We don’t know for sure. My husband who walks and hikes with him a lot is not convinced it’ s the knee … he feels he has had a bit of a gimp for a while and this is not sudden really. We will do the one week of Metacam and I will do the xrays which should give us a proper dx. I cannot see keeping the dog quiet for 5 / 6 months. He is missing his hikes already!
The surgeon who would operate only does this kind of surgery and he travels to the different clinics with his assistant. He leaves a very detailed set of rehab instructions and the clinic does the after care.
Wendy, there is a study in the works (that we are a part of) regarding TPLO/TTA success over a lateral suture. So far, the results are showing far better success rates with TPLO and TTAs. However, this study is over 7 years, so no long term bone cancer results yet.
We also do tightropes, however the problem with these is that there is a cutoff angle in which you will get results. With a TPLO/TTA you are changing the angle of the knee (prevents future strain of cruciate ligament), with the Tightrope you are not. So in a dog with terrible knee conformation, a tightrope/lateral suture will not work.
I had a 100-pound dog with terrible knee conformation do just fine with fish-line repairs on both knees. The first one was one of those slowly degrading away tears- off and on lame for months, then finally totally lame. That knee became terribly arthritic several years after the surgical repair, and I believe this is due to the fact that it went months without proper stabilization because we were messing around with medical management rather than going straight to surgery. The second one blew out suddenly shortly after she healed from the first, and we did surgery the day after the tear, and that knee was completely fine.
This was pre-tightrope. I’d have gone Tightrope if it was available. After reading up on the complete lack of evidence proving that TPLO was better than fish-line, and reading about the painful recovery and adverse events of TPLO I didn’t even consider it as a valid option.
there are some studies published on the topic, and Tightrope is obviously the way to go for any dog of any breed or size- works as well as TPLO with far fewer complications and much shorter recovery period. TTA is far worse than TPLO.
Vet Surg. 2013 Apr;42(3):329-34. doi: 10.1111/j.1532-950X.2013.12001.x. Epub 2013 Feb 21.
Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs.
Christopher SA, Beetem J, Cook JL.
Source
Veterinary Orthopedic & Sports Medicine Group, Annapolis Junction, MD, USA. cookjl@missouri.edu
Abstract
OBJECTIVE:
To evaluate long-term (>1 year) outcomes with respect to function and complications in dogs undergoing TightRope (TR), tibial plateau leveling osteotomy (TPLO), or tibial tuberosity advancement (TTA) for treatment of cranial cruciate ligament (CCL) disease.
STUDY DESIGN:
Retrospective clinical cohort study.
METHODS:
Medical records from 2006 to 2009 were searched and cases included when all data were available and clients returned a completed questionnaire based on their assessment of their dog at least 1 year after surgery. Outcomes associated with TPLO, TTA, and TR were determined and compared based on medical records and questionnaires data regarding return to function, presence and degree of pain, and complications.
RESULTS:
Case meeting inclusion criteria were: TPLO (n = 65), TR (n = 79), and TTA (n = 18). TTA was associated with significantly (P < .03) higher rates of major complications and subsequent meniscal tears than TPLO and TR, and TPLO had significantly higher rates of major complications and meniscal tears than TR. Percent of function >1 year after surgery was 93.1% + 10.0% for TPLO, 92.7% + 19.3% for TR, and 89.2% + 11.6% for TTA. Significantly (P = 0.016) more TPLO and TR cases were classified as reaching full function than TTA. The highest levels, frequency, and severity of pain were noted in TTA cases, however, no significant differences were noted among groups.
CONCLUSION:
Long-term outcomes for TPLO and TR were superior to TTA based on subjective client and DVM assessments. Each technique was associated with a high long-term success rate with TR showing the highest safety-to-efficacy ratio.
Vet Surg. 2010 Apr;39(3):315-23. doi: 10.1111/j.1532-950X.2010.00658.x. Epub 2010 Mar 19.
Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs.
Cook JL, Luther JK, Beetem J, Karnes J, Cook CR.
