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Thread: torn ligaments on dogs

  1. #1
    Senior Member Adk_dib's Avatar
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    torn ligaments on dogs

    my four legged hiking partner, a 70 pound lab, tore her ligament in her rear left leg last week. No hiking for her this winter. the vet said she could hike with me just fine next spring, maybe she will be a little slower but she should be fine. I think I will keep her to easier hikes this year to give it a test. Has anyone had this happen and what kind of results did your dog have?

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    Banned Kevin Rooney's Avatar
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    Could you be more specific as to which ligament? If it's the left cruciate ligament, then yes, I've had experience with that tear and it's treatment.

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    Member Vermonster's Avatar
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    CCL Injury?

    I am guessing you are referring to a cranial cruciate ligament (CCL) injury?

    I'm not a vet and have thankfully not had a dog with a cruciate injury, however a number of friends, primarily with working dogs, have extensive experience.

    You have three options:

    Conservative treatment: restrict activity, perhaps use nutritional supplements and prescription pain relievers, keep the dog at a reasonable body weight.

    Traditional monofilament repair: surgical repair involving replacement of the CCL with an artificial monofilament or wire substitute (fishing line repair).

    TPLO: tibial plateau leveling osteotomy, a surgical repair that seeks to change the entire slope of the joint by cutting the bone, thus providing stability to the joint without reconstructing the ligament.

    TPLO surgery has been somewhat controversial as the inventor patented the procedure and restricted its use. Thus efficacy data has been limited. Recently, I would say there is a growing opinion that the TPLO is likely the preferred surgical option, at least in larger dogs.

    Neither surgery is cheap. Last I checked the TPLO will run around $3000, the traditional repair a bit less.

    You should talk with your veterinarian about the risk of rupture in the contralateral joint. Some studies put the risk as high as 30%

    Be sure and select a surgeon with extensive experience with whichever procedure you select. At least one surgeon at Tufts in Grafton, MA has a lot of TPLO experience. As with human surgery, rehab is as, if not more, important than the surgery itself.

    There are a range of outcomes from the procedure, but I have seen many working dogs return to field trials, flyball, herding, etc. after CCL repair. They are probably not 100%, but many seem quite happy. With either conservative treatment or surgical repair there is a risk of poor outcome.

    Good luck.

    Errol

  4. #4
    Banned Kevin Rooney's Avatar
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    To add to Vermontster's comments:

    If the ligament is actually torn, no amount of TLC will repair it. Surgery is needed in order to restore use of the leg. I could be mistaken, but am quite sure that ligaments which have been torn into 2 pieces do not heal/regenerate spontaneously.

    The type of surgery is often dependent upon the weight of your dog, the vet's knowledge, philosophy and your wallet. When I lived in central VT, dogs weighing > 100lbs with torn cruciate's were referred to a vet in Rutland who used a technique perfected at the Univ. of PA in which the torn ligament was attached to the opposite side of the knee with a metal pin. Recovery time is about 6 months for the giant breeds. Mobility is restored, but 100% is unlikely. Have been thru 3 of these procedures with 2 Newfs, the last being about 10 years ago, so techniques may have changed.

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    Senior Member Dugan's Avatar
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    I am going through exactly this with my dog Dugan. The onset of his symptoms were 12/2005. He had a TTA (Tibial Tuberosity Advancement) in 4/2006. We are currently in the midst of rehab.

    If your vet has not yet advised you to reduce your dog's activity, do so immediately to help prevent further injury. If you can, seek a more detailed diagnoses from an orthopedic vet. Until then, activity should be restricted to short (1/4 mile or les), sedate walks on a level surface only - no running, jumping, active playing.

    This injury MUST BE taken seriously. Because a dog's stifle joint ("knee" of rear leg) is mechanically different than that of a human, there are constant stresses on both the cranial and caudal cruciate ligaments. This makes it much less likely that rehab alone will do the trick.

    There are several repair options beyond those listed by Vermonster.

    Since this isn't hiking related, I hesitate to go into additional detail here. Please feel free to email me for more information.

    One excellent source of information is the Yahoo Group "Orthodogs". You have to have a yahoo email account to join, but you can get that for free. The group is like here - some good contributors, others less so. The best thing about it is the HUGE wealth of information available.

    http://www.egroups.com/subscribe/orthodogs

    Another yahoo group, this one devoted to non-surgical management of canine orthopedic issues:
    http://pets.groups.yahoo.com/group/C...ement/messages

    One person's experience with surgery - some great links:
    http://www.lauriebryce.com/tplo/index.html

    One person's experience with CM:
    http://home.earthlink.net/~tiggerpoz/index.html

