By the time our adopted English Cocker was 11, he had morphed from 42 to 63 pounds. Although he started to resent even short walks, we were surprised to find ourselves in the emergency room with the dog, facing a euthanasia decision over a ruptured anterior cruciate ligament (ACL). It was shocking to be there again eight weeks later with the same problem in the other rear leg. Had we known what to expect when the dog twice underwent surgery for an ACL tear, life would have been easier.

What is ACL Injury?

The anterior cruciate ligament (ACL) is one of two ligaments holding the ends of the femur and the tibia in a dog’s knee in place. This prevents these bones from slipping back and forth across each other, according to

Dogs injure ACLs in several ways. Often an overweight, aging dog like ours attempts to jump on a bed or other furniture. The dog appears to land normally but immediately pulls up a rear leg. Forty-five minutes after this happened, we arrived at the emergency vet clinic.

Even a sudden turn can cause an ACL tear. As we walked behind the fences in our neighborhood, a dog barked, causing ours to swivel. He was only three days away from beginning rehabilitation. This meant a second surgery for a ruptured ACL.

VetInfo indicates that the pain for this type of injury can be so severe and debilitating that the dog is no longer mobile. In the ER, we learned that the type of treatment appropriate for an ACL tear depends on the specific condition of the injured ligament. The ER vet urged us both times to consider euthanasia.

Sometimes the treatment is medical and consists of keeping the pet quiet for two to three months. However, for the majority of animals with torn or ruptured ACLs, the treatment is surgery.

Types of ACL Surgery

After reviewing X-rays, a vet determines the appropriate treatment. Surgery to repair a torn or ruptured ACL is typically performed by an orthopedic veterinarian. The cost can range from around $600 to $2,700, depending on the type of prodedure. There are added charges if the dog requires extra days of boarding at the animal hospital and for rehab. We paid around $2,500 twice to the orthopedic surgeon and another $800 to the rehabilitation vet.

The three types of ACL surgery include:

Standard. The vet uses one of several methods to repair the knee joint. The procedure uses synthetic sutures or the dog’s own tissue to extend a suture from the lower part of the femur to the upper inside part of the tibia. Afterward, the dog must be confined for at least two weeks. For active dogs, this might mean hospital boarding and even sedation for an extended period . For up to six weeks, leash walking is the limit of permitted exercise. It’s essential that owners precisely follow the vet’s instructions about exercise and rehabilitation lest the dog reinjure the leg.

Tibial plateau leveling osteotomy (TPLO). The vet cuts part of the tibia, moves it, and reattaches it to a different spot with plates and screws. This procedure, which our dog had twice, usually produces less residual arthritis. Vets typically recommend it for dogs who weigh more than 50 pounds. Recovery is similar to that for standard ACL surgery.

Tibial Tuberosity Advancement (TTA). The vet cuts a different portion of the tibia and permits it to heal at a different angle to relocate the stress on the joint. This is considered a complex procedure requiring special equipment.


The first step is often reducing an obese dog’s weight. This can require a radical change in diet.

We used a holistic vet for rehabilitation. The treatment involved systematically flexing the dog’s repaired joints, leash walking and walking in about six inches of water on a treadmill.

In some cases, vets prescribe anti-inflammatory drugs or even buffered aspirin to cut inflammation in the dog’s joints and reduce pain. However, owners should never give a dog who has a ruptured ACL or who has undergone surgery for one any medication without the vet’s prior approval.