Cruciate ligament rupture in dogs

[SGirl]

sumo69 said:

To add, our Saluki Whippet doesn't swim and when she needed hydro treatment for a severe shoulder injury, the water filled treadmill worked a treat and was no stress for her after about 20 minutes of figuring out she had to move to stay still!

Hope the op goes well etc

David

Thanks David, that's well worth knowing. Poppy will go up to her belly in water, but she won't go out of her depth so swimming is out.

[SGirl]

Autopilot said:

You're about 40 miles from Noel Fitzpatrick (TV's Supervet). If in doubt, go see him!

When our dog was a pup he damaged a cruciate ligament. Fortunately, while surgery looked imminent, the do nothing option was also available to us. We went down the 'do nothing' option, so he was restricted to on-lead walks starting at 10 minutes a day and did a hydrotherapy session each week. He HATES water, but by the end of his first session, he was much happier. A few weeks in and you had to stop him chucking himself in. I dare say some dogs will probably continue to hate water, but our dog seemed to get used to it and start enjoying it.

After about 10 weeks he could be let off the lead and hasn't had a problem since. The vets seemed keen to do the surgery on him 'and then it's done', but Fitzpatrick Referrals checked the xrays and put the 'do nothing' option back on the table. Our dogs obviously wasn't as bad as yours, but it's worth getting a second opinion.

Oh, so that's who the vet I spoke to today meant when he said his place was much cheaper than Fitzpatrick's because "he hasn't been on the telly"! I wondered what he was on about. I didn't realise Fitzpatrick was *the* Fitzpatrick! Thanks for the heads-up, I'll get our vet to give them a call. I've seen a couple of the shows, the guy is seriously impressive as regards what he does. I'd trust him a lot more to do this kind of surgery than I'd trust our current vet.

Our vet did put forward the "do nothing" option, but she was keen to stress that this will lead to severe arthritis in later life and take months, if not years, to heal. But I did wonder whether this is because it's also the cheap option. Poppy is currently on-lead in the garden only, no more than a couple of minutes at a time. She's a bit miserable about it - she can see the squirrels in the trees but she can't charge after them. I'll have to look into the chances of "do nothing + hydrotherapy" - the vet seemed to think this wouldn't be an option unless we were on a tight budget, but she's not taken X-rays. She said they wouldn't tell her anything so she didn't plan on doing so. Hmm.

[Catz]

SGirl said:

but she's not taken X-rays. She said they wouldn't tell her anything so she didn't plan on doing so. Hmm.

Hmmm indeed!

Without dissing your vet ... our vet took an initial x-ray which confirmed their suspicions. They did offer us a surgical procedure with them but as we were insured they recommended we were referred to a specialist (The East Neuk vets). The specialist also took an x-ray before surgery and 3 months after, I'm presuming there was a need for all these x-rays but what do I know.

MMP does sound similar to TPLO. Sula is 40kg so a fair bit heavier than Poppy which may be why she needed TPLO.
Whatever surgery you get do really follow the aftercare instructions. Sounds obvious but as they recover it's very tempting to let them off lead just for a bit. We were very strict with ourselves, and Sula, because we wanted a clean heal with no added problems.

[bexVN]

Yes really xrays should be done but sometimes it really is very obvious.

Not operating really only suits small breed dogs or elderly dogs etc.

Young, athletic dogs really are better off with surgery.

[SGirl]

Catz said:

Hmmm indeed!

Without dissing your vet ... our vet took an initial x-ray which confirmed their suspicions. They did offer us a surgical procedure with them but as we were insured they recommended we were referred to a specialist (The East Neuk vets). The specialist also took an x-ray before surgery and 3 months after, I'm presuming there was a need for all these x-rays but what do I know.

The vet that'll be doing the surgery confirmed that X-rays will be taken before he does anything, which is good. Her usual vet was certain of her diagnosis the other day, but we'll off back there again tomorrow night to confirm now the injury has had a couple of days to settle. As a complete non-expert, even I can see the leg isn't right - it used to be smooth and muscly, now there's a clear "dent" in it, all down the leg. I had a long chat with our vet yesterday and she's confirmed she's happy to refer us to any clinic we like.

Catz said:

MMP does sound similar to TPLO. Sula is 40kg so a fair bit heavier than Poppy which may be why she needed TPLO.
Whatever surgery you get do really follow the aftercare instructions. Sounds obvious but as they recover it's very tempting to let them off lead just for a bit. We were very strict with ourselves, and Sula, because we wanted a clean heal with no added problems.

Good point - thanks! Poppy is a very active girl normally, so she'll be wanting to get straight out there as soon as the pain is starting to ease. We'll have to be very strict with her. She's already comfortable enough to attempt the stairs unless you watch her like a hawk!

bexVN said:

Yes really xrays should be done but sometimes it really is very obvious.

Not operating really only suits small breed dogs or elderly dogs etc.

Young, athletic dogs really are better off with surgery.

Thanks Bex, you've confirmed what I was thinking. Various people have suggested we should just let nature do what nature does best, but I don't think that would be wise in this case. Poppy is thoroughly miserable at the moment, and anything we can do to return her to her former loony self is going to be done!

