Dog ACL Injuries: Causes, Treatments, and the Road to Recovery

This pet health content was written by a veterinarian, Dr. Debora Lichtenberg, VMD. It was reviewed for accuracy by Dr. Pippa Elliott, BVMS, MRCVS, and was last updated on September 6, 2024

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Understanding Dog ACL Injuries

It was a cold winter evening. My dogs went out for their last little romp before nestling snug in their beds.

Wally, my 11-year-old Cocker Spaniel, calmly walked up two small steps to the deck, turned to check on me, and slipped on the icy step. A tiny yelp broke the stillness of the night, and just like that, his cruciate ligament was torn.

Injury to the anterior cruciate ligament (ACL), also known as the cranial cruciate ligament (CCL), is the most common orthopedic problem in dogs. It’s more frequent than:

• Broken bones
• Hip dysplasia

The Complex Nature of Dog ACL Injuries

Diagnosing and treating knee injuries in dogs can be tricky. Here’s why:

• Controversy around treatment: There’s no clear answer on when surgery is needed or which procedure is best.
• Cost of surgery: Expect to pay anywhere between $1,500 and $4,000 depending on the surgical method.

This uncertainty can frustrate both dog owners and veterinarians alike.

The Long Road to Recovery

Many dog owners assume that surgery will fix the problem quickly, but ACL recovery is a slow process. Here’s what to expect:

• Activity restrictions: Your dog’s movement must be severely limited for several months. Short walks are fine, but running and stairs are off-limits.
• Physical therapy: Be prepared to either perform physical therapy at home or take your dog to a rehab facility.
• Future risk: Dogs who injure one ACL have a 30-40% chance of tearing the other one down the road.

Alternatives to Surgery for Dog ACL Injuries

In some cases, alternatives to dog ACL surgery may be suitable, especially for smaller dogs or those with partial ACL tears. Non-surgical options include:

• Weight management: Reducing a dog’s weight can relieve stress on the knee joint and potentially help with recovery.
• Physical therapy: Regular physical therapy, often combined with anti-inflammatory medications, can strengthen the muscles surrounding the knee and aid in recovery.
• Knee braces: For dogs that aren’t candidates for surgery, a knee brace can provide additional support and stability, though it doesn’t cure the underlying problem.

While these alternatives can sometimes provide relief, they may not be sufficient for dogs with severe ACL tears or for larger, active breeds that put more stress on their joints.

How Dog ACL Injuries Happen

It doesn’t take much for a dog to sprain, partially tear, or completely tear their cruciate ligament. Common causes include:

• Jumping off furniture and landing awkwardly
• Walking up stairs and tripping
• Playing fetch and coming down wrong on the rear leg
• Stumbling during a casual walk

Many owners think their dog has a minor sprain, only to find out it’s a more serious ACL injury.

What Happens During an ACL Tear

Think of an ACL like a cable or thick twine made up of multiple fibers. The extent of the damage can vary:

• Mild damage: Some fibers are stretched or strained, and in these cases, a dog may recover with rest.
• Severe damage: For many dogs, especially those with a fully or partially torn ligament, surgery is often required to restore mobility and prevent long-term limping.

Risk Factors

• Obesity. Fat dogs are more prone to knee injury. Listen to your vet and get your dog back to a normal weight.
• Exercise. Dogs should have regular, daily exercise. If you want your dog to be more of an athlete, condition him as you would yourself. You wouldn’t run a marathon with no training. Neither should your dog.
• The weekend warrior. Don’t let Elmo sleep on the couch all week and then let him run up Mt. Rainier on Sunday. Overdoing exercise with a dog that is not walking/running daily sets him up for injury, particularly knee injury.
• Genetics and conformation. Even under ordinary circumstances, the dog’s knee is under more stress than the human counterpart, and is prone to injury more easily. Many ACL injuries in humans are athletic in nature, but the dog’s knee behaves like it’s on a basketball court in everyday life. In a human, it often takes a bad accident, like what Olympic skier Lindsey Vonn just endured. Now she has lots in common with Tiger Woods! Your pup doesn’t have to take to the slopes or the basketball court to sustain serious injury to his ACL.

Understanding the Stifle Joint in Dog ACL Injuries

The knee is a complex joint, known as the stifle joint in dogs. It consists of:

• Two cruciate ligaments (including the anterior cruciate ligament, or ACL)
• Two collateral ligaments
• The lateral and medial menisci
• Four bones and the patella (knee cap)

The cruciate ligaments form a crisscross structure, connecting the femur (top leg bone) to the tibia (lower leg bone). When the ACL tears, the leg becomes unstable, leading to inflammation and degenerative joint changes.

Dogs, like humans, have only two knees—front legs are built like our arms. However, some owners mistake elbow injuries for knee issues, so it’s important to accurately identify the injury.

Diagnosing Dog ACL Injuries

The best way to diagnose a dog’s knee injury is through a physical exam by a vet. While a vet can’t always diagnose the exact damage, they can determine if the ACL is completely torn. Signs include:

• Drawer sign: Back-and-forth movement in the knee, indicating instability
• Imaging: Advanced imaging like MRIs or CTs is rarely used but may provide detailed info

Regular radiographs are often done to rule out other changes in the knee or hip, though ligament damage itself doesn’t show up clearly on X-rays.

