One of the biggest growing epidemics in small animal veterinary medicine today is the increasing diagnosis of ACL injuries, also known as anterior cruciate ligament rupture in dogs or meniscal damage of the stifles (knees) of dogs and in cats. When I graduated from veterinary school in 1991, ACL injuries were a rare diagnosis, usually only occurring in certain large breed dogs such as Rottweilers. However, today this diagnosis is rampant across all breeds and ages, costing animal guardians thousands of dollars in surgical fees to address this increasing epidemic.
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While there is increasing research as to the role genetics plays in this disease, other evidence also points to an autoimmune destruction of the tissues that stabilize the stifle (or knee) joint of dogs, which means that these dogs’ own immune systems are reacting against their own tissues and bodies. While most animal guardians and even some vets feel ACL issues are traumatic in origin, genetic, hormonal (i.e low thyroid) and/or autoimmune/immune mediated causes are now considered more likely. |
Again, issues like paying attention to healthy diets and avoidance of pet obesity, appropriate nutritional supplementation, as well as avoiding over vaccinating and overmedicating pets with pesticides all seem like prudent ideas in helping lessen the likelihood of illnesses like this, which in many cases are immune-mediated in response to these stressors in my opinion. While many veterinary surgeons feel early and aggressive surgical therapy with various surgical techniques offers the best options, with animals diagnosed with partial tears, often holistic therapies like physical therapy, prolotherapy, acupuncture, Chinese herbs and homeopathy can often help avoid these expensive procedures in my opinion.
As the stability of many joint diseases originate with nervous system dysfunction of the spine, chiropractic evaluation and treatment can be helpful as well. In fact, I find it quite ironic that animal guardians pay thousands of dollars to have these expensive surgeries performed on their pets (sometimes on either stifles or knees) but most surgeons acknowledge that even with surgery, these pets will develop degenerative joint disease in the future.
Using joint supplements such as glucosamine/chondroitin products like Super Joint Enhancer, fatty acids such as Super Omega 3 from 1800PetMeds, as well as antioxidants such as Proanthozone can all work together in helping strengthen the ligaments of the stifles. All natural white willow bark from taacan also help as natural anti-inflammatories. If necessary, veterinarians can prescribe nonsteroidal anti-inflammatory drugs such as Rimadyl, Metacam or Previcox to ease inflammation. However, it is important if your pet is on nutritional supplements, to make sure that your veterinarian is aware of what you are giving, as on occasion too many supplements and/or interactions with prescribed veterinary drugs can occur. With time, patience and exploration of these various other modalities, many pets with at least partially torn cruciate or meniscal injuries of their stifles may be able to avoid the pain and expense of veterinary surgery.
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8 Comments
While there are many accurate statements in this post, the overall tone and thrust is misleading and partakes of a variety of alternative medicine cliches. There is no sound evidence that vaccination or parasite control has any causal connection to CCL rupture, so mentioning vaccines and “pesticides” is simply trotting out those old CAM bogemen to no purpose. Likewise, though there are immune-mediated diseases that can mimic or co-occur with CCL rupture (such as lymphoplasmacytic arthritis in Boxers), it is not approriate to identify CCL as and autoimmune or immune-mediated disease. Genetics are clearly the predominant risk factor, given the dramatic differences in incidence by breed, and body condition, neutering.
There is no reliable evidence that homeopathy, Chinese herbs or chiropractic have any beneficial effects on the undelrying pathology of CCL disease, and while acupuncture may have some analgesic effects (or it may not, the case is open in dogs), it certainly does not eliminate the need for surgical repair. And the suggestion that spinal disease (a sneaky way of referring to the mythical vertebral subluxation) is absolutely ludicrous. GLucosamine/chondroitin have failed miserably in large-scale, well-controlled human trials to show any menaingful benefit, and the limited research evidence in dogs is not impressive.
All-in-all, this pieces is clearly dominated by the canards and cliches of alternative medicine, which blindly advocates unproven or dispoven therapies supported by anecdote and personal experience, and blithely casts baseless shadows of suspicion on mainstream medical interventions such as vaccination and medication. Our clients expect and deserve responsible, scientific medicine from us as veterinarians, not misleading attempts to sell worthless therapies.
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Dr. Michael Dym, VMD veterinarian Reply:
December 19th, 2009 at 11:09 pm
I will summarize my response in a few sentences. I have 20 years of clinical experience as BOTH a conventional and holistic oriented vet and can tell you TRUTHFULLY, from REVIEWING THE LITERATURE that MOST of what we prescribe and do in every day conventional veterinary medical practice is NOT based on your criticism of holistic veterinary medicine of every day medical practice based on double blind placebo controlled studies. Most of drug use in conventional veterinary medicine is based on trial by error, “clinical experience” or extrapolation from drug use in human medicine, or using drugs like silentrol and certain nonsteroidal anti inflammatory drugs which failed safety studies in human drug trials by the same drug companies . . Hardly the safe evidence based medicine that you, on the other hand, demand that holistic veterinary medicine demonstrate. As for vaccination, according to Ron Schultz from the College of Veterinary Medicine at Wisconsin, and leading vaccine researcher in this country for decades, immunity to core viruses such as parvo/distemper lasts for LIFETIME of animal. So where is evidence/safety of giving yearly or even every three years as condoned by many vets and vet schools?……It isnt there.
