Rimadyl, but will be weaning off and giving Golden Paste (turmeric supplement) instead as an anti-inflammatory.

I would love to do hydrotherapy, but don't have a centre nearby.

She is a 5yo 75lb German Shepherd X American Bulldog mix, if this makes any difference for recommendations! Fed Acana, but would be willing to look at other foods or raw if would help with inflammation too.

Just looking for second opinions and also if anyone has any suggestions about managing CCL tears! Thanks in advance
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Old 01-16-2018, 04:25 PM
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My last dog was a 75 pound Akita pitbull mix and he tore the CCL and was instantly three legged lame. When I did research wondering the same thing I was advised to do the surgery since only very small dogs were usually able to be managed without surgery. He was very hyper and active and a terrible patient. He literally tore his wound apart, quickly chewed up all bandages, learned that he could smash and break cones easily by ramming into edges of walls and furniture hard, gave himself an infection from chewing the wound and this was all on heavy doses of sedation and pain meds to calm him down. He hated vets so had to be sedated and muzzled for any visit.
He loved the hydrotherapy though.

You risk the other leg going too from the strain of compensating with a dog that size. Which happened to him two years later. The other CCL tore two years later so had to go through the whole thing again on the other hand knee. Fun! The surgery on the first leg was supposed to minimize the strain on his other hind leg but since he was such a bad patient he had a long tough recovery. Also despite him supposed to be staying quiet and on pretty high doses of sedation and pain meds that were supposed to knock him out, they barely touched him at the highest safest doses they could prescribe and he was bounding around on three legs flying up and down my three flights if stairs for his bathroom trips and flying around the apartment.
Good luck keeping a large fit hyper active dog quiet for months.
But I did the surgery both times and was strongly advised to. Hopefully it'll go better with your dog! The surgery and healing was fine I just had a difficult patient!
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Old 01-17-2018, 09:38 AM
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Thank you for your input. I've heard so much mixed about conservative management. It sounds like it often doesn't work for larger dogs, but I also assume a lot of people aren't fully dedicated to CM recovery either/realize when it's ok to step up exercise, etc., etc. (atleast, I'm trying to tell myself this to stay positive!)
It sounds like recovery was a bit of a rollercoaster with your dog. My dog is terrible at the vets too once she's in the patient room- muzzled and always needs to be heavily sedated. Wonderful when no one is prodding her though!
She's only a couple days into 'bedrest' and looks like she's gonna go crazy, so I am going to try and stock up on some chews to keep her mentally stimulated in her crate until we can resume leash walks. It sounds like this will be a long ride...

I am concerned about the likelihood of a 2nd rupture happening if I chose to have this surgically repaired too. Partly the difficulty of the recovery period (x2) impacting quality of life, and also sucking up the cost of two very pricey surgeries one a single income. It seems the surgery option is so much easier for natural laid back dogs!
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Old 01-17-2018, 09:51 AM
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The way it was explained to me by everyone I asked was not doing the surgery made it much more likely to have a second tear on the other leg in large dogs because they spend much longer limping and compensating for the first injury and the initial surgery gets them back on their feet quicker by putting hardware into support the leg and heal the tear. There's always a risk of the other hind leg getting arthritis and an injury from overcompensating in large dogs but it's less common with surgery. My dog went a full two years and a bit longer before his second surgery and injury. He was seven and unluckily got stepped on by my horse which caused the initial injury. But immediately after the surgery he was fully weight bearing and not limping anymore. It would have been months to get him bearing weight without the surgery and his other leg would have gone much sooner. He was close to ten before he needed the second surgery.

He was also an extremely energetic hyper fit high energy dog who absolutely required at least two hours of running every day. We had to play fetch til he literally dropped and he had to go with me to the stable with me daily and help me with the horses. He could keep up with my fast moving horses for hours on the trails and jump huge horse fences until ten or more years old. So he would have been a terrible patient regardless.

For a large dog it's quicker and safer to do the surgery and I was told makes it less likely of a second injury down the line. My dog was extreme with the wear and tear he out on his legs and joints he ran and jumped high fences daily.
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Old 02-13-2018, 01:36 PM
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doing the surgery

Thank you for your input. I have opted to get the surgery done afterall, as we're not seeing the results I'd like to by now.

Unfortunately TPLO is out of budget, as it is to the tune of about $7K, plus tax when everything is factored in. The vet I am working with, who specializes in orthopaedics has suggested a 3 in 1 stabilization method that will involve a very lengthy recovery time, but supposedly has clinically shown similar long-term results to the other surgeries -if- PT is properly followed afterwards.
I'm a little worried, because of her size opting for anything other than TPLO but vet assures me he has done many larger dogs successfully.

