Is Surgery Really Necessary For Your Dog's CCL Ligamen

[Doc E]

Is Surgery Really Necessary For Your Dog's ACL / CCL Ligament Injury?

What do our Vets and others think of this ?

http://tiggerpoz.com/


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[Misskiwi67]

Having seen many knees (dozens) of dogs who's ligament tears were missed for years and who could barely get up the stairs compared to dogs who go back to normal after surgery I call this utter bull$#*!.

[Misskiwi67]

I also have many clients who cannot afford surgery at the time of diagnosis. We often recommend strict rest and pain medications until they are able to save up for surgery. Many dogs can be managed if they are low energy to begin with. I cannot think of a single case where the dog didn't have recurring lameness after returning to normal activity, proving their ligament did not heal.

When my own dog had a partial tear, I elected surgery immediately even though the surgeon gave me the option to wait. The sooner she had surgery the sooner she could recover. This is how much evidence I have seen that partial tears NEVER heal, and surgery will eventually be the best choice. The surgery was done at a different clinic and so had nothing to gain by doing surgery on my dog, I trul felt it was the best option for my dog.

[huntnvet]

This just can’t be answered with a simple yes/no, the decision involves too many factors. I’ll give 2 answers Doc:

First answer: Since this is a hunting dog website, and most folks on here seem to be fairly serious about hunting, Ill give the answer as I believe it relates to serious hunters: get another dog!
That may seem selfish or cruel to some, but let me explain further... As hunters, we have a limited number of seasons before age/health finally stop us from chasing our dogs around the country. And while I love and care for every dog I have owned/raised, I will not waste a single valuable season with a problem dog. Regardless of whether the problem is behavioral, musculoskeletal, or some other issue. The fact is, your dog is very likely going to rupture the other ACL within 1yr, and no current technique will return your hunting dog to full order following an ACL rupture! Notice I said ‘full” order......I’m sure a number of folks on this site have kept hunting dogs with torn ACLs and had great memories with them. I’m not discounting these stories. Im only suggesting that they will never hunt to their full potential, and for some hunters, that is unacceptable. I merly wish to be completely honest with those that feel as I do.

Second answer:
No, surgical treatment is not necessary for your dog to lead a quality life. When deciding to use surgical or medical treatment, factors that play a key role in the decision include: owner ability and willingness to comply with instructions, dog age, dog weight, dog breed, and dog behavior/lifestyle.

[huntnvet]

In regards to the website you linked: I remember once I sat down to watch a lively debate between two famous research scientists in the field of human vaccines, and a special guest. They were suppose to discuss the controversial link between autism and vaccines. I forget the scientists names, but between them they had about 60yrs of medical research experience in the field of vaccination. The special guest finally came on and it was none other than Jenny McCarthy. By their facial expressions, clearly the scientists had not been informed of who the other person was going to be. One of the scientists stood up, said thank you, and walked off the stage. Thousands of people commented that this scientist knew he was outmatched; thus, he left to prevent being a fool. But this was not the case! That guy was smart enough to know you cant argue reason against emotion, he knew that this debate had already been decided.

Just an anecdotal story, but the point is relevent. The internet is littered with anit-veterinarian websites and they all meet the same criteria: the website was designed following a tragic event with their beloved pet (the emotional component), they do “their own research” (which generally means google), website author often has no experience/education in medicine, some have no experience in any scientific field, and of course their conclusion is that vets are bad and people should follow the website author’s advice.

For anybody that reads the website Doc linked, a few corrections:
1. no, the vet will not hurt your dog by testing with the cranial drawer procedure.
2. complete ACL ruptures are much easier to diagnose in a sedate dog than an awake dog. In fact, in a big strong dog, the vet should require sedation.
3. ***and my favorite, which is why I put an astricks beside this one: the website author claims that the vet often misdiagnoses ACL rupture because some dogs have more laxity in their knees. He is trying to argue that because of differences between dog’s knee laxity, a vet will have a difficult time deciding if the laxity is due to ACL rupture, or just normal for that dog. This is a fair point, except for one thing....and I can only say that the author’s statement is a ringing endorsement for his complete ignorance and lack of experience in what he speaks....why? because the dog has 2 knees! You always test the good knee first, this acts as your control, then test the injured knee. Pretty simple really.