Do you have any views on TPLO vs TTA?

[bexVN]

Honestly not really just because we tend to refer our cruciates and I don't know the techniques they use. We will do cruciate surgery ourselves using the suture technique and I have to say our patients generally do very well with it (our vet that does them is a good and careful surgical vet) but we don't advise it for all dogs due to age etc..it can be an alternative for clients who aren't insured or limited funds.

A quick look into both suggests TTA being the better if the vet you use knows the technique. I'd probably choose this method out the two if I knew the vets ability with it tbh.

Edited by bexVN on Thursday 20th November 11:00

[SGirl]

bexVN said:

Honestly not really just because we tend to refer our cruciates and I don't know the techniques they use. We will do cruciate surgery ourselves using the suture technique and I have to say our patients generally do very well with it (our vet that does them is a good and careful surgical vet) but we don't advise it for all dogs due to age etc..it can be an alternative for clients who aren't insured or limited funds.

A quick look into both suggests TTA being the better if the vet you use knows the technique. I'd probably choose this method out the two if I knew the vets ability with it tbh.

Thanks Bex, that was my thinking too. The vet I've booked to do the surgery has done over 1000 TPLO procedures and over 300 TTAs, and he was recommending the TTA as being newer and "better" (I can't remember what he said exactly now). Our own vet reckons that MMP and TTA are the same thing but that MMP is slightly newer and hence better!

So we're down to TTA or MMP. I'm still leaning towards TTA because the surgeon has a verifiable track record. So does the MMP surgeon, for that matter, but "she does at least one a week" doesn't tell me much.

[bexVN]

http://www.downsvets.co.uk/review-article-the-modi...

The above details the TTA and MMP without too much detail so I think it comes down to your confidence in the vet you choose and poss the sl advantage in recovery with the MMP if done well (and cost!)

I'd still be happy with TTA but I can see why MMP would be an appealing option.

[SGirl]

bexVN said:

http://www.downsvets.co.uk/review-article-the-modi...

The above details the TTA and MMP without too much detail so I think it comes down to your confidence in the vet you choose and poss the sl advantage in recovery with the MMP if done well (and cost!)

I'd still be happy with TTA but I can see why MMP would be an appealing option.

Thanks Bex! That's a very useful article.

I spoke to a different vet this morning, his view was that TPLO is the Gold Standard with an up to 96% success rate, while MMP/TTA are much the same thing with a slightly lower success rate at about 93% but a lower price tag. Would you agree with that suggestion? His view was that he'd rather have MMP for his own dog and an extra £1200 left in his pocket.

The thing is, we have two potential options for this now. One of the vets offers both TPLO and TTA, but not MMP. The other vet, who's closer and is part of the same group of clinics as our own vet, offers MMP. Cost isn't really a concern because we just want Poppy to get better.

My feeling at the moment (might change later!) is that we should go with MMP as it's so similar to TTA anyway, given the fact that it's 20 minutes' drive to the surgery to get it done as opposed to 90 minutes for the other two procedures. This is of course subject to the vet who'd be doing the surgery having plenty of experience of the procedure - if she doesn't, all bets are off and we'll go for TPLO anyway.

I really appreciate all your help and advice, Bex - thank you!

[bexVN]

No problem. My knowledge of the procedures is a bit limited but happy to try and help. Obviously it will be your decision depending on your feelings but having as I have a whippet I think on reading up all the procedures I would choose the MMP if it was easily available.

They've all got their good and bad points but I like the recovery time and the fact physio can be started more quickly with the MMP.

[Jasandjules]

With all due respect to your vet, take this one to a specialist. IMHO it really is an op for a real expert to ensure the best prospects of maximising any recovery.

[bexVN]

Jasandjules said:

With all due respect to your vet, take this one to a specialist. IMHO it really is an op for a real expert to ensure the best prospects of maximising any recovery.

One a week is more than enough experience to be sufficiently expertise in this procedure. Cruciate surgery was regularly done in general practice until equipment became more and more expensive and specialised so too expensive and so became more orthopaedic specific, nothing wrong with that but it doesn't mean an in house vet will be incompetent as long as they have the resources.

[Jasandjules]

Didn't say incompetent. But I've seen specialist results on my own dogs, as well as non-specialist on other dogs. There was a marked difference in the behaviour of the dog, the recovery (both in terms of time and extent) and the system set down for the recovery process.

I would also be rather surprised if many general vets did a cruciate a week.

[SGirl]

Thanks guys. I think the way we go will be largely defined by what the vet says at this evening's appointment. If the damage is "straightforward" we'll go with MMP, if it's likely to be more complex we'll just go for TPLO and be done with it.

As it happens, Poppy is starting to try to bear a little weight on the leg now. Not necessarily a good thing - I think she's just getting used to it. I'll have to try and work out how to prevent her doing this until the joint has been stabilised.

Anyway! I'll report back when we know where we're going with the surgery. And then I can start on the "OMG, did we make the right choice..." posts.