Good Article Whole Dog Journal On Conservative Management for CL Injuries
Koda and I met with Dr. Marty L. Aitken, DVM, DACVS. He's a surgeon who specializes in orthopedics. His diagnosis is a "sprained knee" which essentially means Koda has damaged his cruciate ligament. To what extent, ofcourse we can not tell. What Dr. Aitken did say is that Koda is at 90%. Which means that this is either a strain or it is in fact partially torn. He does not believe that it is fully torn.
Now here comes my dilemna. I need to decide on surgery or wait to see if he heals. The good news is I don't need to decide today. Koda is off all anti-inflammatories and doing well. He's bored, but he's taking it easy. His limp or lameness is minimal and he is bearing weight on the leg.
My options are one of two surgeries, the TPLO or Lateral Suture. Ofcourse, the surgeon recommends the TPLO which is going to shock some and does sound very invasive. They literally saw the femur and angle it better so that the pressure is taken off of the cruciate ligament. Then they bracket the bone back together and let it heal The ligament is kept in tact. The healing process will take 4-6 months. This actually makes sense because I have always felt that Koda, like many kais I've seen pics of, has pure angulation in the rear. I've probably said it on here. This poor angulation puts strain on their knee joints and correcting it like a birth defect will hopefully solve the issue.
Now let me tell you this surgical procedure raises a lot of issues with me. It's extreme to say the least! I also wonder if correcting the angulation will actually raise the risk of his other leg tearing its ACL. I don't know the answer to that.
The second surgical option is to take nylon sutures and build back up the injured ligament. This is the "traditional" method. Scar tissue will hopefully build up around the sutures and stabilize the knee.
Either surgery WILL cause arthritis. So will not doing anything. Basically I can say that Koda will have arthritis in his future. The issue with the suture option is that it could possibly tear and need to be redone.
My other alternative is wait and see what happens and keep Koda on a strict rehab plan for the next two months to see if the ligament heals and restabilizes on its own. The surgeon seemed to think that this does not work out well for dogs and they do end up tearing the ligament more in the future. Some dog owners swear that it can heal if it's strained or partially torn. I really don't know.
In no way will Koda ever be 100%. It doesn't matter what I do, but I do want to make a rational decision in the best interest for him which is hard to do because we're talking about cutting open my dog, best friend, and family member. Koda is soooo sensitive. He always runs to me to protect him, and this relationship we have makes it difficult for me to make this decision.
So with money worries aside which would you chose? What questions would you ask?
Now here comes my dilemna. I need to decide on surgery or wait to see if he heals. The good news is I don't need to decide today. Koda is off all anti-inflammatories and doing well. He's bored, but he's taking it easy. His limp or lameness is minimal and he is bearing weight on the leg.
My options are one of two surgeries, the TPLO or Lateral Suture. Ofcourse, the surgeon recommends the TPLO which is going to shock some and does sound very invasive. They literally saw the femur and angle it better so that the pressure is taken off of the cruciate ligament. Then they bracket the bone back together and let it heal The ligament is kept in tact. The healing process will take 4-6 months. This actually makes sense because I have always felt that Koda, like many kais I've seen pics of, has pure angulation in the rear. I've probably said it on here. This poor angulation puts strain on their knee joints and correcting it like a birth defect will hopefully solve the issue.
Now let me tell you this surgical procedure raises a lot of issues with me. It's extreme to say the least! I also wonder if correcting the angulation will actually raise the risk of his other leg tearing its ACL. I don't know the answer to that.
The second surgical option is to take nylon sutures and build back up the injured ligament. This is the "traditional" method. Scar tissue will hopefully build up around the sutures and stabilize the knee.
Either surgery WILL cause arthritis. So will not doing anything. Basically I can say that Koda will have arthritis in his future. The issue with the suture option is that it could possibly tear and need to be redone.
My other alternative is wait and see what happens and keep Koda on a strict rehab plan for the next two months to see if the ligament heals and restabilizes on its own. The surgeon seemed to think that this does not work out well for dogs and they do end up tearing the ligament more in the future. Some dog owners swear that it can heal if it's strained or partially torn. I really don't know.
