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Canine ACL tear- Surgery or no?

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  • Canine ACL tear- Surgery or no?

    My 10 year old Dobie tore his ACL. Sigh. The vet is recommending surgery. The options are TPLO- which involves a plate and screws, or TTA- which involves reshaping, ie, cutting of the bones in his leg.

    Yes, they are expensive, but I'm more worried about the fact that they are so invasive. I have read about conservative management as well, which involves limited activity and a brace. Vet is concerned about arthritis developing if we don't do surgery, but I don't see how that's avoidable even with surgery. Every person that I know with hardware has pain associated with it.

    Has anybody dealt with this? What did you decide to do and what was the outcome? Thanks!!

  • #2
    My family had a young Labrador puppy who had a similar injury. We went with the TPLO, but lost her a couple years later from bone cancer at the site of where the hardware was inserted.

    Very devastating, however, she did not have any arthritis or other issues with the surgery until the cancer.

    But, in our circumstance, it was a young puppy and felt that she would recover better with the TPLO.
    Semi Feral

    Comment


    • #3
      My last dog had the TTA because he had had a medial collateral tear in the same knee from a car accident, and therefore couldn't have the TPLO.

      After the medial collateral surgery (which involved plates, screws & an artificial ligament) he was in a lot of pain and the recovery was pretty tough. We felt terrible for him.

      After the TTA...holy cow...he practically jumped out of the car when we got home after surgery. We had to call the vet and ask if it was inhumane to take him off pain meds, because he felt SO great that we were worried he'd do some major damage. We almost considered a mild sedative too! The hardest part about the TTA surgery was keeping him quiet during his mandatory "crate-rest" period.

      If I recall, he was 9 or 10 when he had the TTA. He only lived to be 13 1/2, but he ran hard on that knee until almost the day he died. I wouldn't hesitate to do it again.

      That said, I've also heard great things about TPLO. But, if price isn't a major factor (no idea the cost difference between TPLO and TTA), I'd go for the TTA.

      Comment


      • #4
        I did the TPLO on my 5yr old shepherd. If you do it, make sure the surgeon is very experienced in doing them. I drove 4 hours 1 way to the specialty clinic to have Dennis done. According to the chairman of small animal surgery at MSU, it is a very complicated surgery and you want someone who does them well. It's been 9 months and you can't tell which knee was done! A friend had her dog's done locally and it did not turn out well at all.

        I decided to do Dennis because he is an extremely active young dog. Plus I was afraid if I didn't do the left leg, the right knee would go which would leave him without a leg to stand on. They do say that 50% of dogs that tear one will eventually tear the other. And I do see him occasionally limping on the non-surgery leg. (At $3500 I've told him that he only gets 1 surgery).

        I also had his hips xrayed before I made the decision. if he had bad hips, I wouldn't have done the surgery. I'm not made of money and I didn't see the sense in fixing a knee on a dog that would soon be crippled anyway because of his hips. (Turns out he has fantastic hips. Lucky for Dennis).

        The recovery was not nearly as bad as I thought it would be, but Dennis is a good dog, tolerated restricted activity and was using the leg by the 3rd day post op. I was a nervous wreck everytime he moved quick or the couple of times he fell down.

        Good luck with whatever you decide.

        Comment


        • #5
          They do several a day where I work and I have seen all of the great outcomes, and some very bad. When my own crazy dog tore hers this past winter (this is the anxiety one that can't be crated, etc) I spoke with one of the surgeons (she is 11 btw) and he told me the surgery is elective, she will heal, and will most likely get arthritis either way. We did not brace her and I started her on Carprofen for a short time and started her on Duralactin. She was confined to the main story of the house and not allowed out in the back yard to run. He said when she has bad days, rest her, when she has good days, allow her to do more, and eventually the good days will out number the bad days. Honestly, it seems like she healed so fast. We also started her on Adequan shortly after and laser therapy was an option, but I couldn't leave her at work in a cage. Anyway, you can't tell at all. It really seems like it was ages ago, but she is completely fine and has had several check-ups since then. I have had her on a joint supplement for years and I did wean her off the Duralactin and still do the Adequan. I only used the Carprofen when she was really bad at the very begining (with some famotidine) and on some bad days. Also, she is a 50 lb dog and not overweight. Hope this helps.

          Comment


          • #6
            The options are TPLO- which involves a plate and screws, or TTA- which involves reshaping, ie, cutting of the bones in his leg.
            isn't there another option, the "fish line" repair? That's what I had done when my girl tore hers. Much cheaper, much less invasive, and gives the same results as the invasive repairs, especially if you opt to do intensive physical therapy instead of "crate rest" during the recovery period. I'm not sure what you mean by "TTA": in the TPLO repair they cut through the bones and use the metal plates to put it back together.