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Thank you Christian for your kind comments. We do appreciate them. Certainly spread the word to your friends and family on this wonderful service and information I am happy to provide.
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Just want to say what a great blog you got here!
I’ve been around for quite a lot of time, but finally decided to show my appreciation of your work!
Thumbs up, and keep it going!
Cheers
Christian,Earn Free Vouchers / Cash
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Dr. Michael Dym, VMD veterinarian Reply:
June 6th, 2010 at 8:55 pm
Thanks Christian. Please pass this great resource of information on to your family and friends.
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Wow, it’s really gone on to become an epidemic? That’s insane. The supplement recommendations you give are great Dr. Michael. I’ll be referring a few friends to your suggestions. Thanks!
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Dr. Michael Dym, VMD veterinarian Reply:
September 29th, 2010 at 10:53 pm
You are very welcome. I am glad to help with this frustrating clinical syndrome of ACL rupture in dogs with supplements that can help in healing process.
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My own experience is that dogs with genuine cruciate disease patients respond poorly to nutraceuticals and we are ususally putting off the inevitable. I’m all for medical management if possible but it has not been my experience. certainly, partial tears an be difficult to diagnose and arthroscopy is usually required to confirm. Thes patients can make an excellent and rapid response to surgeries such as TPLO.
best wishes
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Dr. Michael Dym, VMD veterinarian Reply:
October 6th, 2010 at 5:52 pm
Hi Andrew: You are indeed correct about diagnosis and surgical treatment. However in today’s economy many clients cant afford surgery and in the trenches I have seen many pets with partial tears respond fine to rest and anti inflammatories and nutraceuticals. Yes they are more prone to arthritis down the road, but then even surgically treated dogs sometimes develop arthritis as well in these joints. I find many pets with partial tears do returrn to function in many cases but you are correct about ideal treatment.
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Our cattle dog was just diagnosed with a ccl tear and we are considering prolotherapy..what is your opinion? Also what are the effects if it is a complete tear vs. a partial tear, and are there any contraindications if there is no tear? He is currently taking prevacox and will need to stop that and start tylenol if we decide to go ahead with the therapy. Cowboy has been taking DS cosaquin for nearly a year now as we thought the lameness came from his hip. This is not our regular vet who will do the therapy, and I am also going to ask her thoughts on the subject as well. His visit with an ortho recommended surgery…the long recovery had me shaken as he is an active dog, more correctly, he wants to be but can’t be now. Thankfully he’s still a happy fellow. Thank you for any information you can share.
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Dr. Michael Dym, VMD veterinarian Reply:
October 19th, 2010 at 3:09 pm
I am not an expert in prolotherapy being only somewhat familiar with it. I dont think there would be any contraindications if there is no tear if prolotherapy done, as harmless injections into and around joint to promote healing from my understanding.
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My dog Ollie was diagnosed with a ruptured cranial cruciate ligament today. He hurt his leg yesterday playing in the snow. Our doctor (who we do not have a relationship with because we just moved) diagnosed Ollie very quickly and said surgery is his best option because he is only 5 and he could handle it. She gave me a quote of $3100.00 and told me I should schedule surgery within a month because it is possible the other leg will go and they won’t do surgery if both of them have been ruptured. I have been reading as much as I can on this and I have heard pros and cons to the surgery and also pros and cons to a natural treatment. So my question is, would it hurt to give Ollie the opportunity to try to recover on his own before making the choice to do the surgery? Lauren
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Dr. Michael Dym, VMD veterinarian Reply:
February 14th, 2011 at 7:55 pm
Ideally surgery is the best choice as early correction of this condition lessens the amount of future arthritis and degenerative joint disease. However in my experience and opinion, I have seen some dogs, particularly small dogs respond well to rest and anti inflammatory and supplement therapy. Many pets will regain function over time, however there is an increased liklihood of more severe joint disease down the road. I would give it 4-6 weeks of rest and supportive care and see if any positive change. If not then you can always go for surgery. Also may help to get second opinion from vet in your area, preferably a veterinary surgeon.
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Hi, my 85 lb lab tore his ACL 6 weeks ago. Our local vet said to rest him up and see how he does. He actually got to the point where he had no noticable limp, doing VERY well on conservative Management. Then 3-4 weeks into Cm we had an “opps” moment with him and another one of our dogs. he could not put any weight on leg. He saw another vet(ortho surgeon) who of course said he needed surgery.(TTA) We are still doing CM while i continue to research and he is doing much better, weight on leg sometimes.I have decided if we do surgery i wont do TTA, will go with the old school fishing line traditional. I just can’t get around the breaking bone to repair ligament if there is an alternative. He has been on a great glucosamine supp(syn-flex) fish oil, vic c, msm, hyrolanic acid, homecooked diet to monitor his weight which has gone up due to confinement. How long can and should i continue with CM (if good results contine) before i decide to go with surgery? I hate to go 6 months on CM then end up having to do surgery anyways and then we have 6-12 restricted activity. My understanding is arthritis will occur wether i have surgery or not. I am also getting him the A Trak Brace which i have heard great success with (most who didn’t like it had a problem with fit and the company has a crappy return policy) any thoughts?
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Dr. Michael Dym, VMD veterinarian Reply:
April 10th, 2011 at 8:43 pm
I would usually give CM 4-6 months. If no improvement by then then surgery would be needed. ..Also consider yucca intensive by azmira from 1800petmeds as well as myristin and myristaid by EHP products.
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