[mlabuff]

huntvet, i like your opinion.. Get another dog.

[Doc E]

What do our Vets think about less invasive surgeries ?

Link : http://tiggerpoz.com/id7.html


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[Misskiwi67]

There are no significant differences in recovery long term between any of the surgeries currently recommended.

The braided tight rope is very popular in some areas, but braided materials are more prone to bacterial colonization than monofilament. I don't know if there are independent studies demonstrating risk of post-operative complications. It's not available in my area do I haven't looked into it.

Without any clear evidence definitively identifying one procedure over another, I recommend picking a surgeon and doing the surgery they recommend. The better the surgeon the less likely you are to have complications. Many regular vets may only do 10 orthopedic surgeries a year, but a surgeon might do that many a week.

[ryanr]

I have a very, very active (he has 2 speeds: floor it or stop) 2.5yr old Drahthaar that was diagnosed in October as likely having a partial tear in his right CCL (to quote, my vet said she detected "slight movement in the knee.") Prior to diagnosis he hunted all week in Maine without any lameness. The day after we got home he didn't want to put much weight on it at first, this was the only time he was ever lame, before or since the diagnosis. I'm very careful with him, especially now with the icy conditions up here. He's still highly active but has modified his movements in very small ways that I can detect. Such as his left hind leg lands a millisecond before his right when jumping up or over something. He doesn't turn as tightly on a dime as he used to. He will occasionally have a slight "skip" in his step while trotting. Going down steep hills seems to cause him to adjust the most but even this isn't to a great degree. Unless you have a trained eye for it or I tell you what to look for, people that have seen him run have no idea. In fact at a wild pheasant flushing survey recently he was grouped with 5 other dogs and after we ran the dogs hard for a few hours all the other handlers couldn't believe it when I told them afterwards about his injury. He was arguably the hardest running dog in the group. Right now he's on a daily regimen of Cosequin and also fish oil and I'm mindful of hunting him real hard multiple days in a row.

I've considered (and am still considering) surgery but my fear is that I honestly don't know how on earth I could keep his activity so severely restricted for that long recovery time. My fear is the surgery would fail during recovery. Misskiwi is the recovery and activity restriction for partial tear surgery much less than they are for complete rupture repair?

I'm also looking at platelet enriched plasma injections either as an adjunct to surgery to aid in recovery OR as a possible treatment for the partial tear without surgery. Thoughts?

I'm not getting rid of him by any means but I've also thought of adding another dog to help lessen his work load (the dog lives to hunt and consistently has as much often more drive than most dogs we hunt with.)

[Misskiwi67]

Unfortunately Ryan, the surgery is the same regardless. You can rest him best you can this winter to see if he will be OK, but I'd bet he will have a full year, or both legs out, by the end of hunting season next year. I'd get the knee repaired as soon as hunting season is over and hope the other knee holds up.

[ryanr]

I'm a little confused. How is the surgery the "same" for a partial tear vs. a complete tear? Wouldn't a partial tear require less "repair" to make whole again and possibly a bit less recovery time?

[Misskiwi67]

For active dogs, you don't tepair the ligament. You cut the bone and change the angle of the knee joint so it doesn't need a ligament anymore. Cut bone = 8 weeks strict confinement.

Ligaments don't heal well, so your options are rest to attempt to postpone the need for surgery, or surgery. That's my opinion anyway.

[ryanr]

Thanks MissK. I'm trying to take all this in and read up as much as I can now (it's not too easy either for a layman to readily understand some of these articles.) The cutting of the bone procedure, is that the TPLO procedure? I've also read about Lateral suture stabilization (LSS) and the Tightrope (TR) procedure. Is TR an advancement of LSS techniques?

I got it in my head previously that up to 5-6 months of strict confinement was necessary which seemed impossible for me to get him to comply with. 8 weeks gives me a little more hope we might be able to do this. (What do they do in cases of young, very active dogs?) This strict confinement, is it 8 weeks of carrying the dog out to relieve itself only and carrying it back in and otherwise keeping it crate confined the rest of the time? How do you keep an active dog from going stir crazy and just suddenly trying to run or jump to release pent up energy? It seems that PRP injections as an adjunct to surgery is very promising for the total healing & recovery process post surgery.

