Recognizing and Treating an ACL Tear

THE COMEBACK KID… another BlueBerry Story
… Recognizing and Treating an ACL Tear…

Submitted by: Barbara Claxton and BlueBerry (Headlines Rhapsody in Blue)

It’s November 2005 and life is good. BlueBerry has been in full remission from her SLO (an immune disease that attacks the nail beds) for 9 months. We are doing herding and agility again going to classes and going to Trials and having fun. My “flying machine” is up and running again.

Then I notice that the day after an agility class she seems to strain a little when she gets up but she’s running jumping and healthy so I don’t think it’s a big deal. It seems to disappear or maybe it hasn’t and maybe I’m just looking for trouble.

Blueberry herding before her ACL injury

Blueberry herding before her ACL injury

Hmmmmmm did it look like one of her back legs gave out when she made that turn while herding? No…it was probably just slippery ground. She seems fine today, but then again did I see her straining to get up?

I started to watch her more closely and it seemed that on days after agility practice she had a harder time getting up but as the day wore on it seemed better — maybe she’s just getting older? Why am I always looking for trouble!

Or am I looking for trouble or just not wanting to see something that doesn’t look right? Does she not want to jump into the van because she doesn’t want to go? Or, is it a problem jumping up? Finally one day after herding practice she comes off the field holding up her right back leg… I help her up into the van.

First we go to our regular Vet who says any time a dog holds its leg up the way Blue is doing its usually an ACL (anterior cruciate ligament) tear BUT her back seems a bit tender so maybe it’s that. The suggestion is that she be given a pain medication and rested for a week, then back into action to see what happens.

What happens shortly after the week of rest is that she continues to not want to jump into the van and seems to be lifting her leg going up stairs rather then walking up as she would normally do.

Luckily we have one of the best Orthopedic Surgeons in the San Francisco Area just 10 minutes away so off we go to see Dr. Andrew Sams at his Clinic in Mill Valley, CA. After a full set of x-rays he suspects a small ACL tear. (The cruciate ligament is a large, strong ligament located within the knee joint.) He suggests another 3 weeks of rest with only slow on leash walks. At the end of 3 weeks, start to bring her back and let’s see what happens.

After 3 weeks she seems pretty good. We go off to a herding trial. Though the following part of the story may seem off topic it is integral to Blue’s ACL story…really.

BlueBerry is walking and running and moving great and is entered in AKC Advanced at a trial site that uses Belgian Sheepdogs to set the sheep.

I sent BlueBerry just as the Belgian Sheepdog left the arena… HOWEVER… just as Blue took off the Belgian decided to move back in amongst the set out sheep. BlueBerry does a beautiful outrun and lifts the sheep and is about to bring them to me when she realizes the Black Sheep is really a Belgian Sheepdog!

She was so mad… I’ve never seen her so angry. Never at a loss to express her opinion to me she left the sheep and came running to me jumping up in my face and barking and twirling (as only a Beardie can do) and jumping and jumping and jumping. She let me know in no uncertain Beardie terms that she did not think finding that Belgian in with HER sheep was the least bit funny. I’ve never seen her so furious. I called the run and walked off with her trailing my steps still jumping and barking in my face.

Later that night, it was very evident that the jumping had caused a problem as she again had difficulty getting up, but she was not limping. We went back the next day and she was working nicely, but I was so preoccupied and worried about her that I called the run even though we were qualifying when I thought I saw her favoring that leg.

After that she would not jump up into the van. Home we went and back to the Orthopedic Surgeon for another review. Now he was sure… the small suspected tear was now a full ACL tear.

BlueBerry’s experience may not be typical in that in the beginning she seemed to have a problem and then didn’t. In talking with Dan Landiss of St. Louis, Missouri about his Beardie, Misha, who also had an ACL tear, he said what he first noticed was limping and Misha being reluctant to climb into the back of the car.

