ACL Advice Needed

[cedarvalleynewfoundlands]

ACL Advice Needed...Update On Clayton Added

Hi All

3 days ago I noticed Clayton limping on a hind leg. I was hoping he had just pulled something and took a wait and see approach for a couple days. Well, by yesterday he wasnt much better, so I took him in to our vet.
I told him when we walked in if he said it was his cruciate I was going to stand there and cry.
He did a physical exam and handed me a box of tissues
He is pretty certain Clayton ruptured his ACL. He referred us to a Specialty Vet Practice up in St Louis (one of the best in the state, next choice would be Univ of Mo Teaching Hosp)
Anyway, Clayton has an appt Monday with the Ortho Doc.
My question is this:
From the experience here, is there a chance he hasnt completely ruptured it and surgery wont be needed
Anyone know what surgery options there are, and whether one is better for Newfs than another?
The only one I have ever heard or read about is a TPLO, just wondering if there are other options or if that is considered the best.
Of course, I know this is all speculation until we see the Ortho Doc, just wondering in advance so I can research some of it before the appt.
Our vet put him on Previcox to help with the pain and it seems to be helping....anyone know of any problems with it?
We had him in the family room, but it is ceramic tile and easy for him to slip. We moved him upstairs (older pine floors, not near as slick) and when he wants to go out, we have him confined in a 10 X 10 kennel to limit his activity. We have a baby bed mattress with a quilt over it, which he always lays on, so should help somewhat with the pain. We went out last night and got another mattress, so he now has one both outside in the kennel and inside in the house.
Any other suggestions on what to possibly expect, or other suggestions to keep him comfortable until his appt?
Thanks in advance for any suggestions or experience.
I know there is lots of experience here with ACL problems.

 

[newfam]

No experience from me, put I want to send my prayers and hugs for patience and healing for you and Clayton. I hope you are able to get great care and decisions made easily. :icon_knuddel:

 

[Sailorgirl]

Sorry to hear this. It really does make your heart drop doesn't it?

OK, first off, go to your favorite (or closest) big box store and buy as many large, rubber-backed cheapie area rugs as you an afford and then put them all over the place. It's really important that he not slip regardless of whether he's headed for surgery or not. My house is covered in them. Not exactly the look I was going for, but oh, well, so it goes.

There is a chance that he might only have a partial tear, and that's something you can opt to not do surgery on (you can actually opt not to do surgery on anything you want, of course, but it can be easier to recoup if it's just partial ... keep in mind though, the ligament won't grow back (not possible). What you're looking for is to build up the scar tissue and muscles to stabilize the joint).

If you decide to do surgery, there are multiple options. One is TPLO. Another is the so-called traditional surgery (extra capsular suture) and then there some others, including TTA. I'd ask your ortho to talk to you about all of these options. And then, even if you LOVE the ortho, I'd get some other opinions from other orthos. In most cases you do not need to set up an appointment, you can talk on the phone, just to get a general idea of what they MIGHT suggest (obviously you would want to have an exam and in-person appointment if you chose that doctor). If you are a member of a regional Newf club, call some people in it and ask them for ortho recommendations, as well as get some names of people who've been through it so you can talk to them about the pros and cons of the various procedures. If you do decide to do the TPLO, you MUST go with a board-certified TPLO surgeon. Only these doctors have been properly trained in how to do the procedure, so if you're seriously considering a TPLO then ask about that.

There are other non-surgical options as well, including a program called Conservative Management (google it).

Hopefully the ortho will have good news for you. Sorry again that you're dealing with this. I know it's not fun.

 

[Ivoryudx]

There are several different surgical procedures being done out there. Some Vets are saying that certain procedures are better for differents size dogs but its been my observation that it has more to do with the experience of the Vet doing the operation than with the procedure used.

Here is a recent thread discussing the different things available even a brace. I also posted a link to a recent report stating one procedure does not have an advantage over another. Each case is different but I personally feel the less invasivie the better.

http://www.newf.net/Forums/showthread.php?t=85374

 

[Brinks' Mom]

Not sure if I could give "advice" but I can share my experience. A few weeks ago I was right where you are now....overwhelmed...confused...and spending countless hours looking for answers as to what would be "BEST" for Brinks.

What I learned was if there is a classic "drawer" movement in the knee then it is fully torn. Sometimes this doesn't show unless the pet is sedated. However in Brinks' case...there was a definite "drawer" movement in the knee and no further testing was needed. Vet had mentioned that a non surgical approach has been done before with other Newfs but they were a female and much smaller than Brinks making it easier to manage the pain and the healing. Brinks is only 2 years old and has a really bad left hip and now had a torn right knee so I made the choice for surgery. Our Ortho had recommended a TTA and so thats what we did. Of course I would have wanted the "least" invasive as possible but I had to "trust" what the Ortho believed to be the best for Brinks as each case is different.

