acl surgery? help!

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Postby tariqhu9 » May 6th, 2010, 12:05 am

My dog has been limping the last day or so. My wife took him to the vet and found out that he's got an acl tear. My vet only does does surgery on dogs up to 30 pounds. Of course my dog is nearly 60.

Has anybody here had a acl repair done on your pit? What was the experience like? How long was the recovery? What was involved?

The other part of the puzzle is that I need financial assistance to help pay for this surgery if he needs the TPLO or TTA. Hopefully he can get the cheaper surgery which seems to cost less than $1000. Does anyone know of organizations that could help me pay for this procedure?

Lastly, I live in Decatur, GA. So if you know of any vets in/around ATL, let me know.

thanks
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Postby Malli » May 6th, 2010, 3:24 am

I'm in canada so I can't comment on prices, vets etc.

I will suggest that you save up for the surgery? This isn't life threatening and although not ideal, the dog can wait.

I used to work at a vet's so I've recovered many many dogs from different kinds of knee surgeries. Recovery will depend on each Vet's personal homecare and your individual dog. I can give you some "most likelies" ; most likely will need complete rest (only brief, controlled leash walks out to potty and no stairs unless tplo), may need to be "sling" walked intially, then controlled specific exercise only for 3-6 months or longer, caution needs to be taken that the dog does not blow the other knee while recovering - this is fairly common as the dog may be medically more prone to it and will be carrying more weight on one leg during the time prior to surgery as their is an injurty as well as after surgery while the knee heals. There will be some aspects of your dog's life that will need to change permanently; any activity that may cause the dog to slip or make sudden sloppy turns on the knee (e.g. : often dogs injure their knees playing fetch, so after the surgery, fetch can no longer be played).

Hope that helps
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Postby iluvk9 » May 6th, 2010, 5:44 am

Sorry about the knee. :( I had two knees done on my Pit Bull, Darlene and two done on my Lab, Louie (RIP).

I can tell you what you probably know and my Vet said: IT HURTS but Pit Bulls have high pain tolerance so it probably hurts more than you realize. Both mine had pain meds for a few days after surgery.


Darlene recovered quickly. She had her meniscus repaired on one, also. The Vet had her up and limping out the door after surgery. :) Of course, I babied her and that wasn't good because she wouldn't try to walk at home, so it kept carrying the 60 pounds of chubba around. My Vet was not happy with me because it hindered her progress. :oops:

When he is home, you can ice the area to keep swelling down. NO running or playing with others even if he "seems to be okay" at the moment. I had to leash walk for a month or so.

The good news is after surgery the knees are "bionic" and the chance of them being rehurt is slim to none.

If you search "knees" or "ACL" here, you will find a lot of information from others.
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Postby maberi » May 6th, 2010, 8:40 am

There will be some aspects of your dog's life that will need to change permanently; any activity that may cause the dog to slip or make sudden sloppy turns on the knee (e.g. : often dogs injure their knees playing fetch, so after the surgery, fetch can no longer be played).


I'll have to disagree with that statement. Obviously every dog is going to recover differently with some recovering better than others, but if a dog has a TPLO or TTA there is very little chance of the dog ever injuring that same knee again once it is healed. There is a slight chance of the meniscus tearing but many vets will do a medial meniscus release to prevent any possibility of tearing the meniscus in the future and tearing of the meniscus on a knee that has had a TPLO is not common.

The TPLO and TTA actually change the angle of the knee so the CCL (note that dogs do not have an ACL) is no longer needed. Most of the dogs that have the TPLO or TTA return to normal activities which include things like fetch and dog sports. This is well documented and through personal experience I've seen many dogs return to agility, flyball, fetch, etc.... As you stated before, the bigger issue is the possibility that the dog could injure the other knee down the road but keeping your dogs weight down and building up muscle in the rear (especially in the leg that was injured) helps to prevent this.
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Postby plebayo » May 6th, 2010, 8:53 am

First off I think it's crazy your vet only does dogs UP to 30lbs... I don't think my vet does dogs under 30lbs because most small dogs usually heal just fine without surgery.

I agree with everything Maberi said. The surgery especially the TPLO or TTA are pretty much designed for your dog to return to normal activity. The TTA is less invasive and has a quicker healing time, and according to what I have read has a smaller chance of failure than the TPLO. However the TTA is a newer surgery so you'd have to find a vet who knows how to do it.

As far as payment I know a lot of clinics accept care credit and you don't have to make payments for like 3-6 months on it... you could always try applying for that.
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Postby maberi » May 6th, 2010, 9:00 am

plebayo wrote:First off I think it's crazy your vet only does dogs UP to 30lbs... I don't think my vet does dogs under 30lbs because most small dogs usually heal just fine without surgery.