Shortly after the experience at the Herding Trial we went back to see Dr. Sams. The diagnosis was early right partial cruciate tear. Dr. Sams explained that the consensus is that larger dogs do better with TPLO (tibeal plateau leveling osteotomy) surgery rather then the traditional surgery, which involves placing either heavy gauge suture material or orthopedic wire from the back of the femur, across the joint, and to the front of the tibia. This will tighten up the joint and stabilize it. Over time, scar tissue will lay down around the suture or wire to form a structure which mimics the function of the normal cranial cruciate ligament*. The majority of animals will regain normal or near normal use of their leg after the surgery and after a period of rehabilitation. (*N.B. The term anterior cruciate ligament is actually referring to human anatomy, and cranial cruciate ligament is the correct dog term, however, ACL tear or rupture is the term most commonly applied to this problem.)

But for large and especially active dogs TPLO surgery is recommended. TPLO surgery actually changes the slope of the knee and eliminates the need for the ligaments altogether by changing the angle of the knee and stabilizing it with special bone plates — this surgery is preferred for canine athletes. So, we schedule surgery for BlueBerry.

BlueBerry had successful TPLO surgery on March 1, 2005. She came home the next day with pain medications and a request to call if she seemed uncomfortable along with clear instructions for her Postoperative care… part of which was that she was to be crated at all times that I did not have her with me on a leash.

This was really a concern for me as BlueBerry had never been crate trained and was not fond of them. But, and why I should be surprised about this I don’t know, she accepted this change and every change along the way as though she completely understood what was necessary. Starting with the first 2 weeks where she was only allowed to walk to the yard on leash to potty…no vigorous activity!

After 1 week we were back to the Vet to have her bandages removed. The following week we went back to have the staples removed.

Starting with week 3 to week 6 she was allowed 3 – 5 minute walks 3 times a day. She moved slowly and limped from time to time but gradually less and less. All other times she had to be by me on leash or crated. Keeping sisters Sadie and Allie out of the way and at a distance was not easy. Sadie especially had a very hard time with the separation and was very sad. Usually the walk time is increased quicker than this but in Blue’s case Dr. Sams felt she needed to take it slower due to her compromised immune system as well as the conformation of her stifle.

Weeks 7 and 8 her exercise was moved up to 2-3 ten minute walks a day. By this time she was quite enjoying them, having trained neighbors to come out and say “Hi” as she passed or offer a cookie. I could see that as much as she disliked this idea in the beginning she would be bugging me for neighborhood walks from now on.

At week 8 we went back for x-rays and evaluation of progress and I was excited about the possibility of her starting physical therapy but instead DEVASTATION! The x-rays showed she was not healing. It could be 1 of 2 things or possibly both — the medication she was taking for her SLO, which was still at a high dose, might be interfering or she might have an infection.

We decided to do 2 things at once as getting that healing started was crucial and trying one thing and if that didn’t work having to take the time to try another did not seem wise. So I dropped Blue’s SLO medications down to a minimum maintenance dose. My idea was that if she had a flare up it would be painful but I could always get her SLO back into remission once the bone was healed. We also put her on antibiotics for the infection, and scheduled another x-ray in about 2 weeks.

Two weeks later the x-rays showed she had started to heal… I could breathe again.

A few weeks later we started physical therapy.

BlueBerry’s progress to this stage was very slow and I am sure that could be attributed in a great part to the SLO.

On the other hand Beardie Misha’s surgery and recovery went “by the book” according to Dan: “For a couple of months stair climbing was limited to the 3 steps required to reach our yard. We walked, first only in our own yard, later increasing length and distance. By 10-12 weeks post-op he could do the carpeted stairs to our second floor and walk about a mile. As of about 8 months post-op he can run, chase squirrels, and we walk about 3 miles a day.”

Also according to Dan, Misha (who was 6 at the time of the surgery) tends to sit with the “bionic leg” toed out at a strange angle, but his surgeon says it is a normal reaction and he is just seeking the most comfortable position.

