Limping Hind Leg After Frisbee Play

[Sticks1977]

Fraser (labrador) and myself were outside on Sunday afternoon playing with his beloved frisbee. We have played many times before without any problems until now. He went up to catch the frisbee in his mouth and must have landed awkwardly as when he stood up, he was holding his right hind leg up in the air.

I did not hear any noises or notice any discomfort or yelping coming from Fraser. Initially I thought he may have done something similar to us humans when we roll our ankle and it is sore to begin with, but starts to get better. This happened approx. at 4.00pm and by 5.30pm he was still showing signs of limping so I took him to the Animal Emergency Centre in Hallam to get him checked out by a Vet (since it was Sunday and most were closed).

The vet examined him and noted that there was possible mild swelling in the stifle but no positive drawer sign. And also that there was mild pain noted on examination of the stifle. She gave Fraser two injections - Meloxicam and Buprernorphone. The vet then mentioned to me that if Frase still had lameness in his right leg in 24 hours to book in with my regular vet and get them to look over him and see if there was any change in his condition.

He went to the vet yesterday (Monday) and Leeanne (the Vet) said that there was no movement of the knee to indicate that there has been a completely torn ligament, she also mentioned that his patella was still in the right position but noted that his stifle was still giving him some discomfort. She also checked his hips to make sure that there was no problems.

Leeanne said that he should have some rest and be on a course of Prolet tablets, given twice a day with food (morning and night). He has showed some improvement, he seems to be walking normally at the moment but is still not fully weight bearing on his right hind leg. I took him for a small walk earlier (for approx 15-20 metres) and he is able to walk comfortably on the lead but he attempted to cock his leg to "mark his territory" but was unable to do so.

I am hopeful that the rest will enable the knee to fix itself if it happens to be a sprain or mild tear of some of the fibres. I have also been reading up on TPLO surgery of the knee joint (particularly when it comes to ligaments) and the cost of such a procedure is expensive, but I have also been reading a few negative reviews in regards to TPLO.

I shall keep you all updated on Fraser's progress - I hope that he has not done any serious damage... are there any signs or body actions I should be looking out for if he has infact partially torn or torn a ligament in his knee? Thanks for reading and look forward to some replies - and later some more updates for you all!

Regards, Shaun (sticks1977) and Fraser.

[Flaves]

Shaun he may have jarred his back too or done a groin injury

Can you take him to a bowen therapist or a chiro?

There is a Bowen therapist at either Devon Meadows or at Narre Warren

They may be able help also

Edited January 13, 2009 by i haz flava!

[Sticks1977]

I'm more than happy to look into alternatives before going down the avenue of surgery that will cost a few thousand... I have never heard of bowen therapists or chiropractors for dogs.

If there are any available in my area, send me a PM and let me know or perhaps refer me to a website or something similar... Thanks for your reply and look forward to reading a few more!

[puggy_puggy]

I would be crate or puppy pen resting him for the next few days to see if there is any improvement.

Did your vet tell you to walk him????

I probably would have crate rested him from the start rather then having to pay the crazy prices of emergency vets.

[Flaves]

I'm more than happy to look into alternatives before going down the avenue of surgery that will cost a few thousand... I have never heard of bowen therapists or chiropractors for dogs.

If there are any available in my area, send me a PM and let me know or perhaps refer me to a website or something similar... Thanks for your reply and look forward to reading a few more!

PM ing you now

[Sticks1977]

I probably would have crate rested him from the start rather then having to pay the crazy prices of emergency vets.

In hindsight it may have been worth resting him on the Sunday when the injury occurred, but considering I did not know how serious it was and that the lamenss in his right hind leg was still there I thought to see the emergency vet to get at least a diagnosis was the best course of action.

We are into Day 3 now and Fraser is still resting around the home, he is happy enough to get up and leisurely walk around the house. I have closed off all doors to bedrooms so he is not able to get up onto the bed and have also stopped him from getting up on the couch. He still had his doggy-door that he goes through which has concrete pavers outside so he has a level surface in which to walk out onto.

He is showing some improvement in that he is able to scratch his ear with his right hind leg (the one with the injury) and is able to stand comfortably with both hind legs level with one another, previously he has had his right hind leg further back than the left with only his toes touching the ground. At the moment he is able to share his weight across both legs and has no trouble sitting, lying down or getting up to walk around.

