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kandy September 16th, 2008 02:31 PM

ACL Ruptures in Dogs
In May of 2005, my husband and I got our second Newfoundland, a female pewter newfie that we named Hazel. During that first summer, we saw that she was severely pigeon toed, both front and back. In the summer of 2006, she started limping.

Because she had not suffered an actual injury, at first we thought she had bruised her paw on the rocks at the lake we frequent. The limp would seem to get better, and then worse again, and then better again. Of course we took her to the vet several times for the limp. Our vet diagnosed the limp as panosteitis. After researching that condition, I was unconvinced that the diagnosis was correct, as Hazelís limp did not change legs. We requested x-rays. Again our vet said that there were no problems indicated in the x-rays and that she was convinced it was pano. During the spring of 2007, Hazelís limp got worse, even with her prescribed pain killer, deramaxx. At different times during the late spring and summer, Hazel refused to use the leg and held it in the air more and more often. Finally in August of 2007, I felt like the pano should have resolved itself if the diagnosis had been correct, and since it hadnít, it was time to insist on answers.

I made an appointment for Hazel at Colorado State Universityís Veterinary Teaching Hospital. We took the x-rays from our local vet with us. After a brief examination, we got the bad news. Hazel had ruptured her Anterior Cruciate Ligament. They arrived at their initial diagnosis because of the results of the Ďdrawer signí, which is where the vet can move the tibia forward while holding the femur stationary. If the ACL is intact, the tibia will not move forward (like pulling out a drawer). A vet may also do a ĎTibial Compression Testí where they hold the femur immobile and flex the ankle. If the tibia has any forward movement, the ACL is likely ruptured. Their initial diagnosis was confirmed through x-rays and an arthroscopic exam.

A dogís knee is bent all the time. Because of the constant stress on the ligaments, dogs naturally have a high risk of rupturing a cruciate ligament but contributing factors such as weight, age, genetic predisposition and breed size play an important role. The knee of a dog has two cruciate ligaments that criss-cross to keep the femur & tibia stable and keep them from rubbing against each other. The Anterior Cruciate ligament (also called the cranial cruciate ligament) and the Posterior Cruciate ligament (also called the caudal cruciate ligament). These ligaments allow the knee to move like a hinge, but if one ligament or the other is stretched, torn or completely ruptured, the bones in the knee will slide against each other. If the condition isnít treated, damage is done to the meniscus (the cushioning layer between the bones) and degenerative arthritis will quickly set in.

Because Hazel is severely pigeon-toed, her ACL was under tremendous stress from the time she was born and began using her legs. The ACL likely tore gradually, until it finally ruptured. The orthopedic vet at CSU explained that while technically I had two options, only one option was viable in Hazelís case. The first option was to build and attach a new ACL, also called an Extracapsular Repair. This method replaces the ACL with a wire or large suture. Because of the malformation in Hazelís legs and her size (120 lbs), the only true option for a successful outcome was to perform a Tibial Plateau Leveling Osteotomy, or TPLO. This procedure actually changes the angle of the tibia in relation to the femur, using the dogs own weight to create stability in the joint. Vets who perform TPLOís must obtain a special certification before being allowed to perform the procedure. There is a third surgical procedure, called an Intracapsular Repair, which involves harvesting live connective tissue from elsewhere in the dog and using it to replace the ACL. A person may also choose to not have surgery but rather to employ medical management of the condition. As it was explained to me, and confirmed through many hours of research, a torn ACL will not heal and while the limping may decrease, leading a person to believe the injury has healed or is healing, the swelling in the surrounding muscles have actually created the illusion of stability. As the swelling decreases, so will the stability in the knee. For this reason, surgical repair of a ruptured ACL is recommended in almost every case. For smaller dogs, the Extracapsular Repair seems to produce favorable results. For dogs of Hazelís size, the TPLO is the preferred surgical procedure for the best results in the long run. Historically, larger dogs that have had an Extracapsular Repair are more likely to require repeated repairs on the same knee. The Intracapsular Repair has the most risk of requiring repeated repairs and as such is being quickly overshadowed by the other two methods. All three procedures are surgically invasive, although the TPLO is the only one that involves cutting and realigning the bones.