            I did consider the "let it heal" method, but upon reflection decided it was very inhumane- the dog has to be kept tightly confined for months on end, which means no quality of life. And there's no real proof it works, unlike with surgery. In fact, letting the dog spend time with the joint un-stabilized is strongly correlated with developing arthitis later in life, so it's very likely that most dogs who are allowed to heal without surgery will go on to be crippled later in life.

            I'm always astounded when people choose the TPLO- there's no evidence it works any better than the simple fish-line repair, and it's insanely invasive, must be incredibly painful for the dog, and has the possibility of some serious adverse events. I think TPLO is verging on a scam- vets who can do it have to get specially certified and use the special metal hardware, and everyone makes a lot of money off pushing it on worried dog owners. But that's just my wild, paranoid suspicion.

            Anyway, I had good results with my fish-line repaired dog: she had both legs done, and went on for years happy and very active afterwards. Her "lay up" was short because she went right into intensive physical therapy afterwards and never looked back.

            - my research at the time indicated the odds of the dog getting crippling arthitis in the leg later on in life (which is the biggest problem with this injury) were related to how long the dog went between injury and repair- the faster the stifle is stabilized the better the odds of no arthritis developing later- and whether intensive physical therapy was used vs. simple crate rest after the repair. Physical therapy dogs, especially if they used underwater treadmills, recovered the best. The actual surgery procedure made no difference in outcomes whatsoever.

            Comment


            • #7
              Our border collie had the fishline repair by an ortho vet. Several years later all the hardware, etc had to come out due to infection.

              Comment


              • #8
                Originally posted by wendy View Post
                I'm always astounded when people choose the TPLO- there's no evidence it works any better than the simple fish-line repair, and it's insanely invasive, must be incredibly painful for the dog, and has the possibility of some serious adverse events. I think TPLO is verging on a scam- vets who can do it have to get specially certified and use the special metal hardware, and everyone makes a lot of money off pushing it on worried dog owners. But that's just my wild, paranoid suspicion.
                I am no expert, and we did not have the TPLO, but had the TTA (Tibial Tuberosity Advancement), but I thought it was quite proven that the TPLO DID in fact work better than the "fish-line" repair, and I am not aware that it is any more painful. Having had a dog with a medial collateral repair, I can say that "fish-line" was extremely painful for him.

                To the OP: do your research and ask your vet(s). Not every dog is a candidate for every surgery, so ask which is best for your dog.

                This site has nice graphics for both TPLO and TTA. Did not check to see if it explains the cruciate repair surgery also.

                http://allwestvet.ca/custom_content/...a_surgery.html

                It also has a checklist for deciding about the surgeries (at the bottom of the TPLO page)....maybe it will help?

                Comment


                • #9
                  It was my understanding from my regular vet and the vets at Purdue and MSU that the "fish line" surgery worked great for dogs under 50 lbs or for sedentary dogs but usually didn't hold for the large active dogs. Dennis is around 90lbs of solid muscle. I could only afford one surgery. The advantage of the TPLO is that once healed, the bones stabilize the knee so there is no need for his CCL. I didn't want to do the fish line and then have to worry about his breaking that.

                  As for the pain, Dennis is a sissy and we did have to adjust his pain medication the first couple of days, but we were able to very successfully control his pain.

                  As for it being a "scam," if vets were only interested in making money, they would have gone to medical school instead of veterinary school. Much more $ in fixing people!

                  Comment


                  • #10
                    My vet did a few TPLOs for cost when he was learning the procedure, and I was definitely aware of how important experience is. He had a specialist overseeing him while he was learning because the exact angles are so important. He used to do the "fishline repairs" all the time, but they have a much more painful recovery.

                    His ranking was TTA better than TPLO better than "fishline repair." And the cost runs along with that. The vet school a few hours away was the only place that could do a great TTA repair.

                    Comment


                    • #11
                      Our hospital literally does 2 to 3 TPLO's per day. Very common procedure, but please please please do your research and find a surgeon who is experienced with TPLO's.

                      TTA's are wonderful also, as are Tightropes (a newer procedure available which is similar to a lateral suture but with stronger material).

                      Most surgeons agree that the TPLO is a more tried and true procedure with less failure rate. Almost all our dogs go home the next day and are weight bearing within 2 days post surgery.

                      Arthritis development is far more severe with conservative management as opposed to a TPLO where the angle is actually changed to create no stress on the cranial cruciate ligament. However, at age 10 and a doberman, arthritis that will develop will likely not be his end...and can certainly be managed.

                      From my personal experience I would not hesitate with either a TPLO or TTA. While some pets can tolerate conservative management, I know my dogs are going to want to play again...and with conservative management you are always likely to rupture or strain again. At 10 years old, its a tough decision. I would say if he was an active 10, and otherwise healthy a surgery might be something that would maintain a good quality of life, rather than extensive rest with only a "chance" at recovery.

