So, your dog just did the cruciate ligament. DON’T PANIC. Okay, you can panic a little.
Just the words “cruciate ligament” can send icy knives of fear through most dog owner’s hearts. It’s common as hell, expensive as hell, and a pretty big deal. It’s a big surgery, with a lengthy recovery period.
I have a Staffy cross something-something called Buffy. She’s loving and sooky and ridiculously friendly and runs like the wind! I’m not kidding. She’s the fastest dog I’ve ever seen, the only dog in the park that can keep up with the local Whippet! 7 weeks ago, Buffy did her cruciate ligament. She was charging across a grassy field, turned around to come back to me, squeaked, and pulled up hopping on three legs. My heart sank. There was no big accident, no big fall, no crying, just a squeak, and then I had a three-legged dog.
Trying to be optimistic, I thought, “oh she trod on something” or, “she’s pulled a muscle or something”, but that leg… well it was not going anywhere near the ground, and though she seemed perfectly happy in herself, from that moment on, she hopped.
I took her to her vet later in the day, hoping against hope that I was going to be told it was nothing. Nope. My vet took one look, a couple of feels, a bit of a bend, and said, “Hmmm pretty sure it’s the cruciate ligament”. Damn.
We decided to give Buffy a couple of days. Just to see if she came good. She was given some pain medication and I took her home, sorted out a bed for her on the floor (she usually sleeps with me), and crossed everything I could cross that a bit of rest was all she needed.
The next morning, she was bright, and happy… and still hopping. Damn. I medicated her up, put her in my bedroom so that she couldn’t move about too much, and went off to work. My vet called me first thing that morning, “Let’s not wait”, she said, “I’ve booked you an appointment to see the specialist tomorrow morning at 10.00am. If he decides it’s the cruciate ligament, he’ll operate then and there.” “Okay”, I said, knowing this was the right move. “Do you know around how much the operation will cost?” I held my breath. “I’m not 100% sure”, my vet said, “But somewhere between 3 and 5 thousand, depending on what kind of procedure the surgeon decides to do”. I sighed. Lucky, I have pet insurance.
The cruciate ligaments are fibrous bands that cross over each other inside the knee joint (stifle) of the dog – so in the back legs. Their function is to allow the knee to flex and extend, whilst stopping the adjacent bones from sliding apart as weight bearing occurs. It is a major part of the knee function, stabilising the joint. Once a cruciate ligament is damaged the joint becomes unstable and painful.
The cruciate ligament can tear or rupture through injury or can degenerate through age or excess stress on the joint area due to the dog being overweight. Some dogs may present with a persistent limp, where others, (like my dog Buffy), will cause enough damage that they are unable to bear weight on the leg.
As planned, I took Buffy off to see the specialist surgeon. He had a quick look at her, wiggling the leg and eliciting a squeak, and told me he was going to keep her in, sedate her and do a series of x-rays. If the x-rays showed, as he expected from examining her, that her cruciate ligament had ruptured, he would do the surgery while she was under. He then drew me a quick diagram of what a dog’s knee looks like, and what the surgery he proposed would achieve, and then told me how much it would likely cost. The estimate was between $5,000 and $5,500. Did I mention how lucky it was that I have pet insurance?
There are two common forms of surgery for the repair of the cruciate ligament. One is to replace the ligament with surgical material that replicates the action of the ligament. This is the standard surgery which has been most commonly practiced in the past. For a small dog, or an inactive dog, this surgery can be highly successful and can usually be performed by your own vet. However, just as the cruciate ligament can be damaged under stress, so can the implanted material, and the surgery may need revisiting due to the material failing. This is especially a problem in large, and active dogs. The other most commonly recommended surgery is called Tibial Plate Levelling Osteotomy or TPLO. This surgery is recommended for use on dogs over 15kgs and highly active dogs and should be performed by a specialist vet surgeon. (This was the surgery my specialist recommended for Buffy). In TPLO surgery, the bone in the knee joint is cut and rotated and repositioned to level the joint – creating a knee joint that more resembles the human knee. A plate and pins are then connected to the repositioned bone to secure it during the healing process – just as with bone surgery in a human. This is the tibial plateau levelling surgery.
After my specialist surgeon x-rayed Buffy’s leg, he called to tell me her ligament was completely shot, it was a pretty bad injury, and he was heading straight into surgery with her. He would call me later with news on how she did and then discuss what happens next.
TPLO surgery takes about 2 hours dependent on the size of the dog, and due to the length of time the dog is under anaesthetic, the vet will keep your dog in overnight. There can be potential complications including infection or loosening of the screws and plate. Around 1 in 5 dogs require the plate to be removed several years down the track, which is a small surgery with minimal impact on leg function. A small percentage of dogs that didn’t have an injured cartilage at the time of TPLO surgery can tear it at a later date. A sudden increase in lameness usually develops and a second operation is necessary to remove the torn piece of cartilage. However, in the majority of dogs that undergo TPLO surgery, knee pain is reduced, and function of the leg is improved.
Obviously, I sweated by the phone until I got the all clear call. The surgery went great, Buffy was doing fine, and I should call in the morning and the attending vet would let me know when I could pick her up.
Stage 1 was complete. Now on to the tricky part! RECOVERY!