In Hazelís case, her tibia had to be cut and rotated to a normal position, and then adjusted to the correct angle before a metal plate was inserted to hold the bones together. We were advised to keep her totally confined and inactive for at least 4 months and possibly longer, depending on the level of bone healing indicated during her 4 month post operative check-up. We would have to strictly enforce the activity restrictions and would have to accompany her on bathroom breaks in the backyard, supporting her weight with a sling around her belly. She could not be allowed around any furniture unsupervised as the risk that she would jump up onto the furniture, or even back down to the floor, and break the leg at the point of realignment was too much to take. She would also not be allowed to be around any other dogs. We were lucky to be able to send our other dog for an extended stay with his cousins.

After Hazelís release from the hospital, I took the first few days off work as we tried to determine how and where we would confine her. When we were home, we would keep her confined to the computer room by blocking the doorway, but the problem was how to confine her once I went back to work. Hazel had never been crate trained and was used to going to work with my husband every day. We decided that the bathroom met the criteria. It was small, but not tiny; it was carpeted; there was no furniture in it; and it was easily cleaned if she had any accidents. Hazel showed us the errors in our thinking as soon as we arrived home that evening. The bathroom door is old and isnít solid, it has slats. We thought that it would provide air circulation but she showed us that it also provided a manageable escape route. She stuck her head through the slats towards the bottom of the door, and broke enough of them out to squeeze the rest of her body through it. Based on the blood on some of the slats, she also chewed through the ones that were not broken to her satisfaction. After the initial panic and a frantic exam to see how badly she had hurt herself, it was obvious that our confinement plan needed to be revised (although now we have a handy hole in the bathroom door so that all the dogs can actually watch you rather than just whining at the door). We decided that the next best idea would be to move all the furniture out of the living room, and use one section of our couch to block the entryway to the living room, with the back facing into the living room. It was a bigger room than we would have liked, but now she would have the television to watch. A major bonus for me was that I could actually use the couch to sleep on each night by just turning it around. I had been sleeping on the floor of the computer room at night to keep her company and my back was starting to complain loudly. The living room worked very well until right before it was time for her 4 month post operative check up.

I came home from work as normal, carefully opening the door so that I did not hit her with it. I opened the door and everything looked normal, the couch was in place, the TV was on Ė but Hazel was not in the living room! My heart jumped up into my throat, and then her head popped up from the other side of the couch. She had apparently decided her confinement should be over and had jumped the couch. We took her to an orthopedic vet who is certified to perform the TPLO but is much closer to us than CSU. He performed x-rays and said that the bone had completely healed, the angle looked to be correct and she could be released from her restrictions.

Itís been 13 months since her surgery. I no longer have people comment on Ďthe old girlí being gimpy Ė she now runs and plays like a 3 year old dog should be able to. So far, she has not shown any indication of her other knee having any problems, and during her 6 month post operative evaluation, the vets at CSU examined that leg and proclaimed it to be intact, for now. The odds are not in her favor though. Typically dogs that rupture one ACL will rupture the other, usually within a year. We are past that threshold, but with Hazelís bone deformity, size, and genetics it is almost inevitable that she will rupture the other ACL. Hazel takes a glucosamine/chondriton supplement every day, and will take it for the rest of her life. We watch her weight carefully to make sure she stays at an optimum weight and her exercise program is moderate but consistent with lots of swimming.

If your dog begins limping on a rear leg, I would advise you to take the dog to a vet who is experienced in orthopedics for diagnosis. I was understandably upset that our vet had incorrectly diagnosed Hazel but the vets at CSU told me that unless a person has extensive experience with orthopedics, a ruptured ACL is easy to miss. In Hazelís case, because she was so young and there had not been an actual injury, our vet had no reason to suspect a ruptured ACL. I believe that if our vet would have had more experience in orthopedics, she may not have misdiagnosed Hazel as she may have suspected that the bone deformity had caused undue stress on her cruciate ligaments.

Melinda September 16th, 2008 02:54 PM

what wonderful information Kandy, well written!!! Thank you for posting your story, I wish Hazel continuing health.