                      I'd also talk to your surgeon about your concerns, they will likely be able to address all the concerns you have and discuss the pros/cons to surgery vs. conservative management.

                      Comment

                      • Original Poster

                        #12
                        Thanks for sharing your experiences everyone! What my vet told me was that the fish line repair isn't very effective in larger dogs. He is a tall Dobie and a very lean 80lbs. He is active and otherwise healthy. He is my baby and I'm just scared of making the wrong decision. Realistically I know that he's not going to be around forever, so I just want to make sure his remaining years are quality. We haven't seen a specialist yet. I'm still trying to figure out the best in my area.

                        Comment


                        • #13
                          I seriously think you will be very happy with either the TPLO or TTA surgery. Although every surgery (even neuters) CAN have complications, the failure rates on these surgeries is very small. Generally speaking, after 8 weeks the dogs are back to regular activities. Up until week 8,its basically holding them back since they feel so good! Most dogs are walking fully weight bearing within a few days after surgery.

                          Prognosis really depends on client compliance. You really need to properly rehab them, not allow running up/down stairs, chasing squirrels etc. We often see after their 6 week recheck radiographs, full healing and suggest increasing walks to 30 min 2-3 times per over the next 2 weeks. By week 8, the dogs should be starting to return to their normal activity between week 8 and 12. By week 12, they are back to full throttle.

                          We have done several TPLO procedures on police dogs, all have been fully back to work by week 12, chasing bad guys

                          Another benefit to surgery over conservative management is less time on NSAIDs.

                          Not all surgeons do TPLO's, or TTA's. My suggestion is to find a boarded surgeon who is in your area and have the consult. At that time, they will tell you which they prefer/perform and why. In all reality though, both are excellent cures for cruciate disease. Both procedures to involve cutting the bone, but this is really no more painful than a lateral suture (or what some people call fish-line). The benefits of cutting the bone is allowing the tibial plateau angle to change, allowing for less stress on the cruciate ligament. With the lateral suture and conservative management you are not actually allowing the ligament any relief by decreasing the angle.

                          Comment


                          • #14
                            We have 3 certified surgeons in our hospital in it seems like they do these all day, LOL. Just do your homework. Like any surgeries, I have seen the majority go well, and there are some that don't end well, but those are few and far between, Do your homework and do what you feel comfortable with. I see the most go wrong when owners don't follow the aftercare instructions and allow exercise too soon, resulting in fractures. Everyone's situation is different, do what you feel comfortable with and ask a lot of questions.

                            Comment


                            • #15
                              Two different friends, both dogs tore ACL, not privvy to the extent of the injury but both were three legged lame. One went with a brace and limited exercise, one went with nothing but crating during the day, let out with the children in the evening, he was not allowed up an down stairs.Both recovered and are sound, neither required pain medication, in fact they deliberately kept them off so that the dogs would not overuse. One dog needs glucosamine but otherwise are fine. Some vets get really wealthy doing these surgeries and the surgical steel guys, likewise.

                              I think it has a lot to do with early neutering and spaying and subsequent nutrional/mineral defiencies in early stage development of muscles and tendons. No, I have not done a peer reviewed study, just a theory.
                              "We, too, will be remembered not for victories or defeats in battle or in politics, but for our contribution to the human spirit." JFK

                              Comment


                              • #16
                                Oh, I forgot to address the "nothing" option. Because I don't see it as an option for a dog like yours. That might be OK for something like a slender shi tzu who is little, so not much weight on the limb to begin with and is relatively chill. Our vet often recommends that for dogs under about 15 pounds and definitely not to a large guy like yours. Too unlikely for it to heal properly.

                                The post above mine is scary...

                                Look up humans who have ACL surgery and see how much pain they are in before the surgery. It is the same for dogs, even if they can't tell you about the pain. Their brain wants them to run around and be crazy, but their leg can still be extremely painful.

                                Comment


                                • #17
                                  Sorry, easily scared person. Both dogs were large, one was a slightly overweight golden retriever who had not been spayed but it may have been the lack of exercise and weight in this case. The other was a large and slender german shepherd mix. Veterinarians and doctors tend to like people who are overly scared, good for the overhead you know.

                                  Neither of these dogs suffered, they were not given pain meds and they managed. Did you not like the outcome? Or was the lack of huge amounts of money being spent on the dog a problem? The brace and a crate, not the least to say the amount of time, money and PAIN that a surgery can cause. I have to wonder what is the problem with two anecdotes that confront the premise that invasive surgery is always called for. Oh wait, I have another successful non surgical anecdote, cocker spaniel eight months old, HBC (hit by car), go to emergency doc with specific instructions from my equine vet to do one inverted xray and if broken pelvis, to crate. Vet talked me into two xrays, but swore that if the dog was not operated on, and a pin inserted that the dog would have an altered gait for the rest of it's life. He did not, he was fine after leaving in a crate except for normal systems breaks, for about 4 weeks with no pain meds after they doped him up at the hospital. He was fine. That probably scares the easily scared person too, but I am just telling you what happened. Not out 3 - 5 thousand dollars, did not have to cart my poor shaved up, sliced up dog with a bunch of metal hardware inserted around in a cart, did not have to give organ damaging pain meds. All good for me and for all of the above doggies and their families.

                                  Then again, I had a torn ACL and I healed myself up too with hot baths, cold ice packs, arnica, massage and managed careful exercise. I knew you would not want to hear this either.
                                  "We, too, will be remembered not for victories or defeats in battle or in politics, but for our contribution to the human spirit." JFK

                                  Comment


                                  • #18
                                    Originally posted by Calamber View Post
                                    Two different friends, both dogs tore ACL, not privvy to the extent of the injury but both were three legged lame. One went with a brace and limited exercise, one went with nothing but crating during the day, let out with the children in the evening, he was not allowed up an down stairs.Both recovered and are sound, neither required pain medication, in fact they deliberately kept them off so that the dogs would not overuse. One dog needs glucosamine but otherwise are fine. Some vets get really wealthy doing these surgeries and the surgical steel guys, likewise.

                                    I think it has a lot to do with early neutering and spaying and subsequent nutrional/mineral defiencies in early stage development of muscles and tendons. No, I have not done a peer reviewed study, just a theory.
                                    A theory based on two individual case studies.

                                    OP, talk with surgeons who do this often. My dog was very, very lame before his surgery. He was an active breed (Brittany), about 40lbs. He often yelped in pain when getting up and sometimes while walking/trotting about the house. This is how we knew he had an injury. (And, he was intact his entire life, so any correlation with early neutering goes out the window in his case).

                                    Post-surgery he galloped on the repaired knee. Every day.

                                    Yes, of course, some dogs might recover without surgery, and some might not. Your vet(s)/surgeon(s) will be able advise you about the likelihood of either outcome.

                                    Comment


                                    • #19
                                      My 43 lb. moderately-active Springer tore her ACL almost four years ago, at age 6. We were told she was a good candidate for either the lateral suture or TPLO surgery. I believe the tightrope surgery was mentioned but my vet wasn't a huge fan of that.

                                      We chose Traditional/lateral suture. This was largely based on cost (half as much) and the fact that our vet has done MANY of them with very good results. When she got into Sunny's knee, she discovered she had not only fully torn the ACL, but the other main ligament as well; she said that even if we'd opted for the TPLO (which, by the way, would have been done at the top-notch surgical specialty hospital or Mizzou) they would have had to place a suture. So I felt pretty good about our choice.

                                      Pain management was not bad, and my dog was a good patient. She left her staples alone and didn't even need a cone. Recovery went very smoothly (no infection) until seven weeks post-op, when she got away from us and tore the meniscus. Fortunately, the knee continued to improve and Sunny was back to normal in about four months total. I was thrilled and remain extremely grateful that she was once again able to run and play as she loves to do. I was so afraid she never would again.

                                      Today, other than a slight popping sound when she goes up the stairs, you'd never know Sunny had a thing happen to her knee. I recently had her x-rayed for an unrelated incident and the knee looked great. :-)

                                      My dog was three-legged lame when she hurt herself, and I can't imagine not having surgically repaired that knee. She's very stoic so there was no crying or carrying on, but it couldn't have felt good! I agree that for a bigger dog such as yours, OP, that TPLO or TTA would be a great choice. Good luck!
                                      "Horses lend us the wings we lack." ~ Pam Brown

                                      Comment


                                      • #20
                                        Senior Citizen

                                        To the OP, this sounds really bad so I apologize in advance. I have coveted the Doberman since I was a child. Isn't life expectancy a problem in the breed? DCPA even has a Longevity Program where a Dobe over 10yo can receive a Longevity Certificate.

                                        I am sad to say your Dobe is a senior citizen. What shape is he in otherwise? How long do you guess he will be around?

                                        Crate rest, physical therapy/management, joint supplements, and pain meds may be a good choice if he is truly a senior citizen.

                                        Originally posted by jherold View Post
                                        It was my understanding from my regular vet and the vets at Purdue and MSU that the "fish line" surgery worked great for dogs under 50 lbs or for sedentary dogs but usually didn't hold for the large active dogs.
                                        That is just about what our surgeons advised clients. I've seen TPLOs respond better when post-op physical therapy is declined than the more conservative surgeries.

                                        To the other posters, the opposite knee has just as high a probability of blowing regardless of treatment. Any surgery is invasive. You slice through to expose it all the same in each option. The TPLO hardware does add greater risk for infection - especially if the owner tosses the e-collar .

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