Dog Breed Info Center(R) DBIC

Bruno's Second ACL Ordeal: Corrective TPLO Left Knee—11 weeks on...

Anterior Cruciate Ligament (ACL) rupture/tear in dogs

11 Weeks

Bruno's left leg, which was operated on twice, is slowly getting stronger. Below is an example of one of his walk workouts. The time says 22:17 minutes, however we stopped a couple of times to get a drink in the stream and the clock was not stopped during that time. If Bruno shows signs of being too tired on that leg he does not go out for a second walk that day other than potty breaks. If Bruno holds his leg in the air, toe-touches or looks like he is in any type of pain at all his walk therapy is skipped for a day or two until he is walking strong once again.

Screenshot of Brunos Workout

So while Bruno's vet’s therapy orders are 15-minute walks three to four times a day, his actual walks are more based on his ability to handle the workout. Some days he gets in the full amount, while other days he either takes the entire day off or only goes for one or two walks. Bruno is not going up or down stairs and is not allowed to jump. We use a ramp to get him in and out of the car. He is not allowed to run and is always leashed. He still does not have free roam of the house as the temptation to start an all-out play session with Spencer the Pit Bull or run to the door if someone were to knock would be unavoidable. Bruno has learned to like his x-pen. When putting Bruno back into his pen I often toss a piece of a sweet potato chip on top of his dog bed inside his pen and make him wait, then tell him to "get it"—a little positive reinforcement to help him associate his x-pen with something pleasant. If the pen is left open, for example, when Bruno is out eating his breakfast, his kid brother Spencer often likes to sneak in there and lie down. Seems that both dogs like the x-pen.

Bruno the Boxer and Spencer the Pit Bull Terrier drinking water out of a creek

Bruno and Spencer cooling off and getting a drink in the stream during one of Bruno's therapy walk sessions.

Bruno the Boxer walking in the underwater treadmill

At Bruno's seventh therapy appointment he did a 14-minute session in the underwater treadmill. That was equivalent to 42 minutes on land, but with less body weight and lots of control. They weighed him and he is 90 pounds. Bruno can most likely lose a little more, however you can easily feel his ribs when you touch him. He is naturally long-bodied and barrel-chested. He is always going to be a big dog.

Muscle Atrophy

Bruno the Boxer standing on a blacktop surface

If you look at the muscle tone in Bruno's left back side you can clearly see he has some muscle atrophy going on. If you touch the right side it's solid as a rock with good muscle tone. The current goal for him is to rebuild his left side to match the right side.

Bruno the Boxer standing on a hardwood floor with his tongue out

The more off-balance he is the higher his chances of either re-injuring the left side or compensating so much on the right that he injures his good leg.

11-Week Surgeon Check

Bruno had a checkup with his surgeon which included a final x-ray. His bone is now totally healed to the point where if it were necessary the screws in his leg could come out and his bone would hold just fine. What we are working on now is all soft tissue building.

11 1/2 Weeks

At his eighth therapy session Bruno did 16 minutes in the underwater treadmill. That would be equivalent to 48 minutes on land as each minute underwater equals three minutes on land.

12 Weeks

Screen on the underwater treadmill detailing how far and long Bruno has walked

At Bruno's ninth therapy session he did 16 minutes in the underwater treadmill, but this time they stepped up his speed. Bruno did great. I brought some sweet potato treats and showed off how fast Bruno will do his “dead dog” trick when there is food involved. He is such a clown. He's been named "wiggle butt" for the way his entire back wags instead of just his nub of a tail. The therapist added another exercise he needs to do daily. We ask him to sit and then move forward and sit again. He needs to do it 25 times a day. Kind of like squats doggie-style to work those leg muscles.

