My Dog Tore Her ACL (CCL)! TPLO vs. TTA vs. Surgery Alternatives

We had planned to take a hike as a family, up to Sedona Arizona on the West Fork Trail.  We got ourselves packed, setup lunches, got kids geared up to go, and loaded everything into the van.  In a last minute decision, we decided to take our American Mastiff Freyja on the trip with us.

We thought it would be a great hike and that she’d do well with a little jaunt in the wilderness. In a perfect world, we would have all gone together on a perfect hike as a family through the woods.

But we don’t live in a perfect world and there was more in store for our Mastiff Baby.

How My Dog Tore Her ACL (CCL)

We got our kids into the car, and Freyja was so excited to go with us that she hopped right into the van, ready to go on an adventure.  We cruised through Phoenix, made it all the way up to North Scottsdale and decided to stop at In & Out Burger to get something to eat.  We all hopped out and as Freyja hopped out, I could tell something about her was a little different.  She seemed just as energetic as she normally was, but happened to be slightly favoring her back right leg.

Dog Tore ACL (CCL) - TLPO TTA and Conservative Management
Freyja after her ACL surgery

She’d gone to the vet before for a bum toe that she’d been chewing on and had swollen up on her, so we looked over her paw and found nothing.  She’d also gone through some small growing pains as a puppy (in probably what was that same leg) so we thought we’d just give her a little time because she wasn’t acting very hurt.

We got back into the car, and she seemed to be favoring it very gently but it was not hindering her from moving around, so we decided to take the hike.  We drove up to Sedona, and she was still favoring her back leg when we got out of the car in the Oak Creek Canyon parking lot.  We started walking and she seemed to trust it more as we went, so we decided to carry on.

Freyja made it a good ways into the hike before she really started favoring the leg.  We sat down as a family to eat some snacks, and she stepped into the river.  When she did, she slipped and when she came up out of the water, she was immediately favoring her leg even more aggressively than before.  It’s a good thing we didn’t make it further into the canyon, because at 130 pounds, I probably would have had a hard time carrying her out.

On the way back to the car, it was easy to see something happened at that point.  She wasn’t hobbling, but she was severely favoring the leg all the way out of the canyon and back to the car.  I had done some research on ACL tears in dogs when she was younger, because we feared she had it happen to her as a puppy.  It’s likely that she started the tear early on, but got through it by conservative management without us knowing it.

The Diagnosis

Freyja has a male mastiff “Uhtred the Fluffy Mastiff” that she’s paired with, and when she was stiffening up as he came around to play, we knew we needed to keep them apart. We took her in to our vet that same morning, after keeping our pups apart so she could rest.

The doctor came in and did some basic physical tests, which included the sit test and rotating her knee to see if she had pain.  The sit test immediately revealed she had one leg extended and the veterinarian recommended that we have X Rays for our dog.

The X-Rays came back and you could see her tear in the Radiographs.  The veterinarian then proceeded to provide us with options.  We also had more bad news – the knee is degenerative, so there was a 50/50 chance that her other knee ends up in the same boat at some point in her life.

Our Options: Conservative Management, TLPO or TTA

First and foremost, the ACL is actually the human term for the anterior cruciate ligament.  In dogs, it’s actually called the cranial cruciate ligament.  The vet walked us through the name differences before discussing our treatment options, so that way we had a basic understanding of dog anatomy.

When the veterinarian was discussing our options, all I could see was the money being sucked from the college fund of our kiddos.  I knew that the surgery would be extremely costly and feared for the worst.  As a result, we looked at all our options and worked our way back to what was best for Freyja’s long term health.

Conservative Management

The first option we considered was conservative management.  I think everyone thinks through this first.  Especially because if you do enough research, you’ll find people on both sides of the coin on the best method to treat dogs that have an ACL tear.

If you don’t know what conservative management is, it’s essentially managing the dog’s pain and not treating the underlying issue that’s causing problems.  It’s very similar to treating the symptoms and not fixing the actual condition that’s causing your dog the pain in the first place.  I could see this making sense for someone that has an old dog that doesn’t want the pup to have to go through a long surgery recovery period.

In fact, some people swear conservative management is all you need.  But after a partial tear in my own rotator cuff, I knew firsthand that she would never be back to herself 100% if we managed her injury conservatively.  We would have felt differently if she were an older dog, but at 18 months old, we knew her best days were ahead of her.

