ACL/CCL Injury Question

[knightrider]

About 4 weeks ago, my dog came into the house 3 legged lame. I had the vet out to look at her the next day and he recommended conservative management with anti inflammatories and pain killers. He said if she was not better in 3 weeks I should proceed the path of TPLO or TTA surgery.

I waited till the 4th week to take her for xrays hoping for improvement but not much. I currently have surgery scheduled for next week but am pretty nervous about it.

I guess I’m wondering if I should wait longer with the conservative management? She’s a big standard poodle at 72 pounds so the vets think she def needs surgery. Just a nervous nellie here and really would like to avoid surgery if I could…

Any thoughts on the success rate of TTA or TPLO? or conservative management and rehab? She’s a young dog at only 5 and we were doing agility prior. she’s super active and likes to play and goes on hikes with us all the time… except now of course.

TIA

[Horsegal984]

if you want your active agility partner back do the surgery ASAP. CCL tears do not heal with conservative treatment, the point is just to wait until the joint scars down enough to become stable. Those dogs are chronically lame and the amount of arthritis in the knee is remarkable.

Most of my experience is with TPLO but while the recovery period sucks from a management standpoint it’s well worth it to have your partner back in the ring.

[knightrider]

This just really kinda sucks…ugh. Thanks…

[betsyk]

I really don’t know what I would do with a young, very active dog. I had a lab mix who started having mild trouble around age 10, and at age 14 really injured it. I couldn’t bring myself to do surgery on a dog that age (we had done it on another lab at age 9 and again at 12) so we opted for rest, NSAIDS, and acupuncture. She came through a “winter off” really well and in the end, that cruciate wasn’t as much of a problem as her hips were. The conservative approach worked for our older dog who was ok with limited activity.

[Where_sMyWhite]

I had a 4 year old 70 lb.Bouvier that I did TTA on in just one of her hind legs.

Never had to do the other and never had an issue until I lost of old age at 11. Having said that, I did not compete her in Agility and would have though twice about competition after that…

[S1969]

We did a TTA on our 10 year old dog some years ago; he wasn’t a candidate for TPLO because he had had a medial collateral repair on the same knee.

He came bouncing out of surgery and never looked back. The recovery period seems really long when you’re in it, but it’s not really that bad. And yeah, it’s not cheap.

But…my dog ran long and hard on that knee for four more years. Totally worth it for us.

Not sure xrays will show what you need to know. If I recall, the specialist sedated my dog to do some extreme “flexions” to really get a sense of what was going on inside. And, not sure you can have a TPLO or TTA from anyone but a specialist, but this is the type of surgery that is worth going to the best surgeon you can get.

ETA: as for competing after surgery - this is, again, why you want a great surgeon with a good post-op care and recommendations for strengthening the repaired leg and preventing damage to the uninjured one. Competition is probably a possibility but you might want to do some PT before going back to agility.

[knightrider]

I just don’t know what to do. My groomer saw her today for a bath and shave down and she really thinks she needs a bit more time because she is weight bearing but not 100%. In her experience after surgery none of her grooming dogs are ever right. So so confused. Waiting for a call from vet.

[AKB]

I have heard that large dogs have more problems with recurrent injury after surgery than small dogs. You may want to pull up some articles on it and see about the long term success rates.

[S1969]

[QUOTE=knightrider;8156795]
I just don’t know what to do. My groomer saw her today for a bath and shave down and she really thinks she needs a bit more time because she is weight bearing but not 100%. In her experience after surgery none of her grooming dogs are ever right. So so confused. Waiting for a call from vet.[/QUOTE]

Wait, I’m confused. I missed in your 1st post that you have surgery schedule for next week. Who is the surgery scheduled with (your regular vet or a specialist), and which type?

Honestly, I’m sure your groomer knows a fair number of dogs but I would definitely not be making a decision based on her opinion. Does she know the extent of the injuries and type of surgery for the dogs she felt weren’t “right” afterwards? And whether their owners actually followed the post-op protocol and mandatory crate rest, etc.?

I agree with the other post that a CCL is not going to just “heal”. So, not sure what “giving it more time” will do.

[Houndhill]

I also understand that when a dog injures one cruciate, they are at increased risk to injure the other one.

I would have a hard time jumping a dog with an injured cruciate, whether in Agility or Obedience. Best to seek advice from a good Sports Medicine Vet regarding future prospects for this dog.

I know some people do it!

It is a hard thing to have to re-evaluate things.

I had a wolfhound that tore a cruciate, had very successful surgery, and became completely sound in a short period of time. He was sound for one week.

He developed bone cancer in the other back leg a week later.

I went to a presentation once on cruciate injuries where they really stressed the opposite leg might have problems. They were doing stem cell transplants as well as other things to try to repair things.

Personally, I’m not comfortable with the demands of jumping or other weight-bearing training or competition on a dog with this type of injury, though I know some people have done it.