Melanie1010 September 16th, 2008 03:03 PM

What a great source of information. I have been researching ACL injuries as Nitro has begun Flyball and I am trying to reduce the chance of any sports related injuries (as best I can obviously) and this is a great story on what to look for and how to treat the problem.

kandy September 16th, 2008 03:12 PM

Melanie - one of the risks is when dogs 'launch' themselves with their back legs. Flyball would create just that kind of risk as the dog tenses in anticipation of the release - and wants to launch themselves off the starting line quickly. That being said, I am sure that Nitro is in very good physical condition - and that reduces the risk quite a bit. Keeping the dog at a good weight is very important - and as we all know, 'good weight' means overweight to alot of people.

While there are things you can do to prevent the injury, it is sadly the most common knee injury in dogs, and moreso for active dogs. Do you have him do some warm up exercise before running a flyball course?

kandy September 16th, 2008 03:13 PM

[QUOTE=Melinda;657806]what wonderful information Kandy, well written!!! Thank you for posting your story, I wish Hazel continuing health.[/QUOTE]

Thanks Melinda! I hope that others find the information useful. :pawprint:

BeagleMum September 16th, 2008 03:45 PM

[QUOTE=Melanie1010;657808]What a great source of information. I have been researching ACL injuries as Nitro has begun Flyball and I am trying to reduce the chance of any sports related injuries (as best I can obviously) and this is a great story on what to look for and how to treat the problem.[/QUOTE]

This might be something to remember if Nitro's phantom hop ever gets any worse than it is now. Like Kandy said, I am sure that with the proper warm-ups he will reduce the risk of injury.

Great article Kandy BTW!!

kandy September 16th, 2008 04:22 PM

Thanks BeagleMum! :)

dogcatharmony September 16th, 2008 04:36 PM

Very informative!! And so glad to hear that Hazel is doing better:thumbs up

rainbow September 16th, 2008 04:51 PM

Very well written, [B]kandy.[/B] :thumbs up

Our yellow lab (Chase) has been through TPLO surgery on both legs. The first surgery went well but the second got infected from bacteria on the plate and then he ended up having meniscus damage as well so surgery for that. Now he is having problems with his knee on the first leg that was done.

I'm glad Hazel is doing well and hopefully will not require any further surgery. :fingerscr :goodvibes:

kandy September 16th, 2008 05:08 PM

Thanks dogcatharmony!

Rainbow - I hope that Chase does not have to have another surgery on his first knee. I do know from my research that some dogs reject the plates or the screws and require it to be removed. I asked the vets at CSU about that and they said that while it is rare, it does happen and that there is no problem removing the plate after the bone has healed. Hazel also had some damage to her meniscus (understandable since the ACL probably ruptured at least a year before she was accurately diagnosed) but they cleaned it up during her TPLO. :goodvibes: for Chase!

Melanie1010 September 16th, 2008 05:09 PM

Thanks for the extra info Kandy. Our Flyball classes/teams members for the most part have all dealt with sports injuries (which is great for knowlegdge, but unfortunate for the dogs) so they are constantly correcting things to ensure we minimize risk. Though impossible to eliminate, I am glad I am learning the "right" way to do things. The team captain had a hound cross who ruptured both ACL's in flyball, so she is very particular about technique (she has corrected many things we do) but like she said, he could hurt himself the same way just playing around. Nitro has a perfect box turn (if the lightbulb would go off that getting the ball out of the box isnt the whole point of the game and that he does have to come all the way back!!! LOL)

Beaglemum, the vet did check Nitro for ACL ruptures when I first adopted him and got the xrays from the former owner. I wish I knew why he took the funny step here and there, but i have noticed when we hike, he never does it!! (or when around other dogs, its very rare..) I got her to check his joints yesterday since it was a different vet from ours, and she found no abnormalities either, but I will keep an eye on it, better safe than sorry! I was so pround, Nitro actually dropped a weight class in his heartworm meds!! All our hard work is paying off! Yay!

