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ACL/CCL injury


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#1 Lori Perry

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Posted 09 September 2015 - 07:07 PM

I would appreciate hearing from those who have had to deal with ACL/CCL injuries.  I have a 48# male BC that has been diagnosed with a "strain or slight tear" of his ACL.


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#2 Gloria Atwater

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Posted 09 September 2015 - 07:30 PM

You might start with Sue R's journal/discussion here documenting her dog's experience with an ACL tear:
http://www.bordercol...topic=33480&hl=

Others undoubtedly will have more to say. :)

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#3 emilyfalk

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Posted 10 September 2015 - 07:05 AM

Hi, that thread was a great one, but I'd just like to add that stem cell therapy is becoming a promising alternative to surgery in both dogs and people with damaged cruciates. I would recommend considering that, laser therapy, and chiropractic regardless of whether you choose to do surgery.

(Disclaimer: yes, I just finished animal chiropractic school so may be a little biased...but, don't forget about the impact the injury has on the rest of the body! It also can strengthen the immune system so can help with the healing process.)

Good luck!
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#4 Sue R

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Posted 10 September 2015 - 04:28 PM

Lori - When Celt's issue first appeared, the first vet we saw thought it to be "soft tissue injury" and put him on a short course of crate rest and Rimadyl.  He seemed fine for a short while after that but the symptoms came back with resumption of full activity (and I might have rushed that).  So we went to a local vet who is interested in ortho issues and he diagnosed it as a "tear" and wanted to do TTA surgery.  I chose to take him to an ortho vet who diagnosed it as a "strain or slight tear" just like your diagnosis, and she put him on three weeks of crate rest and two weeks of Rimadyl, and the strict caution to bring him back into activity gradually. 

 

That worked and he remained sound for almost three years but the ligament did eventually tear entirely, and we chose TPLO surgery.  Two years later, the other leg went and we again had a TPLO. 

 

If I had the option of stem cell therapy at the "strain or slight tear" stage and it was affordable, I would probably choose that, hearing very positive things about it as Emily points out.  But, what I don't know is how effective it is over time.  The original rest-and-Rimadyl served Celt for most of three years before the ligament was finally totally torn.  I don't know how long stem cell has been used as a therapy and whether or not it has been proven to be effective in the long term or not but I'm sure Emily could answer that question. 

 

As Emily says, no matter what course you pursue, laser and therapy can be key to good healing and good recovery over time.  I wish I could afford weekly laser for my two older dogs as I can see obvious improvement each time I take them for a laser treatment (our therapist does not just treat the "injured" area but all the joints of the spine and limbs). 

 

Some dogs seem to be predisposed to CCL injuries due to structure (a sloping tibial plateau that could either be genetically-determined and/or exacerbated by early neuter causing a disproportionate growth of the long bones).  A traumatic incident could cause a tear in an otherwise well-built joint.  The ortho vets I have spoken to felt that structure was certainly a predisposing factor and even much more so than trauma, believing that trauma would primarily be significant only if the structure was already making the dog susceptible to such an injury.  Celt was neutered at six months of age, and I wonder if I had not done that or had waited until the growth plates were closed, if he would never have experienced these injuries. 

 

This is all what I understand from discussing with my dog's vets and therapist, and from what I've read, not being a vet or having any such training myself. 

 

PS - I have been very pleased with the results of his TPLO surgeries.  He will be 13 in November and is still working cattle.  He's a little slower than he used to be, which is reasonable considering his age, but you'd never know he'd had surgeries as he is fully active and useable.  We were careful to do rehab therapy after each surgery, which I believe to be very helpful in the recovery as it helps strengthen the entire dog, including the limbs and back that need to compensate for the injured or recovering limb. 

 

Very best wishes to you and your dog! 


Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

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#5 Pearse

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Posted 14 September 2015 - 05:51 PM

Lori,

 

Back in 2005, Riel had a fairly significant sprain of his ACL while training out at Chuck O'Reilly's. He did an outrun downhill and pulled up lame.

 

I took him to the U of MN vet clinic and had him looked at by a top orthopedic surgeons there who recommended surgery.

 

Christie suggested that we not do surgery and that I give him 100% crate rest (carried him in and out of the house, on leash when outside to relieve himself) and put him up for about six weeks and he was fine from that day forward.

 

So, I think it depends on the severity of the sprain and how well you can manage it.

