ACL surgery with dogs - your experiences?

The Coffee Shop
1

My 4 yr old 90 lb male golden retreiver/lab cross has just blown out his anterior cruciate ligament in his left knee. Took him to the vet today and she confirmed what I had suspected. Since he’s a larger dog, she is now recommending surgery which is slated for next week.

I’ve been researching the various types of surgery and have been unimpressed with the contraversies of all the surgery techniques in current use. My vet wants to do an extracapsular technique which I seem to prefer to the more expensive intracapsular techniques based upon what I’ve been reading. At any rate we’ll still be in for a couple of grand for surgery that may or may not make that much of a difference in the long term. Obviously we can’t do nothing, but it appears that the long term success rate in the literature of virtually all the surgery techniques for this type of injury in dogs is not particularly impressive.

Just wondering if any other dog owners have been through this and what your impressions and opinions are. If you’re a vet please chime in.

2

I had a dog where we did a ligament surgery on her. it wasn’t exactly an ACL, frankly I forget which ligament (or maybe it was a tendon). anyway- yeah, it was a couple grand, but she healed up and had many good years of running after that. A little pricey for a stray dog that followed my wife home, but she was a real sweetie.

3

If you search the forums over the past couple years there have been a couple of threads on this. I posted on a couple of them about my 7yo lab and her surgery- TPLO. She is 11 now and in May it will be 4 years post surgery.

She has done great. She went from limping after a 5min walk to full activity by about 6 months post surgery. She stayed overnight after surgery, was obviously in pain the next night and gradually progressed from there. I followed the DVM’s instructions (except the ice bag post ROM exercises). I knew she was going to be fine about 6 weeks post op when I woke up and she was curled up next to me on the bed (shes got her own bed on the floor).

She is still very active- 40min walk/jog Sun, 50 min walk/jog Mon and 2 hour walk this morning. The only changes Ive made since the surgery are lifting her in my Jeep if she seems reluctant to jump and turning the “runs” into fartlek. This means we go at her pace which sometimes means a sniff walk and usually starting w a sniff, then a trot and often finishing w sprints. I got her a “little sister” last May and the new lab pup- 1 yo last Sun- has been good for keeping her active.

4

What type of vet did you see? A general dvm or a boarded surgeon?
If you saw the surgeon ask him for a TTA.
It is an overall better procedure than the TPLO or basic nylon repair.

5

Our 160 lb great Pyrenees had both back acl’s repaired when he was 2 and 3. Our vet told us that the procedure that he could do, which was essentially stringing them back together with nylon, would probably not be great for a large, young and active dog.

He sent us to a specialist that did a much more involved reconstruction that i believe involved reshaping the joint a bit and some metal parts. in the end it was great. Once he recovered post op, he was absolutely fine. I apologize for not remembering the name of that procedure, but it was quite awhile back.

Several thousand per knee and totally worth every penny.

6

I would recommend an ACVS(boarded) DVM over a general practicing DVM. Don’t get me wrong, I have both in my practice and have seen competence can be on par on procedures(each have their preferences and thus strengths). However, a practice with an ACVS tends to have a higher level of veterinary care(I say tends to, cause it’s not ALWAYS true). Better equipment, better trained staff and better surgical suites equate to lower infection rates and safer anesthetic protocols. An infection after a stifle surgery can mean another surgery and such procedures often take over an hour under anesthesia for the patient. The question of which procedure to perform depends on the patient’s candidacy. Obviously I don’t know all the details of the case, however I can make a few suggestions based on what I do know about your dog.

  1. Weight: At 90lbs, an extracapsular repair would not be the first recommendation. Extracapsular repair such as the tight rope technique will not last very long under such loads. We recommend such an option to very small dogs(below 25lbs), old dogs or as a bandaid.
  2. Age: At 2 years old, you’d want to look at options that will hopefully last the life of your dog. Procedures such as tibial plateau leveling osteotomy and tibial tuberosity advancement lasts longer than extracapsular repairs. Hence why larger but older dogs might go this route.
  3. Angle of stifle: TTA and TPLO have shown no difference in long term efficacy but TTA has a shorter recovery time(could be a good or bad thing). Which option is better depends on the angle of your dog’s stifle. Did your vet take radiographs?