Glad to hear Hazel is recovering well and continues to improve with time and hopefully she doesnt require more surgery!

kandy September 16th, 2008 05:19 PM

Oh they can definitely rupture the ACL just playing around. Jumping up, turning too quick, all the things that dogs do on an every day basis. LOL I know if Hazel gets the zoomies, I am cringing the whole time because I am always conscious of her knees. She definitely learned what "EASY! Careful of the big owie!!" meant....she heard it over and over and over again.

It's good that your team captain has experience with ACL ruptures, she'll know what to watch for that could be an unnecessary risk.

Guinness' mom September 19th, 2008 11:54 AM

wow well written Kandy....and most informative...
I am always afraid of the way Guinness jumps off the deck to chase after a ball or bird or anything for that matter. He literally flys off and the way he lands scares me that he will hurt himself I will make sure that when we throw the ball I get him down off the deck be4 throwing it.

Thulesmom October 23rd, 2008 12:59 PM

Thanks a bunch for your posting
Thanks so much for posting this. My Newfy girl has just been diagnosed with RCL and will be having the TPLO surgery. Your experiences answer many of the questions I've had.... how to confine a 112 lb dog! She's pretty miserable right now; she does not take to the pain meds very well. I've made a ramp for the car, so at least we can take car rides. No walkies for months and months, because of where we are, she can't get surgery until February, when the surgeons visit.

I just hope my girl's surgery turns out as well as your's. Thule will be three in March 09.

kandy October 23rd, 2008 04:04 PM

Thulesomom - has Thule been crate trained?? I know that it would've made the confinement period so much easier if Hazel had been crate trained. And because they feel soooo much better after the surgery, they think they are good to go and should be allowed to run and jump around like a fool. LOL

You can still walk Thule but you need to support the weight with a sling. Many pet stores carry different kinds of slings, but the easiest & cheapest thing to do is to use a towel. Here's a link to a store bought sling:
The one shown is being used under the dogs rib cage, but it can be scooted further back to support the weight of the dogs hips & legs. The pix should tell you how you would use the towel as a substitute. As she favors her hurt leg, the other leg is taking the extra weight, which increases the risk of that knee blowing too. What kind of pain medication is she on? I would also suggest that you put her on a g/c supplement right away.

Newfs are even more prone than other large breed dogs to rupture their ACL, and if the particular newf has significant line and in-breeding in their bloodline, that almost doubles their individual chances of having the injury.

You'll want to carefully monitor Thule's weight since she will be forced to have less physical exercise. You can replace up to 30% of her normal ration of food with pure pumpkin (canned, but not the pie filling). This will help to make her feel full while still cutting her calories.

Feel free to ask me any questions you might have - I'll be happy to share the knowledge that I have. And I hope that Thule's surgery goes well, and that recovery goes well too! :)

Thulesmom October 24th, 2008 07:00 AM

These are great suggestions... thanks so much!

I tried to crate train her as a pup but she'd have no part of it. She was much happier when I baby-gated off the front porch. I'll probably do that again. I had a x-pen for her... she escaped.

I like the idea of the sling.. I've tried with the towel, she stands completely still and will not move. Should I be using the sling now, or is it more important after the surgery? I will order the one on Pet zone... if they deliver to Canada. I'm willing to bet if I can buy one around here, it will only be for a small dog. You'd think Newfoundland Dogs would be better represented in Newfoundland!!

My vet did mention that they are likely to blow the 2nd ligament within a year of the other one.... really hoping to avoid that!

Since we do have so much time before the surgery, I am trying to get a bit more weight off her before then, she's lost 12 lbs since March and I'd really like to get another 10 off before the surgery. She loves pumpkin; I've given it to her when she's had digestion troubles.

Thanks Kandy... good to know your out there!

kandy October 24th, 2008 11:24 AM

You are very welcome Thulesmom. I didn't have any time to research the procedure, or the recovery issues, before Hazel had to have her surgery. When I took her to CSU and they gave their diagnosis, they did the surgery the next day because I did not want her in pain for any longer than absolutely necessary. All of my research was done after the

I would start using the sling now, it will get her used to it so that she doesn't struggle with that after the surgery - and it might keep the pressure off the other leg enough to not increase its chances of blowing. One of the big things is to make sure that they don't slip - whether that's on ice or snow or whatever. And of course going up or down stairs is completely out of the question - but if you can support her weight with the sling and are confident that you or she won't slip, you can do stairs if absolutely necessary. But if you are already getting her used to a ramp, you can also use the ramp to get her up and down stairs. I bought a very nice ramp while Hazel was in the hospital, and she flat refused to use it. I had to lift her in and out of my vehicle during the trip home.

