Is Surgery Really Necessary For Your Dog's CCL Ligamen

[huntnvet]

Ryan, all you have is a suggestion of knee trouble, and a dog that still hunts well. Go ahead and hunt with this dog, deal with the knee when you must. Hopefully you will not need to:)

Good luck in the UT......maybe a sore knee will make him hold better,LOL.

[Misskiwi67]

Ryan,

Dogs that rupture ligaments most commonly do so without any traumatic injury. Its a chronic wear and tear rupture that occurs because of the biomechanics of the canine joint. Obesity and genetics probably contribute, but we haven't got it all worked out yet. Because it is a joint problem, and not an injury problem, statistically 50% of dogs will rupture the cruciate in the opposite leg within a year of the first.

If you are struggling with this, I would recommend seeing an orthopedic specialist. They will know more about options like the PRP, which I have no experience with, and they can offer options like scoping the joint to get a visual assessment of the ligament to make sure the diagnosis is correct before proceeding to surgery.

Cruciate rupture is so common in large breed dogs that most vets, including me, will approach a dog with hind leg lameness as "cruciate until proven otherwise." This is probably not best practice medicine, but if you were going to bet the farm on a dog limping on a hind leg, cruciate is the way to go, its that common. So yes, it is absolutely possible its not a cruciate tear. However, if your dog is still lame, thats all the more reason to get a second look at the leg.

[ryanr]

Okay, let me clarify that he was lame in his leg for only about 3-4 hours the morning after we got home from our weeklong Maine hunting trip. This was October 26th. During the 13 hour ride home he was in his smaller travel crate and I stopped every 3 hours or so to let him out. Towards the latter part of that ride home he got a little stiff and I noticed him favoring the leg a bit. The next morning he woke up lame, not wanting to put any weight on it really. I made the vet appointment for that afternoon. Within an hour or two of being up he started putting more weight on it. By the time we left for the vet in the afternoon he was actually trotting around pretty easily. Since that day, October 26th, he's never been lame again. He only does little, almost undetectable things that I mentioned previously to compensate at times. Other than that he hunts hard and runs & jumps all out.

Oh and thanks Huntnvet, lol about the sore knee aiding steadiness!

[DrahtsundBraats]

I think huntnvet has pretty much covered this one but I will add what I have experienced from the 10 or so dogs I have known or owned that have had an ACL issue. Partial tears ALWAYS lead to reoccurring lameness and except for one dog i know personally, all dogs sooner or later tore the ligament further to the point that a repair was necessary. The exception developed a pronounced fibrosis (scaring) and a noticeable loss of range of motion but otherwise did not seem affected.

Kiwi is right...the newest procedure repositions the bones to restore the proper approximation and load on the joint. My last dog 20 years ago had a synthetic ligament inserted that actually worked quite well but that procedure is no longer the procedure of choice. Assuming your vet has checked for all the simple solutions (Lyme, green fracture, etc), its usually pretty simple to diagnose an ACL tear. If it is, not sure I would wait...at least not without knowing how an inflammatory response over time could possibly hinder a repair at a later time.

Good Luck

[lanco]

Sigh, I have a friend who is a board certified surgeon (veterinary) and he and I have discussed this at great length. My feeling is that all dogs with unstable knees (positive drawer or positive tibial thrust) need surgery if they are to return to near normal function. Dogs who have stable knees with stifle effusion are a much stickier wicket. Optimally we should be doing MRIs on these dogs to ascertain what damage has occurred and guide therapy. Practically I think that agressive medical management is an option for this second set of dogs (stifle effusion without any instability under sedation). When my dog injured her knee (poor creature had a dozen different vets do ortho exams on her ) we went in circles about surgery vs. medical but finally settled on several weeks of NSAIDs, injectable chondroprotectives (adequan and polyglycan in a weekly and then biweekly rotation for 4 months followed by polyglycan monthly ad infinitum) along with JD diet, a month of rest followed by gradual return to exercise. That was in 2010 and she still has good range of motion, good muscle mass and can readily hunt effectively for 4 hour (my general limit at a stretch).Radiographic changes are mild 5 years later and the knee is rock solid. So it can work out. However my expectation at the time was for eventual failure. As to which surgery the surgeons are all obsessed with the various osteotomy procedures but unless something definitive has been published very recently no one has been able to prove them better than the good old nylon suture and the suture has a lower complication rate. I realize this was kinda technical. If anyone has questions please ask.

[lanco]

So the real answer is a sedated exam and possible x-rays sent out to a radiologist. If there is "a little drawer" still then surgery is best. If the knee is stable then ????????

[JTracyII]

the surgeons are all obsessed with the various osteotomy procedures.

I wonder why they would push it so hard with no hard facts???? Can you say..$$$$$

[lanco]

Profit margin is higher on a suture in many cases. A 20 minute operation (for folks that do a dozen a week) using $15 of material vs. 2 hours of nerve racking work $200-$500 in special plates and intra/post operative x-rays which would you prefer to do?? The surgeons I know are simply convinced TPLOs, TTAs ect are a better option for large active dogs. It has just been hard to produce a study that objectively validates those beliefs. Some of the recent data involving running dogs with repaired knees on treadmills in front of fluoroscopes (x-ray cameras capable of capturing motion pictures) showed conflicting results. I've seen good and bad outcomes with all the options.

[JTracyII]

That makes since when you actually break down the figures.

[ryanr]

After not a single minute of lameness all spring & summer training season, out of the blue my dog came up lame again this past Wednesday in the same manner. Just like before it didn't last long, he held that same rear leg up not wanting to put weight on it for a few minutes but put more and more as he trotted around and even broke out into a sprint after a rabbit. It was definitely joint related and not paw. Every now or then he lifts it, sorta skipping a step, as he runs but that's gotten less and less over the last few days. Although I've mostly been keeping him quiet and resting he ran really well and hard during this morning's exercise hour. I have a vet appointment tomorrow and want him to get a shot of Adequan. We're only a week from the grouse & woodcock opener too and this happens.

I was really disheartened at first but I'm just going to deal with it the best I can. If it tears completely I'm still a bit conflicted but I think I've decided against surgery for two reasons. #1 definitely being cost and #2 with his temperament I think it will be near impossible to keep him quiet and strictly confined for 8 weeks. And without being able to hunt hard, this dog's quality of life will be greatly diminished (and let me say that when this dog doesn't hunt or train regularly he can be a real PIA to live with.) I'm hoping the Adequan, and perhaps a more regular regimen of it works, especially after all the work we put in getting him broke. I think he's ready to shine this season. I guess maybe I'm being callous or uncaring in my decision, I don't know.

[lanco]

So just to be clear, if the joint is unstable (positive cranial drawer or tibial thrust) you really need surgery. It can be a simple lateral suture but he will need something to stabilize that joint.

[ryanr]

So just to be clear, if the joint is unstable (positive cranial drawer or tibial thrust) you really need surgery. It can be a simple lateral suture but he will need something to stabilize that joint.

Does the dog need to be sedated for the cranial drawer or tibial thrust exam?

I don't know if dog's with unstable knees do this much but believe it or not he's a running and jumping fool. Even now, it still amazes me how high and how far he can jump, often at full tilt too. It kind of baffles me. Where he tends to show small signs of injury or compensation (I notice it, others don't) is sharp, 180-degree type direction changes to his right and trying to stop quickly while running all out. Steep downhill or sidehill descents seem to cause him to compensate a bit too.

[lanco]

It rare for dogs to be athletic on an unstable knee. Whether sedation is required or not depends on the vet, the dog and the suspicion of a tear. I can get drawer in most dogs without sedation but on a really big really anxious dog with high concern for a serious tear I will use sedation to be sure. How old is this dog?

[ryanr]

He turned 3 back on August 8th. He's always been athletic, amazingly so I think. In that regard I haven't seen any other DD or GWP like him. He regularly runs right with a 2yr old male GSP with a field trial background. In my estimation he's lost about a half step after the "injury" over a year ago and there's just a slight notice of atrophy compared to the other leg. So I know it may sound silly but I can see with certain movements that he's definitely compensating to some degree for that leg. Overall he's just still a real active dog.

It may almost compare to my own story. As an 8th grader I shredded the cartilage all around my knee but somehow didn't tear my major knee ligaments. I never had surgery but it was still a 5 month initial recovery process and my knee was never quite the same as it was pre-injury but I still wrestled all through high school and even played football again my freshman year. As I've gotten older now though I can feel the limitations (and arthritis) in that knee.

[ryanr]

Well we had our vet appointment and received good news. He knee joint was physically examined (unsedated) and there was no positive cranial drawer. The vet actually said she could not feel any movement in the joint and it is stable. The vet suggested the possibility it might have been/is a nerve issue. Both times he was lame with this issue it was after laying down for quite a while. He received a shot of Adequan and will get a followup shot on Friday and then a monthly maintenance shot. When we go back Friday I'm going to ask if she thinks scoping it to see if the joint just needs to be cleaned out might be worth it. At any rate, I feel much better and he's cleared to hunt Saturday's grouse & woodcock opener.