What Lola Wants, Lola Gets – conservative management of CCL injury

I have a great case study. This is on my own dog, Lola. And true to the song, yes, most of the time, What Lola Wants, Lola Gets…. Even when she is not supposed to… but that is another story.
Let me start with a little Lola history. We adopted Lola as a 9 week old puppy. She is a rottie mix. She has always had lots and lots of energy! When she was a little over 1 year old, she tore her left cranial cruciate ligament (CCL,equivalent to ACL in humans) while running in the snow. Within a couple of weeks we had surgery done by a board certified orthopedic surgeon here in town. We opted for the TPLO procedure due to her young age (the tibia is cut and the angle of the stifle (knee) is changed in order to basically decrease the need for a CCL). She recovered well and went back to her active lifestyle of running and hiking in the woods with us. Due to the nature of having had surgery, and the stifle mechanics being changed, she always favored that leg just slightly. If I weren’t a professional lameness finder, I probably wouldn’t have even noticed. I would occasionally perform soft tissue work and various manual techniques to manage the occasional increase in lameness I might find after vigorous exercise. Overall, she was managed very well. The good life continues for Lola.
Fast forward 5 years….
Hm, is Lola limping on her right rear leg? Maybe she just has a soft tissue injury….yes, lameness has resolved with some physical rehab work. Phew!
A couple months pass….
Wait, she is limping on that right rear leg again. Probably just a re-injury of her soft tissue. Uh oh, not this time. The dreaded second CCL injury! (somewhere between 40-60% of dogs with one CCL injury will go on to tear their other one sometime in their lifetime). This is a partial tear this time. I have heard and read about positive outcomes following conservative rehab for partial cruciate tears. What better dog to try this out on, then my own dog? Perfect!(I am trying to make lemonade out of lemons here).
Begin conservative management of CCL injury phase 1. Basically lots and lots of confinement and rest. I rigged up an outdoor space that was the size of a dog pen for her to do her business in. Otherwise she was in the house. That’s it. A few weeks pass, and I start taking her on controlled leash walks and doing some rehab exercises. Things are going great! We are up to about 20 minute walks with barely a limp! This rehab thing is awesome! And then it happens. Lola decides to be a dog. Because, as you probably remember, what Lola Wants, Lola Gets. Lola decided that she wanted what was at the top of our yard. So, Lola pushes/jumps her way out of her pen and runs full blast to the top of our yard. I yell, she yelps, and then she comes back to me on 3 legs. Can you say “I told you so” to a dog? I certainly did.
Full tear this time. Sloppy, sloppy knee. Oh no.
Now, at this point in our lives, we can’t do surgery again for our dear Lola (don’t judge me here). Some circumstances in our lives dictated our decision, and we had to put off pursuing a second surgery. I fix my dog pen area back up for Lola. Lock down time again. So for months, active, energetic Lola is on total activity lock down. And I mean months. Like 9 of them. No walks, no running in the yard, nothing. This time she doesn’t escape. Slowly, oh so slowly, her limping starts to reduce (and she also learns to accept her new life, dogs are so adaptable!). Our lives re-align themselves with some normalcy, and the surgical option becomes more feasible. But, Lola is doing pretty well by now. Maybe I can start some physical rehab with her? Would I be cheating her of a chance at a good recovery if I don’t send her to surgery? Will I ever be able to take her running again if I go this route, or will she have to become a “yard dog”? With trepidation, I eventually decide to go with the conservative rehab route, knowing I may be tucking my tail between my legs and heading to the surgeons in town if this doesn’t work out.
I start slowly. 5 minute walks. Slowly, slowly progressing by a few minutes every day or two. If I go a little too long, she will limp more, so the next walk I cut her back a few minutes. But I am able to gradually progress her walks. I start her in the underwater treadmill and slowly progress, I do laser on her knee, I start some land exercises. Within 4 months we are going for 2-3 mile runs, she is doing 30 minutes in the underwater treadmill and various land exercises.

She is not limping anymore! She will get a little sore if she would do anything more than she was used to. I decided to really test it. I started letting her have some time off leash on our runs (we live where we can trail run from my door). By 5-6 months from when I started “rehabbing” Lola, she could go on 3-5 mile runs off leash in the woods, and basically do anything she wants to do. We are now 1 year and 3 months from her full cruciate tear injury and she is going strong. In fact, when she does do a little too much, she will favor the side that she had surgery on. But I do keep in mind that she has had 5 years for that knee to develop arthritis, so this is not surprising. I can hope that in another 5 years her right knee will be in as good as shape.
Things I have learned from this:
1. It MAY be possible to conservatively rehabilitate a torn cruciate ligament. (disclaimer: I am not suggesting that people not pursue surgery if their dog tears a CCL, but if surgery is not possible for whatever reason, conservative management may be successful)
2. I think it was very, very important how much I restricted and confined her after her injury. If she had been left to run around and play and be her normal self, she would have continued to damage her tissues and caused too much injury and inflammation for this to have been successful.
3. Dogs will be dogs and I shall not judge when someone’s dog jumps out of their fence and runs through their yard when they are supposed to be confined.
4. If you do too good of a job rehabilitating your pet back to an active lifestyle, they may still kill chickens. After all, What Lola Wants, Lola Gets.