Another thing I'm confused on, when you vets talk about the likelihood of rupture in the other (good) leg is that after surgery to repair the bad leg? Or more as a result of not having surgery at all to repair the initial bad leg?

I gotta tell ya, I'm not a weak person mentally and have been faced with some real hard things before but I don't know if I've ever felt so low and with this much despair as I have after getting that diagnosis from the vet (and I lost "my" dog to cancer and lost two others tragically.)

[JTracyII]

ryanr,

I have a GSP that ruptured one of her CCL's on the night of my son's birth. My two dogs were put in a kennel together and they were both young. I assume they began wrestling and she got her leg caught in the fence and attempted pulling it out, hurting her leg. The ankle on that leg had fur missing and a little blood, so I assume she pulled pretty hard when she ruptured. it. Anyway, I had the traditional surgery done where they used monofil. string for the repair. She was a year old when it happened. She is 7 years old this May. She still puts a little less weight on it when standing, but if she moving you never knew she hurt it. Recently, however, she is starting to feel it a little more when getting up or after a wrest than she did. I am assuming arthritis is the culprit and age is taking its toll given the injury and surgery.

About 3 years ago she went lame on the other leg and her symptoms were exactly like the operated leg before operation. I was certain she ruptured it as well given all of the statistics out there saying they will likely rupture the other leg within a year and the symptoms she was experiencing. I had her examined by the vet and she agreed that it was likely a rupture given her symptoms and history. I was going to put her down. I was prepared to do that. When I told the vet my intentions with my wife in the room she thought I should reconsider. My wife wanted me to think about it too, so I reluctantly took her home. Over the next month or two she began to show signs of improvement, until about 3 months later she was back to full recovery in the limb. Don't know what happened. Don't know if it was a partial tear or strained muscle or what, but you wouldn't know she ever had a problem in that particular limb and it has been 2 years. What I am saying is that vets can be wrong too. They are human. If your dog would have to have a full surgery anyway, then I would not let anyone cut on my dog with how well your dog is doing. You have nothing to lose the way I see it. But if you let someone cut on your dog it may be for no reason and your dog will certainly feel it later in life and you will be out 3 grand. If he ruptures it and you are inclined to repair it then do it then. What is the harm and the wait and see approach given the potential misdiagnosis? I am glad my wife talked me into taking this approach.

[ryanr]

Thanks JTracyII, after she told me what she thought he likely did (full disclosure: she did not sedate him during diagnosis and she did not say definitively "he has a partial tear." She said she "felt slight movement in the joint" and she believed that it is likely what he had) she was quick to point out that there are a number of options before surgery. She was also honest in saying he would become arthritic as he aged. I dealt with that with my Labrador (who injured his front leg at age 2 or 3) and he hunted hard enough for me to the day I put him down for reoccurrence of his cancer at 10. From age 7 or 8 on I made adjustments to how we hunted such as he could hunt most of the day non-stop but if we took a prolonged break after a few hours (like to drive to a new location) then it was hard for him to hunt hard again. I also didn't hunt him hard all day twice in row. All these things I'm fine with (hell, I've got arthritis in both knees so it helps me too.) Like I did with my Labrador, as soon as this guy was injured I put him on a daily regimen of glucosamine and fish oil. I think it helped alleviate and even delay the effects of arthritis and lameness.

This is just so tough, so many things to consider and think about. Ultimately I want to do what is best (and what I can afford too) and what will help him do what he loves (hunt) as well as he can for most of his life. One of the articles I read on this is http://www.animalmedcenter.com/faqs/cat ... nt-disease

I really appreciate reading all these opinions and experiences you guys have had, both veterinary and non-veterinary. If anybody's got more, please share.

One thing I'm going to do very soon is schedule a consult with my vet just to sit down and ask more questions and discuss options more and start to move forward more from there.

Oh, we're also officially signed up for my chapter's late August Utilty Test. Good Lord help us, that could be a train wreck, lol!