I suspect My Lab may have an ACL injury. Can rest and anti inflammatory agents heal this or is surgery the only answer?

Just going through this with my dog.
Conservative management (rest, etc) MAY work if the ACL is only partially torn and if there is some stability in the knee. The vet needs to do the drawer test and tibial thrust test to determine if the knee is stable. If not, surgery is the only thing that will help the dog.
Take the dog to a respected ortho surgeon for a diagnosis. Do not mess around waiting because severe arthritis can set in very quickly if the knee is not stable.
If you opt for conservative management, the dog needs to be Restricted for months. No running, jumping, playing or explosive movements. Scar tissue has to form to stabilize the knee in lieu of the ACL.
If you opt for surgery, do your research. Get the best surgeon you can. You have several choices of surgical procedures, some of which may or may not be appropriate for your dog, depending on the angles of his knee, age, activity level, etc.
Good luck with whatever you decide. Not an easy thing, but it is a fixable thing.

When my girl had a partial tear about 5 or 6 years years ago, my vet told me to try the conservative approach first since she could still bear weight on the leg. She healed after about two months of leash restriction and has been fine ever since. She's going to be 8 next month and I don't see any evidence of arthritis.

I'm sure a lot depends on how much injury has been done to the ACL to begin with. Good luck with whatever you decide.

There's a Yahoo group for conservative management, I believe.

just posted our outcome with a brace instead of surgery on a previous post.
I am so glad to have found this vet and brace, I cant say enough about how well it works.
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I wanted to update you on my option with my girl.
she happen to be bred the week before the injury so we were
trying to get our ducks in a row if she was not pregnant and if she was.
Well the pregnancy took so surgery was not an option for her.
she had a extreme tear of the left CCL, I worked with a vet that is not a fan of surgery and she turned me on to a company http://www.aceorthosolutions.com/

the vet has used this product on many dogs with great success. So we cast the leg and waited for the brace to arrive. Once I got the neoprene sleeve cut to fit perfect it was a dream to put on and off, and she really did not seem to mind the brace on at all. It was amazing how much relief it gave her and allowed structured movement while allowing the leg to heal itself.

her litter is now 4 weeks old and she has been wearing the brace since beginning of February and she is doing wonderfully. I jsut started letting her move around the house with out it but I put in on whenever we go outside and the chance of her running is higher. with it on she moves and scoots with the other dogs just fine. The brace stay put with out extra straps due to the neoprene sleeve. Cost was $450 well worth it and I am glad not to have to put her through surgery after all.

A typical error in wording, a CCL not ACL injury in the Lab.

I suggest you see a highly reccomended orthopedic or orthopedic surgeon for a definitive diagnosis and suggestions for the best route to go.

There are 3 surgical options if its close to or a full tear. Rest is imperative for less of a tear or a full.

Surgery is a long process of rest after and then physical therapy.

I would investigate all options and which is the best for your Lab's injury.

Yes, surgical repair such as a TPLO is a long recovery process. I had a male tear his CCL and we opted for a TPLO. His recovery until he was allowed to be in the yard unleashed was 4 months. The day he got the OK to be off leash, he tore the other. We immediately did a second TPLO and after 4 months again, he was given the green light. This was years ago though and I don't think the vets were as "PT Happy" as they seem these days. Nowadays, you'll get sent to PT for just about everything and it's expensive. Resuming walking and low impact exercise on your own rebuilds the muscles just fine. It will be 8 years ago this summer and his vet is very happy with how he's done through the healing and living with the fixed knees.

Yes, get a diagnosis from a specialist but keep in mind a surgeon will always push for surgery, that's what they do. There are more than 3 options available as there are many variations on techniques and materials used.

I will try the conservative approach the next time. TPLO is the most invasive and is not reversible if something goes wrong. There's always the possibility of another surgery later on if the plate has to come out. I've heard of dogs having discomfort in the winter because of the cold steel. A traditional repair just temporarily stabilizes the joint while scar tissue forms. If you can find a good fitting brace that will stabilize the joint well then why have the surgery? Management is the key no matter what you do.

Very few of these tears are injuries so if one goes the other is sure to follow no matter what you do. The condition is now called cruciate ligament disease, it's a degenerative process.

BTW, FWIW, Slocum Enterprises Inc. the company that pioneered and patented the TPLO is out of business now.

I disagree with the statement that if one knee goes, the other is sure to follow! I have had 4 dogs with acl injury, 2 of them healed with prolonged rest, and 2 of them I opted for surgical repair. NONE of them has injured the other knee, and one of those dogs injured her knee at 1 yr of age, and she is over 12 yrs now, and is sound.