    One method of finding a specialist:
    http://www.acvs.org/flash.html

  6. #6
    Senior Member skiguy's Avatar
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    Quote Originally Posted by Kevin Rooney
    To add to Vermontster's comments:
    If the ligament is actually torn, no amount of TLC will repair it. Surgery is needed in order to restore use of the leg. I could be mistaken, but am quite sure that ligaments which have been torn into 2 pieces do not heal/regenerate spontaneously.
    This has been my experience.Getting an opinion from an ORTHOPEDIC VET and not the regular Family Vet can be wise in this situation as would be any Surgery if needed. Treated correctly the success rate for these sorts of things is very good especially if the dog is healthy to begin with as it sounds like it must be if it has been hiking.
    "I'm getting up and going to work everyday and I am stoked. That does not suck!"__Shane McConkey

  7. #7
    Senior Member Adk_dib's Avatar
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    she tore her cruciate ligament, torn meniscus. Dr. Bookbinder in central new york did the operation. he has a good reputation. it cost $1745.

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    Banned Kevin Rooney's Avatar
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    Quote Originally Posted by Adk_dib
    my four legged hiking partner, a 70 pound lab, tore her ligament in her rear left leg last week. No hiking for her this winter. the vet said she could hike with me just fine next spring, maybe she will be a little slower but she should be fine. I think I will keep her to easier hikes this year to give it a test. Has anyone had this happen and what kind of results did your dog have?
    ************************************************** *****
    she tore her cruciate ligament, torn meniscus. Dr. Bookbinder in central new york did the operation. he has a good reputation. it cost $1745.
    Based upon my own experience, I think your vet has given you a reasonable prognosis of your lab's recovery. I think the biggest impact will be her ability to jump - that puts alot of work on the knees, so you may want to consider which trails you take her on when she's better. Good luck - she may need some help in the next few weeks just getting up and around.

  9. #9
    Senior Member Dugan's Avatar
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    Quote Originally Posted by Adk_dib
    she tore her cruciate ligament, torn meniscus. Dr. Bookbinder in central new york did the operation. he has a good reputation. it cost $1745.
    A torn meniscus commonly goes hand-in-hand (or should that be paw-in-paw) with a CCL tear. Without a functional CCL, the joint isn't stable, meaning the femur grates across the tibia, thus "catching" and tearing the meniscus. Osteoarthritis is commonly results because the meniscal pad is damaged, the joint doesn't have the cushioning it needs. You can actually see the instability in the dog's gait. As the dog places weight onto the injured leg, the femur presses down on the tib/fib. Without the CCL to hold the joint stable, the femur slides forward and downard along the tibial plateau angle. This pushes the tibia sideways toward the outside, resulting in a sort of a twist, or bowed leg.

    Which procedure did she have?

    1745 is either really expensive for the "monofilament" (aka suture) type of repair, or really cheap for an osteotomy method (TTA, TPLO, FHT, cranial wedge).

    -

    With any of these options, be aware that rehab can take as long as 12 months. Significant muscle atrophy can occur while the dog is inactive. Your vet is extremely optimistic if they think your dog will be hiking mountains come spring.

    Another statistic to keep in mind is that almost 50% of dogs who tear one cranial cruciate ligament, will tear the other within 12 months. No one knows why - whether it's the strain on the good leg as the dog favors the injured/surgical leg, if it's something to do with conformation (i.e. steepness of tibial plateau angle), or if the ligament tissue is deteriorating.

    In addition, as I understand it, very few surgical dogs regain 100% of their presurgical joint stability.

    Because of these things, you may want to reconsider what you ask of her athletically.

    I can't urge you enough to join Orthodogs. They've got great information on rehab - ROM exercises, stretching, knee braces, diet, nutritional supplements, and so forth. Not many of the dogs over there are hiker-dogs, but quite a few are competitive athletes - even after surgery.

    Another good site:
    http://www.marvistavet.com/html/body...ciate_lig.html

    I wish only the best for you and your dog. The past 10 months with "Dugan 3.75 legs" have been challenging.
    Last edited by Dugan; 10-25-2006 at 04:51 PM.

  10. #10
    Senior Member audrey's Avatar
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    Good luck, I always fear for Genie's health - she is so energetic and athletic. My previous dog Clio partially tore a ligament (not sure which one) at age 9 but the orthopedic vet advised against surgery - he said it was a tossup and that arthritis would probably follow with or without surgery. So, she hiked pretty well till she was 13, though she limped quite a bit after hiking. Glucosamine/chondroitin did help for a while.

  11. #11
    Member kwc's Avatar
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    Quote Originally Posted by Vermonster
    I am guessing you are referring to a cranial cruciate ligament (CCL) injury?

    I'm not a vet and have thankfully not had a dog with a cruciate injury, however a number of friends, primarily with working dogs, have extensive experience.

    You have three options:

    Conservative treatment: restrict activity, perhaps use nutritional supplements and prescription pain relievers, keep the dog at a reasonable body weight.

    Traditional monofilament repair: surgical repair involving replacement of the CCL with an artificial monofilament or wire substitute (fishing line repair).

