Poodle Sleeping On A Sofa

Non-surgical options for CCL ruptures and tears

When is a non-surgical treatment for CCL recommended?

If your dog has a rupture or sprain in their CCL (read more here), surgery is typically the fastest way of returning your pet to an active lifestyle

But surgery may not be the best option for you or your pet.  Non-surgical management may be recommended in the following scenarios:

  • Concurrent medical conditions that preclude anesthesia or surgery, examples:
    • Severe anemia
    • Severe neurological conditions
    • Kidney or liver failure
    • Terminal cancer
  • Dogs and cats weighing less than 20 lbs
  • Geriatric and sedentary pets

There are no long-term studies showing that non-surgical management of CCL ruptures can guarantee that your dog can always avoid surgery. But there are many studies that document the progression of arthritis in a cruciate-deficient (unstable) stifle joint.

What does non-surgical treatment involve?

There are 2 main goals of non-surgical management of CCL tears:

  • Protect the cartilage (minimize arthritis and inflammation)
  • Strengthen the muscles supporting the stifle.

The ultimate aim of this management is to optimize your dog’s quality of life, functional abilities, and avoid surgery. However, non-surgical management can be challenging in terms of activity restrictions and avoiding situations that could lead to complete rupture of the CCL or exacerbation of ongoing arthritis.

CARE Recommends:

  • Adequan:
    • This is a joint supplement that has been shown in studies to minimize the breakdown of articular cartilage, decrease inflammation, and decrease pain associated with arthritis.
    • Adequan is given as a shot under the skin or in the muscle twice a week for 4 weeks and then once a month.
  • Dasuquin: 
    • This is another joint supplement that contains glucosamine, chondroitin, and avocado-soybean unsaponifiable (ASU).  These compounds, when used together, have been shown to decrease arthritis in studies of dogs with CCL tears.
    • NOTE: We recommend this product over other generic versions of glucosamine/chondroitin since there is clinical research to support this product and the lack of regulation of this type of supplement means that some generic products do not actually contain the optimal amount of therapeutic compounds.
  • Laser:
    • Therapeutic laser (also known as “cold laser”) has been shown in studies in people and lab animals to decrease inflammation and pain associated with arthritis.
    • Dr. Kirkby Shaw uses laser therapy in the management of CCL ruptures to decrease inflammation in the joint and to treat secondary muscle tightness or trigger points.
    • NOTE: Laser therapy is not expected to heal the CCL tear.
  • Ice:
    • If tolerated, we recommend ice packing the knee joint (stifle) for 20 minutes after walks or exercise. Ice is a very powerful and natural anti-inflammatory technique.
  • Therapeutic exercise: 
    • We recommend a series of exercises that are aimed at strengthening the hamstrings and other muscles of the back legs as well as “core” stabilizing muscles.  A specific plan will be developed for you and your dog that incorporates leash walks, home exercises and in-clinic therapy including under-water treadmill. Approximately 30 minutes/ day should be devoted to therapeutic exercise—either at home or in a rehabilitation facility.
  • Activity modification:
    • Your pet should not be allowed off leash for 3 months. 
    • This means no running, jumping, playing or dog-park trips!
    • Leash walks of gradually increasing duration will be recommended, including uphill walking.
    • Swimming is not recommended unless it is done in a rehabilitation setting (no open water swimming).
    • The return to activity following this initial period will depend on the severity of the CCL rupture (partial vs complete) and response to therapy.