Fingers crossed that the anti-inflammatory tablets are working and that some more rest will enable him to get back to normal and begin going on some lesuirely walks again.

Regards, Shaun (sticks1977) and Fraser.

[puggy_puggy]

I probably would have crate rested him from the start rather then having to pay the crazy prices of emergency vets.

In hindsight it may have been worth resting him on the Sunday when the injury occurred, but considering I did not know how serious it was and that the lamenss in his right hind leg was still there I thought to see the emergency vet to get at least a diagnosis was the best course of action.

I understand. When I first because a pug owner I would rush to the vets over everything. I've gained alot of knowledge over the last 7 years from both owning my own pugs and fostering rescues that these days unless it's something like an eye injury that I need meds for I either treat at home or wait a little bit before I hit the vets.

Glad Fraser is doing better. I would continue resting him for the next week. If you think about whne we as humans get strains it takes a fair while for them to heal.

[WildatHeart]

I hope he gets bettter and it's nothing too serious. My girl was lame for one month and i was worried it was something bad. I took her to the vet the first day she was lame and he said to crate her for one week. I get home and crate her and take her out for toilet. One day came home from work to see my pup roaming - 60 arces probably chasing a rabbit. My grandma thought i would be good for her to stretch

[Charles Kuntz]

I would guess a partial cruciate ligament rupture as well. Only 50% of dogs with a partial tear will have a positive drawer sign. The medial swelling (buttress) is a more consistent clinical sign. Conservative management is appropriate initially, recognising that many dogs will go on have a tear which requires surgical intervention. The typical history is a lameness which resolves with rest, but recurs after exercise. If it happens a few more times, you should probably consider surgery. The outcome with surgery is very good in most cases. Conventional extracapsular repair has been associated with 6 times the incidence of severe arthritis when compared with TPLO's. While complications with TPLO's do occur, they are uncommon. There are alternatives to TPLO's including TTA's which are relatively new but are associated with a very rapid recovery when compared with all other procedures that I have done. They are also a bit cheaper than TPLO's.

Charles

[Erny]

Charles .... thank you for posting. It is always very interesting to read the information and advice from a professional in the 'field'.

I've had a knee reconstruction done on my own leg. Took hamstring, doubled it, bored a hole a tad larger than was already there so the thickness could thread through. By doing it this way, the loss of 'fibre' due to initial loss of blood flow did not affect the overall strength of the new 'cruciate'. In fact, it is stronger than my other 'original' cruciate in my other leg.

I'm supposing it might be done differently on dogs given structural differences, and apart from the fact that the surgeon who did mine is somewhat unique in his method.

For dogs who have had cruciate surgery, what's the strength of the new cruciate compared to beforehand?

ETA: And please pardon my ignorance. What is "TPLO" and "TTA".

Edited January 18, 2009 by Erny

[Charles Kuntz]

Cruciate ligament rupture is the most common orthopaedic disease seen in dogs. Traditionally, it was thought of as a specific injury resulting from acute stress on the knee causing an acute ligament tear. More recently, theories of an abnormal slope to the tibial plateau have been developed which probably more accurately address the inciting cause.

When the tibial plateau is tilted backwards, the femur tends to slide “downhill” putting stress on the cruciate ligament. Repeated stress ultimately results in failure. Studies have shown that in dogs weighing less than 15 Kg, conservative (non-surgical) management is often appropriate. This involves weight-loss, pain relief, cartilage protectants and exercise modification (physiotherapy). In dogs weighing over 15 Kg, non-surgical management is only associated with a 40% success rate. Surgical management results in an 85-95% success rate depending on issues like body weight and proportions, rehabilitation and surgical technique used.

We regularly perform three different techniques for cruciate ligament repair. There are advantages and disadvantages to each. The traditional technique for cruciate ligament repair is called extracapsular repair. It involves replacement of the ligament with a piece of nylon. Advantages of this technique include technical simplicity, infrequency of complications and cost. These are most commonly done at primary care veterinary clinics with good success. The primary disadvantage is a much higher incidence of severe arthritis when compared with other procedures. It is most appropriate for small to medium sized dogs with a moderate level of activity.

The second commonly performed technique is called the TTA or tibial tuberosity advancement procedure. It is a fairly new procedure which has had very favourable results. In this procedure, the tibial crest is advanced forward so that the patellar tendon acts like the cruciate ligament. The advantages include very rapid recovery, when compared with any other repair technique, favourable outcome, and cost when compared with a tibial plateau leveling osteotomy. The disadvantages include relatively short track-record and potential for meniscal injury. The meniscus is a shock-absorber between the femur and the tibia. A meniscal release procedure can prevent this damage in the future. Results to date are very encouraging and we have been particularly impressed with the speed of recovery.