If you are going to just baby gate a doorway, you need to be very sure that she isn't going to try and jump the gate (been there, done that) - and make sure that the room where she will be confined has absolutely no way for her to get on any furniture. She might be pretty complacent about just laying around right now - but after the surgery she'll likely feel so much better that she will think she can do whatever she likes.

After she gets the okay from the vet during her recovery (at about the 8th week post op) you'll be able to start exercising her. If you can, the best rehabilitative exercise is swimming. It doesn't put any pressure on the joints at all, but allows the muscle to build back up. I live in a fairly rural area, and the closest place that would allow Hazel in a pool was 3 hours away - so that wasn't an option for me. We started out with short walks a few times a day, increasing the duration of the walks each week and making sure that we took her where she would have to walk up hill quite a bit. It's better for them to have 3 ten minute walks during the day than one 30 minute walk. I think the gradual build up to normal activity levels (and consistent but moderate exercise since then), the g/c supplement, and keeping Hazel at a good weight have all contributed to her not having any issues with her other knee (knocking on wood here). I am sure that sometime during her life Hazel will have to have a TPLO on the other knee - she is so pigeon toed that her ACL is probably under tremendous stress and will eventually snap, just like the first one did.

If you have any tile or hardwood floors in your home, you'll want to get rugs with the grippy stuff on the underside to keep her from slipping on those floors. You know that newfie hair gets awfully long between the toes, which makes it soooo easy for them to slip and slide on tile/hardwood floors. Also, a good orthopedic dog bed will help keep her comfortable - I know Hazel likes to lay on bare tile/hardwood because it's cool, but that is really hard on their joints.

Thulesmom October 24th, 2008 12:51 PM

I've ordered the sling and will get her used to it before surgery (I wish it was sooner, but we have to wait). Luckily, we do not have any stairs where we are right now, but my floors are slippery so have have rugs and mats for her, and I have been keeping the hairy feet under control!

I've always used baby gates for Thule, and she's never attempted to jump over but I also have it about 6 inches off the floor so the cats can go under; and she's never been one for getting up on furniture either; watch her make a liar out of me...

I'm getting her used to the ramp now, I'll take her in the car every few days so she'll have no fear of it after the surgery.

Like you, swimming won't be an option for me, especially in the middle of February, and there will be a lot of ice and snow around, so we'll have to be extra careful.

Thule's like Hazel and prefers the cold bare floors, even though she has a great bed; she does use the bed more in the winter than in the summer time.

As it happens, we're moving to our new house mid-January, where there will be two flights of stairs. Guess who won't get to sleep in her bedroom for months???? Thule will not stand for being left alone down stairs, so I'll have to put a bed on the main level for me. If I don't, she won't rest. I have carpet on the stairs, which will make it easier later on, but it's probably best to avoid the stairs altogether, even with the sling until she gets the clearance from the vet, don't you think? That will put us into June; better weather outside anyway.

Oh my, long road ahead.... easy to get overwhelmed!

kandy October 27th, 2008 11:26 AM

Yes, I think that it would be better to just avoid stairs whenever possible during Thule's recovery.

I can totally sympathize with not sleeping in your own bed for months. I could not allow Hazel into the bedroom at all because she would've jumped up onto the bed. So for the first part, I slept on the floor of the computer room where we were keeping her confined, and after we moved her into the living room then I at least got to sleep on the couch. But, like Thule, Hazel never would've slept if we'd have tried to make her stay by herself in another room. In fact she'd have likely jumped the couch and come into the bedroom anyway.

I'm sure you realize that newfs are especially sensitive, and the worst punishment imagineable for them is to be seperated from their people.

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