ACL (Acute Cruciate Ligament) Injury – Kane’s Journey

This is Kane

For those of you who know my dog Kane, no introduction is needed.  But for those of you who have not met Kane, let me tell you a few things about him.  He is a large American Staffordshire Terrier/American Bull Dog mix, who at first look, many people think he is scary, he is not!   He is about 80 lbs of pure muscle including those classic “buns of steel”, along with the big jowls, that his breed is known for.  And in staying in character, life has only 2 speeds – Zero and 120mph with nothing in between.  If he could talk, I am pretty sure, he would be like a drill sergeant always pushing to go faster, work harder, never stop, life is too short!   But there is also a very soft side to him.  He is just as much a lap dog as any toy breed I’ve ever seen.  The only difference,  your legs don’t go numb when they lay on your lap for hours!  So with this zero to 120 approach to life, you can imagine, an ACL injury for him was pretty much inevitable, and in fact is very common in his breed as well as in a lot of other working class dogs.

I could make this a long story going through every minute event and activity that led up to Kane tearing his ACL, but in the end, he didn’t do anything out of the ordinary that any other active and energetic dogs do.   I will say that due to his musculature, diagnosis of the ACL injury took several different vets, many different tests and X-rays, and lots of dollars to finally confirm.  An ACL diagnosis is based on the presence of something they call a “drawer response”.   Basically they hold the leg above and below the knee and then push towards the knee (stifle) to see if there is any give in the joint.  The issue with Kane was that he was so muscular that even though his ACL was most likely partially torn at time of examination, they could not get that drawer response due to how muscular his legs were.  And even though ACL tears don’t show up on X-rays, every vet wanted to do their own X-rays to rule out any other possible issues that could be causing the lameness.  So a long story short,  3 vets and 9 months later, his diagnosis was confirmed – ACL Injury – undoubtedly after the ACL was fully torn, which presented itself in even worse lameness.

So what now?

Even though I was expecting this diagnosis, I certainly wasn’t ready for all of the conflicting opinions on what to do to address the ACL tear.  Each option has its own costs, pros, and cons.  It was a little overwhelming to work through what was the best option for Kane.  Especially since each of the vets had their own opinions which conflicted with each other!

I am going to review some of the options with you because each option is probably the right option for a given dog.   I firmly believe that there is no single option that is the best option for every dog.  In selecting an option, you need to consider, how active your dog currently is and will be in the future, what size your dog is, the recovery time, availability of surgeons with technique experience, etc.  And get several opinions… even if you are overwhelmed!

Option 1:  Simply crate your dog and restrict all activity for 6-8 weeks

If you search the internet, you will find tons of articles that tote that an ACL tear does not require costly surgery of any kind and that given enough rest; your dog’s ACL will heal naturally with scar tissue.  Although this may be true for an acute strain or minor partial tears, if your dog has a significant to full ACL tear, this is not an option to move forward with.   It also is probably not an option for very active and exuberant dogs who will just re-injury the ACL over and over again, causing significant arthritis and other joint complications.

Option 2: TPLO (Tibial Plateau Leveling Osteotomy)

This procedure eliminates the need for the cruciate ligament by cutting the tibia bone (below the knee) without disturbing the cartilage and repositioning the tibia bone in a circular fashion so that it is perpendicular (at a 90° angle) with the bottom of the femur.  Once positioned, a surgical brace is screwed to the tibia to keep it in place.  Unless there are post surgical complications such as bone infection or bone fractures the brace remains in place for the rest of the dog’s life. This procedure has been around the longest, but is also the most expensive and most invasive option.  This option is highly recommended by most vets for medium to large breed dogs that have active or working lifestyles.

Option 3: TTA (Tibial Tuberosity Advancement)

This procedure is somewhat similar to TPLO, but it is a newer technique.  It’s only been around since 2004.  The major difference between the TTA and TPLO techniques is where the tibia bone is cut in order to make the 90° angle.  Because they are cutting the non-weight bearing portion of the tibia  it is supposed to be less invasive and have slightly faster healing and recovery time.  The con on this surgery is that it is a newer technique and not all surgeon are proficient in it, and it, of course, does not have the post surgical success rate numbers that the TPLO option  touts because it  not been performed as frequently  TPLO.  In addition, I had 2 of 3 vets tell me that getting the percise angle correct is much harder with this surgical option.  However, take that for what it is worth, those surgeons may also stated that because they were not personally as familiar with the TTA technique.  Understanding your surgeon’s skills is critical.

Option 4: Extra Capsular Repair (Also referred to as the Tightrope technique)

Knee joint after Tightrope surgery. Shows front & side view

This technique basically uses sutures or Fiber tape to basically wrap around the joint to add strength and stability.  This procedure is the newest, developed in 2008.  It is the least invasive option (other than option 1, of course).  Two holes are drilled into the tibia to attach the nylon sutures or Fiber tape, and then wrapped around the joint to stabilize it.  It is less expensive than option 2 and 3 and has a faster recovery rate.  This option is perfect for small dogs or dogs with less active lifestyles.

So what option did I go with for Kane – TPLO.

There were several factors that went into my decision.  The primary factor was Kane’s personality and lifestyle.  I knew that for a short period of time 3-6 months, I could restrict his activity and control the impact of that restricted activity, which inevitably would cause “bad behaviors” on his part when interacting with his housemates and simply going “stir crazy” when he doesn’t get enough exercise.  The second factor was the facility where the surgery was being performed.  The surgeons at OVRS (Oakland Veterinary Referral Services) had a long history of success rates with TPLO technique.  They  also offered TTA, but the surgeons just didn’t perform that surgery as often, which in my mind increased the risk of complications related to the surgery.  And if there were complications, would they have the experience necessary to deal with those complications? I didn’t really want to find this out!  Lastly, I  did not even consider the Extra Capsular Repair (Tightrope) option.  I did have a vet that was really pushing this procedure on me and Kane, but frankly, I could easily see Kane tearing that suture rope/fiber tape to shreds within a year and then we would have to go through this whole process again.  I truly believe that the Extra Capsular Repair technique is a great fit for many dogs, just not Kane.

Kane’s surgery was done on October 10, 2011 and he came through it with flying colors.  As part of the surgical process, they take additional X-rays, determine their cuts, perform the surgery, and then he remains in recovery for at least 24 hours.   I have to tip my hat of to the staff at OVRS.  They have state of the art pre and post procedures and tools that make recovery as fast as possible for TPLO surgery.  They will take you through their operating area explaining what will happen before, during, and after surgery.  I felt very confident he was in good hands when I dropped him off and he was.  They gave me frequent updates and kept me informed.

Kane fully recovered. It took about 6 months and a lot of water treadmill and physical therapy, but it was worth every penny!