Dogs

Cruciate surgery in dogs: a recovery guide

Cruciate rupture is one of the most common knee injuries in dogs. What surgery and recovery involve, and how physiotherapy helps your dog get back to full strength.

By The Animal Physio Co 6 min read

A tan dog beside the words "Cruciate surgery recovery"

If your dog has torn a cruciate ligament, you're in good company: it's one of the most common orthopaedic problems vets see. Surgery helps most dogs, and what happens in the weeks and months afterwards makes a real difference to how strong and comfortable your dog ends up. Here's what to expect, and how physiotherapy helps.

Key points

  • Cruciate disease is one of the most common orthopaedic problems in dogs, especially in large breeds such as Rottweilers and Boerboels.1,2
  • Surgery helps most dogs: the American College of Veterinary Surgeons reports significant improvement in 85–90% of cases.3
  • The college also notes that physical rehabilitation "can speed up a dog's recovery and improve final outcomes regardless of the chosen surgical technique".3
  • In a randomised trial, dogs given physical rehabilitation after TPLO surgery had lower arthritis scores over the following six months.4

What the cruciate ligament does

The cranial cruciate ligament is one of the main ligaments holding the knee (stifle) stable. In dogs it usually weakens gradually over time, rather than tearing in a single sporting accident, until it partly or completely ruptures and the knee becomes unstable and painful.5

Which dogs are at risk

  • In English first-opinion practices, about 0.56% of dogs were diagnosed with cruciate disease. Rottweilers, West Highland white terriers, golden retrievers, Yorkshire terriers and Staffordshire bull terriers were among the breeds with higher odds, as were heavier dogs and dogs over three years old.1
  • In Swedish insurance data, the Boerboel was among the breeds with the highest risk.2
  • Weight matters. In one UK practice, obesity roughly quadrupled the risk of rupture.6

Signs to look for

  • Limping on a back leg, which can range from mild to severe and is sometimes only noticeable after a long rest
  • Difficulty sitting down (vets call this a positive "sit test")
  • Trouble jumping into the car
  • Stiffness
  • A popping or clicking sound from the knee, which may mean the meniscus (the cartilage cushion in the knee) is torn3

Surgery: what's involved

Your vet or surgeon will recommend the best option for your dog. The common procedures are TPLO (tibial plateau levelling osteotomy), TTA (tibial tuberosity advancement) and lateral suture repair.3 The outlook is good:

  • A systematic review found the strongest evidence supports TPLO for returning dogs to normal function.7
  • After TPLO, dogs' use of the operated leg on a force plate was indistinguishable from healthy dogs by 6–12 months.8
  • In a randomised trial of 80 dogs, 93% of owners whose dog had TPLO rated their satisfaction at 9 out of 10 or higher.9

The recovery timeline

Your surgeon's instructions always come first, but recovery usually looks something like this:

  • The first few days: rest, pain relief and cold therapy. The AAHA pain-management guidelines describe cold therapy after surgery as "very effective" and something owners can apply at home.10 In a small randomised study, dogs given cold compression after knee surgery bent the knee further and put more weight on the leg the next day.11
  • The first two months: activity is restricted for several weeks to protect the implants and healing.3 The bone takes about 8–12 weeks to heal, but most dogs start putting weight on the leg fairly early,5 so this is the time for short lead walks and gentle, controlled exercises to start rebuilding muscle.
  • From about two to three months: once your vet is happy with healing, exercise steps up gradually, with longer walks, hills and strengthening and balance work.
  • Three months onwards: a gradual return to full activity, with strength and fitness still building for months afterwards.8

Why rehab makes a difference

It rebuilds lost muscle. The thigh muscles, particularly the quadriceps, waste away in a leg with a damaged cruciate,12 and the weeks of restricted exercise after surgery add to that. Rehab is how that muscle comes back:

  • In a study of 51 dogs after cruciate repair, dogs given a rehab programme put more force through the operated leg at six months, and it was working as well as the healthy leg. Dogs on restricted exercise alone hadn't caught up.13
  • After TPLO, dogs given physiotherapy had regained their thigh muscle by six weeks, with better knee movement at three and six weeks.14
  • In a randomised trial of 48 dogs after TPLO, dogs that had rehab put more weight through the leg and were more active.15 In a related study, rehab after TPLO was linked to lower arthritis scores over six months.4
  • Dogs treated by a certified rehabilitation practitioner after TPLO were 1.9 times more likely to have reached full function by eight weeks, with no increase in complications.16
  • A 2022 systematic review supported therapeutic exercise and cold compression after cruciate surgery,17 and a 2021 review describes physiotherapy as essential for a full return of function.5

It helps manage swelling. Cold compression reduced swelling after cruciate repair,18 and kinesiology taping reduced knee swelling in the first day after TPLO in a small randomised study.19

It protects the joint long term. Some arthritis develops after any cruciate surgery, even when dogs do well: in one study, dogs' function improved within six months and stayed good for three years while arthritis progressed slowly.20 Years after surgery, many dogs still push off less strongly with the operated leg,21 which is why we keep working on strength after the wound has healed. Keeping your dog lean helps too: in obese dogs with arthritis, lameness improved significantly after losing about 6% of body weight.22

Looking after the other knee

Unfortunately, the other knee often goes too. In a study of Labradors after TPLO, 48% later ruptured the cruciate in the other knee, a median of 5.5 months later.23 In another study of 511 dogs, overweight dogs were more likely to have both knees affected.24 The risk is lower in older dogs: among dogs aged eight and over, 19% went on to rupture the other side.25

Keeping your dog lean, building strength in both back legs and returning to activity gradually are the best things you can do.

How we help

Because we're mobile, we treat your dog at home during recovery, when car journeys and slippery clinic floors are the last thing it needs. Working with your surgeon's plan, we can:

  • Help with early pain and swelling using cold therapy and kinesiology taping
  • Use massage and gentle joint movement to keep the knee comfortable and mobile
  • Build a progressive programme of strengthening exercises such as weight shifting, sit-to-stands, controlled walking, hills and cavaletti poles
  • Measure thigh muscle and track progress at each visit
  • Set up your home with non-slip flooring and safe barriers during restriction
  • Keep building strength and fitness in both back legs long after surgery, alongside weight management

If your dog is booked in for cruciate surgery, or is recovering from it, book an assessment. Starting early means we can plan the whole recovery with you.