Source
Comparative Orthopaedic Laboratory, University of Missouri, Columbia, MO 65211, USA. cookjl@missouri.edu
Abstract
OBJECTIVE:
To develop and test a novel extracapsular technique, TightRope CCL technique (TR), and compare its 6-month clinical outcomes to tibial plateau leveling osteotomy (TPLO) in dogs with cranial cruciate ligament (CCL) deficiency.
STUDY DESIGN:
Prospective clinical cohort study.
ANIMALS:
Medium, large, and giant breed dogs (n=47) with CCL deficiency.
METHODS:
Before clinical use, TR was evaluated by mechanical testing and the surgical technique was developed and evaluated in canine cadavers. For the clinical study, dogs were assigned to either TR (n=24) or TPLO (n=23) groups and the assigned technique performed after arthroscopic assessment and treatment of joint pathology. Postoperative management was standardized for both groups. Outcome measures were performed immediately postoperatively and up to 6 months after surgery and included complication types and rate, subjective measurement of cranial drawer and tibial thrust, subjective assessment of radiographic progression of osteoarthritis (OA), and function using a validated client questionnaire (6 months only).
RESULTS:
TR with a fiber tape suture had superior mechanical properties for creep, stiffness, yield load, and load at failure. Duration of anesthesia, total surgical time, and stabilization procedure (TR versus TPLO) were all significantly (P<.001) shorter for TR compared with TPLO. Complications requiring further treatment occurred in 12.5% of TR cases and 17.4% of TPLO cases. No significant differences were noted between groups for cranial tibial thrust, but cranial drawer was significantly (P<.05) lower in TR stifles at all postoperative time points. No significant differences were noted between groups for radiographic OA scores. No statistically or clinically significant differences were noted between TR and TPLO for scores for each of the client questionnaire categories.
CONCLUSIONS:
TR resulted in 6-month outcomes that were not different than TPLO in terms of radiographic progression of OA and client-evaluated level of function. TR was associated with shorter anesthesia and surgery times as well as a lower complication rate.
CLINICAL RELEVANCE:
The TR technique is safe and effective and can be considered an appropriate surgical option as part of the overall treatment plan for CCL deficiency in dogs.
Vet Comp Orthop Traumatol. 2012;25(5):349-58. doi: 10.3415/VCOT-11-09-0122. Epub 2012 Apr 25.
Complications of tibial plateau levelling osteotomy in dogs.
Bergh MS, Peirone B.
Source
Iowa State University College of Veterinary Medicine, Ames, Iowa 50010, USA. msbergh@iastate.edu
Abstract
The tibial plateau levelling osteotomy (TPLO) is one of the most common surgical procedures used to treat cranial cruciate ligament disease in dogs. Complications occurring during or after TPLO can range in severity from swelling and bruising to fracture and osteomyelitis. Ten to 34% of TPLO surgical procedures are reported to experience a complication and approximately two to four percent require revision surgery to address a complication. Although the risk factors for many complications have not been fully assessed, the best available evidence suggests that complications of TPLO can be reduced with increased surgeon experience, careful surgical planning, and accurate execution of the surgical procedure. Identification of known or suspected risk factors and intra-operative technical errors allow subsequent action to be taken that is aimed at decreasing postoperative morbidity. There is a need for prospective studies with consistent data reporting in order to fully reveal the incidence risk factors for complications associated with TPLO.
I typed a long reply, and then changed my mind. I will say this instead. Talking to strangers on the internet (even strangers with letters behind their names) is no substitute for an exam and consultation with a boarded veterinary surgeon. There is a searchable database on http://www.acvs.org
and now I have to argue with a friend who thinks surgery is useless and a brace would be cheaper and less intrusive. Well, it may have worked for her cocker spaniel and he had other problems which made that surgery risky… but come on… I would not FIX the problem with a brace and I feel I would risk the other knee. Squish, have you heard of Canadian Animal Rehab in Mt. Albert??
Besides, I still don’t know if it is the knee or not!
I hate people who ‘know it all’ once they have dealt with a similar problem!
[QUOTE=FalseImpression;7060654]
and now I have to argue with a friend who thinks surgery is useless and a brace would be cheaper and less intrusive. Well, it may have worked for her cocker spaniel and he had other problems which made that surgery risky… but come on… I would not FIX the problem with a brace and I feel I would risk the other knee. Squish, have you heard of Canadian Animal Rehab in Mt. Albert??
