Partial Cruciate Tears?

Please feel free to move this if you think it belongs in the health section, but I want as much input from you guys as I can get on this because I'm really at a loss.

After being diagnosed with a groin pull, I took Venice to a rehab specialist in my city to hopefully speed recovery along.

Well, he had a different diagnosis. After redoing her x-rays and sending them off to a third party radiologist, he suspects a partial cruciate rupture. I guess there's no real way to know for sure without doing an ultrasound/MRI/going in with a scope.

He basically said that ligaments will not heal themselves - so a partial tear will never be 100% again no matter how strictly the dog is rested. Is this true? I genuinely have no idea. He did briefly discuss my options with me, both surgical and non-surgical, but basically said what they usually do are TPLO surgeries, even on just a partial tear.

That is one hell of a surgery and he didn't hesitate to remind me there's a 50/50 chance she'll need it on the other knee.

I'm going to book a Lyme test with our usual vet just to rule that out but I doubt it'll be positive. I just want to cover all bases before I dive into super pricy treatments.

I am really heartbroken, confused, and have no idea what to do from here. Who on Chaz has experience with partial tears? With TPLOs? With other treatment options for this kind of injury?

This is just... ugh. I don't want her to have awful arthritis, or put her at high risk for re-injury, or deny her a treatment she needs. But at the same time I really dread having to rehab through a surgery like that... especially if she goes and blows the other one. I think I just need some support.

Hey so sorry to hear!

I've only had experience with a full tear. After a lot of reading I wasn't comfortable with the TPLO (the risk of bone infection and other complication post op were too much for me personally to risk it).

I went with the ex cap even though Duke is an 80lb dog and typically ex cap is recommended for smaller dogs. I consulted my vet and their team, along with the Canine Wellness Centre run by Tania Costa in Toronto.

http://www.caninewellness.com/

(There in the process of moving to a bigger facility right now)

They all recommended the ex cap over TPLO and had seen it last in larger dogs.

It's now 14 months after Duke's surgery and both legs are going strong. We did a lot of post op rehab with Tania at Canine Wellness Centre including under water treadmill. He does have an ongoing groin injury which will likely be around for life but I manage it with heat therapy when it seems especially bad.

Wishing you all the best!

I went thru the same thing about 2-3 years ago. First was told she had HD which I knew was not the case. She was injured, I saw it happen. Besides, she had ofa xrays done 6 weeks prior which I then showed the vet with the report. Then he gave a Groin pull diagnosis. Considering he was so fast to throw out a diagnosis of HD based on the fact I owned a shepherd I didn't trust him much. Went somewhere else and they basically said the same thing you were told and I'm not a surgery type person if it can be avoided, so I wasn't doing it just to see.

We did 2 months of rest then rehab on our own. She's been as good as she's ever been since then. I know of at least 2 others I train with that have gone thru the same thing and both have successfully avoided surgery, though one had a relapse about 2 years later, but with a lot of work, came thru as good as before.

Were they really tears? I don't know, we never went in and looked to be certain, but the vets were certainly willing to do surgery on them based on the presentation.

I'd try it, you're out time if it doesn't work, surgery is still an option. and if it does work you'll probably have a dog in better shape than before, your dog avoids surgery, you avoid paying for one, and a very good likelihood of paying for another one in a year or so for the other leg.

Thank you both for the input.

I want to avoid surgery if possible, especially something as invasive as TPLO because that comes with its own lengthy post-op rehab.

I'm trying to find resources in my city for physio, other rehab vets, other options, etc.

My fear is that because this came on slowly and gradually, I'm worried it could be a malformation of her knee that's putting extra strain on the ligament and causing wear and tear over time. X-rays were unremarkable (except to suggest fluid build-up in the joint) and the radiologist also didn't leave a comment on her knee structure. But I don't know. If that's the case, the other knee's likely to go too.

The TPLO really freaks me out so I totally understand where your coming from, on a good note if you did need to pursue surgery, there are other options like the ex cap as an example.

Wishing you all of the best finding resources and that your guy or gal starts to feel better.

Heat therapy helped a lot with Duke's groin pull. Basically just on the each side ahead of his hind legs, on top of that area on his lower back, on the outside of each back leg and then on the inside of each back leg were the muscle groups Tania mentioned to me about being very sore with a muscle groin pull.

She seriously is awesome if your in the GTA ish area, she has sooo much continued education it's pretty cool. (I'm biased though as I had such great experiences with her)

First off, sorry to hear that. I (unfortunately) know a lot about partial CCL tears as Piper has now has TTA's on both rear legs due to them. I also work at a canine rehab center so we see tons of dogs after these surgeries for their rehab.

