Cruciate ligament rupture in dogs

[SGirl]

Hiya,

Our lurcher, Poppy, appears to have ruptured her cranial cruciate ligament this morning while on her walk. She's been near-comatose all day after an injection of Vetergesic, and the vet wants us to go back in on Friday for another look. We'll then decide on surgery, although it's looking very likely she'll need it.

She's almost 4 (we think - rescue dog) and in very good health normally, very fit and loves her running. She won't be doing any of that for a while.

The vet has talked me through the advantages and disadvantages of MMP surgery vs. the lateral suture procedure vs. no intervention, but I was wondering whether anyone on here has any experience of the two different procedures? (No intervention isn't really going to be an option.)

Anyway, any info you can impart would be gratefully accepted. Thanks.

[SGirl]

Jasandjules said:

If you are near Ipswich I can recommend a place to get the surgery done...

I can't advise as to which is best, but perhaps consider that one is newer...

Thanks for the offer, but we're near Reading.

I was thinking of the newer option (MMP), to be honest. The recovery is apparently more obvious immediately after surgery, which isn't the case with the lateral suture. But if anyone has any info on either method, please post it!

[SGirl]

Jasandjules said:

Ok,

We had the old option the first time, the recovery was very slow and laborious (including walking the dog 1min at a time about eight times a day, then going up to 2mins, and so on for weeks and weeks).

The second time we used MMP and when we went to pick up the dog, she was actually able to use the car ramp to get into the back of the car. Oh, the recovery was pretty fast too.

Also, the first OP said she can never go offlead again, second OP we were told no offlead exercise for a month or so.. She spent many years walking off lead....

Brilliant, just the info I need. Thanks very much for that. The choice is obvious, then - it has to be MMP. She'd hate never being off the lead ever again.

[SGirl]

Thevet said:

the advice that a dog can never go off lead again is such crap. Even if a dog was allowed to heal or attempt healing by nature's scarring, is poor. It's what I got taught but nature can do wonders. Would I choose to allow my friends to heal by choice by scarring.....no. And the potential for rapid mending with less longterm damage means that a lot of advanced techniques can do so much more than we are used to, but don't think that nature can't also do some amazing stuff. Some ACL ruptures are best managed by conservative means, most are not, so, you should get what you pay for, but also don't always believe black and white. Not much help without an hours talk over the options, but that should be up to your vet.

Thanks Tim. That's a relief! Poppy lives for her off-lead runs, it would be awful if she couldn't enjoy them any more. I had a long chat with our vet yesterday, she presented me with the MMP vs. lateral suture vs. natural healing options IF Poppy's checkup on Friday does confirm a damaged cruciate ligament. Poppy isn't as spaced out as she was yesterday, and she even managed a waggy tail a couple of times today, but she's doing her best to avoid putting any weight on her leg on that side and she's clearly in pain. She had a dose of Metacam this morning and since then nothing apart from food and water - and of course, her food intake has been cut to prevent her piling on weight while she's near enough immobile. Normally she has two good runs a day and sleeps the rest of the time.

Money isn't the deciding factor in this case - we just want what's best for our dog, the option that'll give her the best chance of a reasonably normal life. I think we're leaning towards MMP at the moment as that seems to offer the best recovery rate. But of course, at this stage we don't know exactly what we're dealing with - but we'll have more idea after Friday's checkup. Our vet is very good and we can trust her to be honest with us, but it's a good idea to have as many opinions as possible so that we can make an informed decision.

bexVN said:

Whatever method you choose I would strongly recommend a good hydrotherapy/ physiotherapy rehab centre to improve level of recovery, reduce risk of weight gain and strengthen other leg to try and avoid it happening in that one.

When this happens in young fit (and presumably not overweight) dogs there is more risk of it occurring in the other leg unless it was a truly freak traumatic injury over a possible weakness.

I hope all goes well with everything.

Thanks Bex, I was thinking of physiotherapy or hydrotherapy. I'll do some research on local practitioners - I know there's a hydrotherapy centre not far from here, but Poppy isn't much of a one for water so the question is whether it wouldn't stress her out more than straightforward physiotherapy. Might give it a go and see how she gets on when the time comes, anyway.

I was thinking about the possibility of a congenital defect - we know nothing about her background, although we did have a doggy DNA test done when she first came to us, just because we wanted to know. Lurchers are prone to injuring themselves in all manner of stupid ways (she managed two X-rays in one month due to being a lunatic while out playing, fortunately no long-term damage though), so while nobody saw the accident happen I suspect she either caught a toe in a hole or on some undergrowth, or she slipped on mud while trying to reach a squirrel.

She's not overweight (yet, anyway!). She's been very fit up to now, I suspect it's going to take some effort to keep her weight down. She was spayed at 6 months as per the requirements of the Dogs Trust, she put on a little bit of weight then but only a kilo or two over her ideal weight, and she soon lost that. So a congenital defect seems likely - I'll do some more reading up on the problem.

Thanks all for your help and advice, I appreciate it.

[SGirl]

rosie11 said:

Husbands ex spent over £20,000 having this op on her dog.
No insurance either :0

Blimey. Were there complications? Our vet has estimated £2000-2500. We're not insured either - our thinking was that if either of the dogs were to need anything expensive, with insurance we'd have to faff around getting their approval and all that. Whereas if we just put the money into a bank account, we'll just pay up for anything they need rather than run the risk of paying premiums for years and then finding the insurers wriggle out of footing the bill.

