Talk to me about ACL injuries (Bugsy)

The artlicle linking CCL tearss to hypothyroidism is interesting.  Brinxx has had TPLOs on both knees & she is hypothyroid.

When we finally found out that the first knee was torn, it was already a complete tear, so surgery was, imo, the only option that I had.  When she hurt the other knee, it was deemed a partial tear.  I decided that, instead of surgery, I would try conservative management.  I confined her, & did leash walks only for 8 weeks.  She did improve, & she could get around normally after the 8 week period was over.  Then about 2 weeks later, she partially tore it again.  I opted for the TPLO immediately.

To this day, I feel guilty about trying to deal with it conservatively.  For me, it is like I wasted 8 weeks of her life for no reason.  That 8 weeks could have been 8 weeks spent on recovery from surgery, not 8 extra weeks of confinement.

Karen, I wish I had some actual help to offer in the way of alternate therapy and treatment.  All I can say is that with my dog who completely tore her ACL, the surgery was the only option that offered her any hope of being an active 11 year old. :)   She was very dysplastic in the opposing hip and she was unable to walk without extreme pain.  The surgery was expensive but I have never regretted it, in her case.  I know of dogs who did not have full tears and recovered without surgery but it was a slow process that required very restricted activity.  The advantage is the dog doesn't have the always inherent risk of major surgery.  I worried about subjecting a senior dog to the risk but the alternative was even worse in her case.

I would limit his exercise to leash walks while you research your choices but I would rely on the Vet for that advice.  If you bite the bullet and decide on the surgery, the results will be worth the recovery and rehab time.  My dog was a crazy to retrieve hunting dog who had been retired from her career but still "needed" much time retrieving and we so dreaded her long recovery (longer than normal due to her age and hip issue).  The fact is, it wasn't as bad as we thought it would be and she adapted very well to her limited activity.   I'm sure others with more first hand experience in the non surgical options will pop in and offer their input. 

 Thank you both for the info - so TPLO is the way to go?  Any other options you might use?

We are fairly consigned the surgery and due to some travel by both of us the earliest (unless he blew it out) we could do it would be November.

Many heavy sighs...................... It does feel fairly confusing because when it is fine it is fine.  You know what I mean?  I am worried that I might put him through a ton of stuff he doesn't need. But I also don't want to limit him a ton and then just extend the time he is limited.

Another thing I worry about is the amount of dogs that have one knee done and then blow the other one immediately.  So if I take action for this leg the other one will be injured.  (sorry throwing out the things running through my head not sorting it out)

And yes I am totally freaked by the prospect of restraining him.  Limiting his activity over the last few weeks has been darn near impossible and had such a negative impact on his emotional state.  Removing all activity feels more than daunting 

Would you say that after the TPLO your dogs were 'normal'?  I only know the golden across the road and he walks terribly funny having had both done in the last 18 mos.  He's happy but floppy.  He is also the laziest dog known to mankind so the impact for him isn't as severe.

ACK!!!!!!!!!!!!!!!!

that is all

Now, I know what I"m going to say is **NOT** popular.  but ... in total honesty, it's true.

While you are confining him OR while he's recouperating -- you might consider a *low* protein diet -- just make up the rest of the % with mashed/cooked veggies (and I tell you, you probably won't have a problem with anal glands either). 

Give a dog a super high protein diet and trying to limit their physical response is like giving them rocket fuel with no way to burn it off. 

I'm never the queen of the high protein diets -- and I know everyone thinks I'm crazy but it is a *TREND* ... and historically my experience with dogs just doesn't bear it out. 

I'm *not* advocating grain.  I'm advocating veggies -- not super pureed either.  I literally cook and mash them with a potato masher to incorporate them.  Today it's white potato, sweet potato, green beans, collard greens, broccoslaw and tomato with basil & oregano.  Also an acorn squash and carrots I already have.  (lots of anti-oxidants -- that's mostly my aim)

I get nice, solid normal poop on all 4 dogs, and everything digests fully.  I peel nothing, but I cut up the potato only enough to keep the pieces of skin small enough to cook and break down well. Becca Shouse swears by a food processor (and I just plain hate them -- that's all in what works well in your kitchen and your right/left shoulder)

But reducing the protein *will* reduce his excessive energy.

Then -- you can do stuff like Hylands Calms Forte -- you can do 2 tablets 2-3 times a day -- and it will help take his edge off no matter what you have to do.

You can add 2 valerian or passionflower capsules twice a day (you can combine those two no problem) and again -- it will help keep him a bit more relaxed.

Those are *not* gonna be habit-forming but will help you keep him under control more easily without frustration than you'd otherwise find.

Now after, you can go back to feeding whatever you like, but while he's having to stay sedentary (whether it's healing or just restricted) it should help.

As far as the surgery -- I'm not sure there is a "win/win" scenario.  It's just plain not unusual for a dog to wind up having to have both knees done.  not always - depends on the dog and what happened in the first place.

I have no chapter/verse on this, but I *have* heard vets say (in seminars) that you might just as well do a surgery to "repair" because ACL tears typically just plain don't heal well.  Once it's torn it's weak forever -- and it tends to be that the personality of the dog may simply ensure that they're going to ram around and tear it. 

I also think (and this is my own personal observation) that often it *is* the more rambunctious dogs that do this, and by the time someone rests them for a couple of months -- but usually doesn't make any changes to try to lessen the dog's energy or how they expend their energy) then by the end of the rest period the dog is SO anxious to go ramming around again then *BLAM* they get hurt right away again.  It's almost a self-fulfilling prophecy.

Same thing wlhen a dog has been cooped up (much against their nature) to heal from a surgery and then once again -- once the restriction is lifted they get a week or two to regain their muscle and BLAM -- they think they can tear around and DO, and they rip the other one.

You aren't going to change a no-holds barred rambunctious dog.  But if I were you I'd try even some diet changes ... and maybe more stuff like different activities to wear him out.

 A thot for you -- you don't have to go all the way to the mega trained "certified" therapy dog stage -- but even doing stuff like taking him to a nursing home to visit -- in total honesty that is WAY WAY WAY more energy expending than you'd believe.  It's typical that when my dogs get back from ANY pet therapy they are zoned for a while.  It's not hugely athletic -- but it IS a huge challenge for the mind.  Dealing with new people and situations -- trying hard to **be GOOD** -- frankly it's awesome how it wears them out.  Obviously you can't do that until after he's healed -- BUT it would be a good alternate activity for him that is less likely to rip/tear some part of his anatomy and it might help expend more energy than you'd believe.

*YOU* are busy -- so it's not like I expect you to just suddenly grow a 2d life -- but it may help.

Even some isometric stuff -- like maybe putting ALL his meals in a kong if you don't already do that (agan -- I know -- more work) but making him work harder -- even in his crate -- to get his supper eaten -- it can help you.

You're more than welcome to slap me silly if you think I'm nuts here -- but in the long haul it might help.

 Thanks Callie - couple of things

we found out at about 10 months old that he is CALMER on high protein - we went to that sort of diet and he could actually engage for more than a millisecond.  Due to excessive allergies we have limited options food wise but I did go to a slightly lower protein food about a year ago and he is definitely more focused when on higher protein.  He has no poop issues and anal gland issues that we have had were allergy related.  Since doing the thyroid meds and getting his allergies under control no problem with the anal glands.

I have wanted, since I learned about therapy dogs, to get him up to snuff as one - but again the struggle is the energy and size.  He truly doesn't walk - ever.  I would be terrified that one whip of the tail could cause fractures in the elderly.  Ask Annie aka Gradyupmybutt she'll tell ya LOL Without meeting him it is almost impossible to understand the energy, power and size.  I dream that one day he will be calm enough to do it - the last trainer we had wanted desperately to help me get him there and then said may be when he is older. Sigh.

I will have to try the calming measures as he was already anxious today solely because I gated off the stairs. He is in such a deep sleep now I am considering not taking him out for his business.  He's part camel so it really isn't and issue but I feel it is better to take him out. Sigh.

Whatever we wind up doing it is going to be extraordinarily difficult. I have vacillated today from scheduling the op to let's try the 8 week resting regime. I want to do what is best for him long term and I don't know what that is right now.

Thanks again to all and I am hoping more ideas come my way.

You know -- I'm going to say TRY him ... a nursing home can be a great place to start.  See what he's like -- sometimes the most rambunctious dogs suddenly turn over a new leaf because they tend to understand "oops -- FRAGILE"

If IS fair to use Hylands Calms and some valerian the first time -- see if you can get his brain to engage.

If you can try a couple of places see if one has enough yard to just let someone toss a ball for him (or a pillow ... be creative).

I've also used dogs that were rambunctious and *I* tossed toys for them, and literally just gave the folks something to WATCH.

Most of them LOVE to give treats -- but be creative again.  Use something HUMAN food-wise.  Either make liver treats or use something that won't hurt if the person puts it in THEIR mouth (they do sometimes -- dementia ... it's an interesting thing)

Even if they just watch you do some elementary obedience work -- it is amazing what entertains them and it may give Bugs a chance to think and realize he's gotta be careful.

Socks LOVED her old people -- and yeah, she had a tail that was a lethal weapon too.  But after the first or second visit -- she began to realize these folks were fragile and she adjusted her strength incredibly well.

kpwlee

 Thank you both for the info - so TPLO is the way to go?  Any other options you might use?

Your choices are pretty much TPLO or a TTA.  After dealing with two successfull TPLO recoveries, I am biased & would go with the TPLO again.

kpwlee

Another thing I worry about is the amount of dogs that have one knee done and then blow the other one immediately.  So if I take action for this leg the other one will be injured.  (sorry throwing out the things running through my head not sorting it out)

There is a good chance that he will blow the other knee out.  I think the thing that you have to consider is that him blowing the other knee out is, at the least, a reasonable possibility any way that you go.  If you opt for surgery, he is going to have to put more pressure on his good knee while he is recovering.  If you don't do the surgery, he is still going to be putting extra pressure on his good knee to compensate for the instability in his bad knee.  I would bet that, right now, his good leg is larger than his bad leg.  It is very likely that his bad leg has muscle atrophy already because he has been using his other leg to compensate.  It is, unfortunately, a lose lose situation. 

kpwlee

Would you say that after the TPLO your dogs were 'normal'?  I only know the golden across the road and he walks terribly funny having had both done in the last 18 mos.  He's happy but floppy.  He is also the laziest dog known to mankind so the impact for him isn't as severe.

After the recovery period Brinxx has returned to normal.  She can do everything that she could do before the surgeries.  Before the surgeries, I used her to help work cows.  After the surgeries, I was a little concerned that her cutting abilities would be hindered, but there have never been any issues.  She is the same dog that she was before surgery, only with better knees!

My current cairn terrier  tore one ACL at 18 months and tore the second one less than a year later.  He would leap off our deck (instead of using the steps) to chase squirrels and then continually leap up against the fence or the trees to "get" them.  We had the surgery done both times and I am glad we did.  His personality did not change.  He recovered well from both surgeries.  As an active little dog it was challenging to keep him on restricted activity, but it was worth it.  He was confined to his crate with something to chew.  When it was time to potty I carried him to the back yard and put the leash on to let him do his business.  I taught him the phrase, "Goooo sloooow," which he quickly learned meant he could not go faster than a plod. He also enjoyed just sitting beside me in the grass in the front yard smelling the evening breezes.  That really seemed to make life a little less boring for him during his rehab time.  He never quite was able to make that burst of speed he did before his surgery, but he has always retained his zoomies around the house and yard.  We did block off the deck and put a ramp for him.  He quickly learned how to use it.  I quit bird feeding, which attracts squirrels, so that has taken care of the squirrels, except for an occasional passerby.  I give him a joint supplement and fish oil daily.  To not do the surgery would be setting a dog up for a lifetime of pain and disability I believe.

 Think about ligaments is -- they don't heal. The knee CAN stabilize on its own with very controlled exercise only, by the means of scar tissue forming around the joint and stabilizing it that way. But the ligament will never heal, whether it's a full or partial tear.

Jasmine had acl surgery on both knees, with 3 months apart (the second one went 3 months after the surgery on the left leg). Her left acl was torn, right acl was partially torn or stretched and tore eventually.

If you're sure about the diagnosis, I would say that surgery is the only way, unless you're sure you''ll be able to control your dog completely and at all times. The problem with injured acl is, that the longer it is left unchecked, the more arthritis develops.

So my suggestion would be do a surgery. I've been through this with Jasmine twice. It is heartbreaking, but I do believe it's the best thing to do. Which surgery to chose is a different question all together. There is the popular TPLO. You can find descriptions, pictures and I think even an animation of the procedure on the internet. Another option is TTA. This surgery is quite different. Not all surgeons believe in this one. But I talked to Orthopedic department of University of Colorado back in the day, they do both and believe in both and recommend one over the other on individual basis. The main differences I see between those are these:

TPLO - the bulk of the surgery is on a weight-bearing part of the bone, so it takes longer for the dog to bear weight on the leg. Personally to me it looks like it's potentially safer and more stable.

TTA - the bulk of the surgery is done on the front of the shin bone, non-weight-bearing part of the bone. Looks that the dog should start bearing weight sooner, potentially I'd figure it might be less painful, on the other hand, personally to me it doesn't look as solid.

Both of these involve chopping and repositioning of bone.

 Both of these are clearly quite invasive. They work really well if they are done well and nothing goes wrong in the post-op.

Then there is an older, much less invasive extracapsular repair. This one is much less invasive, it involves drilling small holes in the bones and stabilising the joing using surgical lines (kind of like fish lines type of deal). We opted for that one, because we found an amazing vet and he did a custom version of the surgery, where he stabilized the joint at more points than it's usually done. It requires strict post op, but we just liked it for the minimal invasiveness. If something goes wrong, there are always options.

Then there is a newer variation of the extracapsular repair, called TightRope. This one is quite similar with some differences.

Then of course there is always a brace route, from the braces I researched I like OrthoPets the best. The guy who runs it used to make braces for athletes. He's got it quite figured out. He has good report with the Orthopedic department of University of Colorado.

Ok, here are roughly the options. I've been exactly where you are, desperately reaching for non-surgical option. As I said, it is possible for the scar tissue to form without the surgery, but keeping the knee stabilized enough just by controlling motion doesn't really seem feasible to me.

The brace works fairly well, but for a younger dog, I hate to say I think surgery is the best option. The question then remains which one. They each have their pro's and con's. 

Yes, thyroid hormone controls cell metabolism -- meaning when its levels are low, it affects the entire body. So it does seem that the ligaments are one of the things that suffer.

There are two types of acl injuries as the cause is concerned. One reason is an accute injury - where some severe trauma to the joint causes the ligament to break. In these cases often only the one ligament is affected and the other one remains fine. Second reason is degeneration of the ligament tissue, where the ligament keeps getting weaker and weaker until eventually lets go. In these cases there is high probability of the other knee going at some point as well.

These are all very crappy facts. But they need to be faced. Because not doing anything prolongs the dog's pain, and the arthritis caused by this will only get worse.

One other note, we did the extracapsular repair in combination with stem cell treatment. Mostly because we hoped that it might 'save' the other knee. Well, it didn't. But it really helped with the recovery and it really works well for the arthritis.

If you want, you can contact me directly, sadly, I know pretty much everything there is to know about acl injuries and treatment options.

Jana

I did TPLO with my Bullmastiff with good results.  The therapy afterwards is a lot of work, and you are the therapist, but you get detailed instructions. It's good if you can have someone home with you dog for as long as possible.  I was warned that he could blow out the other knee, but he didn't. 

Keeping him still was difficult.  I stopped all newspapers, had the postman deliver my mail to the neighbours and asked people to please ensure they phoned before coming to the house and put a sign over the door bell...please do not ring. I blocked off the living room so he couldn't go on his couch and slept on a mattress on the floor in the dining room with him for awhile. He would still find reasons to get excited, but after a few days you are in sync and you know exactly when he needs to go out or when he just wants to go out.  Initially, I was a little overwhelmed at the site of the surgery, but got used to it.  The metacam helped him to sleep and it apparently tastes good (sweet).  He got metacalm treats...slimy metacam on ham with a little bit of bread to keep it contained.

IMO if you take care of the one knee, you have a better chance of saving the other knee.

I guess lastly, my vet was willing to do the surgery for a price.  He suggested that there was a specialist that was willing to come from out of town, and that for the sake of paying for his travel, it was the prudent way to go.  I took his advice.  The specialist had a high rate of success that did not result in the second knee going and he certainly pulled through for us.  

 wow didn't realize there had been new activity on this thread - Bugsy underwent a TPLO on Nov. 5th and is recovering well - there are a few other threads detailing his recovery.  Only problem thus far is he had an issue with Rimadyl

thanks for all the info and especially sharing of your experiences