A friend of mine has a 10 month old mixed breed dog that was just diagnosed with a torn ACL. They have scheduled surgery for Nov. 1. Is surgery absolutely necessary or can homeopathic remedies help? I have an extremely active dog that was diagnosed with a Cruciate Ligament Rupture some years ago, first in one leg and eventually the other. I couldn’t afford ONE surgery, let alone two! I restricted her from running and used homeopathy and never had the surgery. She’s just fine and back to her active self.

~ Donna

Dr Sara ChapmanDear Donna,

It is kind of you to want to help your friend. As you have seen with your own dog, homeopathy and other holistic care can result in a return to normal function after cruciate damage. There are a number of things that determine the importance of surgery as a means of repairing any individual’s ruptured cruciate ligament. You don’t mention the breed or size of this 10 month old pup, nor do you say how the injury occurred. Let’s look at the cruciate ligaments and what causes cruciate disease, so that we can better understand our options for treatment.

The cruciate ligaments are two structures that run between the weight bearing surfaces of the stifle (knee) and help support the joint. One ligament runs from the front of the tibia (shin bone) to the back of the femur (thigh bone); this is the cranial (anterior) cruciate ligament, or CCL (ACL). The caudal (posterior) cruciate ligament crosses the CCL, and runs from the back of the tibia to the front of the femur. In dogs, the caudal ligament is rarely injured on its own, because other ligaments and muscles around the stifle protect it more from extremes of motion than the CCL.

Cruciate injuries may appear to be sudden events resulting from an acute injury, but most are actually the result of degenerative processes in the CCL. This degeneration occurs because of repeated minor stresses during walking, running and playing. These stresses are magnified by obesity, inactivity (the supporting muscles become weak) and poor conformation, such as straight stifles, bowleggedness, and knock knees. Ligaments also tend to weaken with age, and certain breeds (Newfs, Rotties and Labs) develop cruciate disease more than the ‘average dog’. Neutered animals (especially females) are more likely to have cruciate disease. This may be due to the delayed closure of growth plates in animals neutered in puppyhood, which results in larger bones and joints and more stress on the cruciate ligaments. There is an immune component to cruciate disease as well, because there are immune complexes in the joint fluid of dogs with CCL ruptures.

Conventional vets generally recommend surgical treatment for CCL. A specialty surgical practice in my area recently published a study showing that surgical treatment by a skilled surgeon is associated with a 90% success rate in return to function and freedom from pain. In my experience, vets who are not surgical specialists do not have this same degree of success. Two studies (in 1972 and 1984) evaluated conventional conservative treatment (cage rest) and found that 50% of dogs under 50 pounds did well, and fewer than 20% of dogs over 50 pounds did well.

In my practice, I have found that I can help many dogs, regardless of size, with homeopathic treatment, acupuncture, and gentle physical therapy. I have large and giant breed patients with cruciate disease who are pain free and active. However, if an individual does not respond, or if an owner prefers surgery, I refer them to a surgical specialist.

Your friend’s dog is quite young; it is rather unusual for a 10 month old pup to rupture a CCL. If the pup’s leg was traumatized by a severe fall or other accident, it may be necessary to reconstruct the joint capsule. In such a case, surgery is necessary. If the pup is a large breed that is still growing, I would really want to have a surgical specialist working on the joints, as there are a lot of potential problems with joint surgery in immature animals. If the pup is a small breed, it is possible that the surgery is being performed because of a severely displaced patella which has caused the cruciate rupture. So, as you can see, the actual situation of this pup determines the need for surgery.

In the case of a simple cruciate rupture, we certainly can consider holistic treatment for cruciate disease. I approach cruciate disease in this way:
1 – Constitutional homeopathic treatment, individualized for the patient, is the cornerstone of my therapy.
2 – Decrease excess immune stimulation by stopping vaccination and decreasing toxin exposure (such as through spot-on insecticides), to minimize the immune component to the disease.
3 – Optimize diet, feeding a raw diet if possible, and work to keep the patient’s weight in the normal range; many older dogs with CCL disease are overweight.
4 – Incorporate anti-oxidants and joint protectants into the diet, such as glycosaminoglycans, MSM, salmon / krill oil, and vitamin E.
5 – Acupuncture increases circulation to the joint and minimize inflammation and pain.
6 – Dogs must be carefully leash walked during the healing phase, which will vary depending on the individual. Your holistic vet should guide you in how and when to increase activity. Complete inactivity will weaken the good leg, yet excessive activity will slow healing.
7 – Symptomatic remedies in low potencies can be given for limited periods, separately from the constitutional treatment. Arnica is useful for the initial non-weight bearing lameness. After that, Rhus tox is helpful for dogs who are stiff and limber up with exercise. Ruta is better for dogs who remain stiff. Other remedies might also be indicated.

It is important to work with a competent holistic vet to ensure that each dog remains reasonably comfortable through the healing process. There certainly are options other than surgery, but you don’t want to risk your dog’s long term health and comfort. If a dog does not respond to holistic treatment, surgery may indeed be necessary.

S.F. Chapman DVM, MRCVS, VetMFHom

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