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  1. #1
    Puppy MomtoMolly's Avatar
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    My first post ... and seeking input!

    Hi all -

    This is my first post in this forum - would love to hear your experiences around this if any!

    My pup, Molly, is 5.5 years old and has a cruciate injury (cranial cruciate ligament rupture specifically) in her right knee for 4-5 months. She can walk on all four, though we can tell it's at times more difficult. We have had two separate vets tell us two different things - one said unequivocally no to her needing surgery and instead said the right balance of hydrotherapy (which we have been doing already for months), and glyo flex 3 combined with reduced physical activity and decreased weight would allow her to heal on her own. The other vet said she would absolutely require surgery. It's confusing to be told two opposite things by two different vets so we booked a surgery consult with experts in this area just to be sure that we were doing everything we can for her. This consult is in 2 weeks.

    If she requires surgery, TPLO was mentioned as the most likely surgery for her case. But I read online that there's also something like extracapsular repair that is also an option. I know the vet will make their best recommendation on her case, so I'm interested in hearing if anyone has any experiences in recovery for her from this type of surgery - I've read it can take months and am trying to prepare for it as best I can. I have to admit, the idea of surgery is nervewracking to me!

    Michelle

  2. #2
    Senior Dog Tanya's Avatar
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    welcome - sorry for having to deal with a CCL tare.

    There is no magic answer, just what works best for you and your dog. Have things improved at all with conservative management (i.e. no surgery)? are you diligent about her activity and physio? Was there a plan for a re-check to see how things are going? I believe my surgeon said with conservative management you do it like 5-6 months then see if things have improved (ex: is the scar tissue supporting the joint more?). If not then one may want to consider other options. If things ARE improving it can take another 6 months to finish the process. It's long. Did that particular doctor hvae a lot of experience with CCL injuries? what were her stats on how often that worked? why did she think your partiuclar dog didn't need surgery?

    Were both just vets or did you consult with an ortho specialist (not just someone who is a surgeon but an ortho specialist).

    Extra Capular is a type of fix for CCL. they use some king of wire to "re created" a ligament around the knee. More common in small dogs or older/less mobile large dogs. But the Tightrope (specifically) from what my specialist explained had great stats. it's a SPECIFIC type of surgery fix. But some larger dogs do well with any extra capular it depends on the dog and the case (and the surgeon and the after care and goals post surgery).

    TPLO is one of the "bone cutting" surgeries. It's probably the most common now. It's quick and easy to a practiced surgeon. thinking about it makes my stomach turn :P The other similar surgeries are TTA and TTO.

    My 45 or so pound mix tore he CCL and we opted for TPLO fairly quiclky after evaluating the options. Mostly due to how badly she was doing on her knee and how active and young she was. The post right under yours by Abulafia is about her ongoing journey post TPLO (and you can search her others posts below).

    If you go the surgery route, find a qualified ortho specialist and one that is practiced in the type of surgery you pick (some do only one type).

    There are two members who are currently going thru TPLO surgeries as well.

    Your Stories and Information About Labs with Cranial Cruciate Ligament (CCL) Tears

    Cranial Cruciate Ligament Disease | ACVS

  3. #3
    Puppy MomtoMolly's Avatar
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    Hi Penny! Thanks for all the information. Really appreciate it. Here's some of the background to your Qs in red. The advice you have given on the different types of surgery is INCREDIBLE - thank you!



    [QUOTE=Tanya;144249]welcome - sorry for having to deal with a CCL tare.

    There is no magic answer, just what works best for you and your dog. Have things improved at all with conservative management (i.e. no surgery) Somewhat. We will see some movement improvement and less stiffness/limping, but then she'll reinjury it easily. Recently for example, she was feeling groovy I guess and decided to "dig" to cover over her pee which she's never done before. That re-pissed off the knee and then the following week was slowly getting back to more weight bearing. are you diligent about her activity and physio?OH YES! We have the most wonderful hydrotherapist as well and were considering chiropracting care recently. Was there a plan for a re-check to see how things are going?Consistently. It's hard to track improvement when she has reinjury but we have been very diligent. I believe my surgeon said with conservative management you do it like 5-6 months then see if things have improved (ex: is the scar tissue supporting the joint more?). If not then one may want to consider other option We are at that mark more or less. If things ARE improving it can take another 6 months to finish the process. It's long. Did that particular doctor hvae a lot of experience with CCL injuries? what were her stats on how often that worked? why did she think your partiuclar dog didn't need surgery? One vet said surgery was not needed and quoted a stat about how 80% of them heal on their own with time. The other vet did a drawer test and said it required surgery. Maybe I should have asked more questions..

