If your dog has a cruciate ligament rupture or partial tear, you may be wondering about treatment options. Dr. Susan Davis—internationally recognized author, physical therapist for animals, and friend of Dr. Julie Buzby—shares from her decades of experience how you can support, advocate, and make the right treatment decision for your senior dog.
Without a doubt, ruptures of the cranial cruciate ligament account for the majority of my physical therapy caseload at any given point in time. Why are there so many?
My theory involves the indoor lifestyle we shifted our companion pets, particularly dogs, toward, the past four decades. Add to that, more human work hours, less time for the owner to take their dog on leash walks, plus a shift from the use of indoor carpeting to smooth, hardwood, and tile flooring.
Back in the 1930s to 1970s, most dogs lived outdoors and spent their time on grass and dirt, not jumping on and off furniture onto slippery surfaces. Cruciate ligament tears were rare. Fast forward to the present day. Most dog owners are acutely aware of the cruciate ligament, though they may know it as the “ACL.”
What is the cranial cruciate ligament in dogs?
The equivalent to the human being’s anterior cruciate ligament (ACL) is the dog cranial cruciate ligament (CCL). It is a band of fibrous tissue located in the dog’s hind legs at the knee (stifle) joint. The ligament provides inner crossover stability to prevent forward slippage of the shinbone (front of the tibia), relative to the long thigh bone (femur).
Though we have this ligament in common with our canine companions, theirs ruptures much differently than ours. The upright, two-legged human gait is less susceptible to ACL ruptures with normal activity. A person’s ACL ruptures swiftly and completely from trauma and sports-related injuries.
The dog’s CCL is subjected to different biomechanical forces in their down-on-all-fours gait along with a slightly different shape and angle of the tibial plateau. Running, turning, and sliding on slippery surfaces cause gradual wear and tear of the dog’s CCL. It begins to stretch, tear, and slowly degrade. Sometimes it tears fully, called a rupture. Other times it tears only partially. In both cases, compromised stifle joint stability leads to injury to the meniscus (the cartilage shock absorber) and arthritis.
What are the signs of a cranial cruciate ligament tear in dogs?
The first outward sign of cranial cruciate ligament damage is lameness. The dog may either hold the limb up completely or put only partial weight on it. We call this toe-touching. The dog begins to shift its weight onto the other hind limb. That is why a dog with a ruptured CCL has a 25 to 50% chance of tearing the other hind leg’s CCL within 12 to 16 months!
The key to recovery from the rupture (and prevention of the other side tearing) is rapid timing of diagnosis and intervention. Getting started right away promotes early healing, can help prevent full rupture, and reduces the risk of the opposite side tearing.
How is a cranial cruciate ligament tear diagnosed and treated?
Early diagnosis of CCL tear is imperative to your dog’s future health. If your dog is limping or holding up a limb, do not delay in making a veterinary appointment.
Diagnosis of CCL rupture happens through observation, the performance of a drawer test, a radiograph (X-ray), or sometimes an MRI. The drawer test involves the veterinarian or physical therapist placing their hands around the dog’s stifle joint, using a gliding motion used to test the “tightness” of the ligament. A ‘positive drawer’ or ‘cranial drawer sign’ means the ligament is too loose and ruptured (completely torn) or has merely a partial tear.
If your dog has a ruptured CCL, surgical correction followed by rehabilitation is the best form of treatment. On the other hand, your dog might not need surgery if the CCL is partially torn. Partial tearing of the cruciate ligament presents various treatment options.
It’s important to weigh the pros and cons of surgery in terms of a dog’s size, health status, activity level, and lifestyle. Surgery requires recovery of at least 12 to 16 weeks. Smaller (less than 22 pounds) and leaner dogs tend to manage better without surgery than their larger or overweight friends do. If your dog has a partial cruciate ligament rupture but is standing and walking on the limb, non-surgical treatment options may be reasonable.
11 non-surgical treatments for dogs with partial cruciate ligament ruptures
Here are 11 non-surgical treatments for dogs with partial CCL tears and also dogs with a full cruciate rupture that cannot have surgery for reasons such as advanced age, medical risk of undergoing anesthesia, bleeding disorder, seizures, or financial constraints.
