We get asked this question a lot, and wanted to see if we can answer some questions on diagnosing a CCL tear. Is it necessary to have a diagnosis before purchasing a brace? Answer: Yes! There are many other things, like sprains, hip joint pain, spinal issues, tumors, and nerve issues like DM that can cause hind lime lameness other than a ruptured CCL.
At your appointment with the veterinarian, they will most likely want to do what is called a drawer test. Please note: this could worsen the injury if not done properly, or with sedation, and is very painful. Some patients will let out a yelp, or limp much worse after the examination.
Your veterinarian may also want to do some radiographs during the initial examination. These can show gaps, space, swelling, and rule out tumors in older patients. I do recommend radiographs for any patient over 8 years old.
MRI is the absolute best way to diagnose, however, this can cost upwards of $1,000, and may be hard to find someone to do this.
Find a veterinarian that is gentle, and will do a thorough exam ruling out the other injuries. This is the best method, and least painful for your pup. Also, try taking the last appointment of the afternoon when possible, or the first in the morning, as this is when most veterinarians are less likely to be in a “rush.” Right before lunch break, or in the late morning/afternoon can be rushed due to their surgical load that day, or if they have other patients that have been dropped off to be seen.
We leave the diagnosis up to our clients, it is not required, however, I do recommend at least finding a holistic minded veterinarian to help you!
Nikki, Posh Lead Veterinary Technician
Hi! Today I would like to talk about muscle atrophy in dogs, especially with CCL injuries. One of the biggest muscles in the body is the thigh muscle, which is needed in order to have full range of motion with the hind legs.
Without this muscle, we would be unable to completely lift our leg up and take a normal step. Dog’s that have an injury atrophy quickly. This is why it is really important to keep our patients active, while still letting the knee injury stabilize. With bracing, we are still able to place full weight on the thigh muscle, which may become sore initially, however, then we can start building this muscle back up, keeping it healthy.
This is another reason bracing can be better for patients than surgery, as with surgery there is a long period where you will need to confine your dog to keep them from hurting the surgical site. In the 8 weeks it takes to recover with surgery, there can be significant atrophy that sets in.
This is another reason that we include physical therapy with our patients, and walking schedules, to keep our dogs active, and using those muscles.
With dogs that have severe atrophy, say you waited too long, we may need the help of hydrotherapy to really get that thigh muscle back. You may also need the help of a sling or a harness that includes handles as well, so that you can help your dog walk initially, until we start getting strength back in the thigh muscle. Our technicians are happy to help you with this, and with time we can get the muscles back.
Today I would like to go over what a CCL in a dog is, as well as it’s function. First off, a CCL in a dog is the same as saying ACL in a person. Dog’s have a CCL, not an ACL.
The CCL is a connective tissue in the knee that stabilizes the lower leg to the upper leg. It connects the tibia to the femur. Without this ligament, there can be partial or complete joint instability, pain, and lameness present.
The CCL holds the tibia in place, andprevents internal rotation and hyperextension (which is over stretching the leg). The meniscus (located between the femur and tibia) absorb impact and provide a gliding surface between the femur and tibial plateau/tuberosity. Sometimes the medial meniscus can become torn when the knee is unstable from a CCL tear.
Symptoms of a rupture include crepitus (crackling or popping sound), decreased range of motion, hind leg extended when sitting (when the injured leg is off to one side), pain to the touch, not wanting to move as much, sore after a walk, swelling, and turning the leg out to the side when standing.
Leaving a ruptured ligament alone, without the aid of bracing, can leave misaligned joint causing further damage, inflammation, and pain. This can lead to early joint disease and further meniscus tears.
Bracing helps to hold the tibia in place, while acting as a buffer or shock absorber, preventing further movement and issues from occurring.
Today let’s talk about how to get your dog to use or walk with the brace. First, I want you to use just the hock wrap, to let your pup get used to having something on his ankle. Do this for 30 minutes on and off the first couple of days.
Next, I like to freeze peanut butter in a dish, and distract my dog while fitting the brace on.
**Important** Once you have a brace on, go directly outside and walk. Then, remove the brace when you come in. Distraction and treats work great while getting your dog used to wearing the brace.
Soon, your dog will link the brace to getting to go out for a W-A-L-K, something really fun.
Then, you can increase the wearing times as stated on our physical therapy handouts. Let me know if you have any questions!
