Pet Economics 101 What does vet medicine cost? The expense of canine cruciate ligament repairs (Part 1)

Ah, the dreaded cruciate ligament rupture… It’s often a dog owner’s most expensive nightmare. Commonly referred to as an ACL injury in human sports medicine, we vet types are more likely to call this knee condition an RCCL (rupture of the cranial cruciate ligament) when we’re speaking in sciencese, or a “cruciate” for short.

This post is the second in a series discussing what vet medicine costs...and why.

What’s a cruciate?

A cruciate injury is a common problem in dogs of all ages and across all breeds, though middle aged, large breed dogs are the typical patients presenting for this problem. In some odd cases, our feline friends may be affected as well.

It can happen suddenly, when a dog makes a sudden turn, gives out a yelp, and ends up three-legging it home from the park. But it usually happens slowly after gradual tearing and deterioration of this thin strip of tissue connecting one bit of knee bone to another, as seen in this illustration:

Because this ligament is mechanically crucial to maintaining knee stability, its sudden rupture leads to the inability to bear weight on a now-wobbly joint. Pain is also a factor in all these cases, though it’s more evident in acute injury than with more gradual insult to the ligament. While the pain is not as severe or persistent as for a broken bone, for example (though some sufferers may beg to differ), pain relief and strict (cage) rest is the mainstay of its initial treatment.

A gradual or “chronic” series of tearings of this ligament is a more insidious manifestation of the disease. Many owners don’t even realize it’s happening, as the dog may never even limp. In these cases, the knee gets gradually more creaky as the joint, craving stability, finds arthritis a physiologic alternative to its unsteadiness.

A common secondary injury that often accompanies a torn cruciate is a tear of the meniscal cartilage. This secondary injury causes severe lameness, and is often the first time an owner notices severe limping, even in a dog who has had a chronic, progressively tearing cruciate.

Complex problems mean big money

Happily for our US dogs, owners are increasingly unwilling to let their dogs go through life with a bum knee—not without some kind of treatment. As a result, the vet industry is smiling, too. According to one JAVMA study published in 2005, $1.3 Billion was spent on this surgical repair and its affiliated costs in 2003. That’s Billion with a capital B!

Though I take issue with some of this study’s methodology, it’s clear that blown knees lead many owners to blow out their bank accounts, too. It’s an expensive problem.

As with many veterinary concerns I discuss, a variety of levels of care are available after such an injury. The procedures, medications and so-called “conservative” (non-surgical) management of the condition vary, as do the education, experience and proficiency levels of the surgeons performing procedures in these cases.

Like what you've read? Stay tuned. Tomorrow I’ll give you the skinny on the vast range in repair options and their equally schizophrenic expenses.

February 21st, 2008

Add Comment36 Comments

Being in just about every dog spot imaginable... I am almost guaranteed to run across this one sooner or later. It is a common topic of discussion in the Flyball, Frisbee, and Agility groups since someone's dog is invariably recovering from the surgery.

The prognosis is almost always excellent though, so despite the pain and cost... I don't think the risk of this type of injury is greater than the reward to dogs and human alike for being active and competitive in dog sport. It's a question that's worth asking though, since it does appear to be a super common issue.

One of the vets in one of the groups went so far as to say that post op patients can actually be BETTER then healthy dogs given the unfortunate natural structure of that joint. I wish I knew the specifics on why the reshaping surgery is so successful, but perhaps the good Doctor knows what I'm talking about and can elaborate tomorrow.

Border Wars - Christopher February 21st, 2008 06:02:00 PM

Dr. Khuly----Yippee, I am looking forward to part 11 !!If you don't mind, could you add a brief little comparison to "luxating patellas" and the difference between the two injurys & the treatments??
Barbara/NH

Barbara A. Albright February 21st, 2008 07:23:00 PM

Our rescued boxer was hit by a car (just prior to us adopting him) and severely broke his right hind leg. His recovery was complicated by a nasty staph infection that didn’t clear up until every last pin was removed (even the ones they had intended on leaving in there). A few months later he started favoring the same leg again. So back to the same surgeon we went. This time the diagnosis was a cruciate injury. After the vet explained that they would need to once again drill holes in his bone (in basically the same spot the original break was in) and put more metal plates in his leg a little red flag went up. I was very concerned about his body rejecting the metal again and another staph infection reoccurring. And I was concerned about drilling more holes in this poor dog’s leg.

The vet was encouraging us to act quickly but I needed a second opinion. So we put him on metacam and then saw another vet. After a few days on Metacam he was basically back to normal. The second surgeon didn’t agree with the 1st vet’s diagnosis. He couldn’t feel the movement and he didn’t think metacam would have such dramatic results on a cruciate tear. Our Boxer has now been on Metacam more than a month. I am getting ready to wean him off and see how it goes. I still struggle with the fact that we really didn’t do anything for him. But on the other hand maybe we avoided an unnecessary surgery.

I wonder how common it is to have problems making a clear diagnosis?

EO February 21st, 2008 07:45:00 PM

EO: Just make sure you got a second opinion from a boarded surgeon. I distrust even my own diagnoses on this injury. I *always* refer to a surgeon for confrmation.

Dr. Patty Khuly February 21st, 2008 08:56:00 PM

Barbara: Oh my--luxating patellas are another animal entirely. Would you mind my tabling of that one until later so it can get the attention it deserves as a separate post? Thanks!

Dr. Patty Khuly February 21st, 2008 08:58:00 PM

Cost me $2,800 when my big guy ran off on four and came back on three one day. I didn't know what he'd done. Had him at the vet's the next day, surgery within a few days. She always referred to a good surgeon who did it at her clinic. He put in two ligs, an autologous made from the hip joint and a synthetic. He said sometimes one or the other can fail.

Did the total confinement thing for two weeks, carried him in and out of the house (stairs at both doors), gradually moved up to walking, etc. It took a couple of months but he was right back to normal after that, running and everything.

This was about 6 or 7 years ago now, I imagine there are new procedures today.

Caveat February 21st, 2008 11:12:00 PM

I have a staffy that needs both of his CCL's replaced, I found another great site with great info and just wanted to share it with you all - http://dogkneeinjury.com Hope it helps and if anyone has any advice it would be greatly appreciated!!

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Hi I'm in need of advice on how to help my dog Ecko that has a torn cruciate of his Left knee. He is 3 1/2 year old Shepard/Chow mix and he is about 106 pounds, yea he is a big boy with a Wonderful Sole. His surgery is going to cost $2,950. and I don't know how or where or when I'm going to get the money for it. I know just about everyone has a story to tell and I'm not asking for anything but advice on how I can help make him more comfortable. Would it help if I wrapped his knee? I have pain pills from his Vet but, when those run out I know he will still be in pain. I feel so bad that I don't have what he needs right now. I'm waiting on my Social Security to start and I'm living with my son who works part time and goes to college. So Please any Advice will be greatly appreciated.

Thank You Very Much

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So, is this really neccesary, or is my vet just trying to get more money out of me?

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