Not to say you can’t find other venues to work with your dog that might be a bit less strenuous. There is Nosework, Rally, Novice Obedience, Barn Hunt, etc.

[Knubbsy]

Definitely go with the surgery. Dogs hide their pain very well and CCL injures do not heal well, if they heal at all, on their own. I recommend going to a vet who specializes in surgery rather than a general small animal vet, ideally one who shares facilities or has a relationship with a rehab facility (Southpaw or LifeCentre in Leesburg come to mind.)

My cousin’s very active GoldenX had bilateral CCL surgeries with physical and aquatherapy afterwards. She is back to her usual activity level and my cousin does not regret the cost.

[SarahKing]

Find a boarded surgeon and go for a TPLO. That was the preferred surgical correction where I used to work. It’s a highly involved surgery, but should complications arise in the future, the implant can be more easily removed than a TTO plate.

This is actually from that hospital. http://circlecityvets.blogspot.com/2013/05/tta-vs-tplo-similar-until-there-are.html

[SquishTheBunny]

Tplo all the way, boarded surgeon for sure. Its more routine than a spay for them so no need to be nervous. Our clinic does 2-6 per day on average. Complications are low and usually very minor.

[Horsegal984]

We average 2-4 TLPO’s per day 3-4 days a week. Most often the dogs that have issues are older dogs who’s owners waited to do surgery till arthritis set in, or those who didn’t follow the post op rehab instructions.

I wouldn’t base my decision on a groomers recommendation, they are the groomer, not the surgeon. But definately want a boarded surgeon to do it, and the more experienced the better.

[knightrider]

My vet has a surgeon they use who is very good. The surgeon actually likes to do TTA surgeries, but he can do both. My vet also called one of the best surgeons in our area and he thought their surgeon was good and that my dog would be in excellent care. The surgeon my vet called for second opinion felt TPLO would be better if I wanted to return to agility or any active lifestyle.

I know the ligament won’t heal and the groomer is not a vet… but she does see a ton of dogs who have had issues with their legs later and in her words “the legs aren’t right and they are crunchy with arthritis”. I think she just put a ton of doubt in my head.

I’ve also called one of the top sports medicine surgeons offices and spoke to their techs who essentially thought tplo all the way. So I guess I’m just being overly worried about this. I was hoping I could do alternatives like rehab instead. I have been talking to a top canine fitness trainer who is coming to my area in a month or so and hopefully if I can get the surgery done maybe she can put us on a fitness rehab program.

I do need a shave down and bath for my dog though and now don’t really want to take her back to the groomer after she so adamantly voiced her opinion… oh well…i don’t have to take her advice… it just leaves me with a seed of doubt. I guess thats the problem with too much information and talking to too many folks.

[MsM]

It may be hard to face the facts, but the dogs your groomer saw would never be “good as new”. They tore a ligament that would ever heal together just as before. So comparing to uninjured dogs is just not fair.
Sure, a surgically repaired dog may end up with arthritis. ( Might have developed anyway. ) But the increased chance is the price you pay for a repaired, better functioning joint that is not as likely to catastrophically fail as an unrepaired ligament.

Use the best surgeon you can find and listen to what s/he says.

[knightrider]

@MsM;8157434

It may be hard to face the facts, but the dogs your groomer saw would never be “good as new”. They tore a ligament that would ever heal together just as before. So comparing to uninjured dogs is just not fair.

Well…my dog is one of those never good as new dogs now too… but I’m hoping that I can do rehab work that most people don’t do which may help my dog beat that kind of statement. I hope anyway…

[cloudy18]

I’m pretty sure my dog, who is around 12, tore his other CCL last night, just wandering around the yard. He had a TPLO on the other hind leg a few years ago. I don’t regret doing it, but I will not do it on this one. Recovery was not fun last time, and he is now older.

At your dog’s age, I’d do it, realizing you’ll probably end up doing the other one at some point. And I would be uncomfortable doing agility or anything very strenuous. I pretty much put a halt to frisbee and fetch with mine.

[Where_sMyWhite]

Having nothing to do with anything but I am curious under what conditions TPLO would be preferred over TTA? It seems to me they are fairly similar in moving the tibia where the CCL runs over it with different approaches in changing that angle…

[knightrider]

[QUOTE=Where’sMyWhite;8157893]
Having nothing to do with anything but I am curious under what conditions TPLO would be preferred over TTA? It seems to me they are fairly similar in moving the tibia where the CCL runs over it with different approaches in changing that angle…[/QUOTE]

TTA is a newer surgery and I believe it is surgeon preference. The TTA cuts bone in front of the leg essentially and has a cage inserted, whereas the TPLO has a cut in the bone in the rear of the leg which is moved to help stability.

I’m sure someone can explain better than I can. TPLO is the old gold standard and TTA is newer only being around for 10 years.