Let me know if you have more questions. I could also get you names of ortho specific ACVS if you tell me where you live. Not all ACVS are created equal, especially for a given procedure.

7

Thanks for your reponse. I used to be an orthopedic technologist before becoming a chiropractor, so I have a bit of an idea about human ACL injuries but am clueless about dogs. I agree that if it was my knee I’d want an orthopedic specialist and not a general practitionor, so I’ll have to pursue this in more detail. This article has got my head spinning a bit however. What is your take? Can you recommend any good research studies and sources on the net regarding AC injuries in dogs? What about knee braces for rehab or to wear post surgery?

http://www.2ndchance.info/cruciate.htm

8

I’m about to muddle the waters here for you a tad. Newer studies (such as the two listed below), shows little to no difference between the extracapsular vs. intracapsular surgical techniques. In fact, the 2005 study showed a better outcome for the extracapsular procedure. However, this is very contradictory to practitioner experiences and there’s definitely flaws in the studies(as pointed out by many in the ACVS). Both studies did note the results are true for dogs below 80lbs only.

One major flaw pointed out is the fact that one of the studies had data only 6 months out, while the other, only 24 months. Like I had mentioned in my previous post, if the goal is for a short term bandaid(like buying a few years for an older dog), then the extracapsular procedure is definitely an almost equal consideration. Practitioner experiences have showed that intracapsular procedures such as the TPLO had better outcomes for long term repair. In addition, the technique to measure ground reaction force is very poor and inconsistent. (I do however have to interject here and say that osteoathritis is never guaranteed regardless of procedure chosen)

Comparison of short- and long-term function and radiographic osteoarthrosis in dogs after postoperative physical rehabilitation and tibial plateau leveling osteotomy or lateral fabellar suture stabilization.
Vet Surg. February 2010;39(2):173-80.
Kevin K Au1, Wanda J Gordon-Evans, Dianne Dunning, Kristen J O’Dell-Anderson, Kim E Knap, Dominique Griffon , Ann L Johnson
1 Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61802, USA. kevinau2@illinois.edu

Abstract
OBJECTIVES: To compare short- and long-term functional and radiographic outcome of cranial cruciate ligament (CrCL) injury in dogs treated with postoperative physical rehabilitation and either tibial plateau leveling osteotomy (TPLO) or lateral fabellar suture stabilization (LFS). STUDY DESIGN: Prospective observational clinical study. ANIMALS: Medium to large breed dogs with naturally occurring CrCL injury (n=65). METHODS: Dogs with CrCL injury were treated with either TPLO or LFS and with identical physical rehabilitation regimes postoperatively. Limb peak vertical force (PVF) was measured preoperatively and at 3, 5, and 7 weeks, and 6 months and 24 months postoperatively. Stifles were radiographically assessed for osteoarthrosis (OA) preoperatively and 24 months postoperatively. RESULTS: Thirty-five dogs had LFS and 30 dogs had TPLO. Radiographic OA scores were significantly increased at 24 months compared with preoperative scores in all dogs. Radiographic OA scores preoperatively and at 24 months were not significantly different between treatment groups. PVF was significantly increased from preoperative to 24 months among both treatment groups but not significantly different between treatment groups preoperatively or at 3, 5, 7 weeks, 6, or 24 months. CONCLUSION: No significant difference in outcome as determined by ground reaction forces or radiographic OA scores were found between dogs with CrCL injury treated with LFS or TPLO. CLINICAL RELEVANCE: LFS and TPLO remain good options for stabilizing stifles with CrCL injury with all dogs showing significant functional improvement. This study does not support the superiority of either surgical technique.

*** Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs ***

*** J Am Vet Med Assoc. January 2005;226(2):232-6. ***
*** Michael G Conzemius1; Richard B Evans; M Faulkner Besancon; Wanda J Gordon; Christopher L Horstman; William D Hoefle; Mary Ann Nieves; Stanley D Wagner ***
** *1Orthopaedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50010, USA. ***

http://www.vin.com/global/js/switch/plus.gif Companion Notes

Article Abstract
***OBJECTIVE: To determine the outcome and effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament (RCCL) and injury to the medial meniscus in Labrador Retrievers. ***
***STUDY DESIGN: Prospective clinical study. ***
***ANIMALS: 131 Labrador Retrievers with unilateral RCCL and injury to the medial meniscus and 17 clinically normal Labrador Retrievers. ***
***PROCEDURE: Affected dogs had partial or complete medial meniscectomy and lateral suture stabilization (LSS), intracapsular stabilization (ICS), or tibial plateau leveling osteotomy (TPLO). Limb function was measured before surgery and 2 and 6 months after surgery. Treated dogs were evaluated to determine the probability that they could be differentiated from clinically normal dogs and tested to determine the likelihood that they achieved improvement. ***
***RESULTS: No difference was found between LSS or TPLO groups, but dogs treated with ICS had significantly lower ground reaction forces at 2 and 6 months. Compared with clinically normal dogs only, 14.9% of LSS-, 15% of ICS-, and 10.9% of TPLO-treated dogs had normal limb function. Improvement was seen in only 15% of dogs treated via ICS, 34% treated via TPLO, and 40% treated via LSS. ***

CONCLUSIONS AND CLINICAL RELEVANCE: Surgical technique can influence limb function after surgery. Labrador Retrievers treated via LSS, ICS, or TPLO for repair for of RCCL and medial meniscal injury managed with partial or complete meniscectomy infrequently achieve normal function. Results of LSS and TPLO are similar and superior to ICS.

In regards to the linked site, there’s some truths and half-truths to his opinions. Medical treatments for example are definitely options but candidacy defines what is the best treatment options(and this is usually offered if there is suspect of partial tears but not usually for complete ruptures). You can take a look at this link in regards to the whole neuter/spay relationship with hip dysplasia and cruciate ligament ruptures:

https://docs.google.com/viewer?a=v&q=cache:xDVS67cU6L4J:www.columbusdogconnection.com/Documents/PedRebuttal%2520.pdf+&hl=en&gl=us&pid=bl&srcid=ADGEEShx3ZnqQpJxI-8AmXd58R_hJOcG9OR5OvVcS0t2GKOTM-2LJbasyMaWQr3GYZ-fsALmvfnyjb-ZeMX6upBIdcZscLoNohxFSkEnMR0c0CggZNmkEfLsLNuAW7mxoTkm-CBDYvIN&sig=AHIEtbS5FJuGTpNuvcmTDHxPOWH_pvrfVw&pli=1
It is actually a letter of rebuttal but there’s plenty of cited sources so there’s a good amount of reading there. I think a rehab plan post surgery is definitely a smart move(especially hydrotherapy) but whether a brace should be included, is a decision that only the surgeon performing the procedure can advice on.

I know it is quite the number of readings to do but unlike some “gray” candidacy cases, your dog’s seem to point in a clear direction: intracapsular repair. He/She is still young and over the 80lb that the studies showed. Which particular extracapsular procedure? That depends on the other factors that I do not know about your dog’s case. Oh and just to give you a heads up, about 30% of dogs with one ruptured cruciate will rupture the other within 18 months. :X

9

Just to add my N=2 experience. We have a 40 lb Cockapoo and a 60 lb husky/boxer that have both had the nylon filament surgery. One was 2 years ago and the other about 6 months ago. Recovery for each took 3-4 months but both are back to 100% now. $1500 for each, but our results were excellent.

Thom

10

It is very dependent on the experience of the surgeon and how young/active your dog is.