13 Weeks

At Bruno's tenth therapy session he did 18 minutes in the underwater treadmill at the slightly higher speed (2.00). He did great during that session and during his 20-minute walks he goes on two to four times a day. Bruno also had a laser therapy session and session where his leg was stretched. He weighed in at 89 pounds. He has not been on a sedative in a week, which is the reason I think he lost a little weight. The sedative slows down his body and therefore it would only make sense that it would slow down his metabolism (the rate food is digested). As long as he can continue to do his daily walks he will not need the sedative so long as he is relatively calm. We don't need him ripping anything else. The more he builds his muscle back up the lower his chances of a re-injury will be.

15 Weeks

At Bruno's 11th therapy session he did 20 minutes in the underwater treadmill. The therapist tried increasing his speed a little, however he was not fully extending his leg when he moved faster so they slowed him back down, although his range of motion was a lot better than it had been in the past. Bruno has been doing well with the "sit/come" exercises. He is bending his back left leg a little more now.

Bruno the Boxer standing on a blacktop next to Spencer the Pit Bull Terrier

The muscle tone in his leg is getting firmer. He weighed in at 89 pounds at this appointment.

Bruno the Boxer gaining muscle tone back into his leg

You can still see that he needs to gain muscle tone in his left back leg.

Bruno the Boxer and Spencer the Pit Bull Terrier sitting in dirt

A couple of days ago we had set out to do a 20-minute walk in a park on some walking trails and ended up getting a little lost. We walked for an hour and a half before making it back. Bruno did great and showed no signs of soreness afterwards nor was he sore the next day. We do not plan on getting lost like that again, but it is nice to know he is getting stronger.

Bruno gets his hock stretched a couple of times a day. He lies down on the floor and I gently bend his leg with slight pressure. He has to relax in order for this to happen. Putting a piece of food in front of him and telling him to wait to eat it usually does the trick and gets him to relax his leg.

Here is a video of Bruno doing his "sit" exercises. The exercise is to get him to regain some of the motion in his leg that he has lost and to build that muscle. He is to sit, get up and move forward and sit again. This will not only help build his muscle but work on his flexibility. Notice how he gets lazy at times and tries to sit sideways. He even tries to lie down. No Bruno, you silly boy. Get up and do your exercises.

17 Weeks

Bruno had this 12th therapy session. He did 20 minutes in the underwater treadmill at a slightly faster speed. He has been on an every two week schedule and is almost done his therapy. Although he is not fully recovered, his muscle is getting larger. He walks with a spring in his step again. I was warned that this is the stage a lot of dogs have a setback. The owners see how well the dog is doing and the dog feels really good. The owners let the dog run and play and they end up tearing either their good leg from compensating or something else in their bad leg. Therefore Bruno is still not allowed to play or run. We continue to go for walks daily, building up this muscle. We have been conquering some hills and I let him do a few steps.

When Bruno is on the treadmill he likes to drink the water. We tell him not to but he keeps sneaking it in. Watch him as the treadmill fills up. For the sake of this video I didn't tell him to stop drinking. Watch how he holds his leg up. One would think it was because he has a bad leg (left), but if you watch closely he holds his good leg up too (right). He's trying not to get wet. A hopeless effort.

18 1/2 Weeks

Bruno had his 13th therapy session. He did 20 minutes in the underwater treadmill and was asked to trot for a minute and a half of that time. With a little encouragement he did great. They didn't notice him skipping a step and his gait appeared normal. They want Bruno to do more trotting on his walks. He will need a day or two of rest with only slow walking after this treadmill session to allow his muscles to heal, but will start up on the walks with some stepped up trots added in soon. The amount of trotting will all depend on how sore he is. If I spot soreness he will need to rest until it heals. His leg was checked and they are happy with the amount of muscle he has gained.

21 Weeks

Bruno had another checkup with the surgeon. X-rays were taken and his bone still looks good and is completely healed. The screws in Bruno's leg are no longer serving any purpose, and therefore technically could come out. They were only put in place in the beginning to keep the bone in place as it healed. However unless there is a problem we will not put him through the operation of removal. Bruno is making nice strides on his muscle mass on the operated on leg. He still has a long way to go and is not allowed to run or jump for at least 8 to 12 more weeks until the muscle is stronger or he will run the risk of tearing his good leg by compensating or injuring the operated on leg.