I agree with everything Maberi said. The surgery especially the TPLO or TTA are pretty much designed for your dog to return to normal activity. The TTA is less invasive and has a quicker healing time, and according to what I have read has a smaller chance of failure than the TPLO. However the TTA is a newer surgery so you'd have to find a vet who knows how to do it.

As far as payment I know a lot of clinics accept care credit and you don't have to make payments for like 3-6 months on it... you could always try applying for that.


My guess is that the reason the vet won't perform the surgery is that they only perform an extracapsular repair? Although this can be performed on larger dogs, it often doesn't hold up well for larger active dogs, and is the reason it is usually reserved for smaller dogs carrying less weight.

One thing you will want to find out if you decide to go with a TPLO or TTA is the number of surgeries the surgeon has performed. As stated the TTA is fairly new compared to the TPLO
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Postby Malli » May 6th, 2010, 1:08 pm

Right, but if the dog only has one knee done... There is a substantial chance that dogs that blow one knee will blow the other(I used to know a percentage but I've forgotten)
The Vet (who is a surgical specialist and does 100's Knee surgeries each year) that did TPLO surgery on my manager's dog gave him strict instructions to discontinue fetch with her permanently, as this is when she slips and turns etc. I just texted him and he was given two reasons for this : reinjuring the same leg, or injuring the other.
If the OP is having difficulty getting together funds for this surgery, do you think any of us should be encouraging them to let the dog behave in a manner that will give any chance for avoidable injury? :|

maberi wrote:
There will be some aspects of your dog's life that will need to change permanently; any activity that may cause the dog to slip or make sudden sloppy turns on the knee (e.g. : often dogs injure their knees playing fetch, so after the surgery, fetch can no longer be played).


I'll have to disagree with that statement. Obviously every dog is going to recover differently with some recovering better than others, but if a dog has a TPLO or TTA there is very little chance of the dog ever injuring that same knee again once it is healed. There is a slight chance of the meniscus tearing but many vets will do a medial meniscus release to prevent any possibility of tearing the meniscus in the future and tearing of the meniscus on a knee that has had a TPLO is not common.

The TPLO and TTA actually change the angle of the knee so the CCL (note that dogs do not have an ACL) is no longer needed. Most of the dogs that have the TPLO or TTA return to normal activities which include things like fetch and dog sports. This is well documented and through personal experience I've seen many dogs return to agility, flyball, fetch, etc.... As you stated before, the bigger issue is the possibility that the dog could injure the other knee down the road but keeping your dogs weight down and building up muscle in the rear (especially in the leg that was injured) helps to prevent this.
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Postby maberi » May 6th, 2010, 2:21 pm

Malli wrote:Right, but if the dog only has one knee done... There is a substantial chance that dogs that blow one knee will blow the other(I used to know a percentage but I've forgotten)
The Vet (who is a surgical specialist and does 100's Knee surgeries each year) that did TPLO surgery on my manager's dog gave him strict instructions to discontinue fetch with her permanently, as this is when she slips and turns etc. I just texted him and he was given two reasons for this : reinjuring the same leg, or injuring the other.
If the OP is having difficulty getting together funds for this surgery, do you think any of us should be encouraging them to let the dog behave in a manner that will give any chance for avoidable injury? :|


Agreed, I think we've established the fact that after having one knee done the probability of the other knee blowing will certainly go up. The purpose of that surgery is to allow dogs to get back to their normal working lives and that can include fetch. Certainly any exercise that would cause a dog to slip, suddenly stop, turn, etc... would increase the risk of injuring the other knee. I'm sorry but dogs shouldn't live in tiny bubbles and should be allowed to enjoy their lives and if that includes fetch, agility, flyball, etc.. than so be it. My dogs have slipped, turned odd and fallen over from jumping off of couches and coming down the stairs yet I haven't removed those items in my house in fear that they may injure themselves.

The vet that did Earl's knee at the age of 2 was a board certified surgeon who specializes in orthopedic surgeries and actively writes for the Journal of the Veterinary Medical Association and presents lectures on CCL injuries and repair (I'm not sure why that information is important but you made note of your vet's experience above). He actively encouraged us to get Earl back to his previous activities once he was properly healed and that did and has included playing fetch, dock diving, frisbee, flyball and tearing around the yard with our other two at 100 mph. I can't imagine depriving a dog of all of that fun because of the possibility that he may injure his other knee.

If the OP is worried about the other knee blowing out at some point, then they can insure their dog for less than $20 a month and yes, companies will now insure a bi-laterial injury including a torn CCL when the other one was repaired.
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Postby Malli » May 6th, 2010, 2:43 pm

I mentioned the specialists experience because I feel that this further backs any advice he may give, as apposed to the advice of a Veterinarian who does general practice.

