partial tear in knee

Moderator here, 

Hello and thank you for posting...hopefully folks will be along to help...sometimes this takes a bit...

In general duplicate posts tend to confuse things, reply's get posted here, but not there...vice versa. I will remove the other post you made. I hope you can find info to help you here...you will definitely find support.

 I have had a dog have 2 CCL tears on both knees. Both were operated on. She did just fine. I did not notice any abnormal pain issues. Her first surgery they gave her a morphine patch and she was walking as if nothing happened out of the doctor's office. When we took the patch off after a few days as we were told to do, she stopped walking as well. A little pain can be a good thing in a post op recovery. That is all we had both surgeries (no morphine the second surgery) was a little pain.

You can not "fix" a tear without surgery unfortunately. It can heal with rest but most likely will tear again. Sorry it is what has been told to me by many a vet, orthopedic and just plain friends.

We did the TPLO (Tibia Plateau Leveling Osteotomy) procedures on both knees. There is another procedure that is less expensive but I have heard the recovery time is a bit longer perhaps that is what you have heard about. My dog was 8 1/2 for her first knee, 9 1/2 for the second. She is running around now like a puppy. No one believes she is 11. She runs, jumps, plays and is not on any anti-imflamatories. We do give her Cosequin DS too, all my dogs get it.

Once Max ran out of her prescribed post op meds she never had another. I say go for it BUT make sure you trust your surgeon. Also follow the post op instructions to the letter. It was 8 weeks of quiet for us, passive ROM exercises but only potty walks. Once she made 8 weeks we could start walks slowly increasing distance. She was cleared to swim at 4 weeks but her second surgery was in the winter and we could not find a swimming venue.

My puppy just had a total hip replacement, the TPLO was a walk in the park by comparison. No one want their 'baby' to have surgery. I understand your concerns. They are healthy. Maxine had NEVER spent a night away from me until her surgery. It was hard. I have absolutely no regrets with our decision.  

Katie, who blogs at Underdogged.net, had a similar situation with her pittie, Luce, last year and did the surgery- you might go check her blog about it.

 Even a partial tear of the ACL's got to hurt a ton, so I would think that repairing it and getting on with healing would be the way to go.
 

 One more thing Michelle. I am not sure where you are from. We had both our surgeries done by orthopedic specialists. First at a specialty clinic, the second at our State Veterinary teaching hospital. We switched because the procedure was less expensive at MSU and Max was not insured. We had a top of the line surgeon, he did our THR too. Be sure you have a qualified vet, I think that is why our procedures went so well. We had the best for both knees, IMO.

In general going to your state's best vet school (or even one that is within 6 hours or so) can be INCREDIBLY beneficial.  Often vet schools are going to have the most cutting edge technology and the best and brightest new surgeons.  Yes, you deal with students, but usually the vet care is absolutely top notch.

Cruciate ligament surgery is becoming VERY common and honestly never ever have I heard such a story about continuing pain and limping.  Generally the surgery is very successful BUT I second Ann - you ***must*** choose your surgeon carefully.

Often, we expect our regular vet to do such severe surgery and they really aren't equipt to do them -- so they may give you less than glowing reports of what the surgery might do simply because they aren't over-confident of their ability to DO the surgery without side effects.

Seriously -- doing such a surgery should HELP a great deal rather than making the dog live in constant pain (trust me -- it HURTS -- dogs are stoic and won't show it!! but it DOES hurt because that knee is always always unstable -- and even breathing wrong when they stand may make it hurt a great deal!)

Aside from that the constant use of such NSAIDs are really hard on the liver -- and typically the dog is just not going to live as long nor as well as it would without the pain meds.

Please don't be afraid to drive a distance to a vet school -- it can honestly save you hundreds (and sometimes thousands) of dollars. Several years ago I had a dog we were treating for cancer (a cocker as it happens).  Long story but it was recommended to me to go to Gainesville for the chemo treatments (they couldn't get 'clear margins' in his surgery due to lack of tissue so we felt like the deck was stacked against us).

At one point my time was pretty tight, and I knew he needed to go up for a quarterly check up.  They would typically do an ultrasound and some aspirates and I just really didn't want to do the 3 hour each way drive plus being gone from work. Soooooooooooo I called the local "specialty vet" clinic that I had bypassed thus far because I knew they were a bit on the expensive side.

Well -- they wanted $1200 to do the ultrasound PLUS the vet's visit fees PLUS $75 for each aspirate done.  (usually would be maybe 4-5).  Soooo already we were up to over $2000 and THEN she told me it would definitely be an "all day appointment -- typically you might wait a couple of hours for an ultrasound and you'd HAVE to be here!.

Hmmmmm -- So over $2000 plus I'd be gone from work ALL day anyway?  Then I priced it at UF and the Ultrasound was $110 (then - it's a bit more now but we're talking one whole less decimal point here!!).  And aspirates were $10 each.  $35 appt. fee.  Sooo maybe $250?  (as I recall it was $220).  Even with gas to Gainesville, AND I stayed overnight (cos it was easier than driving back tired) I was WAY under half the cost.  In fact I think it was was about $35 with the motel bill.  Since I had to miss work anyway, spending $1700 or so LESS was a winner and ... frankly, I trusted them implicitly.