I didn't say injury isn't possible. If a dog has a true injury then the odds of the other one going is much less. Most cruciate tears are not caused by injury and there is a study that is going on now to find a genetic component to this degenerative disease. Unless you have a LOT more dogs, 4 dogs with cruciate problems is very high, are you saying they all injured their knees? That seems unlikely too. Are they related? There's also a possibility that they weren't diagnosed correctly (impossible to verify without surgery) but 4 in one pack sounds high.

Knee deep, you said very few of these tears are injuries. This is not what I've heard from the veterinary medical profession within my husband's family. His brother and cousin are both veterinary specialists.

Can you elaborate where you got this information? It is my understanding that especially in younger dogs, 18 mo. or under are almost always strictly injuries due to lack of full maturity in the larger breeds. In dogs that are older and fully mature, it can be either an injury, a defective knee or both causing a CCL tear.

Can you send me where you read or heard this information? I prefer keeping up with the medical or non-medical problems within the dog I'm breeding for 25 years. TY.

"4 in one pack sounds high"
no, I said I've had 4 dogs with cruciate injuries....over my lifetime of owning dogs ( over 50 yrs )

How old is your Lab with suspicion of a tear and what's wrong with the dog that makes you suspect it? Is it a youngster or mid to older age? There are differences in treatment going by age also.

I have a girl who had a partial tear from an injury with another dog. Our home is three stories we walk stairs to the street level we walk stairs to the yard level. Surgery was not an option for us. We went the conservative route limited her activity but because of our stairs not as much as the vet would have like. We also added a collagen suppliment to her diet that I had started taking. We had nothing to lose and figured we would live with a happy yet gimpy dog for the rest of her life that we would eventually have to pain manage.

The collagen was the only difference for both her and I. We both started taking it about a year and a half ago. Both her tear healed and my cronic cyst absorbed. The vet was shocked at how well and clean her tear has healed when we xrayed her recently. My cyst had been surgically removed years ago and clamped my ortho said it would always be a reoccuring problem that I'd have to learn to live with. The pain was at times unbearable. I have been cyst free for a year and my girl has been sound for that same time frame.

A friend has also recently started using Collagen on her Dysplastic dog that was having troubles getting up from lying down. She also has seen marked improvement in just a few weeks of use.

It may not be a cure all but it couldn't hurt. I know personally how much Collagen has helped me.

http://www.youtheory.com/collagen-advanced/

This is the product I used two tablets a day far less than the reccomended dose. I also give my Girl 2 a day she crunches the down like candy. The other dogs get 1 a day because they started to get jealous.

I now have a doggy pack in my bathroom with me everytime I open up the medicine cabinent. LOL.

Again I do not recommend this over sound Veterinary Advice. It just worked miracles for us after we explored our options.

Good Luck :)

You can find some information with google (cruciate ligament disease) but access to a professional site where articles can be referenced or journals within the profession will yield the most information. Those in the vet. profession shouldn't have difficulty finding this information as it's been a subject of debate and research since the 80's.

Though not a scientific article, this explains cruciate ligament disease:

CRANIAL CRUCIATE LIGAMENT DISEASE -David F. Merkley DVM MS

Cranial cruciate ligament disease has become the most common orthopedic condition affecting the dog. Data is not available for cats but it is not uncommon in the feline species. This condition not only plagues the athletic working dog, but the family pet as well. Certain breeds have a very high incidence and recently a genetic predisposition has been suggested. Genetic implications of this disease are being researched. It has far surpassed hip dysplasia as a debilitating orthopedic condition and as a financial burden to pet owners.

Diagnosis of cruciate ligament injury with stifle instability is proving to be very complex. For years we have believed the only test for stifle cranial cruciate instability was the “drawer sign”. We now know that cruciate disease is not usually an acute event with rupture as it is in man (quadraped vs. biped). It is now believed to be the result of degenerative changes that occur over time. It appears that the development of instability it is more chronic in nature and with initial stretching to mild ligament fiber separation. It appears that ligament degeneration with histopathological changes within the ligament fibers precedes overt clinical signs of instability and joint discomfort.

That initial presentation of discomfort and lameness that we see with no “drawer sign” may just be a stretching of the ligament or a mild tear (fraying of fibers). This may respond to rest or antiinflammatory therapy. A repeat of discomfort often occurs that may or may not be responsive to conservative therapy again. The process has started from an early stretch to a partial and to an eventual complete tear. This degeneration and stretching eventually allows synovial fluid entrance into the ligament with inflammation. It can then progress to partial fiber separation and tearing long before an acute event occurs. During this long process stifle instability is present (even without a visible drawer sign). You cannot detect this instability with the drawer test. Synovial membrane attachments are torn and osteoarthritis is developing. Articular cartilage is under attack by this abnormal stifle movement. By the time you detect the “drawer sign” osteoarthritic changes can be evident and often can be severe.

