ACL Surgery in Dogs

The dog's cranial cruciate ligament (CCL) often goes by the name "dog's ACL" or "cruciate." This connective tissue connects the upper and lower leg bones at the dog's knee and can get injured. Today, our vets in White House will describe the three primary dog ACL surgeries.

ACL, CCL, or Cruciate - What is it?

In the human knee, there is a thin piece of connective tissue called the anterior cruciate ligament (ACL), which connects the lower leg bone (tibia) to the upper leg bone (femur) and helps the knee to function. Dogs also have this connective tissue joining their tibia and femur. However, it's called the cranial cruciate ligament (CCL) in dogs

While the human ACL and the dog's CCL function somewhat differently, pet owners and vets will often refer to the dog's cranial cruciate ligament as the dog's ACL, CCL, or 'cruciate' interchangeably.

How Did My Dog Hurt Their ACL?

Dog ACL injuries often develop gradually instead of occurring suddenly, and they typically worsen with increased activity. Your dog may not have experienced a specific moment of ACL injury, but as they continue to exercise, mild symptoms will gradually become more noticeable and painful.

What Are The Signs That My Dog Has Injured Their ACL?

Dogs with ACL injuries cannot walk normally and experience pain. If your dog has injured its ACL, you will likely notice that it is limping in its hind legs, experiencing stiffness following exercise, and will likely have difficulties rising off the floor or jumping.

How Are ACL Injuries In Dogs Treated?

If you suspect your dog has an injured ACL, it is important to see a vet to diagnose and treat the condition.

If your dog's ACL is torn or injured, the tibia (lower leg bone) slides forward about the femur (thigh bone). This movement is known as a 'positive drawer sign' and results in knee instability, which could cause damage to the cartilage and surrounding bones or possibly lead to osteoarthritis.

Surgical treatments for ACL injuries in dogs include:

Extracapsular Lateral Suture Stabilization - ELSS / ECLS

This surgical treatment effectively addresses torn ACLs in dogs by countering 'tibial thrust,' which is the forward sliding of the dog's tibia. It achieves this by strategically placing a suture.

Tibial thrust occurs when weight travels up the tibia and across the knee, causing the tibia to move forward relative to the femur. This movement happens due to the sloped top of the tibia and when the dog's injured ACL, which normally opposes this forward force, can no longer prevent it.

Extracapsular Lateral Suture Stabilization rectifies tibial thrust by securely linking the tibia to the femur through a surgically placed suture. This suture pulls the joint taut and aids in stabilizing the knee, thus preventing the femur and tibia from sliding back and forth while the ACL heals and the surrounding knee muscles strengthen.

For the ACL injury to heal, it's essential that the suture remains intact for 8-12 weeks. After this period, the suture may gradually loosen or even break.

This surgery is relatively straightforward and quick, with a high success rate in smaller dogs. Additionally, it can be a more cost-effective option compared to other methods for repairing a torn ACL in dogs. The long-term success of this procedure may vary depending on the size and activity level of the dog.

Tibial Plateau Leveling Osteotomy - TPLO

Another surgical option for treating your dog's injured ACL is the tibial plateau leveling osteotomy (TPLO).

This surgery involves making a complete cut through the top of the tibia, rotating the tibial plateau to change its angle, and adding a metal plate to stabilize the cut bone as it heals. Over several months, the tibia will gradually heal and become stronger.

Full recovery from TPLO surgery takes several months, but some improvement can be noticed within days of the procedure. It's crucial to adhere to your veterinarian's instructions after your dog undergoes TPLO surgery and limit your dog's activities to ensure proper healing.

The long-term outlook for dogs treated with TPLO is favorable, and instances of re-injury are rare. The stabilization plate does not require removal unless it poses issues in the future.

Tibial Tuberosity Advancement - TTA

Tibial Tuberosity Advancement surgery is similar to TPLO but may be slightly less invasive than TPLO. Recovery from TTA appears to be quicker than recovery from TPLO in many dogs.

When TTA surgery is performed, the front part of the tibia is cut and separated from the rest of the bone. Next, a special orthopedic spacer is screwed into the space between the two sections of the tibia to move the front section forward and up. By doing this, the patellar ligament, which runs along the front of the knee, is moved into better alignment and helps to prevent much of the abnormal sliding movement. Once this process has been completed, a bone plate will be attached to hold the front section of the tibia in its proper position. 

TTA surgery is typically performed in dogs with a steep tibial plateau (angle of the top section of the tibia). Your vet will evaluate your dog's knee geometry to determine which ACL treatment surgery is best for your dog.

How Long Does It Take For Dogs To Recover From ACL Surgery?

All dogs vary, and the speed of recovery after ACL surgery differs from one dog to another. Nevertheless, ACL surgery recovery always requires a considerable amount of time!

Your dog might start walking within just 24 hours after the surgery, but complete recovery and a return to regular activities will typically span from 12 to 16 weeks, or possibly even longer.

It's crucial to adhere to your vet's guidance and closely monitor your dog's healing progress. Avoid pushing your dog to perform exercises if they show resistance, as this could potentially result in re-injury to the leg.

If your dog has been diagnosed with a torn or injured ACL and you'd like to learn more about ACL surgeries, contact our White House vets to book an appointment.