So far he's doing well. We had 2 week followup today and Vet feels that he's right on schedule with bearing weight on the leg if not better. So 2 weeks down and 4 more to go with "strict restricted" activity. No walks, no jumping, no stairs, no running, no getting on the couch. Rugs covering every inch of floor. Sling to help him during first few days after surgery. Mattress on the floor...one for him and one for me. In and out of the house on leash only to make sure he doesn't chase some brave squirrel in the yard. Not easy to do but worth all the effort it in the end.....I'm hoping. All of these efforts and restrictions would be whether you choose the surgery or not I believe.

This is my first Newfie and I'm learning as I go. I'd be so lost if it weren't for Newfnet and all of the kind hearted wonderful people here willing to help and share the love we have for these "gentle souls" we call Newfs.

Good luck....:kiss:

 

[cedarvalleynewfoundlands]

Thanks for all the info, it really helps.
I went to the Univ of MO site, and apparently they have a brand new technique that was reworked from human ankle surgeries. It is called a Tightrope repair, and is apparently much less invasive than either TPLO or the traditional surgeries, and seems to offer comparable success rates with fewer complications. The article was from July 2008.
Apparently, the surgery involves small holes being drilled into the bone, and a fiber tape being threaded through to stabilize the joint. The info said it is especially good for large dogs, and dogs must be over 40 pounds to even be a candidate for the surgery.
The info says rehab is 10-12 weeks, which is the same for either traditional, TPLO or conservative treatments.
I cant even tell from the article if the technique is out of the clinical phase or not.
I will be asking the Ortho Doc about it Monday at our appt.
I am also going to make an appt at the Univ of MO also, since whatever the Ortho doc says on Mon, I would still like another opinion.
Anyone here ever heard of or have experience with the Tightrope CCL repair?

 

[Thule's Mom]

Won't give advice, but have lots of opinions!

There are two surgery choices in the States (not so where I am, TPLO was only choice) they are TPLO and TTA (tightrope). Tightrope is the newer procedure. You're surgeon will most likely recommend a procedure. It would be good to find out how much experience he has with giant breed dogs. Whichever procedure you choose, research it thoroughly, join the Yahoo groups Orthodogs and K9Orthopedics for real stories of real dogs who've had both procedures. You'll get lots of pros and cons for both procedures and for surgery in general. My opinion is with our breed, Conservative Management only puts off the inevitable and allows time for arthritis to set in. My Thule has arthritis in both knees, not because we wanted to wait for surgery, but we had to wait a full six months before the Ortho surgeon came.

While your waiting for surgery, there are preparations to be made. The main ones for Thule were lots of rugs and mats around the house over the laminate floor, and most importantly a Sling to use after surgery to help her walk and for getting her in and out of the car.

We're five weeks post Double-TPLO and she's doing marvelous, and has done so from the time I brought her home. We've had no set backs (knock wood) and no infection. The scars are completely disappeared. She stayed at the vet from Wednesday, when the surgery was done to Saturday afternoon. With one knee done, they allow the dogs to go home a day earlier. I believe this time at the vet post-surgery is crucial to a successful surgery.

On the 17th, Thule goes for her 6 week x-rays. I'm expecting her left knee to be a little behind in recovery than her right; she tore the left back in October and the right in January. Surgery wasn't done until March.


Feel free to PM me with any questions!

Hugs & Licks

 

[cedarvalleynewfoundlands]

Thanks Deb for the info.
My understanding is that the Tightrope procedure is a new, 3rd option in addition to both the TPLO and the TTA. The info I have been able to find shows that the TTA is less invasive than TPLO, and the tightrope procedure is even less invasive than the TTA.
Of course, this is all from reading, and I'm sure I will be much better informed after visiting the Ortho on Monday. Just the small bit of info I have recieved looks like at his age (5) and weight (157 yesterday) pain management and restriction of activity probably wont really do anything except buy us a little time.
I totally agree with Deb's opinion that if there is a tear, it probably needs a surgical intervention to have the best possible outcome with the least chance of arthritis developing. My vet said he was able to feel a pretty significant slide in the joint, which he said normally means it is a total rupture, and not just a tear. He also said compared to the other knee, there is a very noticable difference.
Right now, the Previcox seems to be keeping him confortable. Luckily, at 5, he is fairly laid back and he's pretty easy to bring in the house and just have him hang out and not run around. He loves walks, and is used to a leash, so I'm hoping he wont be too bad to keep quiet while we wait for the appt Monday.

