An Alternative to Surgery for Knee Injuries in Dogs

Acute hind limb lameness is a common occurrence in dogs. A unilateral lameness is often the result of a knee injury. The most common knee injury is a tearing, commonly called rupture, of the ACL (anterior cruciate ligament)

, also known as the CCL (cranial cruciate ligament).

The gold standard for treating a CCLR (cranial cruciate ligament rupture) is surgery. Most veterinary surgeons strongly recommend surgery to avoid chronic lameness and pain because, without it, the dog usually suffers with an arthritic knee for the rest of the dog's life.

But there may be another solution for surgery-averse dogs.

Refusing Surgery

In the past, if clients refused surgery, most veterinarians gave a poor prognosis for dogs with CCLRs. Some vets even recommended euthanasia in these cases. In my opinion, alternatives to euthanasia should always be considered in cases of CCLRs.
But people have valid concerns when contemplating surgery, such as:

Cost

This can run well over $1,000.

Rehabilitation

After surgery, the dog needs careful, limited exercise and physical therapy for several months to get the knee back in shape during the healing process.

This means that dogs who live with other energetic dogs must be confined. Some houses have difficult ground plans (for example, many stairs). Certain weather conditions (ice and snow) also make safe post-op walking difficult.

Age and Health Status

Older dogs can rupture their CCL by simply stepping incorrectly, slipping on ice or uneven ground, or awkwardly jumping off the couch. These geriatric dogs may be anesthetic risks or already have a tough time getting up and around due to arthritis or obesity. Older dogs may suffer from concurrent diseases such as Cushing’s, diabetes or heart disease.

Alternatives

Invariably, a client faced with the news of CCLR surgery asks, “Doc, isn’t there a splint or something you can put on the knee to tighten it up?” Our answer is usually “No.”

Although surgery still has the best outcome in reasonable surgical candidates, an external orthosis, such as a brace, may also work. An orthosis is a medical device used to support the injured leg. With recent advances in rehabilitation, some dogs may benefit from a customized brace and avoid surgery altogether.

A recent study was the first of its kind in comparing people's satisfaction with their dogs who'd had surgery for a CCLR versus dogs who were custom-fitted with an orthosis. Results indicated high satisfaction rates for both groups.

Dogs who underwent surgery had a better success rate than dogs wearing an orthosis: Lameness either resolved completely, or the majority of the people in the surgery group reported the results were excellent to good.

The majority of people in the orthotic group said they were happy with their choice.

They also reported some complications to consider:

1. Half the dogs wearing a brace had some skin lesions associated with the brace, and these wounds needed management.
2. About 10% of the dogs in this group wore the brace for a while but underwent surgery anyway.
3. About 7% of people reported their dog never tolerated the brace.
4. A custom-fitted orthosis is expensive and time-consuming for clients in terms of putting it on and off, going to the vet for brace adjustments and managing complications such as skin lesions. Your dog may have to wear the brace for life.

Other Considerations

Small dogs have a better chance of recovering from a CCLR compared to large dogs, but the study mentioned above surveyed large dogs fitted for an orthosis, meaning these devices actually may be considered for dogs over 70 pounds.

Veterinary medicine has made huge advances in pain management

, quality physical therapy and rehabilitation. Dogs wearing an orthosis can have their pain managed while undergoing physical therapy and rehabilitation.

Obesity is a big drawback when it comes to recovering from a CCLR, for both surgical and nonsurgical candidates. If your dog is overweight

, an orthosis may help keep your dog mobile and active and help with weight reduction.

Opting for surgery? Try this helpful post-op exercise:

Find a Specialist

Your vet can refer you to certain veterinarians who specialize in sports medicine and rehabilitation. These specialists strongly advise against buying ready-made canine orthotic devices over the internet. The device should be custom-fitted and built individually for each patient.

Although many vets still think these orthoses are a waste of time, I remain open-minded. There is concrete evidence that certain dogs return to good function without surgery.

Reference

Juliette L. Hart, DVM, et al.

Comparison of owner satisfaction between stifle joint orthoses and tibial plateau leveling osteotomy for the management of cranial cruciate ligament disease in dogs. JAVMA, 2016;249:391–397.

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 Oct. 11, 2018.