    Were both just vets or did you consult with an ortho specialist (not just someone who is a surgeon but an ortho specialist)The first ortho specialist will be in two weeks and I am hoping for a definitive answer!!!

    Extra Capular is a type of fix for CCL. they use some king of wire to "re created" a ligament around the knee. More common in small dogs or older/less mobile large dogs. But the Tightrope (specifically) from what my specialist explained had great stats. it's a SPECIFIC type of surgery fix. But some larger dogs do well with any extra capular it depends on the dog and the case (and the surgeon and the after care and goals post surgery).

    TPLO is one of the "bone cutting" surgeries. It's probably the most common now. It's quick and easy to a practiced surgeon. thinking about it makes my stomach turn :P The other similar surgeries are TTA and TTO.

    My 45 or so pound mix tore he CCL and we opted for TPLO fairly quiclky after evaluating the options. Mostly due to how badly she was doing on her knee and how active and young she was. The post right under yours by Abulafia is about her ongoing journey post TPLO (and you can search her others posts below).

    If you go the surgery route, find a qualified ortho specialist and one that is practiced in the type of surgery you pick (some do only one type).

    There are two members who are currently going thru TPLO surgeries as well.
    ...

  4. #4
    Senior Dog Tanya's Avatar
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    I would want to know more about this stat of "80% heal on their own". what was the population? what types of dogs? how and when was follow-up done? what was "post recovery lifestyle"? I am by no means against conservative management and indeed it is sometimes the best option. But the stat sorta irks me based on what i've read.

    Good luck. Definitely ask lots of questions of the surgeon. Pros and cons of each option, what "post treatment" life should be, etc. My surgeon was very point blank about the cons of each options. Also ask "what could go wrong" (ex: risk with surgery, etc.)

    There is tons of information online. Always keep an open mind that most of what you read i opinion (unless it's numbers backed up with actual hard data). Many pages will have a "slant" but if you read all sides you can sorta come to what works for you. There is NO one answer. There is only what works for you and your dog.

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  6. #5
    Senior Dog Abulafia's Avatar
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    Quote Originally Posted by Tanya View Post
    I would want to know more about this stat of "80% heal on their own". what was the population? what types of dogs? how and when was follow-up done? what was "post recovery lifestyle"? I am by no means against conservative management and indeed it is sometimes the best option. But the stat sorta irks me based on what i've read.
    Yeah, the "80% heal on their own" was quite an eyebrow raiser, especially because it comes from a Vet and not an orthopedic specialist.

    To be clear, torn ligaments cannot grow back. So when someone talks about "healing" from a CCL tear, they do not mean that the ligament really "heals" (in the way we might think of a cut healing, or a bone mending), but that sufficient scar tissues builds up around the tear to stabilize the knee.

    I am far from an expert, but as we are now day 18 post op from a TPLO—and so I've been researching veterinary and surgical sources on everything from stifle geometry and anatomy to joint disease or other causes, to all possible treatment options (surgical and non), to types of surgery, recovery times and techniques, medicine and interactions, physical therapies, nutritional considerations, and so on—some thoughts.

    1. I am very sorry that your dog has had this injury.

    2. After fairly copious research (and I'm a researcher by profession, so I am pretty thorough), I am unconvinced that a full CCL tear can really be managed without surgery, especially in a larger or active dog. I had in fact considered this as a possibility early on, but even with a partial tear (which my girl had), I don't believe it can be managed without surgery. There will always be risk of re-injury to the damaged leg (which you are already seeing), and the forced favoring of that leg is going to put the other stifle at risk of rupture. Can you do this? Yes. But in essence, you are going to have a lame dog for the long-term.