1. Rest and activity restriction
For the next six weeks, plan to reduce the length and intensity of walks and possibly crate or confine your dog several hours per day to allow for healing. Playing or rough housing with other dogs is off limits for a few weeks. Your veterinarian will help you understand what degree of exercise restriction is right for your dog.
2. Medications
Your veterinarian may prescribe anti-inflammatory and pain medications.
3. Ideal body weight
Ask your vet or physical therapist to assess your dog’s body weight compared to normative values for the same age and breed. This is called the body condition score. Check to see if a ‘waistline’ is visible while standing over your dog, looking down at their body shape, and feel if the ribs are easy to find or if a heavy layer of fat makes it difficult to feel them. If your dog is overweight, start a weight loss plan right away. An obese or overweight dog is predisposed to a cruciate ligament rupture or tear.
Get started now discovering your dog’s canine body condition score.
4. Healthy diet and supplements
Keep your dog’s diet lean: provide healthy treats, plenty of hydration, and supplements for anti-oxidant control of inflammation. Ask your veterinarian whether additional senior dog supplements for cartilage support or omega-3 fatty acids for joint inflammation may be helpful.
5. Physical therapy using cold laser for 6 to 12 sessions
A common question I hear is, “Will cold laser help grow a new ligament or reattach the torn ligament?” Unfortunately, the answer is no.
Cold laser therapy for dogs will not regenerate a new ligament or reattach the torn portion of the ligament. But it should help reduce joint inflammation, swelling, and pain. It may also help in the process of scar tissue formation as the body tries to stabilize the joint.
6. Electrical stimulation
Electrical stimulation uses various forms of electrical current delivered through lead wires which are attached to sticky electrodes placed over the stifle joint and thigh. This treatment helps blood rush in and nourish the ligament and surrounding anatomical structures, relieves inflammation, reduces pain, and assists weakened muscles to contract and strengthen.
7. Massage
Using the palm of your hands in a flat position, massage the sides, front, and back of the dog’s knee in circular directions with light to medium pressure.
8. Passive range of motion exercises in dogs
Gently bend and straighten the stifle (knee) and hock (ankle) joints, using your hands, and do not go beyond the scope of natural movement currently available.
Learn more about passive range of motion exercises for senior dogs.
9. Underwater treadmill
Underwater treadmill or swimming water therapy provides a safe buoyant medium to strengthen the limb while undergoing restriction of normal walking activity.
10. Braces
External stability provided by a brace or soft support helps speed the healing process and supports the joint during activity. Dog CCL braces are an alternative to surgery in many cases though inferior to surgery for a complete rupture of the CCL.
Braces are available in prefabricated or custom forms. Custom braces require casting the dog’s hind limb and sending the removed cast to a certified orthotist for precise molding of a brace specific to your dog. Custom braces are more expensive than prefabricated types but provide superior support.
11. Regenerative medicine
Stem cell transplant injections and platelet-rich plasma (PRP) injections are emerging as alternative treatments for non-surgical management of partial cruciate ligament ruptures in dogs. However, they are invasive, expensive, and lacking firm evidence of long-term outcomes on ligament healing. Stay tuned as more research is performed.
Back on the move in no time
If your senior dog is hobbling around, the first course of action is to pay a visit to your veterinarian. Then, diagnosis in hand, you can consider all your options both surgical and non-surgical. Ask as many questions as you need to and never forget you are your dog’s advocate and voice.
With the expert care of your veterinarian and support from your dog-loving friends and family, your senior dog will be back on the move in no time.
Has your dog had a cruciate ligament rupture?
Share your experience so we can learn together what worked and helped your canine companion the most!
Our 4 1/2 year old boxer lab cross has just been diagnosed with partial tears in both hind legs. Surgery was suggested, but is priced at $6500 per leg! We can’t afford that. I don’t know how people find surgery for $2500 or less. We have her on NSAIDS and are giving her weekly injections of cartrophen. We are limiting her activity to walks, but the poor pup is a very active dog and is not enjoying this at all. In the summer she swims in the pool, but it is in the middle of winter now, and no playing in the snow for her. Any suggestions regarding rehabbing her at home?