Conformation issues (straight stifle and steep tibial plateau angle) are also mentioned as predisposing factors to cruciate ligament degeneration and rupture. Since these issues affect both joints is has become increasing clear that bilateral disease is the norm and the second leg often follows with similar discomfort and degeneration issues.

The classic history that is received today on the stifle injuries that are seen is chronic long term rear leg discomfort (lameness) that often responds to rest and/or anti-inflammatory treatment (initially). It is recurring and often frustrating to pin point the painful area. Radiographic evaluation of the stifle early is not contributory to the diagnosis of cruciate disease. Early joint changes are mild and not detectable on radiographs. As the changes in the joint progress from this early lameness (instability), changes do occur that are subtle but very contributory to a diagnosis. The body responses to this joint instability (though mild) by building a fibrous medial buttress around the medial collateral ligament. This is often palpable early but can be very subtle. It can be very mild and you must compare to the opposite “normal” joint. You also can often detect increased synovial fluid in the affected joint on the lateral stifle radiograph. Again you must compare to the “normal” unaffected side to detect slight differences. Early arthritic change (patellar spike) can often be seen. You should also compare drawer sign for differences between the affected and normal leg. Combining all of this information can give you a good probability that you are dealing with cruciate disease as the cause of the rear leg lameness or discomfort. Stifle thrust is usually only detectable with significant instability (severe partial or total tear). With longer standing issues muscle atrophy on the affected limb becomes apparent.

This all is complicated by the fact that chronic cruciate disease is often bilateral and the two legs may be at different stages in this degenerative process. They may both have issues with one being farther along and “more” clinical.

Medical therapy (rest, NSAIDs, and physical therapy) in these early stages does not halt this process. You mask signs of the instability but it is still present and is causing damage. We are beginning to recognize that early surgical intervention may be necessary to correct this instability and halt this osteoarthritic progression. Early surgical intervention increases the chances of saving the medial meniscus from damage.

http://www.veterinarysurgicalspecialists.com/positionpapers/cranialcruciateligamentdisease.pdf

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"...Research under way at veterinary schools at the University of Wisconsin in Madison and the University of Minnesota is helping to provide new insights about CCL ruptures. One study examines the effect of inflammatory arthritis on degeneration of the stifle joint and looks at drug therapy as a possible treatment option. The other study uses gene mapping to potentially identify the gene mutation that causes the condition.

Effects of Inflammatory Arthritis "Our research has shown that the majority of cruciate ruptures in dogs are not associated with accidental injuries," says Peter Muir, BVSC, Ph.D., DACVS, associate professor at the University of Wisconsin-Madison. "We believe that CCL ruptures are secondary to development of stifle arthritis. In the majority of dogs, the rupture is a pathological consequence of joint disease, not traumatic injury.""

http://purinaproclub.com/Dog/ResourceLibrary/BreederEnthusiastResources/TodaysBreeder/639c9127-5f9c-4fec-af28-5cab2b2fdf72/334fbb20-36d4-4c54-af5b-3458d9dc0ad9

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One paper that I read estimated cruciate rupture due to trauma at only 20%. The tibial plateau angle or conformation might play a role but many dogs with a steep TPA do not develop cruciate ligament disease. I witnessed the injury that resulted in a cruciate tear in my dog that has good conformation and it was hardly anything to speak about. This is a common account of many, our dogs shouldn't be tearing their ligaments with normal dog play. The second knee followed almost a year to the day after completely recovering from the first rupture.

In addition to rest, I would use a custom fitted brace to help with joint stability.
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Evaluation of fibular head transposition, lateral fabellar suture, and conservative treatment of cranial cruciate ligament rupture in large dogs: a retrospective study
AE Chauvet, AL Johnson, GJ Pijanowski, L Homco and RD Smith

Abstract

Sixty-one large dogs (weighing 22.7 kg or more) with cranial cruciate ligament ruptures (CCLRs) were treated with either fibular head transpositions (FHTs; n = 22 stifles), lateral fabellar sutures (LFSs; n = 39 stifles), or conservatively (CT; n = 11 stifles) with rest and aspirin. Based on owner evaluation, dogs treated with FHTs or CT did not perform as well as dogs treated with LFSs (p less than 0.05). There was no difference in owner evaluation scores for the dogs treated with FHTs or CT. Thirty dogs were reevaluated by investigators. No differences between treatment groups regarding age, sex, or time until diagnosis were noted. No differences in scores for lameness, stifle instability, or forceplate analysis among the treatment groups were observed. Degenerative joint disease progressed or remained severe regardless of treatment, based upon radiographic evidence.