    3. While partial CCL tears may be dealt with w/ CM (though again, I'd still be pretty skeptical about this for a larger or more active dog), if it's been 4 to 5 months with hydrotherapy, joint supplements, and reduced movement and she is still showing limping and easy re-injury, I think what you are seeing is that CM is not working in this case.

    4. Our orthopedic surgeon does not think that extracapsular (tightrope, etc.) is a good choice in a larger, more active dog. I believe he said that his cut off was about 40 lbs for that. He recommended TPLO, and so that's what we went for. On that:

    5. I think you really just need to wait and talk to the orthopedic specialist rather than your Vet. It's good to research ahead (I sure did—I think I may have annoyed our surgeon with the details of my questions!), but this is really a call for an expert.

    6. On TPLO and recovery. Our girl is an 18 month old Lab, about 85 lbs (which was good for her, but we're going to bring her down to mid-upper 70s). Active, no other health problems (no joint disease, for instance: her CCL tore in an injury). Surgery went well, and recovery has gone very smoothly. The first days are the hardest, then the first couple of weeks—well, also no fun. She won't really be cleared for off leash until May or so, but to be honest we are going to keep her on longer (that is, just keep her on leash, even when she's cleared for long walks and hikes), and probably looking at more like 8 or 9 months for a full recovery with no muscle wasting. But it's not so bad. You know? It's not like 9 months of no activity. Just 9 months of her not romping like a madman on the beach.

    She had her 17 day post-op yesterday, and the surgeon said everything felt and looked solid. She was cleared for short walks twice a day, and starts hydrotherapy today. Her incision healed without incident (there's a photos of it somewhere here, maybe under "Day 13 post op with photo" or something). She's off all meds save a Rimadyl (anti-inflammatory) once a day, and is on bone broth (for calcium) and an extra joint supplement. She's walking without much of a limp, to be honest, but we're not letting her walk much.

    Best of luck in your decisions.
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  8. #6
    Senior Dog Snowshoe's Avatar
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    No experience with this but welcome to the board, sorry this is why. I saw your new thread earlier and was hoping the two ladies above would give their input. They are among the most experienced and helpful on this board.
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  10. #7
    Puppy MomtoMolly's Avatar
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    Quote Originally Posted by Abulafia View Post
    Yeah, the "80% heal on their own" was quite an eyebrow raiser, especially because it comes from a Vet and not an orthopedic specialist.
    Thank you all! I REALLY appreciate this. I cannot even begin to express how much. I was feeling very alone (and stressed!) in having to potentially make some big decisions in the near future and feeling a bit lost in knowing how to make them.. and afraid to make the "wrong" one because of the conflicting vet advice. I would think for what I have been told is a "common" issue that there would be much more clear information out there.

    Molly's about 75 lbs and we are trying to get to 70. Luckily, she's always been a mellow lab.. just VERY uncoordinated, so reducing activity hasn't been a problem, but preventing her from doing something boneheaded like the digging has been the bigger issue (haha). I will do TONS of research on all the incredible suggestions so I go into that meeting prepared and ready to ask questions.

    I'm inspired by your recovery stories. It gives me a lot of faith

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  12. #8
    Senior Dog Macy's Avatar
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    I am sorry Molly has this injury but you've come to the right board for support, opinions and expertise. Please keep us posted.

  13. #9
    Senior Dog SamsonsMom's Avatar
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    So sorry to hear about the CCL injury. Samson had TTA surgery on July 1 of this year. It was a very strained 12 week recovery for me and for the boy, well, he was confined to an x-pen so he was bummed out. Happy to say we made it through and he recovered 100%. He doesn't even have a limp! Past few weeks in NE Ohio have been frigid and snow. Leads to sidewalks packed with ice. We haven't been able to walk so I make sure to do some exercising (romping around in the house) to keep him loose.

    Best of luck and I hope you get straight answer from the ortho.

  14. #10
    Puppy MomtoMolly's Avatar
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    Quote Originally Posted by Macy View Post
    I am sorry Molly has this injury but you've come to the right board for support, opinions and expertise. Please keep us posted.
    Will do! Will have much more information following Wednesday's surgical consult.

 



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