The next morning, I was told the only hic-cup was that Buffy appeared to be allergic to the adhesive in her wound dressing (hilariously so am I!), but that wasn’t a problem and that they were going to leave the wound dressing free. She would be wearing a cone (of shame) which must not be removed, preferably at all, but certainly not unattended, and that I could pick her up at any time as she was fine to go home.
When I went to collect Buffy, I had a consultation with the attending vet to discuss her post-operative after care and OMG I was handed a 4-page document! I’m going to be honest, I panicked a little!
The post-operative care for cruciate ligament surgery is vitally important and contributes to how well your dog will recover and will go a long way to minimising the severity of the arthritis that will most likely occur later in the damaged knee.
Buffy was on anti-biotics, a morning painkiller (which she was on for 6 weeks), and codeine, which she could have morning or night as needed. She was on restricted movement, she was not to play, jump, run, or do any of the other things she did constantly. She was to have 3 x 5minute walks per day and was to be kept in a secure space with limited room for moving around. After 2 weeks, she would need her wound checked, and if all okay, her stitches could come out and the cone of shame could come off. At the same-time she would need to start a series of weekly injections – 4 in total, and as long as she is starting to use the leg, walks could be increased by a few minutes a day until she was at around 10 minutes 2 – 3 times a day by 4 weeks, and 15 minutes 2 – 3 times a day by 6 weeks. At 6 weeks she was to have the leg x-rayed again to ensure that the bones had healed correctly, and then if given the green light, she could be slowly eased back into normal life! Somewhere in this she was also supposed to start physio therapy! I’m going to say it, I broke my ankle and didn’t take anywhere near as good care of myself!
I bought Buffy a memory foam arthritis bed, because she generally slept on my bed or on the couch, and as she was not to jump, those places where out. It was winter, so I got her a couple of new blankets to keep her toasty and kept her locked in my bedroom when I wasn’t home. I soon discovered that certain bowls did not work at all with her cone of shame, and I had to revert to a tiny, flat bowls that she couldn’t accidentally flip, sending water and biscuits everywhere! I reduced her diet by 25%, because her exercise was so reduced, and started her on rosehip at the recommendation of my brother, who found it worked wonders with his dog’s bad back. I walked her twice a day, because I worked full time and couldn’t manage 3 walks and felt guilty the entire time because I knew she should be getting a walk in the middle of the day! After just 2 days, she started to put the foot down. By 2 weeks, she was putting it down to walk on here and there, and it got better from there.
I tried so very hard to keep her calm, and on the ground, but she’s an excitable girl and there were times when she was jumping around so much, that I was freaking out stressed that she was destroying her brand-new knee! She’s a dog, she’s going to be an idiot! Everyone from me, to my friends, to the vet nurse, to the vet would be grabbing her and saying, “STOP!” as she jumped around trying to give all the humans all the love.
We did the best we could, because that’s all we could do, and at the 6-week check-up and x-ray, thankfully, she was given the all clear.
We are now coming up to 8 weeks post-surgery. Buffy, for the most part is back on four legs, albeit with a limp. She limps less in the morning than in the evening, when she obviously gets a bit tired. We did one session of physio therapy, where I learnt some stretching and massage treatments to do on her, which I do every morning before we head out for a walk. She hates the massages…NOT! We are now at around 30 minutes of walking in one stint, which she handles well. She plays with her friend Wilbur, and uses the stairs. But by the end of the day, she will often pull the leg up, which relentlessly worries me. My vet says this is habit as much as anything, and that I need to try and stop her doing it as much as possible – hilariously, she now understands the command, “foot down”! Typically, it can take 9 -12 weeks until a dog with a cruciate ligament injury starts to get back to normal movement, and sadly, chances are they will develop arthritis in the knee joint
As it turned out, the recovery period and post-operative treatment wasn’t as overwhelming as I initially thought it would be. Buffy and I just did the best we could. And that would be my recommendation if you and your dog are facing cruciate ligament surgery, just do the best you can. Listen to your vet and have the recommended surgery performed. If TPLO surgery by a specialist is recommended and the cost is prohibitive, see if the specialist can perform the operation in your vet’s surgery, my vet does this for clients that find the procedure at the specialist vet centre too expensive. It is likely to cost a lot less at your vet’s surgery than in the specialist centre. Most of the time, vets will find a way to help. Do your best to keep your dog restricted and quiet, but don’t freak out when they do the exact opposite of what you want them to, they’re dogs, and they feel okay as long as that leg isn’t on the ground, so they just don’t get it! Keep that cone of shame on them, even when they give you the puppy eyes, you do not want them pulling out the stitches! Keep up the recommended walking routine, it’s super important, if you can’t do as much as recommended, do morning and evening, or see if there is someone who might be able to help you out. If you can afford to see a pet physio therapist, do it, you really only need 1 appointment, so you know what to do yourself, and your vet can also give you advice on anything extra you can do to help your dog’s healing along. But most of all, don’t panic! It will be okay. Just trust your vet, talk to them if you have any questions or concerns, follow their instructions and just do the best you can. That’s all any of us can do.
Oh, and if you can afford it, get pet insurance, seriously, it’s worth every cent!
(c) Amy Hutton