ACL JOURNEY - Conservative Management

[Benson]

Hi All,

My 3 year old DDB cross injured his knee two weeks ago running for a ball. The vets have diagnosed it as cruciate ligament damage and advised surgery.

Having done plenty of research and received amazing advice from members of this forums in other posts I just want to record his journey, keeping it as up to date as possible.

I hope this will be helpful for any other owners that experience the same....

The initial plan was to try CM for two weeks and if nothing improved to really consider TTA surgery. Benson is restricted to the living room and conservatory, only taken out for the bathroom 5 times a day. He is taking inflammatory drugs given by the vets.

The most concerning part of the situation was the loud clicking which started a few days after injury, apparently this is common for dogs that have this kind of injury.

Below is a video showing his 2 week progress.

While he is doing great, if there is any other advice anyone would like to add to help Benson and other owners that might be in the same situation it would be much appreciated!

NB: I'm going to start him on the Phycox supplement ASAP.and really considering getting him a brace to start using a few months down the line.

Bensons recovery - YouTube

Thanks for reading and welcome any feedback!

 

[marke]

I think a crate would be better , I think if he were going to improve , you'd see it faster . he really couldn't walk around on it .

 

[angelbears]

I can see some improvement. The biggest mistake people make is loosening up on restricting their activity. At least another month of nothing but eating and going out to relieve himself and keep that to a minimal. It seems to be two steps forward and one step back. Don't get discouraged.

This thread is great I hope you have to time to keep it updated. Good luck.

 

[Benson]

Hi Market and AngelBear,

Thanks for your input.

@marke - I've heard two opinions... Some say crate if possible but others say no crate but very restricted is best, while we want to limit movement as much as possible the leg shouldn't be constantly idle. I can almost see him standing up in his crate more out of frustration to whine and bark For freedom or changing positions all the time. Not to mention his mood, don't want him getting depressed in a crate he already has a boring life with no usual play and no walks. Currently all he does is sleep on the carpet most of the time.

Any other thoughts on this from anyone else?

@angelbear - thanks we will definitely keep at it with limited activity, the hardest part is keeping my family onboard and being as strict with them about the situation. One thing I need to figure out is the best way to play with him with him needing to use his legs. I try to mess about with him when he's on his back but have to stop everytime he gets to excited and wants to sit up

 

[marke]

the reason I prefer a crate is , I had a dog with an injured hip , I tried to heal it up by keeping him in a kennel 8x10 inside and 8x20 outside , which i'd think is like 2 rooms . he reinjured himself twice in that area , I assume by jumping up and running outside at noises , because I had seen him do that ....... I finally put a crate in the kitchen/living room close to me and gave it 3-4 weeks before I put him back out , that did the trick ........... if you can get it healed without putting him in a crate i'd go that route too . I know what you mean about locking him up in a crate , I hated to do it too ....... if he reinjures himself when he starts feeling better try a crate ..........

 

[angelbears]

I'm not sure where you are located but I have heard great things about hydrotherapy. A member here, NYDDB, did it with her dog and was really happy with it. It may also help yours burn some energy.

 

[QY10]

My boy, Angus, ruptured his cruciate ligament and we went the conservative management route. Angus is a mixed breed dog and about 80-ish pounds.

I do not think 2 weeks of conservative management will show a drastic improvement. Angus injured his cruciate last October (ish) and we have been doing Hydrotherapy and Laser Therapy since December. We also incorporated Acupuncture later in his recovery.

The hydrotherapy (walking on an underwater treadmill) is great! It burns the excess energy and also helps to build the scar tissue that is going to stabilize the knee. You really want your dog to be walking on an underwater treadmill first before swimming. The underwater treadmill gives a better range of motion, is very low impact and a lot of dogs are not super strong swimmers and will drop their hind end when in a pool. Dropping the hind end can cause more damage. Once the knee is stronger and more stable, swimming can be introduced.