Dan also says that “I credit Misha’s success to his excellent Surgeon. She was very clear in her explanations of what was going to happen and what must be done post-op to ensure recovery. I cannot emphasize too much the importance of the surgeon and the pet owner working as partners to plan and implement the dog’s recovery.”

Since I had hoped that Blue would get back to working with her sheep again I decided to go the physical therapy route since the facility was almost at my front door.

During those early days of recovery the first exercise and the very best is swimming and the facility has a great swim tank. For BlueBerry, however, by the time she was ready to exercise she was passed this period and ready for weight bearing exercises so that’s where we started.

The minute we walked in and BlueBerry saw what looked like fun agility equipment to her she brightened up and you could see how happy she was to be back getting treats for “performing”. It was obvious that the work was hard for her and though she was happy to be there she did not have her old pizzazz back.

We started out with balance work on large balls that made her incorporate the surgery leg into keeping on balance. We did turns around cones and the treadmill and worked our way up to all different kinds of balance equipment. She was eventually allowed to do low jumps on agility equipment and running and sprinting on the treadmill. We then worked our way up to doing fast weaves through regular weave polls. Since she’d been in agility this was natural and fun for her. This happened over a series of several months.

Introducing Blueberry to the treadmill

Introducing Blueberry to the treadmill

About 2 months into doing the physical therapy, as we were walking in for a session I noticed that old “Beardie Bounce” I hadn’t seen for a while and it was clear that my BlueBerry was back and ready to go…it was very obvious that she had made the shift from recovering to recovered!

I think that because of the extensive physical therapy that we did, Blue does not sit with her ACL leg out, but tucks it under her almost the same as her normal leg. I have to think what leg it is that had the surgery.

We were finished with physical therapy and Blue was given the OK to do whatever she wanted…including back to working sheep…so now it was up to BlueBerry to decide if she wanted to go back to working her sheep or not.

Blue had made no indication that she had any interest. Had not pulled to the gate, had not watched the sheep and had not made the AHHHHHOOOOOEEEEEEEEE sound that was so sad when I took Allie off to practice. In the past I’d hear that long and loud if I took one of the other girls and not her.

I decided to try her out in a beginning area with very quiet sheep and though Blue followed commands it was obvious she was very concerned and very, very unhappy to be there so I cut it short. Obviously she had lost interest or was not ready. The Vet had said that since the leg would “feel” different some dogs are always conscious of it and don’t like to push off of it. Blue had no confidence that she could cover the sheep. Without confidence she couldn’t work. I decided to use Blue’s enthusiasm for agility to re-train her brain to accept this new “feeling” in her leg as the new normal and see if that would help.

I set out 2 agility jumps side by side and had her go over one turn and back over the other. In the beginning her enthusiasm kept her from thinking about her leg but initially after 2 or 3 jumps I could see she was beginning to catch on so we’d go on to something else then come back to it. Eventually she was as happy doing these U turns as everything else and no longer thought about it.

About this time she also started “flying” again…pushing off at the end of the hallway over the heads of Sadie and Allie onto the bed (a good 6 feet away) and around and back again. When it came to playtime she was totally the old BlueBerry. She was obviously very happy so I was as well.

Then one day when we went to herding practice and I took Allie out to work I heard

There it was that terribly baleful sound that told me she was ready to go back to work. We started out slowly just moving sheep around and are taking baby steps to get back to where we were. Whether BlueBerry will get back to trialing in Advanced again or not is up to her…I know that she will clearly let me know what her plans are.

For me… I’ve reached my goal… my Happy Flying Machine is back.

Blueberry herding after ACL repair and rehabilitation

Blueberry herding after ACL repair and rehabilitation

As Dan Landiss mentioned picking the right Surgeon can make all the difference. BlueBerry and I could not have asked for anyone better then Dr. Andrew Sams who was always just a phone call away along with the support of his Physical Therapist and Staff.

So, BlueBerry “The Comeback Kid” is up and running yet again!