We had planned to go on a hike as a family, to Sedona Arizona on the West Fork Trail. We packed up, prepared lunch, got ready for the children, and loaded everything into the van. At the last minute, we decided to take our American mastiff Freyja with us on the trip.
We thought it would be a great hike and she would do just fine with a little trip into the wild. In a perfect world, we would all have gone on a perfect hike through the forest together as a family.
But we don’t live in a perfect world and there was more to our mastiff baby.
How my dog beat their ACL (CCL)
We got our kids in the car and Freyja was so excited to ride with us that she jumped straight into the van and was ready to go on an adventure. We drove through Phoenix, made it to North Scottsdale, and decided to stop at In & Out Burger for some food. We all got out and when Freyja got out I could tell that something was different about her. She looked as energetic as usual but happened to prefer her back right leg.
She had gone to the vet once before to get a bum that she had chewed and that was swollen on her. So we looked over her paw and found nothing. She had also gone through some minor growing pains as a puppy (probably in the same leg) so we figured we’d just give her a little bit of time because she wasn’t acting very hurt.
We got back in the car and she seemed to prefer it very gently but it didn’t stop her from moving so we decided to do the hike. We drove to Sedona and she still preferred her back leg when we got out of the car in the Oak Creek Canyon parking lot. We went out and she seemed to trust him more over time so we decided to move on.
Freyja made a good way into the hike before really starting to favor the leg. We sat down as a family to have some snacks and she stepped into the river. When she did that, she slipped and when she got out of the water she immediately preferred her leg to be even more aggressive than before. It’s good we didn’t make it any further into the canyon because at 130 pounds I would probably have had a tough time doing them.
On the way back to the car at this point, it was easy to see that something was happening. She wasn’t limping, but she preferred the leg to the car and back to the car. I did Some Research on ACL Tears in Dogs when she was younger because we feared it would happen to her as a puppy. Chances are she started the tear early but got through it from conservative management without our knowing.
Freyja has a male mastiff “Uhtred the Fluffy Mastiff” that she is paired with and when she stiffened when he came over to play we knew we had to tell them apart. We took her to our vet that morning after keeping our pups apart so she could rest.
The doctor came in and did some basic physical tests, including the sitting test and rotating the knee to see if she was in pain. The seat test immediately showed she had one leg straight and the vet recommended that we have x-rays for our dog.
The x-rays came back and you could see her tear in the x-rays. The vet then gave us options. We also had more bad news – the knee is degenerative, so there was a 50/50 chance that your other knee would end up in the same boat at some point in their 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 is actually called the cruciate ligament of the skull. The vet walked us through the name differences before discussing our treatment options so we had a basic understanding of the dog’s anatomy.
When the vet talked about our options, all I could see was the money pulled from our children’s college fund. I knew the operation would be extremely costly and I feared the worst. As a result, we have reviewed all of our options and worked back to what is best for Freyja’s long-term health.
The first option we considered was conservative management. I think everyone thinks about it first. In particular, if you do enough research, you can find people on both sides of the coin trying to find the best way to treat dogs with an ACL tear.
If you don’t know what conservative management is, it is essentially treating the dog’s pain, rather than the underlying problem that is causing problems. It’s very similar to treating the symptoms, rather than correcting the actual condition that is causing your dog pain in the first place. I could see this make sense for someone who has an old dog who doesn’t want the puppy to go through a long recovery period.
In fact, some people swear that all it takes is conservative management. But after a partial tear in my own rotator cuff, I knew firsthand that if we treated her injury conservatively, she would never return to herself 100%. We would have felt different if she had been an older dog, but at 18 months we knew her best days were ahead of her.
We immediately ruled out conservative management because we knew it would not only prevent her from being with her best friend Uhtred but also the risk of arthritis Rubbing your bones together at an early age was very real. Since we had unsubscribed from the conservative management, our vet referred us to a knee specialist to advise us about Freyja.
After we met with the surgeon, he gave us the last two options left, TTA or TLPO.
What is TTA?
TTA stands for Tibial Tuberosity Advancement. It basically means they cut the shin bone and move it forward. Once it’s advanced, they stabilize it by attaching plates to the knee bone and leaving them intact. It’s a procedure that has worked well for many dogs, especially dogs that have torn both knee ligaments in their knees.
The main reason we decided against TTA is because the surgeon in our area recommended TLPO for our pup. He had a feeling that it would be less intrusive on her, considering that she only broke one of the tendons in her knee and not both.
Our choice: TLPO
We decided on the TLPO operation, which stands for Tibial Plateau Leveling Osteotomy. This is the most popular way to treat an ACL tear in dogs. Essentially, the surgery shaves the bone in the area where the tendon is missing.
This will allow the bones to move freely without creating friction and will prevent early arthritis in our pup. This method has become more widespread in the past 20 years as an effective method for treating ACL cracks.
TLPO recovery timeline
Unfortunately, TLPO has a long recovery time. Freyja wanted to see 8 weeks of rehab, including breaking up with her best friend as a male mastiff in the first few weeks. Our intention was to keep them completely separate until the end of the 8 week recovery period. However, this wasn’t the case as we wanted them to be together and just managed very effectively.
In short, below is the timeline we stuck to when we brought Freyja’s knee back to health over an 8 week period.