[SGirl]

bexVN said:

Wtf! I have never ever known cruciate surgery to cost anywhere near that much, even on the largest dogs or with complications!!

Re: hydro on a water phobic dog, they will take their time and usually use a treadmill rather than swim. A good place will never force a dog to do more than they are comfortable with (my Jimmy whippet was not a water dog at all but accepted the treadmill well with a bit of patience initially)

Thanks Bex, my heart rate has begun to return to normal on reading your post.

Poppy isn't really afraid of the water, she just doesn't like swimming. She's happy to go into the river for a splash in summer, but she's not keen on being out of her depth so the treadmill sounds like a good idea. I'm thinking hydrotherapy will probably be easier on her joints than physiotherapy. I'll give the hydrotherapy centre a call when we know what's happening with the surgery.

[SGirl]

Catz said:

Been there, done that!
With total full recovery I'm glad to say!

Our retriever tore her cruciate ligament and undertook TPLO surgery (google that) at East Neuk Vets in Fife (apparently specialists in this type of surgery). I was very, very worried! The surgery took place in October 2013 and although recuperation was a 3 month stretch it was definitely worth it. Sula, our flatcoat retriever, was a little cautious for almost a year and although off lead she still seemed to be more careful than before. However the past few months she's gone bonkers! It's like she's had a new lease of life, she runs around, leaps over things, chases squirrels, gives me a heart-attack every time she does things!

I honestly never thought I'd see her back to normal but she is.

Wishing you all the best whatever you choose.
All in the cost was about 3K. I'd have paid it no matter what but luckily we were insured.

Thanks Cat, it's brilliant to hear of someone who's had a positive outcome. Poppy's problem is that she's never careful - typical lurcher, steam in first and ask questions later. Sula is probably a bit bigger than Poppy, so it's really good to hear of a successful outcome in a big dog - so glad she's enjoying her life now! smile

I've checked out the options, and I see that MMP is a "miniaturised" version of TPLO, suitable for use in smaller dogs. Poppy most certainly isn't a smaller dog (lugging 30kg of lurcher up and down the stairs is proving to be a challenge...), so I'm guessing the vet might've meant TPLO? I'll ask her at our Friday appointment. Or I might give her a call this morning, so that I have time to book a different vet if TPLO isn't available.

Either way, if surgery is needed then she'll have the best. The suture method isn't going to be an option, I don't think, because she's a big girl and the bigger the dog, the bigger the chance of rupture and suchlike. So TPLO it'll have to be - if MMP proves to be the "smaller dog" option.

Poppy is getting back to normal now in all ways except for her leg. This morning I got the full 21-gun salute when I woke up, she pottered out of her bed and stood at the top of the stairs, waving her paw at me to ask me to take her downstairs, scoffed her breakfast (what there was of it - reduced rations while she's immobile!) and then had a little wander round before heading back to her bed. She's still in pain, but she seems to be getting used to it.

[SGirl]

Right, progress!

I spoke to our vet this morning, she's insistent that MMP and lateral suture are the only options she can offer and that MMP "will be okay", but she's happy to call round for us if we want TPLO instead.

So I did some calling around myself, and I've just spoken to a vet in Camberley who has lots of experience of both TPLO and TTA. He's recommending TTA for a big girl like Poppy, with a muscly body and spindly greyhoundy legs. And he certainly knows his stuff, so I've booked her in provisionally for Monday. He could've done her tomorrow, but since we have an appointment booked with her own vet for Friday to verify whether she will actually need surgery, I thought it was best to stick to that. After all, she'll need to look after both dogs and our guinea pig for some years to come, so I don't want to upset her by going over her head.

[SGirl]

bexVN said:

Your usual vet will need to do a referral letter and you need to let them know you are going elsewhere (ethics etc) the 2nd vet has prob told you this already though as they shouldn't be agreeing to take on her case without having some contact with your normal vets.

Thanks Bex, I didn't think of that. Good advice. No, the new vet didn't mention it, and I haven't spoken to our usual vet since I spoke to him. I'm sure she won't mind doing a referral letter - though I don't know whether she'll know him, he's a bit of a distance away. I might give her a call later on - or maybe I'll just mention it on Friday when we're there. Which do you think would be best? You know vet surgeons better than I do, do you think our vet might be a bit miffed if I just drop the info on her on Friday, or should I call her beforehand do you think?

bexVN said:

Good to know you have found someone you feel comfortable with tbh vets have their own preferences and you will get two vets same experience/skill etc prefer different methods for different reasons (bit like consultant/surgeons!) also good to check with your own vet if they know his reputation etc (we have referral places we prefer to use over others for various reasons)

Fingers crossed in a few weeks things will get back to normal for you all !

I can see why our own vet prefers MMP/lateral suture - by her own admission the practice has nobody trained in TPLO or TTA. That's fair enough, we can't all be good at everything! But a lot of what I've been reading over the last few days backs up the claim that these procedures are less effective in larger dogs, and we've also spoken to a professor in Germany who also recommended TTA for precisely the same reasons as the new vet I spoke to this morning. We'll do more research before we go ahead with surgery in any case, but at least the Monday slot is booked now so we can get on with it and get the surgery done - TPLO or TTA, the vet can do either. And the sooner she's in less pain, the better.

I will ask Sally (our vet) if she knows him, though. She might well know something that's not public knowledge.

Thanks Bex! All your info is much appreciated.

[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.

[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?

[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.

[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!

[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.