Nikki, Posh Lead Veterinary Technician
Today we want to talk and educate you on Meniscus tears, and what they mean for your dog. Say you just got back from a visit to your vet, to find out your dog has a CCL tear with a Meniscus tear as well. Now what? Your vet I am sure has gone over all of the surgical implications for this problem I am sure, but have they explained what the meniscus is? How important it is to have in our knee, or what the function is? No, most likely they have quoted you for removing the meniscus, and the CCL repair only. Now I do know many Veterinarians that will try conservative management first, and a very huge thank you to those vets!
Well, you are in the right place. Our goal at Posh is to give you, as the dog mom and dad, options. Yes, you heard me, there are options with a Meniscus tear, not just surgery. Think of yourself for a minute. If you go into any orthopedic Doctors office, would they simply take an xray and schedule you for immediate removal of your meniscus? Absolutely not. There would be follow up appointments, probably an MRI to confirm, and then they would go over the options. Yes, there is that word again. Options.
What is the meniscus? Well, There are actually 2 menisci in each knee. The Menisci is a C shaped component made up of cartilage, and composed of collagen and joint fluid. 70% of the menisci is made of fluid that will compress with normal movement and release synovial fluid into the joint so that the knee can easily move. They act as our shock-absorbers and buffers, like in a car or truck.
With a CCL tear, it is very common to have a meniscal tear. There are several grades of tears, from a small tear, toa complete folding over of the meniscus. In most cases, the patient will have a minor tear. With this you may hear a pop or clicking sound. These tears are minor, and do well with bracing and Physical Therapy and Adequan Injections.
You can see now how it is very important not to completely remove the meniscus, as some vets may suggest prematurely. Now if the meniscus is folded over, usually you will see the knee sticking and unable to bend correctly. This is a surgical issue, and will need corrected.
Removing the meniscus almost always leads to arthritis and chronic lameness, as you just took out the joint’s buffer. Only if the meniscus has folded over, and I have seen this only twice in over 4,000 patients, will you need to consider removal.
It will take several months to heal, but healing is possible! Usually bracing for 12 months during activities, along with supplements and a good diet are enough to let the meniscus recover. Let us know if you have any questions, and we are happy to help your dog!
Nikki, Posh Lead Veterinary Technician
Today I would like to discuss bilateral injuries with you. First off, once a patient has a CCL injury, there is a 50% chance or greater of the second knee having a tear.
This goes up with surgery, due to the overcompensating and atrophy that develops with post-op patients, and can decrease with bracing.
Lots of things can factor in as to why a patient is now bilateral. Genetics may predispose our pups, such as bully breeds, as well as early spay/neuter, diet, etc.
Just because a patient is bilateral, does not mean you must do surgery, or euthanize! We can help bilateral patients recover using a posh dog knee brace, and they do just as well as having a single brace.
So, weather your dog had surgery, and now the second knee has gone out, or both were close together, a knee brace would still be the best and most conservative option. Please let me know if you have any questions, and give your dog a Big Hug for us!
Nikki, Posh Lead Veterinary Technician
Let’s talk about Adequan today, and the many benefits it has! Another name for Adequan is Cartrophen, for those in Canada or other countries.
Adequan is an injection given either in the muscle (most common) or under the skin.
This medication stops cartilage loss in the joint and helps to restore lubrication , relieve inflammation, and renew building blocks of healthy cartilage. It is also one of the only medications that can help slow down arthritis.
Adequan has been shown very helpful for CCL patients, as many dogs also have meniscus tears or strains.
I find patients with meniscus tears see results rather quickly with Adequan therapy, especially if they also have arthritis findings.
Adequan or cartrophen is very safe, with basically no side effects in their study groups. Much safer than NSAIDs and anti-inflammatory drugs.
Can be administered at home after a prescription is given.
This can be very helpful when used in conjunction with our brace for CCL tears and meniscus issues.
This is why we, at Posh, recommend Adequan for any dog with a knee injury.
Today I want to talk about surgery vs. bracing, and why we suggest bracing first.
First off, not every patient is a good surgical candidate. Be it weight, age, anesthetic risk, liver enzymes, poor health, or maybe the owners don’t have the $10k saved that it will take to fix not only the first knee, but the second knee that will go eventually once surgery is done.
