Some Help With Cruciate Options Please

[disintegratus]

So about a week and a half ago I took Zehra (rotti x something) to the vet as she's been limping. Turns out she's ruptured her left cruciate ligament. about 2 years ago she did the right one, and we had that one fixed using the TPLO method where they put the plate in, as at the time we were advised (and all my research agreed) that the deangelis method, where they tie it with surgical twine, was not really appropriate for a dog her size (about 35kg)

This time, I took her in this morning to get her preliminary xray done so they could measure her up for the plate, and the vet told me that she didn't really want to do the TPLO on Zehra and thought that the Deangelis would be a better option for her. She said that they're using some new fandangled kind of fibre that's much stronger than the old stuff, but I'm a bit confused because you would think that they would have mentioned this a week and a half ago when I took her in. The vet did say that she was displaying some signs of arthritic movement in the right leg, that was the main reason she didn't want to go ahead with the TPLO.

So at the moment I'm doing a bit of research of my own to see what I can come up with, and if I'm not happy with that I'll call them a bit later to speak directly to the surgeon if he's available, but in the mean time I wanted to get some opinions from the fountain of knowledge that is DOL :)

So, what are everyone's thoughts? Have you had a dog that's had its cruciate repaired? Were you happy with the surgery? Why or why not?

Thanks everyone!!!

[Wundahoo]

The TPLO method is not an easy one and takes a bit of training for the procedure to be done well.

Is this the same surgeon who did the first TPLO or a different one ?

If you have seen a different surgeon this time then it might be that they are not quite as experienced as the last one and may not be as confident with their technique.

Perhaps you might want to seek a second opinion from a specialist orthopaedic surgeon before committing.

Edit for spelling.

Edited July 29, 2013 by Wundahoo

[Xyz]

Definately wouldn't recommend a deangelis on a dog that size. Seek a specialist opinion IMO!

[disintegratus]

Thanks, you've all confirmed what I was thinking. Same clinic as last time, but not sure about whether it would be the same surgeon. I also spoke to Lost Dogs home clinic, who agreed that it sounded very strange.

I'm going in tomorrow morning to talk to them and find out what's going on, I'm a bit disappointed to be honest, as last time they were fantastic, though this kind of misinformation leaves a lot to be desired.

[westiemum]

Sigh... yes Mac again - he doesn't read the textbooks! He's a westie and has had both - a Deangelis the first time which worked well in a 8-9 kg dog. A Deangelis for the second one which failed so a TPLO with a specialist surgeon the third time who also changed the angle of his leg. At the time of the TPLO it was very unusual to use that technique on a small breed where they usually use a Deangelis but it was necessary fro orthopaedic reasons..

So I'd definitely be getting a second opinion before making a decision - having the oepration fail hurts financially but more importantly hurts the dog to have to go through it all again and to have a second GA (which IMO should always be minimised).

Hope that helps. Will be very interested to hear what you decide.

Edited July 30, 2013 by westiemum

[Rappie]

Generally speaking a plateau leveling procedure would be recommended for a dog that size (TPLO, TTA, TWO, TTO etc).

I can think of two things that could explain the advice that you've been given about the suture. One is that they are referring to a tightrope procedure which is not commonly done but is an alternate option for large breed dogs. It used a very strong braided suture and bone tunnels for isometric stabilisation of cruciate deficient stifles (the aim for TPLO etc). It is still classed as an extra capsular repair but is not a De Angelis suture. The other reason is perhaps that they are now using a product called Ligafiba which is a reasonably new suture material that is much stronger than the nylon that is traditionally used. It is stronger and will hold up better, and a DeAngelis repair is better than none but it would really depend on the measurements of the rads as to whether it's a good alternative or not.

[Jess the Lab]

Gee, reading this topic makes me realise I was ignorant. I was simply told my Lab's rear ACL needs reconstruction. No technical discussions on the types of operations.

It was done on a 9 year old (then) and she weights about 45 KG. The operation went well in theory and she was jumping after a few days! We actually went to another vet to confirm if the operation was actually made and was proven not a con job!

For the short few weeks right after the operation, the vet gave pain killers pills and cartrophen injections. But we did not go for the subsequent optional injections...that was supposed to last her life time. Too cheapskate to spend that money. In fact, for about close to 2 years we never gave her any injections nor supplement of any kind.

Occasionally she has a bit of limping after some aggresive walks and runs in an off leash park. Vet says it's arthritis on the operated leg. We never did anything for close to 2 years. It was only recently we gave her Rose Hip Vital as a supplement to ease the pain. It seems to work.

Edited July 31, 2013 by Jess the Lab

[3labs]

My Lab Tessa ruptured her about 7 months ago while at the beach. She kept her leg up so took her immediately to the vets who said rest over the weekend and come back Monday. I knew it wasn't right so Monday they took and xray and Wednesday they did a TTO. It all happened so quickly I trusted the vet and did as she suggested. When they told me there is a chance the other leg can go I said with her other vet bills there is no way I could afford another one. She told me they usually prefer to do a TTO, but obviously some people can not afford it so the other one is fine.

Tess is a very bouncy dog so think this was the best option for us. Unfortunately she has a pivot shift which they thought would come right, but hasn't. I don't regret it, but think if I had to do it again I might read up more and get others opinions as you have done.

My surgeon said they will get arthritis so Tess has been on Pentosan and supplements to try and lessen the degree of arthritis.

Good thoughts for your dog.

[*kirty*]

I did a TPLO on my dog's first cruciate but when the second one went 6 months later, I opted to try medical management. She is sound on both legs and only limps after strenuous exercise. She is 12yo and weighs about 18kg. She has cartrophen injections, glucosamine and sashas blend to help with her arthritis.

[disintegratus]

Update:

My Mum's going with the DeAngelis (using 500lb Ligafibre) on her dog Jack (who after years of issues with his legs has finally been properly diagnosed), as his not a straight snap of the ligament but a degeneration over a long time and has a lot of associated joint damage, so the DeAngelis is the less invasive option.

I'm still not sold on the DeAngelis for Zehra though. They said this fan-dangled Ligafibre is comparable to the TPLO, but it's only relatively new, and the best I could find claimed similar results to the TPLO in a 6-month retrospective study. 6 months is not a very long time, and is not really long enough to be a proper indicator. But on the other hand, the recovery time for the DeAngelis is a lot shorter and it is a significantly less involved surgery. It's also about 2/3 the price of the TPLO, but that's neither here nor there.

Zehra's not so much a "running" type dog as she is a "bounding around breaking her legs like an idiot" type dog. Do you guys think the DeAngelis will be alright for her in the long term? Or will the extra strain she puts on the Ligafibre with her idiocy make it more likely to rupture and have to be repaired again?