Cruciate Injury Options

[billbro]

Hi all,

Apologies for adding another post about this topic, I have tried to browse through the search option before posting.

Unfortunately, we have a 3 year old Japanese Spitz who has potentially torn or ruptured his cruciate ligament - he was running at the park, when all of a sudden he started limping. We have had a number of consults with the vet and it has been quite a few weeks now, the limp is definitely improving, but when he starts jogging the limp will be present and he isn't really bearing weight on it.

Long story short, we have booked him in for surgery next week after a consult this morning, but I have some lingering concerns.

1. When I asked the vet about risk factors to surgery, she only talked about the anaesthesia (saying it was no more risky than for a human). However, the concern is more around risk factors resulting from invasive surgery and post-op.

2. I have read previously that it isn't necessarily recommended for young dogs to have invasive surgery, but the vet actually suggested that it was the other way around (e.g. she might not recommend it to an older sedentary dog, which seems consistent with other forum posts).

Essentially, I just want to confirm that surgery is the correct action for a small young dog. Also, is there a preferred CI operation for a small dog, e.g. I've read about Suture, TPLO, TTA? The surgery estimate doesn't outline which method will be performed by the vet.

Appreciate any comments and thoughts.

Thanks

[westiemum]

bilbo thats what happened to my departed westie Mac - he was running across an oval at Ocean Grove and blew his ACL. He was 6 or 7 at the time and had a TPLO when he returned home which was very successful. Then from memory six months later he blew the other ACL. He had a TPLO which failed within a fortnight. The vet was devastated and referred us to a specialist surgeon who altered the angle of his leg and performed a TTA which I was told is unusual in a small breed - but it worked well.

The problem you have is that both doing surgery and not doing surgery will both have consequences. I think you do whatever you have to do to normalise the joint as quickly as possible. And if thats surgery then so be it. And if you don't do surgery the dog may develop compensatory gait characteristics which probably won't be good. I think as your vet seems to be saying , its less about the age of the dog and more about the return of function. So yes on the info you've given, I'd go ahead and have surgery.

Edited June 18, 2016 by westiemum

[Rascalmyshadow]

Cruciate surgery is generally very successful, although its a big op the recovery is easier than patella surgery.

I have had two dogs and two cats have the surgery done and the biggest issue was arthritis as they got older.

Be aware dogs that rupture one cruciate are at a much higher risk of rupturing the other one within two years.

I would do the surgery ASAP, keep your dog lean (not skinny) and fit, avoid fetch games where the dog has to pull up suddenly and use glucosamine, shark cartilage or something to help the joints stay mobile.

[billbro]

Thanks for the responses, I'm hopeful that this isn't a bilateral event for him.

We kind of suspect this only occured because a while back at the dog park a man accidentally stepped on the same leg and he yelped - which is rare for him. I think that started a trend that lead to the eventual tear/rupture.

The little guy is getting better slowly, which is the confusing thing about operating on him - but we want him back up to speed as soon as possible, so there probably isn't any other option.

[Rascalmyshadow]

My poodle girl had a partially ruptured cruciate for about 6 months before it fully ruptured, the vets wouldn't do surgery at first so we tried all alternatives, I believe this just prolonged her discomfort.

[Xyz]

Bone levelling surgeries (TPLO, TTA) offer a much quicker and permanent return to normal function. Recommend you have a referral to a specialist surgeon! Good luck and good on you for not leaving him in chronic discomfort ????

[*kirty*]

I wouldn't let a general vet do such a surgery. Ask for a referral to a specialist.

[billbro]

Kirty,

Is a specialist needed - as we prefer the familiarity of our regular vet. Only the veterinary director at the green cross clinic we go to performs the acl surgeries.

Thanks for all the feedback, our main concern was having invasive surgery for our little guy who is pretty young - but definitely seems like the best course of action.

Edit: woops autocorrect on phone.

Edited June 19, 2016 by billbro

[denali]

Kirty,

Is a specialist needed - as we prefer the familiarity of our regular vet. Only the veterinary dictator at the green cross clinic we go to performs the acl surgeries.

Thanks for all the feedback, our main concern was having invasive surgery for our little guy who is pretty young - but definitely seems like the best course of action.

I would definitely recommend a specialist for a large and important operation such as this, as you really want to make sure it has the best outcome.

In fact, many general vets would bring in a specialists to do it- or this has aways been the case in the clinics I've worked in.

[westiemum]

I've used both a general vet and a specialist surgeon. And the generalist was successful once and not successful the second time - while I think the world of my generalist vet, I think in hindsight I'd go with the specialist given my time again.

[Jumabaar]

I suggest calling the clinic and asking what method of repair they are proposing. The general clinic that I have started working at part time has arthroscopy and the surgeons do a brilliant job. That being said we do still offer the option of referral particularly for complex cases.

Its also really important that your dog gets some rehab after- and not just a walking program! Particularly as he is so young and active.

I would also want an accurate diagnosis. There are many things causing a dog to skip and so you want to know that this is the structure that is causing the problem.

[billbro]

I suggest calling the clinic and asking what method of repair they are proposing. The general clinic that I have started working at part time has arthroscopy and the surgeons do a brilliant job. That being said we do still offer the option of referral particularly for complex cases.

Its also really important that your dog gets some rehab after- and not just a walking program! Particularly as he is so young and active.