I'll start off by saying that you can *try* to rehab a partial tear. I did with Piper at first because I wanted to try to avoid surgery, and she really wasn't that bad (would be lame right after getting up after rest and then "work out" of it). Looking back though, I wish I had just done the surgery from the get go. Would've saved me a lot of money and she would've been further along in recovery had I just done surgery from the beginning.

You can look into stem cell treatment for her. We recently had a patient (Boston Terrier) with a partial tear who opted for this over surgery and it did heal well. Small dog though, so big difference. If you go that route, go to a specialist. Most regular vets *can* do stem cell treatments but a specialist really is the way to go. I didn't consider this for Piper because it was around $2,000 for everything (they have to scope the knee to see the damage, etc.) and I figured I might as well just do the surgery to have a "for sure" fix.

I chose TTA over TPLO because TTA is less invasive and generally has a quicker recovery. I would never do (and 99% of surgeons will say the same thing) a lateral suture repair on a dog over 40lbs., especially a muscular active dog. We have had a couple larger dogs come in who had it done and it failed miserably. Not worth the risk IMO.

Piper was toe touching when I picked her up the day after surgery. Here's a video of her 4 days post op from her first TTA:

[YOUTUBE]tzaJHYCqRoU[/YOUTUBE]

17 days post op:

[YOUTUBE]iL2D0EQ9jpI[/YOUTUBE]

Your vet is correct in that they are likely to tear the other knee (usually within 12 months of the first knee going), just the way it goes unfortunately. Piper had her first surgery in Sept. '13 and had her second surgery in May.

It's scary to think about, but honestly, it's not that bad. It's a good 3 month recovery period. First 6-8wks. pretty strict crate (Piper did well in an ex pen) rest, then build up back slowly from there. We started Piper in the underwater treadmill right after her sutures came out (so 2wks. post op). The longer you wait, the more muscle they lose, and the harder it is to build back up.

Sorry for the lengthy post, but hopefully that gives you some insight!

Great post Kady! I guess I'll have to see what happens with Duke ex-cap over time, it's good to know TTA is an option.

There are some larger dogs that do okay with it, but I heard too many stories of it failing which is why I threw that out as an option for Piper. I hope for his (and your) sake his holds up!

I've been very pleased with the TTA for Piper. We see lots of TPLO dogs who do very well after their surgeries too.

Luce's first knee was a partial tear. I think it was like 80%, which they couldn't know until they went in to see. She had a lateral suture repair on that knee, which was a huge mistake.

Thankfully by the time she blew the second one, TTAs had become more common, which is what she had on the second knee. Night and day difference between the two both in recovery time and the way her arthritis has progressed. TTA was so much better.

I also work in a rehab clinic and while we do rehab partial (and complete) tears successfully without surgery, for a young active dog, surgery is usually the best option. Many people don't know/believe that very few tears are traumatic, and that most are actually gradual due to the structure of the dog. If that's the case, it's difficult to rehab if the wear and tear that started it in the first place isn't changing.

TTA and TPLO are most recommended for dogs over 40ish pounds.

I had the ex-cap on my dog that was 49 lbs. I've also had a TTA & TPLO on a dog 139 lbs. I have to say that all 3 surgeries were successful. I felt the ex-cap took longer for rehab over 10 weeks with slowly moving, walking, light jogging, etc... until fully healed. The TTA & TPLO still needed time to heal but the dog was to already put some pressure on the leg the next day.

I've known some people who do nothing and let the dog limp or not use the leg since they didn't want to do any surgery. I could not do this.

Whatever you decide, I'm sending lots of vibes.

I have heard surgeons say that the long term outcome is the same regardless of the type of surgery that is chosen. But IME after a TTA or TPLO the recovery process is much shorter and the dogs are less likely to have long term problems with the knee. That's partially because the knee is super stable right away, but I think it's also partially because the dogs are using the legs more normally faster and so if people slack off on their aftercare (PT) it doesn't have as bad of an impact on recovery. The incidence of complications is very low, but having said that... when complications do occur they are spectacularly awful.

IME with the extra capsular repair, the dogs take longer to recover and I feel like I see long term minor nagging lameness more often. I think rather than a fault of the surgery, that's a fault of making sure the dog gets proper aftercare (PT and exercise). It's just so easy to think "oh he had surgery he's fixed." But, at least the worst that is likely to happen complication wise is that it doesn't fix the problem.