First two weeks:
- Wear an Elizabethan collar
- No interaction with other dogs
- Limited daily exercise in the back yard
- Handline always in the back yard
- Use a sling to support your hind legs at all times
- Allow Freyja and Uhtred to be in the same room, but only in separate boxes
- Elizabethan collar removed
- Daily walks around the block
- Handline always in the back yard
- Only have Frejya and Uhtred supervised during their daily walks together
- Daily walks around the block
- Under supervision, let Freyja walk on a leash through the back yard for 5 minutes
- Daily walks from 0.5 miles to 1 mile
- Walks take place with Freyja and Uhtred
- Enable supervised socialization on a leash around the house and during walks
- Return to normal activity levels
- In weeks 8 through 9, you continue to recommend interacting with other dogs
When we arrived in week 8, Freyja was acting pretty normal. You could tell she was still learning to trust her leg and lean on it because she knew it wouldn’t hurt every time she did it. But at this point, we had both dogs playing outside together in a supervised setting, and it was the first time we’d seen them since their surgery.
The hardest part of the operation for us was post-operative management. Our children love our mastiffs and cuddle and play with them on a regular basis. It is also very difficult to watch and manage both dogs as both of them still have puppy characteristics and like to bite, jump and wrestle very consistently. If you do this too early after surgery, there is a risk that the plate or screws will loosen, you will return to the veterinary clinic for the second round of surgery and start over.
The biggest takeaway we had was starting rehab and starting it early. If you choose TLPO, the dog can start putting weight on the leg almost immediately, which goes against conventional wisdom. But she really started to trust how the leg felt after about 2-3 weeks. You could see how, over time, she gained confidence that it would work as it should.
The average recovery time is around 8 weeks, although I’ve seen other older and/or weaker dogs take longer. Our Mastiff is stubborn and plays with pain so she has recovered on the faster end of the recovery spectrum.
CCL tear warning signs and symptoms
We ignored our bitch’s warning signs early on when she was young. As a puppy, she had one knee, probably in the 8-10 month range. The vet took anti-inflammatory drugs from us, which seemed to help her get better. The reality is that it only masked her symptoms.
We actually think that although the lameness was very minor, it started when she was a puppy. It is quite common for a dog to have a very slight tear and recover from it without appearing to be wearing worse. In this case, it is only a matter of time before the tear becomes more aggressive and requires surgery. When in doubt, always take your dog to the vet for a checkup.
TLPO operation costs
Maybe you skipped the story about Freyja and just want the meat and the potatoes …
How much money will this ACL tear cost me to fix it?
There’s no one-to-one answer here, but expect to pay near $ 3,500 to $ 5,500 for the surgery. Our final bill was roughly $ 4,800 and we called. After getting the first offer, we called a couple of surgery centers that specialize in ACL tears in dogs and ended up going to the first center because the vet was very good.
So we had spent about $ 4,800 on the operation. Until we weren’t. It found I was still paying for a statewide pet policy that I thought was canceled. I looked it up and found that on the day I originally intended to do this, I forgot to call and cancel the policy.
Nationwide insurance to the rescue
I’m the type of guy who complains like crazy when something is wrong but praises a company when they do something that really looks after a customer. It turns out that Nationwide pet insurance is not only easy to understand, but it stays true to its word.
My national experience with ACL surgery
We had to pay our vet bills out of pocket. But once we got the receipts, I filed the outstanding claims online for Freyja’s surgery and uploaded my documents. It was pretty easy. I have a deductible and then Nationwide will cover 90% of the balance after that deductible is met.
After about 2 weeks, Nationwide 4k deposited my checking account via wire transfer. I have been following this policy for about 2 years and it has only paid for itself, plus any other medical issues any of my dogs had during that period. I now consider pet insurance mandatory for all of my dogs. If you adopt a puppy who will be around for a long time, take out insurance. If a serious illness such as cancer strikes your dog, you at least have the opportunity to discuss whether you want to treat your dog or pass it on in peace.
We were fortunate enough to be able to pay for Freyja’s surgery if Nationwide didn’t take it on, but we’re so grateful that they considered the cost of a semester of tuition for one of our children. If you have an older dog, you may not get the mileage from such an insurance policy because you know you might ditch your dog if there is a serious health issue. The policy has paid off for us and we now have full pet insurance for our two dogs.
Post-TLPO: One year later
It’s hard to believe that a full year has passed since the TLPO operation. I’m happy to say that from today Freyja is behaving the same way as she did before the ACL tear. She’s active, running, and routinely getting the zoomies and letting them fly through our tiled floor house.
Do I think that means she can do anything she wants? No, there are restrictions. For example, I have no plans to take her on a rock-intensive day hike into the Sedona wilderness. There are too many traps and pitfalls she could succumb to on such a hike. All it takes is a hind paw trapped in a rock that is spinning the wrong way so that it lands right back in the vet’s office.
We also have to be careful because the condition is degenerative. This means that it is hereditary and there is a 50% chance that she will have the same health problem in her other leg as the first. We’ll continue to be more conservative with her, but we always take her for walks and always let her play on the lawn 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 surgery if you can afford it. It’s not for everyone and definitely requires someone at home who can monitor the dog’s progress and time in the outdoor bathroom. These are things to plan out before even adopting a puppy.
The general rule of thumb is that your dog is younger than 7 years and does not have any serious health effects. Then you should opt for the operation (our veterinarian has informed us about this). The biggest factor here, however, is cost. If you can’t afford the surgery, there are programs available to crowdfund your pet’s surgery or you can set up a Gofundme account.
When your dog is older, a conservative management approach can be effective if you are given the right medications and watch your pup closely for side effects. Ultimately, only you can answer the question here and do what you think is in your dog’s best interests.
It’s been a wild ride since our mastiff broke her knee ligament and sent us down the rabbit hole to fix it. I hope after reading our story that if you end up in the same situation, you will consider what you think is best for your dog. It is likely that later in life we will need to supplement her joints or feed her a diet high in glucosamine.
If nothing else, take out pet insurance! It’s cheaper to get catastrophic coverage that mitigates big bills like this when you have a significant health impact on your pup. Overall health insurance is great when you have big dogs because the bigger they are, the more of everything they need.