I would also want an accurate diagnosis. There are many things causing a dog to skip and so you want to know that this is the structure that is causing the problem.

Thanks, I sent them a note earlier today to confirm a few things:

1. What are the go/no-go criteria for the surgery following the x-rays that are being performed.

2. What type of repair method (it might actually be the suture method)

3. What are the risk factors of the surgery, as this wasn't explained clearly.

Would it be impolite to be asking my regular vet for a specialist referral? Also, should I be concerned about delaying this further, by looking for a surgeon, but he is on the mend?

Sorry for the silly questions.

[billbro]

So I reached out to the owner of the tiggerpoz website, which I saw mentioned on a thread here. The owner of the website seems adamant that surgery would not be a good idea, but I obviously have no idea about his background.

Is there any merit in delaying the surgery and seeing how my dog recovers? He is improving, though the risk with his improvement is that he will re-injure it (e.g. he is already starting to jump onto the bed again).

I've also read that x-rays won't help diagnose a ligament injury (so not sure why it has been recommended to me on so many occasions) - should I be paying for an arthroscope instead ahead of all this surgery? The current approach was to x-ray him under anaesthesia and move straight onto surgery, but I'm okay with the additional cost to ensure we are going down the optimal approach.

I should stress, that unlike some others, cost is not a primary consideration for us (though a relevant one) - but I am reluctant to open my little guy up unless it is the best option.

Apologies, I am going around in circles but the more I read the more conflicting opinions there seems to be.

[Ruffles]

I think you should speak to a specialist surgeon. They will be able to discuss the pro's and con's of going ahead with surgery (or delaying). I dont know what clinics you have available in NSW but here we have surgeons that will do an obligation free consult upon referral from your veterinarian.

There is a reason there are specialist surgeons - because it requires a speciality, and is not a general practice thing. That's not to say GP vets cannot successfully perform these operations it's just that, well, as I said above there are specialists for a reason.

[ness]

X-rays as far as I am aware are taken to rule out other potential causes of the lameness despite a clear cut cruciate. They can test for a cruciate rupture fairly easily. Conservative method of the dog building scar tissue can work ok with a small dog but with a dog a young dog who is highly active I would certainly be seeking specialist input and at an early stage.

Edited June 20, 2016 by ness

[billbro]

Thanks for the responses, I'm actually trying to organise for another paid consult at another veterinary clinic.

I'll ask about a referral from my regular vet and the new one to see what is available.

[persephone]

I think you should speak to a specialist surgeon. They will be able to discuss the pro's and con's of going ahead with surgery (or delaying). I dont know what clinics you have available in NSW but here we have surgeons that will do an obligation free consult upon referral from your veterinarian.

There is a reason there are specialist surgeons - because it requires a speciality, and is not a general practice thing. That's not to say GP vets cannot successfully perform these operations it's just that, well, as I said above there are specialists for a reason.

definitely!!

Would you let your GP give you a hip replacement?

I once worked for a vet who was a brilliant surgeon ... and he always called in a specialist to do the knees/hips/elbows . Why risk it?

[juice]

I would say where you live and see if someone here can recommend a specialist.

[Jumabaar]

So I reached out to the owner of the tiggerpoz website, which I saw mentioned on a thread here. The owner of the website seems adamant that surgery would not be a good idea, but I obviously have no idea about his background.

Is there any merit in delaying the surgery and seeing how my dog recovers? He is improving, though the risk with his improvement is that he will re-injure it (e.g. he is already starting to jump onto the bed again).

I've also read that x-rays won't help diagnose a ligament injury (so not sure why it has been recommended to me on so many occasions) - should I be paying for an arthroscope instead ahead of all this surgery? The current approach was to x-ray him under anaesthesia and move straight onto surgery, but I'm okay with the additional cost to ensure we are going down the optimal approach.

I should stress, that unlike some others, cost is not a primary consideration for us (though a relevant one) - but I am reluctant to open my little guy up unless it is the best option.

Apologies, I am going around in circles but the more I read the more conflicting opinions there seems to be.

There are certain specific cases where I suggest that surgery might not be the best option. But on principle these are dogs that have already started building some scar tissue and have owners that are willing to do formal rehabilitation and follow through with a home exercise plan. I think that in the future this will be much more possible but at the moment it is still a work in progress and so I am erring on the side of surgery with all my clients where possible.

Your vet should know if your dogs knee is stable or unstable.

X-rays are done to allow planning for surgery- to check the shape of bones and where implants will be put. We use arthroscope to look inside the joint to look at the meniscus but many clinics open up the joint and visualise it without the scope.

I personally prefer the TTA or TPLO (bone cutting procedures) rather than the suture method. There is a risk of suture break down that means the surgery has to be re-done. There is a small risk if you do not rest your dog after a TTA/TPLO that the implant can break but following home instructions minimises this risk. The other major concern is infection which we combat with antibiotics throughout the procedure. Some vets will also keep your dog for a few days after to allow them access to really really really great pain relief. Since regardless of what procedure is done it is orthopaedic surgery and I know I wanted the good drugs after an ankle reconstruction.

[billbro]

I would say where you live and see if someone here can recommend a specialist.

Well I live in Sydney, fairly close to the CBD - though I'm happy to drive where ever if there is a good specialist that people recommend.