The third procedure is the TPLO or tibial plateau leveling osteotomy. This procedure has been around for around 20 years and the results are as good or better than anything else published to date. This procedure is based on the fact that the tibial plateau in cruciate-deficient knees is tilted backward, causing excessive tension on the cruciate ligament. The top of the tibia is cut and rotated to make the cruciate ligament obsolete. The advantage of this procedure is the excellent outcome. The disadvantage is cost when compared with the other procedures.

[Lab lady]

wow how lucky are we to have a expert to pass on information

Thanks Charles ;)

[labsrule]

Shaun - How is Fraser doing? hope he is doing ok and recovering well . We need an update

Charles - thank you so much for your informative post. It is fantastic to have qualified, knowledgeable, experienced veterinary experts contribute to this forum ;)

[Charles Kuntz]

Anytime. You can also PM me.

Charles

[Sticks1977]

Shaun - How is Fraser doing? hope he is doing ok and recovering well . We need an update

Thanks for the poke along 'labsrule'...

I'm pleased to report that Fraser is doing quite well, he has no lameness in his hind leg that I can notice. He is able to walk without any discomfort and has begun cocking his leg again when "marking his territory" on any bushes or gardens. Earlier in the week he attempted to do this but was unable to support his weight on his right hind leg that showed the lameness.

I took Fraser to the vet yesterday to get him checked over since it had been just over 1 week since the initial injury. She assessed the knee area and said that there was still no positive drawer sign and then asked me to take him for a walk outside of the practice so she could view whether the leg was under any pressure or there were still any signs of lameness.

She seemed happy with his progress and prescribed some more anti-inflammatory tablets (Prolet) for him this week. Another week of rest for Fraser and she said that if he was still showing improvement - no lameness or limping - that I could slowly ease him back into normal activities of walking on the leash daily and eventually - running around.

Thanks to all for the replies - it has been great reading the advice and good to know there is always help out there if needed.

Regards, Shaun (sticks1977) and Fraser.

[Kelly_Louise]

Glad to hear that Fraser is on the mend... fingers crossed it stays that way.

Charles, I am interested in the difference between a TPLO and a TWO. Are they similar as they appear to be similar in some aspects? The specialist surgeon that operated on Chloe did not offer us TPLO as an option, just the tibial wedge osteotomy which to me was the closest to a TPLO.

Also, we were given the option of a new surgery at the time (2 years ago) that was still in testing stage where they inserted some sort of rod/plate that had a spring in it or similar. I have no idea what it was called, or exactly how it worked... just wondering if you had heard of that and if there had been any results of longer term testing? I haven't heard of anyone's dogs having such a surgery so it doesn't seem to have taken off (thank goodness I said no).

Thanks!

[Charles Kuntz]

TWO is similar to a TPLO but has theoretical disadvantages compared to TWO primarily related to the position of the patella as it courses through the groove. TPLO and TWO have never been compared in a study, but I would imagine results are similar. The other procedure you are referring to is probably the TTA which I address in my previous post. Bottom line is that all of the tibial plateau procedures (TWO, TPLO and TTA) probably have similar results. I would base my decision between those on cost and recovery in the hands of the surgeon. The comfort level you have with the surgeon is as important as anything, particularly how they deal with aftercare and complications (we all have them). Not all specialists are equal in this regard.

Charles

[Kelly_Louise]

Thank you Charles, as always very interesting.

Yes I do agree with your comments on aftercare etc. It does make a difference, as does finding a surgeon you are comfortable with I think.

I was very lucky and had very few issues, and would trust our specialist and the nurses and staff there with Chloe's life. To me, he is a saviour because everyone else (mind you we were very panicked)... but all the follow ups were good and very informative.

The aftercare was precarious, and sometimes draining, but the few weeks of immense effort were more than worth the fabulous results we got and the way my girl can run freely again.

I know not everyone is a fan of surgery... I know my mum wasn't either. She thought it very cruel to put an older dog through 2 surgeries and have her confined for so long. But the alternative was bleak and I wasn't prepared to watch her suffer everyday, so we gave it a shot and if I had to do it all over again I wouldn't change a thing.