Besides, I still don’t know if it is the knee or not!
I hate people who ‘know it all’ once they have dealt with a similar problem![/QUOTE]
FI - My suggestion to you is to ask for a referral to an orthopedist, boarded and one with significant years experience with cruciate disease. Then go to the consult and chat about your dogs history, how the lameness occurres, go over the radiographs and then discuss conservative vs. surgical therapy. Then, if surgical therapy is indicated, discuss the different types and why they recommend one over the other. A good orthopod will listen to your concerns, but back up their answers.
We have one surgeon with us who has done over 3000 cruciate surgeries. The three other surgeons here have also had many cases. They all have their preferences (some do arthroscopies as well, some prefer TPLO some offer Tightropes) - lots of variety for you to discuss and choose from.
If you are unsure if its actually a cranial cruciate tear, you need further investigation. A qualified radiologist can ultrasound the knee (here its about $300 to do so), also radiographs can be repeated of excellent quality and angles to show joint effusion (unless they are straight, and 50% of referring radiographs are not, its hard to tell). Full manipulation of the knee for a drawer/tibial thrust is sometimes indicated under sedation for some dogs as well.
I do not have much experience with the “other” rehab places, as Im biased with our rehab specialist (she’s the only boarded one in Canada) - however saying that, the courses that one has to take to have a special interest in rehab are quite extensive and I know there are lots out there that do excellent jobs. Im wondering if Mt. Albert is now run by Jenn P - she’s a technician, not a vet, but was one of the leaders in animal rehab.
Again, not saying surgery vs. non surgery but it might be worth your time having a good long consult and discussion with someone who has thousands of cruciate surgeries under their belts. As much as its great to have a travelling surgeon go to your clinic, its often nicer to go to a referral place and actually sit down and DISCUSS and watch the surgeon feel up your dog 
If yu already have radiographs done, the consult shouldnt cost you much at all. They will often review your own radiographs instead of repeating them (unless they are of non-diagnostic quality).
thanks Squish… which end of To are you located? I don’t have the xrays yet. Dog is still on Metacam and frankly, he just looks stiff when he gets up. Just like when I get up after having sat on a small stool after weeding for hours…
My husband is agreeing to the xrays anyway, not sure if he is convinced until we know more.
He did say that he “owes” the dog because he got him out and walking when he was recovering from hip replacement surgery!!
I know my friend said “she” when she talked about Mt. Albert… so it could be the same person.
[QUOTE=FalseImpression;7062190]
thanks Squish… which end of To are you located? I don’t have the xrays yet. Dog is still on Metacam and frankly, he just looks stiff when he gets up. Just like when I get up after having sat on a small stool after weeding for hours…
My husband is agreeing to the xrays anyway, not sure if he is convinced until we know more.
He did say that he “owes” the dog because he got him out and walking when he was recovering from hip replacement surgery!!
I know my friend said “she” when she talked about Mt. Albert… so it could be the same person.[/QUOTE]
We are more of the “east” side of the city. There are three good referral clinics in the GTA, I can vouch that ALL are very experienced with cruciate surgeries. They are all around the same price too…but its all about what you feel comfortable with. I cant PM respond, but if you want to PM me your email I can gladly share the top 3 referral clinics that may be worth looking into. Personally I love the one I work at…but I am also biased! For the consult fee, a second opinion on whether or not its actually a cruciate is a good idea. Often times no sedation is needed (unless the dog is in agony or is massive) to feel a drawer/tibial thrust. They can also palpate the hips to see if there is any other issues going on there 
thanks. Of course, I am west of the city.
I will pm my email, but the vet could move my dog’s leg in every direction it seemed. No pain, no cry, nothing. He would need sedation because he gets so darn excited at the vet (even as an 8 yo) than we can’t even weigh him first. We have to do it after he has calmed down after the exam! He loves going to the vet.
My lab tore both ACL’s when she was just 4! No crying, no indication other than she was lame…a lot. We started with the conservative approach but it just never healed and she gradully had a harder time getting up and down. Had one leg fixed then when that healed (at about 3 mths) we had the other leg done. Best decision we’ve ever made! Now the first time she took off a mach 7 when she was given the go ahead to run, I held my breath…but it was all good!
