Degenerative ACL Disease

We found out today that our 4 year old male malamute/GSD mix has degenerative acl disease in both knees. He’s been having some difficulty getting up, yelps with sudden stops, & anything above a 3 mile walk he gets really uncomfortable. His Doctor said that neither is unstable or a complete tear yet. His left knee has the beginnings of some bone spurs as well. He has also had 2 total hip replacements due to severe bilateral hip dysplasia. Aside from TPLO what are our options? We are pretty well versed in ortho rehab, aside from his hip replacements, his GSD sister had both knees done last year.

Hello and thankyou for this excellent question.  Historically there were many surgical procedures available aimed to replace the cruciate ligament with various different materials and methods.  These may still have some uses but were associated with a relatively high failure rate and are recommended less commonly now, especially by referral vets. There is an operation called the TTA (tibial tuberosity advancement) which also alters the angle of the bone, so that the tendons pull on it in a different direction, making the cruciate ligament unnecessary. However, it is up to your surgeon - who should be someone who does these procedures regularly and can actually examine the patient, giving them much more authority than me - to pinpoint the best procedure.  They will have criteria for identifying good candidates for different surgeries.  They can also advise the most appropriate timing for that procedure.  This may be early, as may the introduction of pain relief; almost all dogs already have arthritic change when they are diagnosed and this can affect weight bearing further.  They will help to identify the options that work best for your particular pet. It sounds as though this line of dogs comes prone to orthopaedic problems and looking at the wider picture, it may be that breeding / buying further puppies of this family should be discouraged; cruciate disease is very much an inherited condition, associated with the angle of the hips and femurs that breeders have and are selecting for. I hope that something here might help.  

Thank you for the response! I have every faith in our surgeon… we’re just curious about alternatives to surgery since neither knee is a full tear is there a more conservative approach or is surgery the only option?

Is it necessary to take the dog on 3+ mile walks? Have you tried the leg braces sold online? We were told by our vet that our one dog had a partial torn ACL and would most likely need operation at some point, but using the brace for a few months except for at night when he slept helped heal and avoided having surgery. Somehow I think the ACL wasn't really torn, or very minor. Best of luck to you and your dog.

A study published relatively recently compared dogs that had undertaken surgery to those that had not and found that those that had, were 25.7% less likely to show lameness three months after diagnosis – and 31.7% less likely  after a year.  However, yours is only one dog - and the ability to sit in the successful group rather than the other can be predicted to some extent. The best prognosis goes to dogs that are not overweight, with fewer signs of instability and arthritis (which will develop to a greater extent in dogs that walk around on this injury for long periods).  Arthritis is often, if not always, present to some extent before it happens - and pain relief can be important in order to promote good weight bearing at this time).  There will also be some implication to having damaged both legs - altered weight bearing for one injury will affect the other.  Therefore, your vet will have a lot of factors to juggle in making this call and we would recommend speaking to them as soon as possible to understand their thoughts on this as specific to your dog.  A surgeon who is used to doing this operation should have a good understanding of the prognosis within their own clinic, and factors your dog shows that will affect this.  Wishing you both the best of luck.