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Pet Forum / Miscellaneous / Animal Health / December 2007Cruciate --- Looking for opinions on options.
Hi all, I'm faced with the possibility that Erwin (3.5 y.o. lab, ~78lbs, well muscled, good weight), *may* have buggered his cruciate (probably a partial tear). We're going back next week when we can sedate him and have a really in depth examination. All he's doing right now, is he'll stiffen up in that leg a bit after lying down for a while (he loosens up after a couple minutes). Anyways, assuming he has screwed his cruciate, I have essentially two surgical options open to me (I'm sure there are more, but these are the big ones available).. 1. TPLO - Pros -- Best available, quick recovery time, he likely won't blow the other one while waiting for this one to heal. Cons -- More expensive. 2. Don't know the name, but it involves stabilizing the joint with a nylon cord. Pros: Cheaper (my regular vet can do this one). Cons: He's on the edge of what he likes to do weight wise. Longer recovery time. Have to keep him quieter, longer (he's a lab remember? ) Third option, is to do nothing. He's not really bothered by it, but then again he's pretty stoic (it took a while to even figure out that something was wrong...at first I thought the stiffness might be related to another problem he'd been having), so I wouldn't want to have him in pain and not know about it. Any thoughts on things I might not have considered? Dale Dale, When Buddy did a partial tear in his the vet wanted to wait and let it go and "hopefully" he wouldn't tear it completely. Well that wasn't the case and when he finally blew it out a year later it was much worse than if I'd just told him no fix it now. Plus I didn't realize how much it bothered him until I saw the change in his personality once the surgery was done. I would have it repaired now with the nylon method its cheaper plus it's not as invasive. I've had 2 dogs and both have had surgery by this method with really good results. Of course they are going to get some arthritis even after the surgery but nothing like they would if you wait and see. Like you said he's a lab the recovery time is going to be crucial no matter what method you choose. I took a very long time to work Barney backup to full running after his surgery. The vet told me 8 weeks I stretched it out to 5 months before I would let him off leash. He was a sprinter and I could just see him doing just that before it was healed completely and damaging it again. I'm glad I took that long because it made a huge difference for him. Now with Buddy we did the regular 8 weeks recovery. He's not a very active dog and I had no fear of him running across the yard full tilt and hurting himself. Although he's ran down the ramp a few time since and jumped off and almost slammed into the side of the car..........LOL Good Luck Celeste > Hi all, > [quoted text clipped - 28 lines] > > Dale > Hi all, > [quoted text clipped - 27 lines] > > Dale I'd factor in Erwin's activity level. My dog was very athletic when he tore his and not doing surgery wasn't considered a good option. He had option 2 and 7 years later at 11 years old and 75 lbs, the arthritis and HD are slowing him down. He did the 12 week rehab and while I thought it would seem like forever, the time passed quickly and we bonded even more, starting the gardening game "Throw the weed - just throw the weed!" We still play it, but I no longer throw the weed right into his mouth. :) Kate Grrr. I hate this stage of learning. The more I learn, the more I doubt what I thought I knew. Been skimming some research articles that are claiming that the supposed benefits of the TPLO are not all they are billed at. No (significant) decrease in risk of arthritis later, no better restored function, problems with the recommended TPA (apparently 5 degrees is recommended, but 5 degrees is doesn't seem to be optimal). Its hard, because most of this flies in the face of all the anecdotal evidence I had before starting my research, and I don't (yet) have the skill set to critically evaluate what I'm reading. Dale > Hi all, > [quoted text clipped - 28 lines] > > Dale you might check out the yahoo group orthodogs. lots more information to read and be overwhelmed by! i opted for a traditional suture repair mostly because of the cost. my dog's a 45 pound pit bull. she's doing well, back to normal activity, and i'm (so far!) happy with the decisions i made as far as surgery. >Grrr. I hate this stage of learning. The more I learn, the more I doubt what >I thought I knew. [quoted text clipped - 6 lines] >evidence I had before starting my research, and I don't (yet) have the skill >set to critically evaluate what I'm reading.  Signaturehttp://shattering.org x-no-archive:yes in headers > Been skimming some research articles that are claiming that the supposed > benefits of the TPLO are not all they are billed at. ......Personally I'd also be looking at a literature review or a review of cases over a certain number of years. Still, it depends so much on the health of the dog to begin with, how careful the owner is in following rest instructions afterwards, how skillful the surgeon was, and maybe even if certain supplements were given to the dog after surgery, that it's still all a crap shoot as far as anything definitive. If one particular surgeon has data on his/her cases, to me that would be more reliable than a bucket full of papers. At least you would feel more comfortable with the outcome with one particular person. I don't (yet) have the skill > set to critically evaluate what I'm reading. .......a very neglected portion of any student's education, IMHO. If read critically, opposing conclusions usually point to something different in methodology, procedure, etc. And in the case of surgeries, there may be something different that the surgeon is doing that he/she is not aware of. .....at any rate, hope you have a good outcome, whatever you decide. Remember this moment when you're wearing that white coat. buglady take out the dog before replying If it's a recent injury, and an athletic dog, you are better to do surgery sooner rather than later, or not at all. That being said, while it seems that TPLO is touted as the "gold standard" for cruciate repair, I don't think I agree. I'm sure it works just fine, but the dogs that we've referred have done no better (and in some cases have done significantly worse) than those who had the "old fashioned" extracapsular repair. We have at least one patient who had his first ruptured cruciate repaired via TPLO. He did just fine, but then blew out his other cruciate. My boss performed that surgery, and he actually had a quicker recovery and the owner was much happier. And while they may be weight bearing sooner, it actually takes a long time for the bone to heal. I had one dog who didn't have