References

  1. Taylor-Brown FE, Meeson RL, Brodbelt DC, et al. Epidemiology of cranial cruciate ligament disease diagnosis in dogs attending primary-care veterinary practices in England. Veterinary Surgery. 2015;44(6):777–783.
  2. Engdahl K, Emanuelson U, Höglund O, et al. The epidemiology of cruciate ligament rupture in an insured Swedish dog population. Scientific Reports. 2021;11(1):9546.
  3. American College of Veterinary Surgeons. Cranial cruciate ligament disease.
  4. Verpaalen VD, Baltzer WI, Smith-Ostrin S, et al. Assessment of the effects of diet and physical rehabilitation on radiographic findings and markers of synovial inflammation in dogs following tibial plateau leveling osteotomy. Journal of the American Veterinary Medical Association. 2018;252(6):701–709.
  5. Spinella G, Arcamone G, Valentini S. Cranial cruciate ligament rupture in dogs: review on biomechanics, etiopathogenetic factors and rehabilitation. Veterinary Sciences. 2021;8(9):186.
  6. Adams P, Bolus R, Middleton S, et al. Influence of signalment on developing cranial cruciate rupture in dogs in the UK. Journal of Small Animal Practice. 2011;52(7):347–352.
  7. Bergh MS, Sullivan C, Ferrell CL, et al. Systematic review of surgical treatments for cranial cruciate ligament disease in dogs. Journal of the American Animal Hospital Association. 2014;50(5):315–321.
  8. Nelson SA, Krotscheck U, Rawlinson J, et al. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. Veterinary Surgery. 2013;42(1):38–50.
  9. Gordon-Evans WJ, Griffon DJ, Bubb C, et al. Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. Journal of the American Veterinary Medical Association. 2013;243(5):675–680.
  10. Gruen ME, Lascelles BDX, Colleran E, et al. 2022 AAHA pain management guidelines for dogs and cats. Journal of the American Animal Hospital Association. 2022;58(2):55–76.
  11. Szabo SD, Levine D, Marcellin-Little DJ, et al. Cryotherapy improves limb use but delays normothermia early after stifle joint surgery in dogs. Frontiers in Veterinary Science. 2020;7:381.
  12. Mostafa AA, Griffon DJ, Thomas MW, et al. Morphometric characteristics of the pelvic limb musculature of Labrador Retrievers with and without cranial cruciate ligament deficiency. Veterinary Surgery. 2010;39(3):380–389.
  13. Marsolais GS, Dvorak G, Conzemius MG. Effects of postoperative rehabilitation on limb function after cranial cruciate ligament repair in dogs. Journal of the American Veterinary Medical Association. 2002;220(9):1325–1330.
  14. Monk ML, Preston CA, McGowan CM. Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament. American Journal of Veterinary Research. 2006;67(3):529–536.
  15. Baltzer WI, Smith-Ostrin S, Warnock JJ, et al. Evaluation of the clinical effects of diet and physical rehabilitation in dogs following tibial plateau leveling osteotomy. Journal of the American Veterinary Medical Association. 2018;252(6):686–700.
  16. Romano LS, Cook JL. Safety and functional outcomes associated with short-term rehabilitation therapy in the post-operative management of tibial plateau leveling osteotomy. Canadian Veterinary Journal. 2015;56(9):942–946.
  17. Alvarez LX, Repac JA, Kirkby Shaw K, Compton N. Systematic review of postoperative rehabilitation interventions after cranial cruciate ligament surgery in dogs. Veterinary Surgery. 2022;51(2):233–243.
  18. Rexing J, Dunning D, Siegel AM, et al. Effects of cold compression, bandaging, and microcurrent electrical therapy after cranial cruciate ligament repair in dogs. Veterinary Surgery. 2010;39(1):54–58.
  19. Ludwig B, Ihrke A, Holich K, et al. Kinesiology taping with a double-lymphatic pattern reduces canine stifle joint swelling 24 hours after tibial plateau-leveling osteotomy. American Journal of Veterinary Research. 2026;87(5).
  20. Shimada M, Mizokami N, Ichinohe T, et al. Long-term outcome and progression of osteoarthritis in uncomplicated cases of cranial cruciate ligament rupture treated by tibial plateau leveling osteotomy in dogs. Journal of Veterinary Medical Science. 2020;82(7):908–916.
  21. Mölsä SH, Hyytiäinen HK, Hielm-Björkman AK, et al. Long-term functional outcome after surgical repair of cranial cruciate ligament disease in dogs. BMC Veterinary Research. 2014;10:266.
  22. Marshall WG, Hazewinkel HA, Mullen D, et al. The effect of weight loss on lameness in obese dogs with osteoarthritis. Veterinary Research Communications. 2010;34(3):241–253.
  23. Buote N, Fusco J, Radasch R. Age, tibial plateau angle, sex, and weight as risk factors for contralateral rupture of the cranial cruciate ligament in Labradors. Veterinary Surgery. 2009;38(4):481–489.
  24. Grierson J, Asher L, Grainger K. An investigation into risk factors for bilateral canine cruciate ligament rupture. Veterinary and Comparative Orthopaedics and Traumatology. 2011;24(3):192–196.
  25. Murphy CL, Niles J, Radasch RM. The prevalence and risk factors of contralateral cranial cruciate ligament rupture in medium-to-large (≥15 kg) breed dogs 8 years of age or older. Veterinary and Comparative Orthopaedics and Traumatology. 2024;37(1):8–12.

This article is general information, not veterinary advice. Speak to your vet before starting any supplement or treatment, and ask a qualified animal physiotherapist to assess your animal individually.