25 Weeks

Screenshot of the details of the walk

While Bruno still has muscle atrophy in his left back leg, he continues to do better. He is slowly getting more of his freedom back, for instance he is no longer locked in his pen at night, but he is locked in when we are not home. He is still walked on a leash to pee and he is not allowed to run free in the yard with Spencer yet. His bone is fully healed but his muscles, ligaments and tendons are weaker in his left leg compared to his right. This puts him at a continued high risk of pulling something, either in his good leg or his bad one. Therefore he still is not allowed to run free, but he can go for short controlled trots and long walks. Above is a walking tracker showing one of Bruno's longer hikes. He walked five and a half miles with no problems at all. It's the uncontrolled exercise we have to worry about. The goal is to build his muscle in this left leg as strong as it is in his right leg.

27 Weeks

Bruno the Boxer sitting in a vets office with his tongue out looking happy

Oh Bruno, you were doing so well and then we get the first big snowfall of the year and we are at a house on top of a mountain. This house has steps. Power goes out and we light candles. Spencer decides to show off some of his tricks for a sweet potato treat and we realize you’re not standing there with us. Bruno, you are always around when there's food involved. I call you and you don't come running so I get a flashlight and go downstairs and find you at the bottom of the steps. "Bruno, come here boy." You start to walk and you yelp! Darn, you must have tripped down the steps! Now you’re holding your leg up and sitting with your leg out like you don't want to bend your knee all of the way. When you lie down you do it really slow and carefully as if something hurts.

X-ray of Bruno's hip

Off to the vet for x-rays. They show that your bone is fine, which means you must have pulled something. I was told most likely scar tissue. Back to the confinement of an x-pen until you heal up.

Update: 27 Weeks

Three days after Bruno pulled something in his leg he is doing much better. He is no longer holding his leg up, will trot as if there is nothing wrong and is sitting without signs of pain. He lies down much quicker, and not so carefully. He is also bearing weight on his leg. We are going to continue to restrict his playing and other exercise for a while longer to ensure he does not reinjure himself again. We are not out of the woods yet after only three days. Soft-tissue injuries take a bit longer to heal.

Being on rest mode is tough for a Boxer. He was given a sedative to keep him from romping around and hurting himself worse. It's the toughest when they start to feel better yet they are not ready to resume normal activity. I needed to walk him out to pee one last time before bed. He was in a daze and was not getting up. Bruno is trained to alert us of any fox because they come and eat our chickens. Watch how this working dog responds to the chance to do some work. Luckily when we got outside we actually did hear a fox call so Bruno was able to point in its direction for me so he got a little work in even in his injured state.

Update: 58 Weeks

It has been over a year since Bruno's second surgery, the TPLO procedure. I have been hesitating to write this update worried I may jinx the situation, however I think it is time to report back with his progress. If you do not look at Bruno's scar on his knee and are not aware of his history you would not have any idea there was once something wrong with this knee or any other part of his body. His gait is normal and he does not limp at all. I just recently, as in the last two weeks or so, allowed Bruno to run free in the fields and resume normal dog activities including playing outside with Spencer. I had him on leash restriction for a full year after the surgery trying to build up his muscle atrophy. I was told by one vet that the chance of him blowing out his second knee after the surgery was around 80 percent. When the vet said the reason was because the dog compensates I was afraid to set him free until his leg muscles were about even on both sides. You now have to look really hard to see any difference in the muscle mass between his two back legs and even then you may not notice. It is not even that noticeable if I touch both sides, squeezing to feel the difference. He is almost equal on both sides. I was very hesitant to set him free but knew at some point he had to be a normal dog again. He still worries me and I still hold him back a little, for example no quad runs, but he does run and play like he used to with no noticeable issues. Let’s all keep our fingers crossed.