Our yellow lab, due to genetics, had significantly deteriorated/torn LCLs before the age of 2. We were told by our specialist (who has 20+ years of surgical experience) that while extra- is cheaper, with an active/young dog such as ours there is a much higher likelihood of repeat injury or tearing of the nylon. Intra-, while more expensive and more intrusive, has significantly better results in younger dogs and usually results in a 100% recovery within 6 months.

She had her left knee done and then had her right knee done about 10 months after the left. Recovery time for each was ~6 months. Total cost for both knees, including PT was around $7K.

In Summary:
Make sure the surgeon/specialist you are working with has extensive experience with both types of surgeryThe age, activeness, and size of your dog are the variables that will make the decision for you - My lab was 1.5 years old, 65lbs, and very active - the choice was easy for meYour dog is going to need significantly more TLC from you post-surgery, especially for the first month - make sure you are ready for thisDon’t just account for the cost of the surgery - your dog is going to need a significant amount of PT, which for us ran at 40/hr, two hours a week, for 4+ monthsAnd as the poster above me stated, most dogs who tear one ligament, have a very high chance of tearing the other one, which happened to my dog
Good luck!

11

I happen to be another N=2 (same dog, both knees) “expert” on the subject.

My 10 year old 55 pound yellow lab blew out her right critiate ligament playing on the beach with her pal. We opted for TTA surgery, covered 90% by our doggie insurance. Recovery was long, but we did the physical therapy religiously and she was pack to her playful self in about 10 weeks under light duty and leash only activity up until about 20 weeks. So for us it was a 5 month process. She didn’t ever get all of her nibleness back, but her quality of life did not suffer at all really. Then around month 5 she was playing fetch in the backyard and my wife heard a “pop” and she started limping on the other leg. She had torn the other one. We contemplated putting her down because she was now 11 years old and we didn’t want her to suffer and quite frankly, I didn’t have a spare $6000 just sitting around to use to pay for it. We decided that since our dogs are basicaly our kids, we would find a way to pay for it. We are very glad we did because the second time she recovered much more quickly. Now at 12 years old, she runs off leash in the open space near our house, playing like a 5 year old dog.

12

PM me if you want some info on Frequency Specific Microcurrent. I attended a symposium last year where the DVM presented some case studies for cranial cruciate ligaments in dogs. Not saying it’s replacement for surgery, but it may help, can’t hurt, is non- invasive and can be done pre and post surgery to facilitate healing. Have had great success in the office treating athletes with it for years.

Mike

13

I would bank money more on a class IV laser therapy over FSM(especially if you’re looking for more recent studies). However, both modalities are symptomatic treatments, often recommended for partial cruciate tears and not complete ruptures(and there’s definitely many naysayers on their effects). I personally believe class IV lasers help, especially pre surgery if surgical intervention cannot be performed soon and post surgery for recovery purposes.

By the way, some of these non-conventional options can cause some harm(thermal burns have occurred numerous times) so get a competent practitioner!

One more note: the profit margin on an extracapsular repair is higher than intracapsular so please don’t view the recommendation as a profit-hungry tactic. Yes, the overall cost of intracapsular surgical procedures is higher but surgeons make more on the faster, less invested extracapsular option.

14

This is making me a nerd on the details, but I want the OP to be able to return from having consulted Dr. Google and be technically correct…

Perhaps more semantics, but all the repair methods (nylon suture/tightrope, TPLO-tibial plateau leveling osteotomy, TTA-tibial tuberosity advancement) that have been mentioned here are extracapsular techniques, not intracapsular. The name refers to whether the stabilization is inside or outside the joint capsule and with all of these, implants are placed outside of the joint. Going into the joint to remove cruciate fragments, or more commonly to check the meniscus, happens routinely and doesn’t make the procedure intracapsular.

Intracapsular techniques were considered outdated when I graduated in 2001 and you are unlikely to find someone that performs them anymore. They use the dog’s own tissue (portion of patellar tendon or connective tissue along the thigh usually) and are placed through the joint in an orientation similar to the cruciate ligament like a graft. The profit margin is higher and cost lower on these actually due to quick surgical time, no need for specialized orthopedic surgical instruments (high speed drills and saws), and minimal implants (at most a screw). They fail because the inflammation in the joint degrades and weakens the transposed tissue and it tears. With so many better options available, I believe most would argue that intracapsular repairs are below current standard of care.