You'll probably also notice a big lump start to grow on the inside of your dog's leg. That would be the medial buttress. I called our canine rehab specialist all in a panic thinking that it was something bad, but its actually just new bone growing, which is the bodies response to help stabilize the knee.

From December - July we have been doing Hydrotherapy and laser therapy 2x a week. For the summer months, I have dropped it down to 1x a month because Angus is out doing activities with me more often.

From October - December Angus was on strict crate rest. He was only outside to go potty and was only on-leash.

December, he was allowed out for 10 minute walks on-leash and only on grass. Each week, we increased the walking time by 5 minutes, assuming his leg was not suffering. By the time we reached the 30 minute mark, we were given the OK to attempt gravel and concrete. After he responded well with that, we started going inclines/declines. When he responded well to that, we started jogging etc...

It is now July and Angus goes off-leash (about 10 minutes at a time) to romp around our property. He goes hiking, jogging and swims in lakes and rivers.

The underwater treadmill also does incline and increases in speed. More often than not, he's jogging up a hill in the water during his sessions.

In addition to the exercise and rehab, we do weight shifting exercises to get him to start putting more weight on the leg when he is just standing around. I have him put his front paws on a chair or step and put a treat above his head. The farther back his head goes, the more weight he has to put on his bad leg. I also get him to walk backwards and sideways.

For pain management, I only used Turmeric and Golden Paste. For joint support/supplements, I used Glycoflex stage 3, which I have found to work great.

 

[gilles]

limit his space ( crate or just barriers) in a way he is comfortable and can turn around easily and lay down and stretch ...let the flooring be rubbery not slippery. take him out just to pee and poop and once a day take him for a walk in a controlled way( dont let him run and get excited ) ..walk him slowly uphill for 5-10 minutes then increase the time. after 2 weeks if you see improvement start walking him up some shallow stairs if available...or also on deep sand .....but do not let him run around on his own and be wild. just build his muscles ..if his cruciate ligament is damaged but not completeely ruptured it will build up again no need for surgery. if its ruptured he can build up muscles to compensate and then if there is need of if you chose to do surgery he will be fit for surgery...a good fitness level and some muscles before surgery will help healing quicker after surgery (this applies to human so i guess it applies for dogs).

 

[seeknoxrun]

We're going through the same thing, Benson, and we also chose conservative management. I'm glad you started a thread and I would love to see updates on your boy's recovery!

 

[NYDDB]

*I cannot believe I wrote a whole, long essay and nothing was saved....argh!*

Anyway, I'll try again.

Sorry to hear of your boy's injury, but good that you are doing the research. I know when Mateo, my DDB, was diagnosed at age 3 with an ACL/CCL injury, I did so much research i thought my head would explode...)

Mateo was diagnosed last fall with the same injury. My vet wanted to move him into surgery right away, saying it "a surgical fix." But, I said no, that I wanted to look into alternative therapies first, then decide.

BTW, if you haven't already looked into this site, please do: Dog ACL Injury-- Is Surgery Really Needed?. It is a wealth of information, and is updated often.

We decided to go with conservative management--- short walks, more rest for awhile, then when I discovered a rehab place for dogs in the city, I signed him up for a 10 week program. This included underwater treadmill, cold-laser therapy, physical therapy, massages, and eventually free swimming in a heated pool with a therapist. It took awhile, but after 6 weeks or so, Mateo started to show improvement. He was putting more weight on his injured leg, and less toe-touching.

Eventually, after about 2-3 weeks post therapy, he had no limp at all and was almost 90-95% of where he was prior to the injury---running short spurts, going up and down stairs with ease, etc. I couldn't have been more pleased- even my original vet saw him while out walking and was surprised and impressed with how he was moving.

Alas, the happy story took a turn about 2 months ago. We were sitting on the grass in the park, I was talking to a friend, and for some stupid reason, did not have my hand on Mateo's leash. Well, he took off after a squirrel like a torpedo...he zigged when he should have zagged...and evenytually came up lame, again.

