To decide whether to choose conservative management or surgery is not an easy decision to make.  It all depends on the extent of the injury and how you handle it. After your vet has done the draw test and if the  Knee is still stable you can try conservative management (CM), if the knee is unstable then surgery options are the best. You have a choice of traditional "fish line" type surgery or the newer TPLO or TTA.

Conservative treatment (weight control, rest, medication) is often combined with surgery, but it can be used alone for dogs that weigh less than 25 pounds and for cats.  CM is a great approach and works for many dogs but unfortunately not for all dogs. Conservative Management may be the way to go if your dog has a partial tear but can be difficult to manage with complete rupture. If you're not comfortable with surgery and you are going to try CM for a complete tear, you must be realistic and understand that it may or may not work, depending on many factors.   On the whole complete tears are probably best dealt with by surgery.   If your dog is showing signs of a problem or favoring a leg at all, that is a sign that he's experiencing some pain. The instability that ACL injuries  produce result in inflammation which in turn results in pain which needs to be addressed. If you don't believe that surgery is the right option  then conservative management may be worth a try. But it's not an easy process and it's not a short process. On the contrary, it's very hard and it's very long. You're looking at anywhere from about 6-12 months of restricted activity and that's the same kind of restrictions that you would be faced with during the post op period. This is just long enough for the build up of scar tissue to support the knee.  If there is little progress after 2-3 months of conservative management it is probably wise to research  the surgery options.   Lameness may continue until surgical repair. Degenerative joint disease often progresses regardless of treatment.   Losing weight reduces stress on the joint. The recommended diet has a low fat, protein, and calcium content and is given at specific times of the day.

Restricted activity includes:
On leash for toilet breaks, no running, no jumping, no jumping on furniture, no jumping into or out of  the car (the use of a  ramp is a must) no chasing anything, no running up and down the stairs, no rough housing with other dogs and confined to a safe area while you can't watch him (either a crate or x-pen).  All floors have to be made non slippery, i.e hardwood floors need non slip rugs so that the dog can place his feet squarely on the floor without slipping.  As any misdemeanor can exacerbate the problem and you will have to start the rehab all over again.

Complete rest and immobilization are not in the dog's best interests while healing. As soon as your dog is bearing weight on that joint while walking, it is important to give him several small walks  a day as well as passive range of motion exercises (which should start from day one).  The reason we need to do these specific exercises and not just walking, is that some muscles in the body atrophy faster than others and included in this group is the hamstrings which actually work to support the cruciate.  Early weight bearing helps to reduce inflammation, maintain joint proprioception (the ability of the joint to quickly 'right' itself when on uneven surfaces, thus protecting the ligaments in the joint), prevent excess muscle wasting and hasten healing. As soon as your dog is capable, start with three, five minute walks per day and increase.  Make sure that you are walking on a flat terrain to reduce stress to the injury.  Once your dog can manage a good 15/20 minutes walk without any pain and a point of stability has been reached it is time to step up a notch and do the more vigourous rehabilitation exercises.  Be vigilant and watch for signs of fatigue, leg shaking or limping during walks and his head bobbing and cut back on the duration of the walks if that occurs.


Physical therapy
The goal of physical therapy and rehabilitation is to return the affected part and the animal to full function.
Physical Therapy can be very useful. Physical rehabilitation should begin immediately after surgery, beginning with icing inflamed tissues, and in the following days, incorporating passive range of motion, electrical stimulation, ultrasound therapy, and massage therapy (to reduce the possibility of the scar tissue adhereing to the muscle) and reduce stiffness in the joints. The goal of physical therapy during this time is to minimize inflammation and pain, preserve joint range of motion, and to prevent or further minimize muscle and soft tissue atrophy.  If you can, have a qualified animal PT therapist make up a therapy regime specifically for your dog. Make sure they check your dog's hamstrings and gluteals before considering letting him off leash, to make sure proper balance has been established. If it has not, reinjury is likely to occur.

Accupuncture
It can be used to treat diseases but it is most useful for the relief of painful conditions of the joints, muscles and back. It is a good alternative to anti inflammatory drugs in cases where the animal cannot tolerate them

Chiropractic Care
Chiropractic literally translated means 'done by hand'.  The aims are to treat causes rather than symptoms, the principle is that many disturbances to the nervous system result from misalignment of bones of the spine and other parts of the body.  These are believed to be at least a contributory factor in the pathological process of many common human and animal ailments. 

Canine Massage
Massage can help in pain management for dogs suffering with Hip dysplasia, cruciate ligament and other common problems by helping to reduce inflammation and swelling in the joints and easing tension throughout both the areas affected and the areas under stress from that compensating.
Aqua Therapy
Muscle wastage begins within 3 days of any immobilisation so to prevent further weakness or injury it is important to rebuild, through safe exercise, any muscles that have deteriorated. It is better to swim dogs in heated water since cold water causes constriction of the blood vessels near the skin and to the superficial muscles (those just under the skin) which restricts the flow of blood making the muscles less efficient.

Ultrasound
Therapeutic Ultrasound is a commonly used modality in physical therapy and has been shown in clinical and scientific trials to increase collagen extensibility, enhance collagen remodeling, enhance collagen production, increase heat in deep tissues, increase blood flow, increase range of motion, reduce pain and muscle spasm, and accelerate wound healing.

Electrical Stimulation
The use of electrical stimulation to stimulate a peripheral nerve to cause the desired effect is called neuromuscular stimulation. Electrical stimulation can help

 1.   Increasing muscle strength.
 2.   Improving muscle tone.
 3.   Increasing range of motion.
 4.   Pain relief.
 5.   Muscle re-education.
 6.   Reducing muscle spasms.

Supplements
These are extremely important.   Glucosamine, Chondroitin, MSM, Vit C, Vit E, Fish Oil, Ester-c and Hyaluronic acid to name but a few.

Nutraceuticals, also called dietary supplements, are oral agents that provide health benefits but are not regulated as drugs. Chondroprotective agents, made from extracts of components necessary for cartilage development, are used to promote the development of new cartilage and strengthen existing cartilage.

Two chondroprotective agents used to treat arthritis in humans (chondroitin sulfate and glucosamine) are being used to prevent further joint degeneration caused by CCL rupture. Chondroitin sulfate blocks enzymes that break down cartilage, and glucosamine builds cartilage and may also decrease inflammation.

The supplements are available in tablet or capsule under these names:
 SynoviCre®, Glycoflex®, and Arthramine® (all contain glucosamine); Adequan® (contains chondroitin and glucosamine), and Cosequin® (contains chondroitin, glucosamine, and manganese). Glucosamine can be injected directly into the joint or into a vein and works more quickly than the oral form.

An uncommon side effect is gastrointestinal upset; taking the supplements with food can help. If upset continues or if there is no improvement within 6 months, other treatment methods are required. Taking the supplements with aspirin may cause problems in forming blood clots.

Ask your veterinary surgeon about Adequan injections