Hi Lee Anne,
I am sorry your dog is having issues with both knees at the same time! Rehab is a great idea and should be able to give your pup a better quality of life. There are definitely some exercises and therapies that can be done at home, but without examining your dog myself, I can’t give you specific recommendations. I wouldn’t want to suggest an exercise that may do more harm than good depending on the details of your pup’s specific situation. Your best bet is to find a rehab vet in your area and schedule a consultation. They can guide you through the recovery process and let you know what treatments will be of most benefit. Your sweet girl is lucky to have you advocating for her health and well-being. Keep up the good work!
I have a 3-yr-old pit/boxer mix. At age 2, she had a partial tear of her ACL. Over a 3-4 month period, she had heat therapy and physical therapy, joint supps, and she ate lots of sardines in water, meat, veggies, etc. I had a soft knee brace on her leg and took her for short walks hoping she would heal without surgery. She did not. As a larger dog at around 60 lbs, She had fibular transposition surgery and healed well, but as soon as she healed, she got a partial tear on her other knee! Vet said at her young age, it was most likely genetic. She recently turn 3 years old and had surgery on leg 2 four days ago. The first vet charged $2500 for the ACL surgery. I found a different vet to do the same surgery on leg 2 and he charged $1000 less! It included 3 prescriptions and everything needed for the surgery along with one night’s stay at the vet. She has always been very high energy but her meds make her drowsy so she rests alot right now. She is on the mend and will get her staples out in 10 days. On her first knee surgery, it took about 5-6 months for her to completely quit limping and to heal completely. I suppose it will be another 5-6 months to recover from her recent surgery. In my opinion, the soft knee braces help some with stability, but I would recommend that larger dogs have surgery and don’t mess with trying to heal the ACL without it. Hopefully my dog will last another 10 years with no more knee troubles. I got her to hike with me, but will most likely not be taking her out on trails with hills & valleys as I believe it may be too hard on her knees as she will be developing arthritis. Plus I don’t want to risk any problems, so I will keep her on shorter walking trails and walking on pavement at the local park and around the neighborhood.
Hi Linda,
I am sorry your big girl has had so many issues with her knees. What a blessing you were able to get them both surgically corrected and give your pup a better chance for a bright future. I hope the recovery is going well and she will make a full recovery. Thank you for sharing your story and experience with our readers. I am sure this will be extremely helpful to someone else in a similar situation. Bless you and your sweet girl.
I have a 4yr old female German Shepherd with a Partial ACL.. This happened in March 2022.
Kept her “quiet” and on leash in large backyard for 8weeks. She is on Joint Max and Omega3 pills daily. She presently, as appears to the vet , is putting most weight on her leg. She is mostly an inside dog (her choice), does not appear to be in any pain. She has a carpeted den, orthopedic bed, does not get on furniture and LIGHTLY plays with a ball at any chance. No throwing any distance where she has to run to get the ball and certainly no jumping. Mommy and Daddy do not walk her in the neighborhood due to their elderly age. On last vet visit for annual checkup he felt a little “grinding” and recommended we take her to surgeon for evaluation. Does she sound like physiotherapy and not surgery.? Really do not want surgery. Have appointment in 22 days. Really want to see what you say.
Hi Charles,
I understand your concern for your Shepherd and the want to avoid surgery if at all possible. I think physical therapy is always a good idea, with or without surgery. But I don’t like the thought of “grinding” in the joint. Your girl may be more painful than she is letting on and surgery might be the best option. My recommendation is to wait and see what the specialist says. Make sure you are honest about your wishes and let them know you would rather not pursue surgery if possible. This way you can get the information you need to make the best decision for you and your sweet girl. Praying for a positive outcome. Keep me posted!
My 5 year old English mastiff partially tore her ccl. We are trying medical management first before opting for surgery. She’s on an anti inflammatory and pain med and she’s confined to a small area. I was wondering if it would be best to have her injured leg straight or bent while she’s laying down resting. Also, how often should you keep a brace on it?