Second, surgery has a lot of risk! Screws coming out, plate failure, angle was done incorrectly, bone fractures are very common, especially with large breeds doing TTA surgery, and infection is also very common. I have had several patients come to me that have been fighting infections for almost a year, such as mrsa, due to the surgical site not being sterile! Unfortunately, some have the leg amputated due to complications. Also, if the angle is done improperly, they will start to weaken the ankle and hip joints, as things are not in alignment any longer, and start breaking down. Complications are common, and unfortunately some cause irreversible damage. I have even seen some patients have surgery done on the wrong leg, and yes that actually happened!
Also, 1 in 4 dogs that have surgery have lifelong lameness! With bracing, we don’t have any complications, or risk. Our patients are able to place full weight on their affected leg within just a few hours of receiving the brace. They can go for walks right away, which we will encourage. We also do physical therapy from your home, to help build the leg up and muscles, as well as Passive Range of Motion to help build strong tissue. We also go over diet and supplements, to give you the best outcome.
Just remember, you can’t undo surgery complications, but with conservative management there is always more we can do. Surgery should be a last resort.
Today I would like to discuss diet, and what is best to feed a dog with a ligament injury. I get a lot of questions regarding if you should feed your dog a grain free diet? Answer: yes, you should. So the reason is, gluten and grains such as corn are some of the more inflammatory foods you can feed. We actually want to take down the amount of inflammatory foods that we feed, and not be adding that to the diet. So you want to be looking for gluten and corn free diets if possible.
The next thing to go over is protein. We want to find a really high, good quality, protein source diet. Some people like to feed poultry, I prefer beef, salmon, or venison. Also, you really want to make sure to check the label. It should not say “by product of.” If it says by product of, or chicken by product, that is garbage, please do not give that to your dog. Protein is really important for dogs, as it has amino acids, which are muscle building blocks. So, without those quality protein amino acids, your dog can’t form muscle, and really can’t get that strength back that we need during this healing time.
Some healthy additives to supplement diet are sweet potatoes. Sweet potato is a safe source of amino acids as well. I personally feed salmon and sweet potato, because my dogs have a lot of energy. Another thing to add is celery. Celery can remove uric acid, which causes and makes arthritis form. This can make an injury more painful. So, we want to take out that uric acid. Another additive is fish oil. Fish oil has a great source of omega-3 fatty acids. Omega-3’s are helpful in reducing inflammation, and lubricating joints. You can also add coconut oil, in small amounts. This also contains healthy fatty-acids and aids in lubrication of joints.
Thanks, and please let us know if you have any questions!
Nikki, Posh Lead Veterinary Technician
I want to talk about possible home hazards today, and things that we can do to make the recovery process smoother for our dogs. The first thing that I want to discuss is slippery floors. Our poor dogs trying to walk on slippery floors can have a real challenge. They are usually digging in those nails, slipping, and can cause a real injury. Commonly we see groin sprains, muscle tears, and even CCL tears from this. Even with a brace on, they could injure the other leg, so it is a really good idea to cover those slippery floors for our dogs who are injured. You can also separate the carpeted area from the slippery part with child gates or something to block them from walking on the slick floor. Then you can leash walk them very gently through that slick area.
Another thing to do is put carpet down, with runners on the bottom. This is usually the easiest, and gives your pup a pathway that they can go from room to room.
Also, there is a great product called Dr. Busby’s Toe grips. These actually go onto the dog’s toenails, and give them full traction for slick floors. This way they can go through the house without worry, and will keep them from slipping and sliding. You can try dog shoes or boots, but usually dog’s don’t like having something around the foot area. Toenails they usually don’t mind, but the foot pad is sensitive.
Another hazard we see is staircases. When your dog is going up the stairs, they are using those back legs to push off. It is really important, if you don’t have a brace yet, to use a sling to help your dog up the stairs. Going down the stairs is not as big of a deal, as they are using more of their front legs, but I would still like to have either a sling, or a leash, to make sure they are taking things slowly.
Lastly, let’s talk about dog doors. If your dog has free access to going outside with a dog door, please block this off during the recovery process. You can also fence off a small area in the grass, so they only have a small area to go to, but trying to go through the door with a brace on is not a good idea. I know they are convenient, especially when we are gone, but please don’t let a dog have access during the day with their brace on, or injury could result.
Again, please let us know if you have any questions, we are happy to help!