So, I put him on some rymadyl short term, as he seemed to be in pain the first 2 days, then went back to the old protocol of short walks, etc.

Now, Mateo is improving every day- more strength in his injured leg, and only has a limpy/gimpy movement when he moves faster than a walk. He is in no pain, (I am giving him turmeric golden paste, which helps a lot with inflammation, as well as a few other supplements), and is enjoying these summer days at a slower pace (which is how he is in the summer anyway, LOL.)

Eventually, I will get him back into some water therapy to help strengthen his surrounding muscles and build up his stifle strength, but for now he is doing really well.

Good luck, and I hope Benson continues to show improvement.

 

[DMikeM]

I would bet it was never the cruciate ligament but actually a tear in the meniscus which would account for the clicking and popping. If a chunk of that flipped over in between the rest of the joint it would cause the joint to separate every time he extended the knee. After time it would compact or wear down and your joint would create scar tissue to compensate for the imbalance.

I would not crate but still keep him calm and no jumping around. If he is a window attacker (barks at everything out the window) then a crate would be best. Also try to lead him to his pee spots on the good leg so he has to lift the injured one and not put all his weight on the bad one. I would start making him bone broth and put it on everyone of his meals up to 1/4 cup liquid a day.

Here is a photo that shows in detail what the meniscus is and how it relates to the ligaments.

 

[NYDDB]

Mike that is a great image of the stifle- best I've seen and very clear.

I forgot to mention, Mateo's knee never clicked or popped---that I noticed. So to the OP, I am not sure how common that symptom is--unless it is related to the meniscus.

 

[Benson]

Hi All,

Just a quick update from me, but firstly thanks for all the input from everybody.

I saw the vet about a week ago and he is actually glad we didn't go ahead with surgery as Benson is making good progress . He confirmed that the injury was only a partial tear which wasn't clarified by the junior vet initially (still.... Good news).

Benson is now receiving a reduced amount of inflammatory drugs, reduced further in a weeks time. The vet advised that we can walk him 4 x 10mins a day, which we are starting. I am booking him into hydro classes from next week and starting on the supplements for his joints.

I've put together another short video of his progress from 2 weeks to today (1 month).

[video=youtube_share;Iie2GS5besU]http://youtu.be/Iie2GS5besU[/video]

Any questions please ask and I'll try to response in good time.

 

[DMikeM]

That's great news I am so glad you did the conservative approach.

 

[angelbears]

YES! That is excellent news. You are doing a wonderful job. Can't wait for the next update.

 

[marke]

did the popping noise stop ?

 

[Benson]

did the popping noise stop ?

Yeah it's completely gone now - stopped at around 2 weeks. During the whole ordeal that was the most concerning, it was awful to hear.

 

[Benson]

Hi all,

Massive set back over the weekend. On Monday Benson's limp is much worse and lame again, I think he got over excited over the weekend when family were at the house.

It seems like we are back to square one.

Not sure what to do....

Do I start again or will this cause even more damage and longer term issues?

We have once again restricted his exercise - no more 10min walks.

 

[angelbears]

Poor Benson. I'm so sorry. If it were me I would take a wait and see. I would go back to no activity and give it a couple of weeks. If you start to see improvement then I would continue. After a couple weeks there is not improvement I would reassess the situation.

 

[NYDDB]

When my dog was going through conservative management, he had a few setbacks. And, of course, it made my heart sink. But, he rallied back and continued to slowly get better...to the point of being about 95%, with no limp.

And then, as stated before, he had a major setback from which he is still healing. I, too, have my moments of doubt, but as he continues to get stronger and more willing to put full weight on his injured knee, I am convinced that CM works.

I have read many, many stories of people choosing to get surgery, and then regretted it. But there are also some success stories with surgery as well. But know that CM takes a long time-- some people say up to a year even.

It's a personal decision...and a tough one.