Hi Elizabeth,
I am sorry your big girl has injured her knee. I hope the medical management will be enough to get your dog back to normal function and avoid surgery. I don’t think leg position while resting makes much difference. The things that we are trying to prevent are internal rotation and the bones sliding in an unnatural way while weight bearing. I am not a huge fan of braces but realize they can play an important role in the recovery process for certain specific cases. I highly recommend you schedule a consult with a veterinary rehabilitation professional. They can let you know if a brace is a good idea and help you find one that is the best fit for your pup. Also, they can recommend exercises and other therapies to help reduce inflammation, control pain, and promote healing. I hope you can find the right combination of treatments to give your sweet girl the best quality of life. Praying for a complete recovery.
my 2 year old golden retriever injured his hock, the vet said he might have torn or partial torn his ligaments, he did an xray and didn’t find anything and manipulated the joint he heard some clicking and was abit loose. The first day of the injury he held his feet up and occasionally back down. the second day he was walking and putting weight on it with an occasional limping. Now it been a week he is walking on it and tries to run and get up the couch and bed and acting completely normal with some limping here and there. What is the best course of action. should I completely rest him with no activity at all or should i take him swimming and short gentle walks? what is the best course of action to help him heal
Thanks
Hi Mo,
I am sorry your young golden is having issues with leg pain from this recent injury. Since I haven’t personally examined your dog, I can’t make specific recommendations. Your best bet is to have him evaluated by a veterinary rehabilitation professional. They can let you know if his current condition is normal for his stage of healing or if some intervention is needed. Ideally, rest would be the best idea during the first stages of recovery. As a dog progresses toward regaining more function, short gentle walks are best. Although swimming is good because it doesn’t require the dog to bear weight on the affected limb, it also doesn’t allow a full range of motion for the joints. Walking uses more of the normal range of motion than swimming. Jumping is probably not a great idea depending on how much inflammation is in the injured joint. Your vet should be able to help guide you in this recovery process but may need to re-evaluate your pup. I hope your sweet boy makes a full recovery and can get back to living his best life. Best wishes to you both!
My dog has a cranial cruciate ligament tear. Would casting the leg to immobilize the ligament help in the healing process if surgery is not an option rather than a brace?
Hi Camille,
The goal of medically managing a cruciate tear without surgery is to reduce inflammation and pain. The ligament itself does not really “heal” as ligaments have a very poor blood supply. Unfortunately, while casting would immobilize the leg and help reduce inflammation, it will also immobilize the muscles. If the leg muscles are not being used and cannot flex and extend in their normal range of motion, they will start to atrophy and become weakened. This is similar to what you see with people after a cast is removed from a broken arm or leg. For this reason, a cast is not a good option for dogs with a cruciate tear. I hope you can find a treatment that works for you and your dog. Best wishes!
Thank you for your informative blog and advice. My dog had a partial ligament tear around 8 months old. He was jumping off the couch when he began holding his leg up. They are a very active and athletic dorkie (half dachshund and half Yorkie). Loves to fetch balls and to play frisbee at the park each day as well a tugging on his flirt pole on our tile floor. After the initial injury was evaluated he was on crate rest for a month and started to improve but his limp still returns occasionally after he has been very active. Sometimes after tugging or park visits. They said it could just be arthritis from the initial injury and that full healing could take several months. Besides taking him to a chiropractic vet and getting a second opinion on wether surgery is necessary there have been no other treatments recommended. It will be almost a year since his injury next month and we are wondering what else we should do. He’s doesn’t appear to be in pain and will hold his leg up off and on after too much exertion/exercise. Then once he rests he is fine again. Would water therapy help or should we get him reevaluated again (maybe with an MRI this time) as they only did an x-ray and physical exams initially?
Hi Julie,
I am sorry your pup is having ongoing issues with his leg. I do think it would be a good idea to have him evaluated by a veterinary orthopedic specialist. Although it isn’t impossible, it is rare for a dog to tear a cruciate ligament at such a young age. It makes me worried that there could be other issues at play that might not have been apparent when the first diagnosis was made. Scheduling a consult with a rehabilitation veterinarian would be a good idea as well. They could give you some suggestions of exercises to do at home that can help strengthen the affected joint and help reduce inflammation. They may even be able to prescribe a medication on supplement that would be of some benefit. I hope you can find the help you need to allow your little guy to live his best life. Best wishes and good luck!
Thank you so much for your response and advice. I’m wondering too if it’s another issue. I should have mentioned we got a second opinion from another vet, who supposedly specializes in orthopedics when exploratory surgery was mentioned as an option with our initial vet. They recommended more rest and possibly physical therapy but only did a physical evaluation and hinge test. I think I need to advocate for further diagnostics. We will be returning to this vet for another re-evaluation soon and starting physical and water therapy. Thank you again!!!