Immediately we ruled out conservative management because we knew it would not only inhibit her from being with her best friend Uhtred, but the risk of Arthritis at an early age with the bones rubbing together was very real.  Because we opted out of conservative management, our veterinarian referred us to a knee specialist to consult with us about Freyja.

After we met with the surgeon, he gave us the last two remaining options, TTA or TLPO.

What is TTA?

TTA stands for Tibial Tuberosity Advancement.  It basically means that they cut the shin bone and advance it forward.  Once it’s been advanced, they stabilize it by attaching plates to the knee bone and leaving that intact.  It’s a procedure that’s worked well for many dogs, especially those that have torn both knee ligaments in their knee.

The primary reason we opted against TTA is that the surgeon in our area recommended TLPO for our pup. He felt that it would be less intrusive for her, considering that she only ruptured one of the tendons in her knee and not both.

Our Pick: TLPO

We opted for TLPO surgery, which is short for Tibial Plateau Leveling Osteotomy.  It’s the most popular method of treating a dog ACL tear.  Essentially the surgery shaves down the bone in the area where the tendon is missing.

This allows the bones to move freely without creating friction, and preventing early arthritis in our pup.  This method has become more widespread over the last 20 years as an effective method in treating ACL tears.

TLPO Recovery Timeline

Unfortunately there’s a long recovery time with TLPO.  Freyja was going to be looking at 8 weeks of rehab, which included being separate from her male mastiff best friend for the first few weeks.  Our intent was to keep them completely separate until the 8 week recovery period lapsed, but that didn’t hold true because we wanted them to be together, just very effectively managed.

Dog CCL Tear Post Surgery
Freyja from behind post CCL surgery.

In a nutshell, below is the timeline we stuck to while we nursed Freyja’s knee back to health over a period of 8 weeks.

First Two Weeks:

  • Wear Elizabethan Collar
  • No interaction with other dogs
  • Limited daily exercise in backyard
  • Handheld leash at all times in backyard

Weeks 2-4

  • Allow Freyja and Uhtred to be in the same room, but only in separate crates
  • Elizabethan Collar Removed
  • Daily walks around the block
  • Handheld leash at all times in backyard

Weeks 4-6

  • Allow supervised on leash socialization of Frejya and Uhtred, only during daily walks together
  • Daily walks around the block
  • Allow Freyja to walk around the backyard off leash for 5 minute intervals while supervised

Weeks 6-8

  • Daily walks of .5 miles to 1 mile
  • Walks occur with Freyja and Uhtred
  • Allow supervised socialization on leash around house and during walks

Week 8+

  • Return to normal activity levels
  • Recommend weeks 8-9 you still supervise interactions with other dogs

Once we got to week 8, Freyja was acting pretty close to normal.  You could tell she was still learning to trust her leg and lean on it knowing it would not hurt each time she did it.  But it was at this time we let both dogs play together in a supervised setting outside, and it was the first time we’d seen her do so since prior to her surgery.

The hardest part of the surgery for us was post-surgery management.  Our kids love our mastiffs, and they regularly cuddle and play with them.  It’s also very difficult to keep both dogs watched and managed because they both still have puppy characteristics and like to play bite, jump and wrestle very consistently.  If you do this too early after surgery, you risk that the plate or screws get dislodged, putting you back in the Animal hospital for round 2 of surgery, and starting all over again.

The biggest takeaway we had was to start rehab and start it early.  When you opt for TLPO, the dog can start putting weight on the leg almost immediately which goes against conventional wisdom.  But she started really trusting how the leg felt after about 2-3 weeks.  You could see her start to gain confidence over time that it would function the way it should.

The average recovery time is about 8 weeks, although I could see other older and/or weaker dogs taking longer.  Our Mastiff is stubborn and plays through pain, so she recovered on the quicker end of the recovery spectrum.

CCL Tear Warning Signs & Symptoms

We ignored warning signs from our dog early on when she was young.  She had a bum knee when she was a puppy, probably in the 8-10 month range.  The vet had us give her some anti-inflammatory medication which seemed to help her get better. The reality is that it just masked her symptoms.

We actually think that even though the lameness was very slight, that it started when she was a puppy.  It’s quite common that a dog can have a very slight tear and recover from it without seeming any worse for wear.  When this happens, it’s only a matter of time before the tear gets more aggressive and will end up requiring surgery.  When in doubt, always take your dog to the Vet to get it checked out.