She’s now coming 12 yrs and besides some arthritis in her shoulder area, those legs have never bothered her again 
Just had the results of the xrays and long discussion with our vet. Samson did rupture his ACL. No ligament left at all. We are going ahead with the surgery, scheduled for August 13. We are going away tomorrow for a good 10 days and he will be swimming a lot. His hips are great and there is no sign of arthritis around his knees.
We will have it done at the clinic by the visiting board certified surgeon. It is not cheap, but at least I was able to confirm the check ups are included (thanks for the tip Squish). We are going with the TTA surgery because he is a big, active and healthy dog and after 12 weeks… should be as good as new!!
thanks for all the testimonials!!
Jingles for a speedy recovery!!!
Today was supposed to be Samson’s ACL repair surgery… but the vet called this morning. The surgeon feels his liver values are a bit too high (180 vs 118 ?). We also discovered a lump on his neck/chest last night (perfect timing!). So, the surgeon decided to postpone this non-emergency surgery until the values are in the range he wants and we know what this lump is (vet could not tell from the bit she aspirated). So… more blood tests and sample sent to the lab…
At least, the surgeon is ethical and will not do a $$$$ surgery if…
Please jingle that everything gets back to normal…
Sam is 8 yo and misses playing and running with his friends…
In the meantime, when I stress, I bake… so that’s what I am doing today (can’t say my family is delighted about that because of the cause of the stress!)
Well, at least you know you have picked the right type of hospital.
Good medicine. Plain and simple.
When its time for the surgery, I`ll bet they will take excellent care of your dog
Relief! the vet called this morning.
the lump is a lipoma, and because of its location, it will be removed at the time of surgery for the knee. That will happen next Friday!
The blood work confirmed the liver is working fine!!
Phew…
thanks Squish for the words of confidence. I do love my local vet(s).
Sam is home after surgery today. He is doing very well, kind of dopey of course, but he is putting his foot down, not just the toe, and walking fairly well. He finally had a good long pee at 11 pm… He is on Metacam, abx and some probiotics (did not really want to repeat the diarrhea episode after the sedation for xrays…)
I have mats and carpets remnants all over the house so he can lie down and have some traction when he gets up!
The surgeon gave us a booklet full of instructions… oh my… as the vet said “We did the easy part, you do the hard part!”
They also removed the lipoma from his neck.
Yep, recovery is the hardest part! He will likely feel TOO GOOD, so you need to follow the rehab program they gave you even if Sam is saying “NOOOO I want to run!!!”.
Its worth it though, that will hopefully be the bionic leg now!
Well I am just checking in again. My dobie torn her ccl in the other leg. UGH. Surgery for TPLO is scheduled for Sept 4th. Since I seem to panic when it is my own pets I will not be doing the anesth. Luckily we have a boarded anesthesiologist. He will be in on her surgery!!! Yay Then my sweet and wild girl will have both knees full of hardware.
oh SuperD, I am sorry! How long ago did the first CCL got torn? This is scaring me!! A co-boarder had her big lab done as a 9 yr old and he got another good 6 years! I am hoping for no repeat!
Now, I got totally confused and cannot remember which procedure we did. I am pretty sure it is the TTA… We have been doing the PROM exercises and Sam is cooperating. This morning, the incision was oozing a bit of pink fluid and we sent pictures to my daughter’s vet friend for reassurance. I really did not think this warranted an ER visit. Poor boy had to wear his cone most of the day and tonight. I don’t want him licking!!
I remembered to use the Halti to walk him outside because any collar may rub his neck incision.
He does love all the attention, petting, massages, icing, etc.
FalseImpression- The doberman torn her left CCL in the end of November 2012. She has been off and on lame on her right hind since February 2013. We treated her with rest and meds off and on since then but then she became really lame on the right so we are doing the surgery. She is getting the TPLO since she is a large breed and is crazy active. She is also 1 of 4 large dogs!!! The boxer had his knee done in the end of January 2013. So far his other leg has held up and is the craziest dog I have ever seen.
I am glad that Sam is being good. The recovery is the hardest part!!