I have decided that from now on if one of my dogs injures their ACL again (knock on wood) I will be getting the TPLO procedure. I will never have another suture lateral performed on a dog. While it may somewhat work for smaller dogs it does not hold very well for larger dogs. I know three dogs that have had the suture lateral procedure and they walk funny with their legs slightly bowed. Their owners all report that they are doing "OK," but have good and bad days. They all limp from time to time and they have really slowed down. I know a fourth owner who says he had the TPLO procedure done about four years ago and his dog is running around playing as if nothing happened. He says his dog seems perfectly normal. The surgeon who performed the TPLO tells me that he does not like the suture lateral procedure. He says he is always fixing dogs that have had a failed suture lateral.

Update: Three Days Later

I posted the update above three days ago. First let me mention that I do not really believe in the jinx. I just say it, well because it is entertaining to think about it. However, I noticed last night that Bruno was holding his right leg up! Yes, his right leg—the good leg. Or should I say the leg that was not operated on? When the surgeon said that Bruno had a high rate of blowing out his good leg I wanted to be part of the low statistics that never had that happen. Allowing Bruno to be a normal dog and run through the fields may have taken that dream away. I obviously do not know if he ripped his other ACL or not until we get to the vet for a checkup. I am going to give him a few days to see if he heals up and uses his leg again. No more running through the fields for Bruno; only leash walks. Time will tell if I have to do this ACL thing for the third time. I'll keep you posted.

Update

Over the next two weeks Bruno continued to improve daily. He walks with a spring in his step once again. ACL tears do not heal, therefore I am hoping that was not what was hurting him. Sometimes I think he is favoring his operated on leg, putting more weight on it, but it has only been two weeks and soft tissue injuries take about six weeks to heal. I am going to continue to keep him leashed when we walk through the fields and keep an eye on this progress.

1 Year and 4 Months after TPLO

Bruno's left knee, which he had the TPLO procedure done on, seems to be holding up. It does not seem to ever give him any trouble. I am keeping a close eye on his right knee however. A few times he has held it up in the air but after stretching it out back behind him he started walking on it normal again. It seems his right knee pops out of joint from time to time. He does well on walks, the trouble seems to arise when he runs, which make the walks even more important for him. Without the walks he would be running around the yard trying to burn off energy. He tends to limp a bit after running. So long as I only limit him to walks he seems to do fine. I am not sure how long his right knee is going to hold out. I do not want to put him through another operation with the long recovery unless I have to. As long as he can walk I am going to hold off on a second surgery. Bruno is still on Dasuquin with MSM which is a Glucosamine Chondroitin joint supplement. He is also on an omega 3 fish oil which works as a natural antiinflammatory.

One Week Later

Bruno suddently started holding his right leg up in the air (the leg that did not have surgery in the past). He was toe touching and in obvious pain when using the leg. I thought this is it, I have to take him in for surgery. He went and lay down on his dog bed. I walked over and rolled him onto his back belly up. I stretched his right leg behind him. Putting the palm of my hand on this knee I gently bounced his leg in an extended pose and that is when I felt it, a pop. Hmmmm, I wonder if it pops all of the time or if it just popped back into place. I gently bounced the leg with my palm on his knee again. Nope it was not going to pop again. I walked into the kitchen and opened up this sweet potato treat bag. Bruno knows the sound of the bag and never passes up a treat! He got up out of bed and trotted into the kitchen as if nothing at all was wrong with his knee. Oh my Bruno, my suspicions were correct, your knee pops out of joint. At what point do I decide to put you through a major surgery? The TPLO surgery works well, but has a long painful recovery. If I can pop your knee back to the point where you walk normal we may be able to hold out longer. That is assuming it is your ACL. It very well may be something else this time.

Raising a Puppy: Bruno the Boxer