    TPLO: tibial plateau leveling osteotomy, a surgical repair that seeks to change the entire slope of the joint by cutting the bone, thus providing stability to the joint without reconstructing the ligament.

    TPLO surgery has been somewhat controversial as the inventor patented the procedure and restricted its use. Thus efficacy data has been limited. Recently, I would say there is a growing opinion that the TPLO is likely the preferred surgical option, at least in larger dogs.

    Neither surgery is cheap. Last I checked the TPLO will run around $3000, the traditional repair a bit less.

    You should talk with your veterinarian about the risk of rupture in the contralateral joint. Some studies put the risk as high as 30%

    Be sure and select a surgeon with extensive experience with whichever procedure you select. At least one surgeon at Tufts in Grafton, MA has a lot of TPLO experience. As with human surgery, rehab is as, if not more, important than the surgery itself.

    There are a range of outcomes from the procedure, but I have seen many working dogs return to field trials, flyball, herding, etc. after CCL repair. They are probably not 100%, but many seem quite happy. With either conservative treatment or surgical repair there is a risk of poor outcome.

    Good luck.

    Errol
    This is very good advice.

    TPLO surgery ran us about $2400 after the "professional discount" (my wife is a veterinary technician).

    An x-ray of your dog's injury should indicate which surgery is best ... if the angle of the bone is too great, then TPLO surgery is recommended. The bone is cut (in TPLO) to reduce the angle, and then a metal plate is attached to the lower leg bone for support.

    One of the most important parts of the initial rehab is keeping your dog quiet ... no jumping, no running, no climbing of stairs, always on a short leash when taken outdoors (to urinate/defacate) ... and your dog should have a protective cone on his/her head to prevent him/her from licking the incision.
    Take nothing but pictures. Leave nothing but footprints. Kill nothing but time.

  12. #12
    Senior Member Dugan's Avatar
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    An alternative to the e-collar ("cone") is the bite-not: http://www.bitenot.com/

    Some dogs have difficulty tolerating the elizabethan collar. For others, like Dugan, they don't come large enough to keep them from licking around the edge. Another trick Dugan learned was to use the edge of the e-collar for scratching the incision. I used some foam pipe insulation duct taped around the outer edge of the collar. That made the collar big enough and soft enough to keep him from licking, and soft enough that he couldn't damage by scratching with it.

    A sling or bottoms-up leash is invaluable for added support in the first few weeks: http://www.handicappedpets.com/Mobil...%20Harness.htm

    I hate to disagree with KWC, but current research does not support any one type of surgical option over another. The ortho-surgeon we saw at Tufts said that 12 months after the surgery there is no difference between a dog that has had lateral suture, TPLO, or TTA. There is evidence that many dogs have an allegedly too steep tibial plateau angle never tear a cruciate ligament. It's unfortunate that this, the most common injury in dogs, is not better understood.
    Last edited by Dugan; 10-26-2006 at 07:47 AM.

  13. #13
    Senior Member Adk_dib's Avatar
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    Thanks for the replies. I think I will keep her off the trails until next fall. I do the big ones including the peaks in the summer so she cant go with me then. Spring is to early. In the fall I do the leisurely walks in the woods. This is going to put a kink in my schedule. I want to do 10 peaks next year and finish the 46 on my birthday (sept). This means in the spring I will need to get out on the trails and workout my legs. I will feal bad about leaving her almost every weekend. Well, theres always next year.

  14. #14
    Senior Member Paradox's Avatar
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    Chips, my chocolate lab, tore both cruciate ligaments. The first when she was 3, and the other when she was 4. She is 9 now and has been an active and avid hiker after about a year recovery. We keep her very lean, good to do anyway. She most likely tore them while rough-housing with the dogs next door. The only downside is she sits rather stiffly with her legs off to the side. I give her glucosamine/chondroitin/MSM every morning and that seems to help. The cost of the surgury was only $700.
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  15. #15
    Senior Member Dugan's Avatar
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    Quote Originally Posted by Paradox
    The only downside is she sits rather stiffly with her legs off to the side.
    Very common in dogs with cruciate problems. Also known as the "positive sit test"

    Quote Originally Posted by Paradox
    I give her glucosamine/chondroitin/MSM every morning and that seems to help.
    I started Dugan on Cosequin as soon as the original diagnosis came in. i don't know if it helped, but his orthosurgeon said that he'd have expected more damage and deterioration than he saw. There's also some buzz about unfiltered apple cider vinegar and hyaluronic acid being helpful. I hate to repeat myself - but check out Orthodogs - great info on current injury, and keeping dogs going afterwards.

    Quote Originally Posted by Paradox
    The cost of the surgury was only $700.
    A discussion of surgery and cost is irrelevant unless you can say which procedure was done. There are several commonly performed surgical procedures with a wide range of costs.
    Last edited by Dugan; 10-28-2006 at 11:24 AM.

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