any radiographic signs of healing even 3 months after the procedure, and the orthopedist said "that's not unusual". My boss does all our cruciates. He used to just use nylon line and tie 2 strands with knots. He has switched to a securos bone anchor system -- instead of having so much foreign material and big knots, you use a bone anchor and crimps for the suture material. It is much faster for him to do, and the results seem to be significantly better than with the old system. So my vote now would be for finding a vet who does the "old fashioned" repair but uses the securos system and have it done that way! Deborah, DVM > Hi all, > [quoted text clipped - 28 lines] > > Dale So my vote now would be for > finding a vet who does the "old fashioned" repair but uses the securos > system and have it done that way! ...............and that to me would be worth more than papers. On hands real life experience. P.S. Dr. Deb go look at gecko/lizard thread please! buglady take out the dog before replying > If it's a recent injury, and an athletic dog, you are better to do surgery > sooner rather than later, or not at all. I'm not really sure *how* old the injury is. Unfortunately we didn't catch it right away (I have a feeling he did it on a walk with my Dad, but I can't be sure). It coincided with some other issues, so to start with we (both myself, and one of the vets) wrote it off as being related. Still don't know for sure that he *has* injured it, but I think he has. Looking over my own notes, and posts and what not, I'd say he did it nearly a month ago (which makes me feel awful for not realizing something was wrong sooner, but he didn't complain, so I didn't see it). The only thing that might put off the surgery I think would be the diagnosis for his front leg. He seems to be tender in places on that one too, and we don't know why (hopefully we will on Friday). That being said, while it seems > that TPLO is touted as the "gold standard" for cruciate repair, I don't > think I agree. I'm sure it works just fine, but the dogs that we've > referred have done no better (and in some cases have done significantly > worse) than those who had the "old fashioned" extracapsular repair. While I've been reading, I've come across a number of different names for different techniques used, but I'm not sure I understand them all. Theres a LSS (lateral suture stabilization), ICS (intra-capsular stabilization), Lateral Fabellar Technique. Can you give me an idea of kind of the broad stroke differences in what these techniques are? (I've got a pretty good handle on TPLO). >We have at least one patient who had his first ruptured cruciate repaired >via TPLO. He did just fine, but then blew out his other cruciate. My boss [quoted text clipped - 10 lines] >be for finding a vet who does the "old fashioned" repair but uses the >securos system and have it done that way! That sounds (somewhat) like the method that they do at the clinic I volunteer at (obviously there may be differences in where exactly the nylon line goes). The concern they have about doing it with Erwin, is that the weight of the line might not be strong enough. I think the rule of thumb they mentioned was that the weight of the line needs to be about twice the weight of the dog. (So he's need about 150lbs line, which they have no way of getting). > Deborah, DVM > [quoted text clipped - 30 lines] >> >> Dale >>If it's a recent injury, and an athletic dog, you are better to do surgery >>sooner rather than later, or not at all. [quoted text clipped - 10 lines] > tender in places on that one too, and we don't know why (hopefully we will > on Friday). Bear had torn his at least a month before it was diagnosed - the vet thought it was something else and was treating with prednisone. (Bear is very stoic.) I finally drove to Memphis for a second opinion and that vet figured it out quickly (and probably painfully - Bear has never been good with any male vet since.) Basically I'm saying don't feel awful. You are doing the best you can. Peace, Kate >> If it's a recent injury, and an athletic dog, you are better to do >> surgery sooner rather than later, or not at all. [quoted text clipped - 10 lines] > leg. He seems to be tender in places on that one too, and we don't know > why (hopefully we will on Friday). A month isn't that old. After 6 months you've probably already got so much arthritis that surgery won't help as much. > While I've been reading, I've come across a number of different names for > different techniques used, but I'm not sure I understand them all. Theres > a LSS (lateral suture stabilization), ICS (intra-capsular stabilization), > Lateral Fabellar Technique. Can you give me an idea of kind of the broad > stroke differences in what these techniques are? (I've got a pretty good > handle on TPLO). I couldn't even begin to tell you the subtle differences between the many textbook methods to repair cruciates, because I have no idea what they are! My boss call's his method "modified flo's" which I'd never heard of. I call his technique extracapsular suture/lateral fabella/suture or something like that. It's definitely not intracapsular. > That sounds (somewhat) like the method that they do at the clinic I > volunteer at (obviously there may be differences in where exactly the [quoted text clipped - 3 lines] > twice the weight of the dog. (So he's need about 150lbs line, which they > have no way of getting). While that's the rule of thumb, in reality 80-100 lb test nylon seems to work okay even for larger dogs. I know my boss did an 80 lb dog with 100 lb nylon with his older technique, and he just did a 95 lb dog with 100 lb nylon with the securos technique. Both dogs have done fine. I think they used to think (at least I was taught years ago) that the line actually served as a replacement for the ligament. Now it seems that the school of thought is that the line only has to stablize the knee long enough for good healing, and after several months it probably isn't even necessary. Deborah, DVM Had Erwin at the vet's today, and we took some X-Rays, and checked out his knees. Good news bad news. Good news first. The good news is his cruciate doesn't seem to be too bad. Probably *some* damage, but surgery isn't really a good option at the moment. Now for the bad news. His front left elbow (the other thing that's been periodically giving him trouble), has some pretty ugly looking (well ugly to me anyways... it looked pretty painful on the x-ray) arthritic changes. We gave him a shot of cartrophen, which we'll be repeating in (about) 10 days, we also gave him a shot of metacam (because we'd been playing with his sore joints), and lots of hugs and kisses : P . We're also switching his food over to mobility support (royal canin). Dale > Hi all, > [quoted text clipped - 28 lines] > > Dale |
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