I don't think its deprivation. She(manager's dog) runs around the yard, she plays with her sister, she can go for hikes and walks, she can run around WITH a toy in her mouth, she just can't fetch. Oscar isn't allowed to fetch any more on Dr's orders (we occaisionally do a few tosses, but thats rare), we do everything else, just no fetch, it isn't the end of his world either.

We didn't need to get nasty :|

I'm just trying to look out for this person's(and dog's) interest. What if they had the surgery and then their dog injured the other knee because of advice they got here :| Not everyone can afford to risk a second incident like this, or an extra $20/month
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Postby maberi » May 6th, 2010, 2:57 pm

I'm not sure my post was nasty but if it came off that way, it certainly was not my intention. I guess I just don't agree with making blanket statements that a dog's life has to change permanently because of a CCL injury. It's just not true, and stating that to someone especially when it is coming from someone who works in the field, is very misleading.

Obviously anyone reading advice on an internet forum should be taking what they read with a grain of salt and should consult with their vet and make their own educated decision.
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Postby tariqhu9 » May 6th, 2010, 11:03 pm

thanks to all that have replied. I misunderstood my vet. He actually said that he wouldn't suggest surgery if the dog was less than 30lbs. He doesn't perform this type of service at all, but he did recommend two doc's that can do the surgery. I'll be calling them tomorrow hopefully.

I've been researching and there seems to a lot of information available about the 3 types of surgery. Based on what I've read, the biggest diff between the 3 types of surgeries is the recovery time. There doesn't seem to be much, if any, difference in the long term.

Does anyone here have a vet in ATL or Decatur?

Thanks again for the feedback.
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Postby TheRedQueen » May 6th, 2010, 11:27 pm

I chose not to do a surgery on my old guy when he tore his ACL over a year ago...I didn't/don't have the money for the good surgery...and since he has a bad heart murmur, he'd have to have his surgery done at the vet specialist (the regular vets don't have the monitoring equipment or simply aren't comfortable with it). So we decided against surgery, and gave him about 3 months of leash walking, and very limited activity.

He's on glucosamine of course...and gets a rimadyl for bad days (only once a month or so)...but honestly, he's been doing pretty well. He limps after a full day of exercise...but so does my old guy with arthritis! Xander (the one with the ACL tear) runs, chases balls, catches frisbees, wrestles with the other dogs, jumps on and off the furniture. Most people don't even realize that he's got anything wrong with him...he still brings balls and chases 'em...obsessively. ;) He's retired from flyball...but I don't think he sits and broods about it...even the days where he's crated during flyball tournaments. ;)

Not saying that anyone SHOULD NOT get surgery...just sharing my experience. :)
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Postby Malli » May 7th, 2010, 1:37 am

unfortunately, as is often the case with money, the more expensive surgery(s) lend to less complications with healing(arthritis etc etc) and more stability in the knee.

I can't recall hearing about the TTA but I know the TPLO is a much more solid (and, more expensive :neutral: ) option...
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Postby maberi » May 7th, 2010, 8:39 am

Malli wrote:I can't recall hearing about the TTA but I know the TPLO is a much more solid (and, more expensive :neutral: ) option...


As is the TTA. This was a few years back, but at the time, the TTA was a bit more than the TPLO due to it being a newer surgery. The TTA is less invasive than the TPLO since they only have to make a small cut in the tibia where the TPLO requires a rather large curved cut in the tibia (both surgeries are rather disgusting).

At the time, I think for the surgery and a follow up x-ray I paid around $3600. That was pricier than other places such as Cornell, but the surgeon was one of the best around and Earl was very young so I didn't want to chance anything.

I have friends who have had the conventional surgery done and it was around $1,000. As Malli pointed out, these are not considered as stable and aren't usually suggested for very large active dogs.

I suggest joining the yahoo ortho board. There are surgeons and vets on there and they can answer just about any question you have including vets in your area that specialize in the different surgeries.

http://pets.groups.yahoo.com/group/orthodogs
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Postby maberi » May 7th, 2010, 1:14 pm

Not really needed but still interesting. Here are graphical views of what each surgery does to the knee joint

TTA

Image


TPLO -- Earl's still pimpin that sexy steel plate in his knee

Image


Extracapsular or "conventional surgery"

Image
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Postby call2arms » May 7th, 2010, 9:00 pm

While the dogs can go back to normal activity after 4-6 months slow recovery, there's still the fact that the knees 1) have plates and screws in them, which can cause issues, even if perfectly adjusted and placed and 2) they can tear their meniscus or fracture parts of the tibial crest. That's uncommon but may still happen, I know many dogs take up flyball and agility and hunting after surgeries like this, but if it were mine... I'd always try to protect the knees.