 

There's no objective evidence that stem cell therapy or laser therapy does anything for this injury although lots of people swear by both and neither will do any harm (except to your wallet). I've asked several academic small animal vets (internal medicine and surgery) and one rehab. vet. who I think is really good. The university vets all said that they cannot recommend stem cell therapy or laser for soft tissue injury at this point. The rehab vet gave me some research papers on laser therapy that were interesting and suggestive of some effect, but not enough to totally convince me yet.

 

Pearse



#6 Liz P

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Posted 14 September 2015 - 07:29 PM

Many years ago I had a Border Collie with a partial tear of his CCL.  (Diagnosis was confirmed by sedation with palpation and radiographs.)  Thankfully, being only a partial tear, the option of rest, NSAIDs and physical therapy were offered.  That dog tore it while making a sharp turn during a dog sledding run, though he did have luxating patellas and poor structure.  So, likely a combo of structure plus trauma contributed to his injury.  It took over a year of physical therapy before he was back up to speed, but he did recover 100% and had a long career as working dog.  He never did injure his stifles again.

 

I also had a partial tear to my ACL.  Guess what?  I have luxating patellas, poor knee structure and the above dog yanked me sideways while chasing a squirrel as a pup.  I had just recovered from this injury, treated with rest, NSAIDs and PT, and was getting back in the game training dogs when the dog hurt himself.   :blink:   (Sometimes you have to wonder about the universe.)

 

I would not wait to treat a full tear aggressively.  Do make sure you have a clear diagnosis so you can be certain you are providing the needed treatment.

 

BTW, the reason I mention structure is that most CCL tears we see are from poor structure.  The wrong angles in the stifles create unusually high stress on the ligaments and predispose them to injuries.



#7 ShoresDog

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Posted 14 September 2015 - 08:08 PM

14 months ago my my male border collie (age 5 then) began to intermittently pack one of his rear legs.  He was diagnosed with a partial CCL tear by x-ray and the fact that his knee slid a bit when it was manipulated while he was sedated for the x-ray.  He went on NSAIDs and rest for almost three months, at which point he seemed sound.  He gradually went back to full activity, and he's now a very active dog who trials at the open level.  I watch his gait like a hawk, and he hasn't limped since then.  Perhaps he'll have the same experience that Sue R's dog Celt had, but maybe not.  While it can be very helpful, the surgery -- TTA or TPLO -- is very invasive and serious, and my preference was to avoid it if possible.


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#8 Lori Perry

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Posted 14 September 2015 - 09:29 PM

Thank you to all who have responded.  He is definitely out for the season either way so I think will try rest for a few months and see how that goes. 

 

After rest, what physical therapy exercises would you begin with?


 Lori Perry
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#9 Sue R

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Posted 15 September 2015 - 04:34 AM

In the topic that Gloria links, there are a number of the exercises I was given for Celt after surgery.  I think they would be appropriate for a dog that did not have surgery as their goal was to strengthen and increase flexibility in all four legs, improve balance, and help him get back to utilizing his body in a symmetrical manner to avoid stress on any one limb or his back. 

 

Another poster here (name eludes me) did quite a different series of exercises, some involving "props" like balance balls, etc., with which she was very pleased.  I'm not quite sure just whether or not her dog's injury was quite the same as Celt's but the goal of the exercises was similar. 

 

Wishing you the very best outcome and rapid healing! 

 

PS - Concerning surgery, our ortho vet, who had over 20 years of experience, did try the TTA procedure for a few years after it came out but felt that the results of the TPLO were better overall in the dogs that he performed surgery on. 


Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#10 alligande

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Posted 16 September 2015 - 02:34 AM

I would not attempt the exercises on your own without guidance from a rehab pro. My dog was diagnosed with mild hip dysplasia and my local vet/physio gave me a list of exercises to work on, being a typical border collie owner and border collie we over did it and made it worse. I now work with an American vet/physio online who gives me the program reviews his progress with videos etc, and I go to my local vet/physio for diagnostic work, as I have complete faith in his diagnostic abilities just that he is not current with what is possible with athletic working/sports dogs.

#11 emilyfalk

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Posted 22 September 2015 - 07:34 AM

If there were one surgery that were far superior, I'd be more inclined to strongly recommend surgery vs. conservative management. The Tightrope procedure may be on the way to becoming such, but the TPLO and TTA are so invasive that it makes me think twice about surgery.

Ask 5 different people recommendations for CCLR; get 5 different opinions. Dogs have been managed successfully with all.