Of the extracapsular techniques, there are two main approaches. The TPLO and TTA involve cuts (and then plates/screws) to the upper shin bone that change the weight bearing angles and forces inside the joint and patellar tendon. These are both very popular, especially with large breed, active dogs and one of these would likely be best for your pup. The other (lateral fabellar suture, tightrope, ole’ doc and his 80 pound test fishing leader line) involves a strand placed between the upper and lower leg bones across the joint that restricts motion on the joint similar to the cruciate ligament. The method works great when the suture doesn’t break, so not the best for a large active dog that puts a huge loading force on the leg during play.

The really good advice a few people here have mentioned is to plan for the second leg to blow in the future and then be happy with your good luck if it doesn’t. Just like all orthopedic issues and probably unecessary to mention in a triathlon forum, making sure your dog is at a lean body weight with good muscle strength can really help with longterm return to function.

15

Couldn’t agree more, both with the advice and technical corrections :wink:
.

16

This is making me a nerd on the details, but I want the OP to be able to return from having consulted Dr. Google and be technically correct…

Perhaps more semantics, but all the repair methods (nylon suture/tightrope, TPLO-tibial plateau leveling osteotomy, TTA-tibial tuberosity advancement) that have been mentioned here are extracapsular techniques, not intracapsular. The name refers to whether the stabilization is inside or outside the joint capsule and with all of these, implants are placed outside of the joint. Going into the joint to remove cruciate fragments, or more commonly to check the meniscus, happens routinely and doesn’t make the procedure intracapsular.

Intracapsular techniques were considered outdated when I graduated in 2001 and you are unlikely to find someone that performs them anymore. They use the dog’s own tissue (portion of patellar tendon or connective tissue along the thigh usually) and are placed through the joint in an orientation similar to the cruciate ligament like a graft. The profit margin is higher and cost lower on these actually due to quick surgical time, no need for specialized orthopedic surgical instruments (high speed drills and saws), and minimal implants (at most a screw). They fail because the inflammation in the joint degrades and weakens the transposed tissue and it tears. With so many better options available, I believe most would argue that intracapsular repairs are below current standard of care.

Of the extracapsular techniques, there are two main approaches. The TPLO and TTA involve cuts (and then plates/screws) to the upper shin bone that change the weight bearing angles and forces inside the joint and patellar tendon. These are both very popular, especially with large breed, active dogs and one of these would likely be best for your pup. The other (lateral fabellar suture, tightrope, ole’ doc and his 80 pound test fishing leader line) involves a strand placed between the upper and lower leg bones across the joint that restricts motion on the joint similar to the cruciate ligament. The method works great when the suture doesn’t break, so not the best for a large active dog that puts a huge loading force on the leg during play.

The really good advice a few people here have mentioned is to plan for the second leg to blow in the future and then be happy with your good luck if it doesn’t. Just like all orthopedic issues and probably unecessary to mention in a triathlon forum, making sure your dog is at a lean body weight with good muscle strength can really help with longterm return to function.

I think the reason our dog responded so favorable atfer the second blow out is she is considered by most people (not vets) the be a “skinny labrador”. Yes, you can actually see her waistline and has been really active her entire life!

17

Did you decide to do one or the other? Hope doggie is feeling better!

18

Yup. He had his operation two days ago. It was a rough first night when we brought him home but he seems to be doing surprisingly well tonight. We’ve begun the home rehab and ice and intend to be consistant with it. The vet did the nylon/tightrope technique. Let’s hope everything works out.

19

I don’t see a picture of said doggie anywhere in this thread. FAIL

20

"I don’t see a picture of said doggie anywhere in this thread. FAIL "

You don’t want to see a photo of Murdoch right now. There’s nothing cute or attractive of a dog with a shaved leg with stitches gimping around on the other three. :slight_smile: