Torn Ccl, What Type Of Surgery?

[Guest daisies5]

Hello, my name is Michele and my grey's name is Phoenix. Phoenix is 5 years old, male and currently 69 pounds. He is extremely healthy, other than he tore his cranial cruciate ligament on November 2nd. He is scheduled for surgery on November 30th.

 

I have been researching TPLO vs. Traditional for weeks, but I'm still not sure what I want to do. I took a huge list of questions to our appointment with the surgeon and he patiently answered every one of them! I am comfortable with the surgeon, he was very honest with us about possible risks and benefits of each option. He's recommending TPLO, but he's not pushing us into a decision - which is probably what I need right now - a push in the right direction He said he's had about the same results with Traditional (Lateral Suture) and with TPLO. He is recommending TPLO because it should hold up better than a Lateral Suture with a larger, active dog. Of course, he also said that the traditional surgery may hold up as well ... every dog is different

 

For those that have gone through this, did anyone go for the traditional surgery? What were your reasons for doing TPLO or for doing traditional surgery?

 

My biggest fears with TPLO are complications leading to amputation and future osteosarcoma at the plate site. I did ask, and the vet uses a newer type of TPLO plate, so that will lower the OSA risk. My biggest fear with the traditional surgery is that it won't hold up to a greyhound sprint and we'll have to do a TPLO anyway.

 

Does anyone have any experience with this? If not with a torn CCL specifically, any input on the general idea of cutting bone and screwing it back together (ie. TPLO) would be extremely helpful!

 

Thanks so much for your help!

Michele

[tbhounds]

I'm sorry Phoenix has a boo-boo--such an unusual injury for a greyhound--lucky you

Personally, I have always heard that TPLO surgery's are preferred for larger active dogs. I do know of a few large breed dogs (non-greyhounds) that had to have the surgery repeated because they chose to do the traditional route and then the knee broke down. Which ever you chose I'm sure your thinking of the best for your boy--give him a hug.

[Guest WarmheartedPups]

My lab had TPLO's on each knee. I chose that due to his weight. I would probably choose TPLO for my greys due to the stress they put on their legs with running and digging in and turning fast.....however.....Dewey did develop Osteo in his one knee. He had the surgery at 18 months old and had to be put down at 8.5 years.

 

Its a rough one.....I wouldnt want to do the "regular" surgery and end up going in again if tthe pup re injures the leg.

 

I have heard that the material they use is better now.

 

I researched and researched...if you want to chat feel free to pm

 

[Burpdog]

My chiropractic vet (who will be opening a rehab center soon), told me the old surgery was just as successful and there is less of a chance of blowing out the other side.

 

I'll ask her again on Monday when I talk to her.

[BrGreyhndz]

Good luck with what ever you decided to do. Nate did a partial of his ACL many years ago- we opted for rest and rehab. He came back very well from it.

[Guest daisies5]

Thank you all for your input! I have also heard that the traditional and TPLO have the same success rates. We're currently leaning toward the traditional Lateral Suture, although we change our direction daily. The TPLO just sounds so risky and when they go wrong, they go very wrong. If the Lateral Suture goes wrong, you always have the TPLO to fall back on.

 

It's a very hard decision I greatly appreciate any input on this topic!!

[Guest tricolorhounds]

My Shepherd Mix Felicity had a TPLO in 2003. No problems with surgery and recovery went fine. She's had no problems since.

 

The way it was explained to me was... The traditional surgery is more effective when used on smaller, quieter/calmer dogs. The TPLO is more effective on larger, active dogs.

 

I would do it again

[feemandvm]

I would do a TPLO if it were my Grey. Less longterm arthritis with TPLO than with traditional therapy. I would make 100% certain that the diagnosis is correct though as ACL rupture was one of the most commonly misdiagnosed injuries that we saw at Ohio State.

 

 

[Guest LynnM]

How many athletic dogs' knees has this vet fixed? I'd want to know the level of success of each procedure that *that* vet has done on dogs in good physical shape. There is a big difference between a fit greyhound and an obese cocker spaniel.

 

As the good doctor said, also ensure that the diagnosis is correct.... this holds true for humans, too... it's one of the most misdiagnosed orthopedic condition in humans, too.

 

Lynn

[Guest daisies5]

After many, many hours of research, we have decided to go with the traditional surgery - the lateral suture. From everything I've read and heard, the TPLO and the Lateral Suture have about the same success rate. The TPLO is said to have a lower risk of arthritis in the long run, but that has yet to be proven. The Surgeon has the same success rate with both options as well. He has never done either surgery on a greyhound, but not many people have - apparently, this isn't something that normally happens with greys!

 

I'm not sure how to be 100% certain that it's a torn CCL. So far, all indications say it's a torn CCL. Both our regular vet and the surgeon have said it's the CCL based on the "drawer" movement of the knee. I'm not sure there is much else we can do, besides opening up the knee to take a look

[Guest LynnM]

Which way does the patella luxate? Greyhounds (and other athletic breeds) tend to luxate LATERALLY.... that's the way a knee tends to go due to injury/athletic stress. Hereditary luxated patellas (toy breeds, cockers, etc) tend to luxate medially.

 

It's all academic if it's so slippy/inflamed, etc that it requires surgery, but is still worth noting.

 

Lynn

[feemandvm]

Just thought I'd post some opinions of some specialists from the Veterinary Information Network on TPLO vs. lateral suture repair.

 

Outside of the posts below, you might want to consider contacting Dr. Dyce at OSU or Dr. Radcliffe (private practice) as they are probably two of the top Greyhound ortho specialists around. See if either of them strongly recommends one procedure over another. Also... with the 2nd post below I'm not implying in anyway that you are looking for "the cheap way"... I was just sharing some of the posts and this was one of them.

 

 

 

In general, I think the consensus of most of us would be that TPLO would be the best alternative for a dog this size. While many large dogs can have very good function with extracapsular repairs, the degree of degenerative joint disease seems to be much greater than with TPLO. You ask about cost. While obviously costs will vary from area to area, TPLO is always a much costlier option (sometimes by 2-3 times).

 

 

 

I always remind folks looking for the cheap way that if the suture repair fails they get to spend more money doing the TPLO that should have been done in the first place :-)

 

 

 

In addition to saying the same comments that both Doug and Greg made, I ask owners what kind of outcome they want for their pet. It they want their dog to return to pre-injury function, and not have progressive degenerative joint disease in that knee, then TPLO is the only option. I would also really look at this dog's alignment. Is he bow-legged in his conformation? Does he have excessive tibial plateau slope? If so, then any other procedure besides TPLO will fail, since TPLO is the only procedure to address limb malalignment issues.

 

 

 

 

It's a perfectly good question Jered. As you will be aware, the recent literature has not found much evidence-based medicine to back up anything we do with cruciate ruptures so I don't have compelling evidence to present you in that vein.

 

However, this board is a pretty good snapshot of the general consensus in the rest of the profession. Between the regulars here, Kathy, Vic, Jim, Gary, Michael, Aaron and others, we've all done 100s of extracapsular repairs on all kinds of dogs. Many have done well. Others, especially of the larger breeds, have done mediocre...or worse.

 

Personally, I got tired of reexamining extracapsular repairs 12 months later and finding a big, arthritic stifle joint with varying degrees of disability. With TPLO, all of us report a quicker return to function, better athletic function and no more big, arthritic stifle joints.

 

This is especially important to me because in my own practice the average age of these patients has dropped in the last decade from 7.8 years to 5 years (and getting younger). It's not for every dog....I don't do TPLO in dogs under 20-25 kg and I think twice about it in dogs over 10, but it's an option in the big guys....and an option that virtually every major academic institution and referral center in North America and Europe is offering.

 

 

 

As Greg put so succinctly, there are no good, large scale, well-blinded, prospective/controlled studies comparing various techniques, so most of what we do is based on the weakest form of EBM (evidence based medicine), namely personal experience and anecdote.

 

Conventional surgical procedures (such as lateral suture, fibular head advancement, etc.) all share the concept that the way to replace the function of the torn CCL is by building a new one, ie, some structure that is mechanically oriented in a way similar to the original CCL. The goal in this type of operation is elimination of cranial drawer.

 

What we have learned over the years are two major things: (1) These repairs don't hold up in a consistent way (and also have inconsistent clinical results); and (2) Dogs don't injure their CCLs the way people do. So while conventional reconstruction works well in humans, it leaves us short in a lot of cases. Because of their stance, dogs naturally develop a lot more shear force (tibial thrust) than humans do (mostly compression). Our current thinking is that this shear force results in a repetitive stress injury to the CCL. This dog/human difference then explains several things: Dogs having partial tears that progress (rare in humans), and the frequency of bilateral problems sans trauma.

 

Understanding this biomechanical paradigm, it makes sense that if we simply replace the torn CCL with substitute, the new ligament will be subjected to the same mechanical forces, and thus likely loosen/fail over time the same way the native CCL did. This is in fact what we find, and hence the development of geometry modifying procedures (TPLO, TTA, CWTO, etc) to alter local anatomy in such a way as to eliminate the shear force trigonometrically. Once done, the CCL (or any replacement) becomes moot. We don't worry too much about drawer with these operations since that is passive laxity only significant when the dog is in lateral recumbency. With TPLO and TTA (tibial tuberosity advancement) we achieve functional stability in the weight bearing position (no shear).

 

On a theroretical basis at least, there is no justification for a size cut-off when choosing a conventional reconstruction vs. geometry modifying. But from a practical and cost basis, the differences in clinical outcome are less dramatic (we think) in small dogs than in larger dogs (very similar situation to the question of whether to do hip replacement or excision arthroplasty in a smaller dog with end-stage hip disease). So fewer geometry modifying operations are done in small dogs.

 

As you noted, the greater complexity of TPLO and TTA can translate to more or at least more serious complications (and cost). This is always a part of my discussion with clients therefore when we review available options for treating their dog's knee injury.

 

Hope that helps...