That's just one experience. 

My Am Staff tore her ACL several years back.  I have known our vet for years and trusted him implicitly. He did her surgery and she walks just fine--no limps, no nerve damage, NADA. She didn't need pain pills, but she's a bull breed with incredibly high pain tolerances.  I gave her pain meds the first day and then she was fine. I crated her and watched her carefully.  If she head even whimpered, I would have given her pills. 

Partial tears can sometimes be healed without surgery- apparently you have to confine the dog for six to eight weeks, which you'd have to do after surgery anyway.

I've never heard of letting ligament damage go.... we do this surgery often (well, not us but the specialist, we deal with the re-coup time). Dogs do very well with it - often no longer than 2 weeks of pain pills is needed.

Personally, I would get a second opinion from an orthapedic specialist and do what he says needs to be done. I know a fantastic vet down in FL that does this, I don't know where you are located, but if you're in my area let me know and I can pass his info to you.

I'm in Massachusetts.  My dog is not limping nor does he seem like he's in pain.  Occassionaly he gets a flare when his knee hurts him, but it gets better with Metacam or Tramadol.

Those types of medication, when used long term, do damage the dogs system, along with the other pain killers - like rimadyl.

Have you been to a specialist? Or just your regular vet? A specialist will have much better answers for you, and will be able to tell you the best plan of action for your dog. We have a smaller poodle right now in our kennels with the same problem, he will be evaluated by our surgeon. I hate seeing him like this - even though he does not always limp, you can tell he is in some amount of pain. As your dog gets older, the damage will only greaten. In my opinion, you are doing him no favors by not getting the surgery - or at least an evaluation by an orthapedic specialist.

There are many types of surgeries they do for ACL tears in dogs. None of which actually repair the torn ligament. Extracapsular repair they basically stabilize the knee with sutures so it won't slip around and develop inflammation while scar tissue develops to support the knee. The actual sutures break at some point. Confining the dog, or using an external brace, can accomplish the same purpose without putting the dog through surgery. Then there is TPLO. They cut the dog's bones and re-position the knee so it doesn't need an ACL. This is a very invasive, expensive, painful surgery with a risk of severe complications. The vets really like it, but if you do a lot of research there's very little solid long-term data out there supporting the use of such an invasive surgery over extracapsular repair. In all cases, whether you go the conservative management route, the less-invasive surgeries, or the TPLO, some dogs develop arthritis afterwards, and some recover without incident.

mudpuppy

Then there is TPLO. This is a very invasive, expensive, painful surgery with a risk of severe complications. 

My senior dog has had two TPLO procedures. She was never in severe pain post operatively and runs around like a pup now. I have no regrets doing this surgery. Perhaps because my surgeon was one of the vets who perfected the technique is why we had no complications but we had none.

I think a orthopedic specialist should determine if it is a tear. Then take things from there.

I have a vet friend who did conservative treatment on one of her dogs who had a partial tear CCL, she ended up still needing surgery on it later. She also did the suture technique first on one of her other dogs, only to have to go back and do the TPLO. Just wanted to mention these scenarios too.
 

TPLOs, when done by qualified surgeons (i.e. not your average downtown vet), have a very high success rate with few complications. The complications arise because owners don't follow the strict crate-rest and physical therapy protocols post-surgery

Conservative treatment is really only a viable option in *mild* partials tears in young dogs that weight less than 15 kg. Even then, I'd still advocate surgery, because the crate rest (2-3 months) and extensive management to avoid a second tear (which usually fails anyway) is too much for most people. Plus, there is NO guarentee of return to function and a much higher risk of secondary arthritis and the like with conservative treatment. TPLO is 99% of the time the best option, unless the owner cannot financially afford the surgery.

Extracapsular repair is also an option, especially for dogs who aren't good healers and would benefit from less invasive surgery - although it too has it's drawbacks. Again, it varies from dog to dog. But conservative treatment should really be last on the list, because there are just too many things that could go wrong. 

The problem with simply treating the flare-ups is that you are setting yourself up for a full tear later on, which will be even more painful and devastating. Not to mention all of the issues with long term medication.

Once he has the surgery, he will always limp (which he doesn't do now).  The doctor says he will have arthritis.

Dogs who undergo a successful TPLO should not limp, and arthritis as sequelae is not inevitable, nor is it even common....I have no idea why your vet is saying this and it makes me raise an eyebrow.

I agree with everyone else - go to a state vet school, get a thorough exam/opinion from a real orthopedic guy, determine if it is a tear and , if it is, the extent of the tear, and definitely get the surgery done there, if needed. Cruciate surgery is very common in the ortho departments there and will be done better and cost less than at a run-of-the-mill vet, 9 time out of 10.

 
Max's Mom, who did surgery for your dog? I'm very curious since you said it was one of the people who perfected the technique.