In no way will Koda ever be 100%. It doesn't matter what I do, but I do want to make a rational decision in the best interest for him which is hard to do because we're talking about cutting open my dog, best friend, and family member. Koda is soooo sensitive. He always runs to me to protect him, and this relationship we have makes it difficult for me to make this decision.
So with money worries aside which would you chose? What questions would you ask?
Comments
In general, I tend to agree with Lindsay; however, one risk you run is a complete ligament tear if left untreated. If that happens, you won't have either of these surgical options on the table anymore. I would start by asking the surgeon what the odds of you seeing a noticeable decline in him before there is a complete tear are. Is it one of those things where if he gets worse, it's likely to get all the way worse? Or will there be a slow progression?
Also, I would try to contact a veterinary rehab facility. Ask them 1) what they would recommend as far as exercises to strengthen Koda's rear, and 2) what success they've had using physical therapy to preempt the need for surgery. Then get a second opinion.
Keep us updated. Know me I'll probably come up with more questions.
Just keep in mind, whatever you do, make the best decision you can with the information you can get, then don't look back. Hindsight is always 20-20 and it is all too common to kick yourself for making a great decision. Don't let that happen to yourself. You're already going above and beyond what 99% of dog owners would do, and you should have no regrets.
We're sending you good vibes from the east coast!
Bear ruptured his about a year ago and healed up pretty nicely without surgery. He was very upset that he had to be stuck in the sun porch with me for 2 weeks though. I think Koda could heal on his own. After all, he must weigh 100 lbs less than Bear.
I know how much this troubles you, so like Dave said, once you make a decision, do not look back. I know that you will do what you feel is best for Koda. So whatever decision you make will be the right one.
If it were one of my girls, I would probably go with the more conservative route first. I would also check to see if I could get some sort of brace to help stabilize the joint while it heals. If after a few weeks, things have not improved (or at the first sign of things getting worse), I would re-evaluate.
I will be sending good, happy, healing vibes your way... Give Koda an extra hug from us!
I too would probably take the least stressful approach. But that's easy to say cause I'm not going through some thing like that. You have seriously went above and beyond for koda so follow your inner voice. It can't steer you wrong.
We'll definitely keep you in our thoughts. Give koda a big hug for us!
Since I haven't decided on surgery or which surgery, we have started conservative management. I actually found a great yahoo group with over 3,000 members who have had dogs with the same injury all over the spectrum from strains, partial tears, to full tears. They all began with conservative management, and I'm going to read their posts this weekend to try and figure out what the percentage of success was on this method. Some did have to get the surgery when their dog blew the ACL or tore it more.
Either way, my plan has to include a decision on surgery. I could go the management route, but he could blow out the ACL which means emergency surgery.
Koda is lucky. He's in very good health with great muscle structure which probably helped him not fully tear the ACL. He's also on a slew of vitamins right now to hopefully stop atrophy from happening. I need him to keep his muscles without exercise.
The problem with this is it's not black and white. Bear had HD, I saw it in the xray and he was in surgery the next week. It was such a clear and rational decision.
Koda and I actually made the surgeon cry yesterday. He started telling me about TPLO and he had the metal bracket out and this model that showed you exactly what it was and I lost it. I just started to cry looking at all that metal and the bone being cut in half. Tears were just streaming down my face as I silently sat and listened. Koda got up and put his head on my lap. I started rubbing his head and he looked up at my crying. Then he crawled up in my lap and started licking my tears. He's always been into cleaning me up. He licked my face and then we nuzzled a little. When I looked up at the surgeon he was crying. I think that's the point where he stopped being so technical and started telling me that we were all in this together and that we would get Koda better.
I've found that lots of alcohol helps! lol
http://www.whole-dog-journal.com/issues/13_2/features/Canine-Ligament-Injury-Options_16198-1.html
Anyway - I'm so glad you're educating yourself. I'm so glad this forum exists, too. I can't imagine raising my dogs without this kind of support. *group hug* lol