My 6 year old male Pembroke Welsh Corgi has just been diagnosed with a partial tear of his cruciate ligament – I don’t know if caudal or cranial. No diagnostic imaging was performed. The recommended plan is a month of rest and then physiotherapy. Our vet also put him on a Meloxicam product for a week. During this period of 4-5 weeks of rest would heat or cold compress treatments of the stifle be of value if I performed them for him? Also when I take him back for re-assessment in a month should I ask for any diagnostic imaging to be done?
Another concern is about the likelihood of recovery to the point where he can continue the performance sports he is involved in.. He is a fit and very rambunctious boy who is also very active in a variety of dog sports.
Thanks for any advice you can share.
Hi Ellynne,
I am glad to hear your Corgi just has a partial tear and has avoided surgery for now. I am also happy to hear that physiotherapy is in the treatment plan for the future, but your dog could probably benefit from some rehabilitation therapy during his weeks of rest as well. Cold compresses are great for reducing swelling and inflammation during the first few days after the initial injury. After the inflammation has subsided, warm compresses are good to increase blood flow to the injured tissues to promote healing (laser therapy does this too). Your vet will probably evaluate how well your boy has responded to his treatment and then decide if imaging is needed or not. There is a good chance that your pup will return to normal function, but I have some concerns about performance sports. Make sure you let your veterinary rehabilitation specialist know what his performance goals are so they can either tailor his treatment plan to reach these goals or advise you if the goals are not attainable. I wish you both the best for a happy future and hope your sweet guy has a quick recovery.
My 15 week old puppy has began limping. We took him to the vet and she said he has damaged his cruciate ligament, she didn’t say if it was a tear or anything and I asked but she said she couldn’t tell on the X-rays. However she did say there was abnormal movement in the limb and she could see possible small onset of arthritis around the limb.
But he seems extremely energetic, his limp is on and off and doesn’t happen 24/7. He doesn’t cry about it, nor does he moan when I touch it ect.
I have been told to put him on bed rest and they have said he should have surgery and laser treatment. But I am on the fence about spending all the money when he seems fine.
What should I do ?
Hi Romana,
Sorry to hear that your puppy may have damaged his cruciate ligament. We typically see ACL tears in adult dogs, so he is quite young. It can definitely be difficult to know what to do in these situations. Dogs can be very good at hiding their pain and many of them don’t cry out or whine even when they are in pain. If he is still limping sporadically, that tells me that there is still something going on with the leg. Perhaps the best course of action would be to seek a second opinion/recheck with a different vet or with an orthopedic surgeon. They can examine your pup and look at the X-rays (which I can’t do) so they would be able to give their opinion on what they think is going on now and what the best plan would be. I hope you find some answers for your pup!
My dog has a full tear about two years ago and we had corrective surgery on it right away. Now he’s 12.5 and his other leg us bothering him. I don’t think surgery at his age is a good idea..? What do you recommend to maybe just try and maintain?
Hi Sharony,
Sorry to hear that your dog had one ACL tear a few years ago and is now facing some pain in his other leg. The first thing I would suggest is a trip to the vet to see if he does indeed have a partial or complete tear in his other ACL or if he actually has a different orthopedic problem in the leg (such as arthritis in the hip). Odds are probably pretty high that it is his ACL since many dogs do end up tearing both, but it is always good to get a clear idea of what condition(s) you are trying to manage. If he does have an ACL tear, it may be worth discussing the pros and cons of surgery with your vet. An older dog who is otherwise healthy and has normal bloodwork can still safely undergo anesthesia and surgery in many cases, so the number of birthdays he has had doesn’t automatically mean he can’t/shouldn’t have surgery. I talk about those decisions more in my blogs (Is My Dog Too Old for Surgery? and Is My Dog Too Old For Anesthesia?).
In general, when trying to manage orthopedic problems in my patients, I like to ensure they are a good body condition score (Your Dog’s Body Condition Score (BCS): Find Your Dog’s Number in 3 Easy Steps), and consider joint supplements such as Encore Mobility (learn more in The Best Supplement for Joint Pain in Dogs Is Not Just About Joints…). ensure they have a nice comfy bed to lie in, continue low impact exercise (with your vet’s blessing) to maintain muscle mass, and most of all, also seek and follow the advice of your vet since he/she knows your pet well. Hope you are able to get some answers and find some good solutions for your sweet pup!