Crossing fingers this works. CCL tears sound so exhausting no matter what method you choose, the more I read....dog has been better patient than expected so far, but we've got a long road ahead
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Old 02-13-2018, 02:43 PM
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Good luck! I don't remember which surgery I did for my dog, but it was about $5000-$6000 total at a specialty referral hospital that's not known for being cheap, by an orthopedic surgeon. For rehab, I took my dog to physical therapy after the wound was healed enough and he absolutely loved the hydrotherapy.

The toughest part was keeping him quiet the first two weeks and keeping him from chewing off his bandages and chewing up his wound. He could and did take off anything except a full leg cast which is what he eventually ended up with. He also learned that if he crashed his cone into the edge of a wall or corner hard enough (yep attached to his head and neck no problem!), The cone would snap and he'd be free.
He did all this sedated on so many medications for sleep and pain he should have been in a coma.
But he was an extremely high energy dog.
At ten he was more hyper than my current dog is at three.
I hope you have a much easier time and your pup recovers fast!
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Old 02-13-2018, 03:03 PM
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My rottie had this surgery. Bank loan for the $4000. Total crate rest with on leash toiletting. Then slow walk 50 yrds. Then swimming exercise. Her life quality was hell. Very active IPO dog. At 6 weeks the other ACL went. No money forced us down moderation management route. Very very slow recovery. Quality of her life very bad. More than once i considered PTS over 1st yr. She simply was useless at couch potatoe life. But.... she did recover and lived 5 more happy yrs. IF i had to make choice again. I would put to sleep. Working dogs do not retire well. And dont understand why suddenly, they cant mix with their dog family. For months and months. And arthritic pain was hard to watch. Hindsight: larger breeds cannot cope with strain on good limb that comes out of line to compensate. Sad.
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Old 02-14-2018, 01:40 PM
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Oh my goodness- hearing all sorts of horror stories does worry me. So sorry to hear about your dog, rotten. That's got to be so tough to see your dog not coping at all. My pup has, thankfully, been handling the extreme rest restrictions much better than I ever thought (so far), considering she is a very high energy farm dog- probably similar to Shadowmom's previous dog. Loves chasing the horses, hacking out, and going for bike rides. Gets several walks on top of that each day. I've been really, really focusing on keeping her mentally stimulated- teaching her new 'tricks' that aren't going to hurt her legs (i.e. identifying objects, moving head certain ways on command, etc.), giving her dog treat puzzles and also having a variety of durable chews for her. Cutting her food ration down by atleast 1/3 has been necessary with the lack of exercise. Vet has offered sedatives for me to give while she's on the prolonged bedrest, but I'd rather not have her drugged for 4months.....

I'm worried because she's now already been on 4+ weeks of bed rest, still has a few weeks before vet even has time for the surgery, and then another 12-16 weeks of rest/extreme limited activity from there..... I hope she will stay happy enough during this time....I don't want her to be miserable.

It's so hard deciding what's right. I've done lots of research and hear so many horror stories about recovery, but there are lots of (apparent) successes too.... I just wish I could find more on the 3 in 1 method to put my mind at ease.
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Old 02-14-2018, 08:21 PM
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That's awesome that you're keeping her so mentally stimulated and she's doing so well emotionally for so long without tranquilizers. I wasn't as good with the mental stimulation with my last dog, but I was also working fifty or sixty hours a week so he was alone a lot. He also was tearing around like a maniac on three legs. He didn't walk on a leash, he bounced and flew!
Complicating matters further were during his first injury and surgery I also injured my knee and needed and eventually had surgery on it so had a lot of difficulty managing and helping him. I think I had also started graduate school then too. During his second surgery years later I was working fifty or more hours a week and had a medical issue and another surgery and wasn't supposed to lift more than twenty pounds. All the while living in a third floor apartment with no elevator and narrow twisty stairs that were easy to fall on while not injured and half carrying a seventy five pound hyper squirming pulling strong dog! So he absolutely needed the sedatives! He would bound out the top door and jump off all the stairs and just fly down at the speed of light, even three legged. When not injured I usually let him go down loose to avoid getting pulled down.
I don't miss that apartment and when I got this current dog I immediately taught him to wait on the stairs and walk nicely down with me.
If your dog has been good this long without any sedation she might be fine for the duration. You always have the option if tranquilizers later.
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