When you are all grown up

One of the most common orthopedic problems in dogs is a torn cranial cruciate ligament (CCL). A ligament connects one bone to another, often allowing for movement and stabilization of a joint. People have this ligament also. We call it our ACL, or anterior cruciate ligament. The difference in names between dogs and people is due to nomenclature but they’re essentially the same ligament.

As the weather gets nicer, people and dogs are more active. It is this time of year that I see more injuries to this ligament. As in people, it may just be a strain, or it can be completely torn. If a strain is not given the appropriate time to heal, it will tear. a ligament usually takes 2-6 weeks.

If the problem is severe, there are a number of surgical techniques to correct it. However, in cases of less severity, I try to tailor a rehab plan (with or without surgery) to each patient’s (and client’s) needs and situation. This particular case, as you will see, tailored the plan for me.

Dexter is a very cute Golden Retriever puppy, long on looks and sweetness but short on common sense. He is your typical pup, an active and happy new soul. He was about 3 months old the first time I met him. I had been seeing him for his vaccines and wellness visits. He had always had very nice conformation and movement. When he came in a month later holding up his left hind leg completely, I was worried.

He had been playing with his dad, Mr. Miller, out on the dock at their lake house. Dad was in the kayak when Dexter decided he should join him. Good intention, bad outcome. Dexter slipped off the dock and kayak, and landed in the lake. Dad got him right out, but the pup was very tender in his back leg.

In normal growing puppies, there is a certain bit of laxity in the knee-joint. This is because the ligaments are growing, and are not completely taut yet. This “puppy drawer” goes away around 8-12 months of age. While Dexter had this in the right knee, there was definitely more laxity in the left. The left knee was also very swollen and painful.

Good dog that he was, I was able to take x-rays (radiographs) of him awake to make sure there was no fracture. Going on the principle that puppies are made out of rubber, I hoped for just a bad strain and started Dexter on oral anti-inflammatories and pain relievers. That, in combination with icing of the left knee and strict crate rest for 1 week, I hoped would reduce the swelling and give me a better understanding of what damage was done.

If a person has this type of injury, they can have an MRI done. In dogs, this is possible too, but requires general anesthesia and costs around $1600 all by itself. Needless to say, we usually hold off on that.

One week later, I saw Dexter again. Mom and Dad have been very careful with Chip. The swelling reduced, but while he is placing the leg on the ground some of the time, he is definitely not healed. We continue the oral medications and add in an injection series that goes under his skin and gets into the damaged joint. We also begin laser treatments to help stimulate the ligament to heal. The restricted activity is also continued – not fun for 4-month-old puppies. We will re-convene in 2 weeks this time.

I had avoided surgery since Dexter and his knee-joint is still growing. The established surgical protocol requires that bones and joints be fully grown. This usually happens around 1 year of age. I reviewed Dexter’s case with an orthopedic surgical specialist, and there was an experimental technique for growing dogs, but it had only been done in 6 dogs in Europe, and none in the states yet. I offered it to the Millers, but they didn’t want to pursue it.

2 weeks later he is doing a fair bit better. We continue the twice-weekly laser treatments and injections, and add in underwater treadmill therapy to strengthen the muscles of the leg. This also allows for some exercise, which is needed for Dexter and the Millers mental health.

While some of the laxity in Dexter’s knee has decreased, I am not confident that the ligament is going to heal completely on its own. I prepare the owners that we may need to tread water with Dexter until he is done growing, and then surgically repair the problem. They understood and were okay with it.

Over the next few months Dexter does pretty well. The knee does bother him some days, but a combination of continued rehab, laser treatments, and anti-inflammatory medications keep him comfortable and happy. We take new radiographs for his first birthday, and see that the bones are done growing. I also see why he had such a problem.

We all have growth plates at the top and bottom of our long bones (tibia, femur, humerus, etc.), and when Dexter fell the previous summer, he damaged the growth plate at the top of his left tibia. The fall did initially damage his cruciate ligament, but as he grew the tibia grew with an angle that constantly pulled on the ligament. It was this angle that didn’t allow his ligament to heal properly.

We prepped Dexter for surgery and corrected the inappropriate angle of his tibia. The surgery was a success. After the healing process and rehabilitation, he was running and jumping safely at the lake the next summer.

Normally, when conservative therapy doesn’t work after a few weeks on a strain or partial tear, I will recommend surgery. In this case I had to wait for Dexter’s body to give me the green light. And it was the patience and dedication of mom and dad that made him such a success.

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