For any surgery of this type, I highly recommend a board-certified surgeon. Some generalist veterinarians may be great at it, but it's worth paying the extra bucks for someone who can do a TPLO with 2 finegrs up his nose... It's a big one.
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Postby maberi » May 7th, 2010, 9:04 pm

call2arms wrote:While the dogs can go back to normal activity after 4-6 months slow recovery, there's still the fact that the knees 1) have plates and screws in them, which can cause issues, even if perfectly adjusted and placed and


Very rare and the plate and screws can be removed if they are causing a problem


2) they can tear their meniscus or fracture parts of the tibial crest.


Meniscus tears are rare and if they occur, they can be easily corrected by scoping the knee. Very invasive

That's uncommon but may still happen, I know many dogs take up flyball and agility and hunting after surgeries like this, but if it were mine... I'd always try to protect the knees.


Yep and that is a personal decision we all make.
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Postby katiek0417 » May 7th, 2010, 10:21 pm

Okay, I'm going to chime in because I'm currently going through this.

I have a malinois that was imported 2 years ago...he is a fully trained narcotics detection dog and was to be my next PSA dog...this is a very high drive dog that is only 2.5 years old. This is a dog that CAN'T be kept quiet (meds do nothing for him!)

In January he tore his ACL. I immediately made an appointment at VOSM, which is considered by most to be the top orthopedic veterinary hospital in the country. The 2 vets that work there are very big in sports medicine and are known for their very high success rate (and their willingness to take part in cutting edge techniques). In fact, they get referrals from all over the country, and are starting to get referrals from all over the world. They both have several publications under their belt...(they even have a rehabilitation vet that specializes in agility and flyball dogs and works very closely to get "working" dogs back to working quality).

Now, Peter (our vet), when we first went to see him, suggested therapy. He didn't believe it was a full tear, and wanted to be a bit more conservative so as to not keep him out of work for the least amount of time as possible.

We did that, then a few weeks ago, at a follow-up visit with Peter, we decided that since Nemo was not getting better, we should move ahead with surgery. Because of his age and his activity level we determined that the TPLO was the best bet for him.

I had several concerns. The first was his ability to return to work after recovering. Peter has guaranteed that Nemo will return to full working capacity for both detection and bitework. He has performed this surgery thousands of times (he does 5-6 of them a day now) and showed us video of dogs that do both agility and flyball within 4-5 months of having the surgery.

My second concern was the likelihood that Nemo would blow out the other knee. He said, believe it or not, in reality there is only about a 40% chance of that occurring.

Furthermore, while I'd have to keep my dog totally drugged out for the first 1-2 weeks after surgery, he actually wants Nemo to start doing finds (for drugs) after that 2 week post-surgical mark. He said that typically he would never recommend that for a dog just getting out of a TPLO, but he has to with Nemo because of his energy level, and he doesn't think mere walks are going to wear him out enough...

He said that starting around 3 months post-op, we will begin working with the rehab specialist towards getting him ready for bitework again...

Matt's cost quote is pretty typical of the surgical costs...
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Postby call2arms » May 7th, 2010, 11:02 pm

Well... There was a dog who underwent a TPLO a while long ago, the owners did not respect the restrictions for resting, the plate and screws literally busted and he had to go under again. And died of anesthetic complications on the table. First surgery went fine.

Obviously as with any surgery, the risk is there but being on the table for 1.5 - 3 hours makes it a bit worse, even with all the super-close monitoring. My point is that, had he not had complications from the TPLO, he would still be alive.

Again, it's one in how may surgeries - they do orthopedic surgeries day in day out, and I'd never heard of such a case, but it happens.

Oh and from another clinic we saw a modified FLO that failed - different technique implying implants and other hardware - the knee was just dangling. Still done by a certified surgeon. Complications happen.
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Postby katiek0417 » May 7th, 2010, 11:18 pm

call2arms wrote:Well... There was a dog who underwent a TPLO a while long ago, the owners did not respect the restrictions for resting, the plate and screws literally busted and he had to go under again. And died of anesthetic complications on the table. First surgery went fine.

Obviously as with any surgery, the risk is there but being on the table for 1.5 - 3 hours makes it a bit worse, even with all the super-close monitoring. My point is that, had he not had complications from the TPLO, he would still be alive.

Again, it's one in how may surgeries - they do orthopedic surgeries day in day out, and I'd never heard of such a case, but it happens.

Oh and from another clinic we saw a modified FLO that failed - different technique implying implants and other hardware - the knee was just dangling. Still done by a certified surgeon. Complications happen.


This is definitely a concern of Peters...but with Nemo it's not me that wouldn't respect the restrictions...it's Nemo! We had this discussion...but he doesn't seem to get it... :rolleyes2:
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