Personally I would probably go with a TPLO or TTA regardless of the size of my dog. They get back to using the leg SO much faster and I think that's so important for maintaining and rebuilding muscle mass and flexibility and preventing muscle contracture. If they are lame too long, a lot of these dogs end up with awful trigger points and knots in the quads along the front edge of the thigh that feel like they can be as hard to deal with as the cruciate tear was.

/.02

It really depends on the dog, as with any surgery. I know of an Amstaff that had the lateral suture technique done (dog has a lot of allergies and the vet was concerned about her rejecting the hardware from a TTA/TPLO, apparently). Her owner was SUPER diligent about recovery, did months of rehab with the dog. A few months after the surgery the dog came up lame again so she had to go back on strict rest, more rehab, etc. As far as I know, she's "okay" now, but they're still very careful.

So they technically did everything "right", but it still seemed like the dog had some issues despite that. It can happen with any surgery really, just seems to be a lot more commonly seen with the lateral suture.

I think I mentioned this before, but Mira took a nasty fall last year (dove at full speed for a toy after laying on cool shady concrete for a good long while while I did chores, the toy bounced, she twisted after it still in a headlong dive and stepped in a hole, fell and tumbled tail over teakettle down the water drainage grade around the barn) and came up lame on a rear leg.

I took her in for x-ray first thing the next morning and it didn't show anything, vet thought it was very small tears in the cruciate but definitely not a full tear and probably not enough to call a partial. She prescribed Adequan shots and 100% crate rest (we even carried her out to potty and back).

I'm a paranoid person so also set an appointment with a widely recognized orthopedic specialist with particular interest in cruciate ligament work. Couldn't get in til the following week (8 days after injury) so followed the original prescription. By the time we walked into the specialist's office, x-rays in hand, she was no longer limping. The vet and his team worked her over thoroughly and had us moving all over and decided she had microtears in the ligament. Didn't do an ultrasound -- they offered but added that they were very confident. Prescribed four weeks of light duty -- leashed walks on level ground then moving to inclines and gaiting, etc. and recommended cold laser therapy if available. Eight weeks later, having done all that, she was working field and back in agility and passed her patella exam with flying colors and hasn't taken another misstep.

That said, she was in top working condition at the time of her fall (we had been working field + agility all summer), has good underlying structure (which according to the vets probably saved us given the nature of the fall), and we just, quite frankly, got lucky. And were fortunate enough to have a team of really good vets who knew what they were dealing with and how to correct it.

It sounds like you are dealing with a more serious tear. My real point is to decide whether you trust your vet, and if so, to follow their advice. Soft tissue injuries are hard to heal and generally the sooner you start the better. I know a lot of folks who have done TLPOs and many are successful -- especially the ones that didn't hesitate, that kept any extra weight off to help with healing and to prevent future injury, and who were religious about following the rehab protocol afterward.

Zoe had a TPLO done 7 years ago, and I have never regretted it. She had a partial tear and we were waiting on a consult with the specialist when she tore it the rest of the way. There was no way she could have gotten around comfortably as she has without the surgery. She has never needed the other side done.

There are pros and cons on both sides, but keep in mind prolonged injury = more swelling = more damage, and probably more arthritis. Getting the TPLO doesn't increase risk of the other side going. Having a tear means your dog is likely to end up in that situation. For Zoe it is a structure issue, and probably her early spay before I knew better. But we are careful and have been lucky. She does have more arthritis in her opposite elbow from compensating, though.

It is a serious surgery with a brutal recovery, but it was that best thing I ever did for my girl. There's a podcast by Bad Dog Agility you might be interested in listening to. It talks about CCL tears and the TPLO.

Thanks everyone.

Looks like surgery it is... now to find the funds.

You have gotten some really good advice and info it looks like. I can not add a thing. But did want to say how sorry I am that you're having to go through this. It sounds like quite an ordeal. But it also looks like things can be made much better. I wish you all the best with this process and hope for a successful recovery.

Let us know how things are going. If you do the TPLO, just know the first two weeks are HELL. Not to scare you, but the one thing I wished when I went through it was that I had known it would be that bad.

But, the mantra that got me through, was "It only gets better from here." Over and over.

I was lucky with Piper and her recovery from her TTA. It really wasn't bad at all, and she handled everything well. I never had to sedate her during the entire process either, which was nice. I mean it's kind of annoying to have to leash walk everywhere and at first I was afraid I'd "break" her, but once I got over the initial "OMG", it was fine.

We've been continuing to rest... She had a Lyme test done today just to rule that out, we'll get the results in a couple days. If it comes back negative, time to go to the third vet, the surgeon I would want to do the TPLO.

Thanks again for the support, guys. It means a lot.