 

[Murphy]

All I can add is "been there.. done that.. may be doing it again. " Good luck on Monday.. :icon_knuddel:

 

[Sailorgirl]

Just a quick note on the rehab time ... whoever said 10-12 weeks was either lying or very, very lucky. I think they may mean 10-12 weeks of severly restricted activity, but count on months before your dog can be a dog again. My guy's surgery was Feb. 18 ... 2008. We've had a few setbacks during that time, but he's still on a leash always and we work every day on strengthening and stretching exercises. He has not run for well over a year and has not played with another dog for that entire time either. I'm not trying to be negative, and certainly there are people on here with much different experiences, but I do not think that a three-month recovery to your dog being "back to normal" is at all normal or realistic.

I will say that I think a formal physical therapy program is probably the absolute best thing you can do for your dog during the recovery.

Oh, and the ortho is probably going to tell you to take some weight off him. At 157 he's probably by no means fat, but the lighter the better with these injuries. Hudson was at 155 when he had the surgery and in great shape. He's now at 132, and yes, he's skinny, but it helps a lot.

 

[nowhavethreebears]

Mary, I am sorry to hear that Clayton is injured. Best of luck to you whatever you decide to do for him.
I went conservative both times with Sophie and it worked for us, but she is a smallish bitch, barely 100 lb.
Her first injury was April 2008 and the second in Oct 2008. She is still on limited activity and doing well...She was on COMPLETE crate rest for three months....

 

[Murphy]

Just a quick note on the rehab time ... whoever said 10-12 weeks was either lying or very, very lucky. I think they may mean 10-12 weeks of severly restricted activity, but count on months before your dog can be a dog again. My guy's surgery was Feb. 18 ... 2008. We've had a few setbacks during that time, but he's still on a leash always and we work every day on strengthening and stretching exercises. He has not run for well over a year and has not played with another dog for that entire time either. I'm not trying to be negative, and certainly there are people on here with much different experiences, but I do not think that a three-month recovery to your dog being "back to normal" is at all normal or realistic.

I will say that I think a formal physical therapy program is probably the absolute best thing you can do for your dog during the recovery.

Oh, and the ortho is probably going to tell you to take some weight off him. At 157 he's probably by no means fat, but the lighter the better with these injuries. Hudson was at 155 when he had the surgery and in great shape. He's now at 132, and yes, he's skinny, but it helps a lot.

Yes.. I can echo those thoughts. We are 6 months post op. No running yet.. No long walks. Some days no walk at all.. Still many many issues which I will not go into right now. :icon_knuddel:

 

[Thule's Mom]

I echo the weight issue; Thule was 127 when she tore the first one; I got her down to 114 before surgery; a big part of her successful recovery, I believe!!

 

[lilly06]

Only speaking from my own experience, in having have had multiple surgeries initially starting with cruciate surgeries then went on from there with complications and secondary infections. It has been one hell of a long road thus far and we still have a long road of physical therapy to come.

So with that said, my advice would be to explore all of your options. Get a second opinion if you need to. Talk about all of the complications that can happen. Some OS's do not cover that area very well at all. Be sure that you have great communication with your OS. Our most recent OS is at UC Davis. I love the facility, student assistants and our OS. It is great because it is a one stop shop. They are equipped to handle anything!!!! If you have access to a teaching school, that would certainly be my first choice. The price is not much different then private practice.

You can get some really good information on the types of procedures available on Yahoo Groups Ortho Dogs.


Lilly's case is very extreme to say the least. Please feel free to PM me if you'd like.

 

[Brinks' Mom]

Correct me if I'm wrong but the way I understood it is that the TPLO is the most familiar and used surgery and is the most "invasive" with cutting into the bone, plates and screws and with a longer recovery time. The TTA is a couple of years old and is a bit less invasive but still cutting into the bone and plates and screws are used as well. Supposedly a little less recovery time but personally I think it all works out to be the same even in the best circumstances. The Tightrope I was told is the very least invasive but that it didn't have the "greatest" success out of the 3 surgical choices for a "larger" dog. Not sure if thats correct but thats what I was told. Either way..surgical or not.....just like everyone said before....its MONTHS of recovery and healing.

I think the age/activity level/weight of the dog should all play into the decision somehow weighing everything out. Its a tough call to make. I still wonder and hope I made the right decision. I guess Brinks being only 2 years old and having a bad left hip with a torn right knee with no where to distribute his weight helped me in the decision process of having to alleviate "pain" somewhere and help him out a little. Stupid me I thought his limping had to do with his hip...imagine the shock on my face when Vet said it was his knee....totally unprepared for that one.

Go with your "gut" instinct on what would be best for Clayton.... "you" know him best! I'm sorry you're going through this...I feel your pain as I'm sure everyone else does too. Give Clayton a big kiss and a hug!!!

 

[Sailorgirl]

It is worth a read of the study Ivoryudx posted the link to, which basically says no one surgery is proven better than another. And don't forget the ex-cap suture surgery, which was omitted from the list above, but which many, many people on NN have chosen for their newfies.

