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Old 07-31-2014, 09:00 PM
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Default 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.
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Old 07-31-2014, 09:16 PM
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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!
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Old 08-01-2014, 10:08 AM
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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.
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Old 08-01-2014, 10:38 AM
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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.
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Old 08-01-2014, 11:46 AM
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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)
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Old 08-01-2014, 01:52 PM
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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:



17 days post op:



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!
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Old 08-01-2014, 03:29 PM
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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.
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Old 08-02-2014, 01:10 PM
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Quote:
Originally Posted by Kayla View Post
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.
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Old 08-02-2014, 03:45 PM
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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.
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Old 08-02-2014, 04:20 PM
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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.
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