TLPO Surgery Costs

Maybe you skipped the story about Freyja and just want the meat and potatoes…

How much money is this ACL tear going to cost me to fix?

There’s no firm answer here, but expect to pay in the neighborhood of $3,500 to $5,500 for the surgery.  Our final bill was right around the $4,800 mark, and we did call around.  After we got the first quote, we called a couple surgery centers that specialize in ACL tears in dogs, and we ended up going with the first center because the veterinarian was very good.

So we were out about $4,800 for the surgery.  Until we weren’t.  Turns out I had still been paying on a Nationwide whole health pet policy that I thought I had cancelled.  I looked it up and realized that I’d forgotten to call and cancel the policy the day I had originally intended to do so.

Nationwide Insurance to the Rescue

I’m the type of person that will complain like crazy if something’s not right, but will praise a company if they do something that properly services a customer.  Turns out Nationwide’s pet insurance is not only pretty easy to understand, but they are true to their word.

My Nationwide Experience with ACL Surgery

We had to pay our vet bills out of pocket.  But once we had the receipts, I filed the open claims online for Freyja’s surgery and uploaded my documents.  It was pretty simple.  I have a deductible and then Nationwide covers 90% of the remainder after that deductible has been met.

After about 2 weeks, Nationwide deposited 4k into my checking account via direct wire.  I’ve carried that policy for about 2 years and it just paid for itself plus any other medical issues that either of my dogs have during that timeline.  I now consider pet insurance mandatory on all my dogs.  If you are going to adopt a puppy that’s going to be around a long time, get the insurance.  If a serious condition like cancer hits your dog, you’ll at least have options to discuss if you want to treat your dog, or let them pass on in peace.

We were fortunate enough to be in a position to pay for Freyja’s surgery had Nationwide not covered it, but we are so thankful that they did considering it’s the cost of a semester of college tuition for one of our children.  If you have an older dog, perhaps you may not get the mileage out of an insurance policy like this because you know you might put your dog down if there’s a major health issue.  For us the policy has paid dividends and we now carry whole pet insurance on both of our dogs.

Post TLPO: One Year Later

It’s hard to believe that it’s been a full year since we had TLPO surgery.  I’m pleased to say that as of today, Freyja is acting just like she did before she had the ACL tear.  She’s active, running and routinely gets the zoomies, sending her flying around our tile floored house.

Do I think this means she can do anything she wants?  No, there’s limitations.  For instance, I’m not planning on taking her on a rock intensive day hike into the Sedona wilderness.  There’s too many traps and pitfalls she could succumb to on a hike like that.  All it takes is one back paw getting trapped in a rock that twists the wrong way for her to end right back up in the Vet’s office.

We also must be careful because the condition is degenerative.  This means it’s hereditary and there’s a 50% chance that she will experience the same health issue in her other leg that she did the first one.  We will continue being more conservative with how we manage her, but we always walk her and will always let her play on the grass with her best friend Uhtred.

Is TLPO Surgery Right For Your Dog?

Only you can answer this question, but if you have a younger dog – I would highly recommend having surgery if you can afford it.  It’s not for everyone, and definitely requires having someone at home that can monitor the dog’s progress and outdoor bathroom time.  These are things you should be planning before you ever even adopt a puppy, however.

The general rule of thumb is that your dog is younger than 7 years old, and is free of major impact health conditions, then you should opt for the surgery (this is what our vet told us).

However the biggest factor here is cost.  If you can’t afford the surgery, there are programs that allow you to crowdfund your pet’s surgery, or you could setup a gofundme account.

If your dog is older, a conservative management approach can be effective if you get the right medications and watch your pup closely for any side effects.  Ultimately only you can answer the question here, and you have to do what you feel is in your dog’s best interest.

Final Thoughts

It’s been a wild ride since our Mastiff tore her knee ligament and sent us down the rabbit hole of getting it fixed.  I’m hopeful that after reading our tale, you’ll consider what you think is best for your dog if you end up in the same situation.

If nothing else, get pet insurance!  It’s cheaper if you get the catastrophic coverage, which will alleviate big bills like this if you have a major health impact to your pup.  The whole health coverage is great if you have big dogs, because the bigger they are – the more of everything they need.