It's a LOT of information all at once. Do your best to soak it in, research your options, then choose what is best for you and your dog. That's all any of us can do.

 

[Ginny]

Tightrope, from what I understand, is a variation of the traditional procedure. As was said, find out exactly how many of whatever type you choose, the vet has done. Find someone that has done a ton of them. A lot of vets want you to go TPLO with the giants and I truly don't think that's necessary. I had a girl with the traditional extracapsular stabilization do just fine.

Get his DNA to the data bank so it can be used in the study they're doing right now. The ortho vet hopefully will draw the blood for free. Many do since it's being used for research. Go on the OFA site, download the paperwork and take it with you. Good luck!

http://www.caninehealthinfo.org/dnabank.html

 

[suse]

I am sorry that you and Clayton have to go through this. Making a choice is a difficult decision. Many on this site have been through the same thing. What I'm gathering is most all procedures have been successful. TPLO seems to work as well as ligament replacement. Good luck to you both. We are all here to support you.

 

[Pregreen]

Puddles had TPLO surgery three weeks ago today and I can't tell you how happy I've been with the results. Puddles has been putting full weight on her leg since day one and is getting stronger everyday. She is still under house arrest, leash and sling walked and my house is covered with mismatched throw rugs (I've heard that fashion statement is known as ortho chic). We had a relationship with her surgeon at U Penn due to her hip displaysia and I felt totally comfortable when he told me that TPLO was the way to go. Teaching hospitals are great, not only do they have all of the latest technology, they are staffed 24/7 with specialists in every field which gave me peace of mind. Hang in there, and I hope Clayton is back on all fours soon.

 

[noblenewf]

I'm so sorry. First let me say that TTA and TPLO ARE NOT the only options. There is conservative management and also Traditional surgery. I've recently researched all of these options myself (last fall) and spoke with several specialists. Tightrope is simply a traditional repair...using a stronger, more durable material to stabilize the joint. It's simply a suture material...sutured a slightly different way to stablilzed the knee. I could debate for hours regarding TPLO vs. Traditional and get nowhere. I've been told by several highly respected vets in our area that TPLO is all the rage...and the big push right now because it's the latest and greatest technique. There is a lot of bone cutting involved...and although they do thousands of these per year (Ortho Surgeons) the research shows that there is not a significant difference in the outcomes of dogs undergoing TPLO vs. Traditional surgery. The facts are (there was a link posted about this last week in a thread...I'll try to find it...) that there is no "better outcome" if you will with dogs undergoing TPLO vs. those who have traditional repairs. Many ortho surgeons will tell you that with a dog of this size and weight...TPLO is the only way to go. Simply not true. I personally have talked with several people who have had traditonal surgeries done on their Newf with excellent results. For years vets were repairing ruptured cruciates with the traditional method and dogs did just fine. However, regardless of the surgical approach...the recovery phase is CRITICAL in the outcome for your dog. The restrictions, the rest, the therapy to rebuild muscle...it's all what makes the surgery successful or not. I personally chose the traditional repair with my Gabe because after much research, I decided there were too many risks and potential complications with TPLO. It made me very uncomfortable. It's all about what you are comfortable with. I personally didn't want anyone cutting my dog's femur and displacing his bone. There is also the school of thought that conservative management (rest, antiinflammatory drugs, restriction) should be tried first. We did this..and it worked for about a year but then Gabe chased a rabbit and blew his cruciate completely. He couldn't walk. I think too what should be taken into consideration is the age of your dog, their activity level (my boy is three and still very active) and lifestyle. I chose surgery in the end because I wanted my boy to be able to run and play and not live his life restricted. Everyone has their reasons for different routes they choose and simply put...you have to choose what's best for you and your Newf. Gabe was on Previcox for about two months without any issues whatsoever. I did, however, monitor him very closely as so many dogs have serious reactions to these NSAIDS and they can be potentially life threatening.
For what it's worth: Gabe had a traditional repair, was walking the following week and still gets around very well. He's feeling good, wants to run and play (but he's only 4 months out so he's still restricted somewhat...) and other than a slight difference in amount of weight placed on his surgical leg (not full weight bearing yet...) he has done beautifully activity wise. Now...he is having a reaction to the suture material used to stabilze the joint (happens 1 in 20 dogs)...but that's a rarity. Otherwise, I would highly recommend traditional surgery.
As far as waiting it out. I did that...and he did OK for a while. Then it completely tore...in the meantime I feel he lost a lot of muscle tone...atrophied quite a bit...arthritis set in (joint was full of arthritis according to the surgeon) and he was very depressed being restricted. If I could do it over again, I would opt for surgery ASAP and start on the road to healing and recovery.

Good luck! And hugs to your boy! I know it's so scary to be facing this. It's very heartbreaking. He will be OK...no matter which route you choose.