And food for thought for those who say strict rest for something on the order of months: 80% of the support to joints is performed by muscles and tendons...not ligaments (their job is to limit range of motion, to provide an end point). So if you let them atrophy with rest, you really need to focus on rebuilding muscle as you bring them back.
Emily

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#12 Liz P

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Posted 22 September 2015 - 03:52 PM

Emily, my dog was rested for about 2 weeks, then we slowly began to do controlled PT to build up his muscles.  I believe my treatment plan was about the same, focused on building muscle that would support the joint.  I remember the swelling in my knee took many months to resolve.  This was back in 1999, so things have changed a bit.  In both of our cases it was successful and neither myself or my dog needed surgery.



#13 Alfreda

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Posted 22 September 2015 - 06:17 PM

I had an 8 yr BC who developed a recurring rear limp and was diagnosed with a partial tear. Did rest/ NSAIDS several times, but was told that partial tear would become a complete tear most likely. He kept re-injuring it and then having activity restricted and then re-injury. When he was 9 the tear was more severe and I researched the surgeries. TPLO- more invasive for sure, but the more research I did, the better the outcomes appeared to be, even for a 9 yr old. So I did that with great rehab and PT exercises afterwards, and he was back in business-- very active and apparently pain free  :-)

 

The rehab exercises were high frequency at home (5 min.s 4 times/day and building time up to 30 min.s ) I did that and all the ROM and strength exercises religiously and he was a fantastic patient!

 

About a 1.5 yrs later he tore the other one. But at that point, I was too worried to put him through such an invasive surgery and anesthesia at 11yo ... Vet said without surgery the soft tissue on that knee would scar over, and could stabilize, though it would have less ROM, and would be arthritic. So, I chose not go with a 2nd TPLO, but kept him from all jumping, or steep hills, and treated with Rimadyl and fish oil for inflamation. He enjoyed short level hikes and knee-friendly games, and used a ramp to get in and out of our truck. He was a great dog, I miss him. Good luck with your decision!



#14 Sue R

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Posted 22 September 2015 - 08:05 PM

As Emily said, if you ask five people, you will get five different opinions! 

 

Like Alfreda's dog, my Celt started with a partial tear or strain, at about 6 1/2 years of age. He returned to apparent soundness after a reasonably short course of crate rest and Rimadyl, and stayed sound for most of three years. He was 9 1/2 years old when we opted for a TPLO and I was happy with that decision as the vet found that the ligament was totally torn by this time and he had been experiencing pain in that joint for a few months prior to the surgery. 

 

He was 11 1/2 years old when the second CCL tore and since we were pleased with the first surgery, I was still hoping to keep him able to work, and I knew I had a good rehab therapist available, I chose another TPLO.  This time, though, I also chose to not strictly limit his exercise prior to surgery as I had done the first time, and so his muscling was not at all as atrophied as it had been for the first surgery, and his recovery was much faster because he was stronger. 

 

I have no regrets at having had the surgery done.  My dog is still very active at almost 13 years of age, does help work the cattle on our farm (our work load is limited so it's not a lot of work), and seemingly doing very well.  But my choice is not necessarily the right choice for another person, their dog, their pocketbook, their goals, or their situation. 


Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#15 Blue Dog

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Posted 15 May 2017 - 01:42 PM

On the 23rd of May, I took my 2½ year old male for a low-speed, 7 mile hike in the Vicksburg Military Park. At about three miles he began to occasionally limp favoring his left front leg.  Immediately after rest and water breaks, the limp was more pronounced but then would disappear and re-apear without any obvious cause.

 

We inspected the paw very thoroughly but found nothing wrong with it.  Pressure on the joints resulted in no obvious sign of pain.  The next day, we forced complete rest and he appeared to have made a complete recovery.

 

The day after that, we returned to a normal level of activity and the limp returned. Two days of forced rest took care of that.

 

"Normal" activity for Blue is generally chasing a ball over a two-mile shady circuit including a dip or two in the lake.  Sometimes it means Border Collie intervals which is alternating 2:00 and 4:00 quarter miles for anywhere from 3 to 9 miles total.

 

Today, he did his two mile ball chase in the Park and was, if anything, friskier than usual.  He came home and collapsed on the cold marble fireplace hearth as usual.  When he got up, he had the worst limp I have seen yet and it is still there three hours later. 

 

Do I need to restrict all exercise for several days ... a week ... more?  Is there something else I should be doing?  Looking for?



#16 Pearse

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Posted 15 May 2017 - 01:52 PM

On the 23rd of May, I took my 2½ year old male for a low-speed, 7 mile hike in the Vicksburg Military Park. At about three miles he began to occasionally limp favoring his left front leg.  Immediately after rest and water breaks, the limp was more pronounced but then would disappear and re-apear without any obvious cause.... (stuff deleted)

 

Do I need to restrict all exercise for several days ... a week ... more?  Is there something else I should be doing?  Looking for?

 

I would give him a week, or two, with no running or jumping. If it's gone by then, gradual return to exercise (walking) and if it is OK after a week then gradually ramp up to normal exercise levels. If the limp isn't significantly better after a few day's rest and gone after a week or so, then have a vet look at it.

 

If it was yourself who came up lame after a run or a hike, you'd ice the affected muscle or joint, take NSAIDS and rest until a week after the pain went away. Then gradual return to exercise over several weeks. I think you need to give the dog the same prolonged recovery period. They are super-athletes but biology is biology and a strained muscle or ligament still takes time to heal.



#17 Blue Dog

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Posted 16 May 2017 - 12:30 PM

He is back to the appearance of 100% today.  We will limit his activities to a little indoor ball this week and weekend then try gradually stepping it up next week. I'm sure he will be bouncing off the walls by then.

 

It is really odd to me that all of this started in the middle of a relatively gentle activity and no apparent trauma.



#18 urge to herd

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Posted 16 May 2017 - 10:29 PM

Ligament/tendon strains take longer to heal than muscle. If you can, I advise you to find an orthopedic vet. They are more expensive, but the specific knowledge & experience that a specialist brings with her/him is worth the extra $. I tried many things for one of my dogs, had several visits & phone calls to my general practice vet. Nothing of what he recommended did anything for her.

 

One visit to the dermatologist made a big difference. His recommendations for her care and explanations for me were what I needed. If you can find an orthopedic vet, or if your regular vet would do a phone consult with an ortho, has a good chance of being money well spent, and giving you clearer direction about what your dog needs from you.

 

Good luck and please let us know how you get on.

 

Ruth and Gibbs



#19 Heartful

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Posted 22 May 2017 - 02:51 PM

How to proceed depends on many factors:

 

Is the knee unstable (cranial drawer or cranial tibial thrust)? 

What types of career goals do you have for him and can he be successful if his knee is unstable?

How long do you want to wait for him to "heal" if you opt not to do surgery? 

Does he have any other orthopedic conditions which would be exacerbated by compensatory responses?

How old is he? 

Do radiographs show any significant OA?

 

Doing exercises is great, but I would really recommend going to a rehabilitation professional so that they can give you the correct exercises and teach proper form. It's not just about getting on balance equipment. 

 

Laser therapy - I personally haven't seen any success with this for CCL injuries in the 9 years I've been doing rehab on dogs. Once the knee is unstable it either gets stability from scar tissue or surgery. 

 

Be sure to rule out other soft tissue injury.

 

Yes, it is much more likely to have the other CCL sustain an injury within 2 years. IMO, this is due to compensation and return to work too quickly (before the dogs are 100% evenly weight bearing). Can also be due to conformation and, I believe, they know there is a genetic component in some breeds. 

 

Sorry you are having to deal with an injury. My own worst nightmare, only because I see them every day at work. 

 

Kristin 


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#20 ShoresDog

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Posted 23 May 2017 - 02:47 AM

To update our situation, my dog is still sound, and still running in USBCHA Open trials.  I still try to be very careful to keep his activity level pretty consistent, so he can stay fit.  But of course, that would be important for any dog.

 

14 months ago my my male border collie (age 5 then) began to intermittently pack one of his rear legs.  He was diagnosed with a partial CCL tear by x-ray and the fact that his knee slid a bit when it was manipulated while he was sedated for the x-ray.  He went on NSAIDs and rest for almost three months, at which point he seemed sound.  He gradually went back to full activity, and he's now a very active dog who trials at the open level.  I watch his gait like a hawk, and he hasn't limped since then.  Perhaps he'll have the same experience that Sue R's dog Celt had, but maybe not.  While it can be very helpful, the surgery -- TTA or TPLO -- is very invasive and serious, and my preference was to avoid it if possible.


Jan & Daisy & Juno & Star
LJ Shores, San Diego CA

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