Treatment Options for Dog ACL Injuries

If your dog has an ACL injury, the first recommendation will likely be:

• Activity restriction: Rest is crucial to prevent further damage
• NSAIDs: Non-steroidal anti-inflammatory drugs are typically prescribed to reduce pain and swelling

If the ACL is only sprained or partially torn, rest may help the dog recover. However, if the injury doesn’t improve within a week, surgery may be needed, especially for larger dogs (over 30 pounds) or those with a completely torn ACL.

For smaller dogs or dogs with less severe injuries, non-surgical options may be more effective.

Surgical Repair Options for Dog ACL Injuries

There are three common surgeries for repairing dog ACL injuries, and each one varies in technique and cost:

• Lateral suture technique: A synthetic suture is placed in the knee to stabilize the joint. This is often recommended for dogs under 50 pounds.
• TPLO (Tibial Plateau Leveling Osteotomy): The tibia is cut and repositioned to change the knee’s alignment. This procedure is typically more expensive and recommended for larger dogs.
• TTA (Tibial Tuberosity Advancement): Similar to TPLO, this surgery adjusts the knee’s geometry by altering the tibia.

Even though these procedures are common, there’s still no consensus on which one is best for each case. It’s always worth seeking a second opinion to determine the best approach for your dog.

How Much Does Dog ACL Surgery Cost?

Dog ACL surgery costs can vary widely, depending on the type of procedure, the size of your dog, and your location. On average, you can expect to pay:

• Lateral suture technique: $1,500 to $3,000
• TPLO surgery: $3,000 to $4,500
• TTA surgery: $3,000 to $4,500

These are estimates and do not always include post-surgery expenses like medications or physical therapy, which can add another $500 to $1,500 to the overall cost. Additionally, recovery time can increase expenses if follow-up visits are necessary. It’s always wise to ask your vet for a detailed breakdown of the costs.

Does Pet Insurance Cover Dog ACL Surgery?

Pet insurance may cover part or all of the cost of dog ACL surgery, depending on your plan and whether the injury is classified as pre-existing. Typically, pet insurance policies that cover accidents and injuries will include cruciate ligament repairs like ACL surgery.

However, if the ACL injury occurred before you purchased the policy, it might be excluded from coverage as a pre-existing condition. It’s important to review your policy carefully or consult with your provider to understand what is covered and if additional options are available for covering dog ACL surgery costs.

Surgical Options for Dog ACL Injuries

There are three commonly used procedures to fix a torn ACL in dogs. Each surgery varies in technique, complexity, and cost.

1. Lateral Suture Technique
   • A synthetic suture is placed in the knee to restore stability in place of the ACL.
   • It’s a common procedure, especially for dogs under 50 pounds.
   • When performed by a skilled surgeon, it’s highly effective and less invasive.
2. TPLO (Tibial Plateau Leveling Osteotomy)
   • This procedure changes the conformation of the knee by cutting and repositioning the tibia.
   • It can result in fewer arthritic changes long-term, making it ideal for larger dogs.
   • It’s more complex and expensive, requiring specialized training from the surgeon.
3. TTA (Tibial Tuberosity Advancement)
   • Similar to TPLO, this surgery changes the geometry of the knee but through a different method.
   • The tibia is cut and allowed to heal at a different angle, reducing mechanical stress on the knee.
   • It is also more expensive and requires a specialized veterinary surgeon.

While all three procedures are common, there’s no clear consensus on which one is best. Always seek at least two opinions when considering surgery for your dog, and ask your veterinarian to discuss all available options in depth.

Recovery from Dog ACL Injuries

Recovery from a dog ACL injury is a slow process, often requiring physical therapy. This can be done at home or with the help of a professional canine rehabilitator. If you have the resources, professional rehab can greatly improve your dog’s recovery.

The Role of Physical Therapy

There’s a misconception online that dogs with ACL injuries don’t need surgery and can recover solely with physical therapy. While this might work for:

• Dogs with incomplete ACL tears
• Smaller dogs
• Dogs with a more sedentary lifestyle

For most dogs, surgery is essential. Without it, many dogs will continue to limp or even worsen over time, leading to painful arthritic changes in the knee, hip, and other leg.

Our Personal Experience

At seven weeks post-op, Wally is doing well after his ACL surgery. It hasn’t been easy—walking him on icy winter nights and carrying him upstairs—but it’s been worth it. He’s slowly returning to his old routines, thanks to daily physical therapy. By spring, Wally should be back to normal.

Frequently Asked Questions (FAQ)

References

• “Dog ACL Surgery Cost.” GoodRx. https://www.goodrx.com/pet-health/dog/dog-acl-surgery-cost
• “Dog ACL Surgery Cost: Everything You Need to Know.” CareCredit. https://www.carecredit.com/well-u/pet-care/dog-acl-surgery-cost/
• “Cruciate Ligament Surgery for Dogs: What You Need to Know.” MarketWatch. https://www.marketwatch.com/guides/pet-insurance/cruciate-ligament-surgery-dog-cost/
• These citations follow the struct