ACL Injuries in Dogs

Tags: dogs, acl, tplo, experiences, complications, mrit, injuries



Experience with ACL Repairs, TPLO?

Comment 1: Emerging from lurking to ask any advice on ACL repairs... I know there is huge expertise on the list.. hoping you can share your experiences with ACL repairs.

My 3yr old girl (not overweight but a big girl!) has hind lameness, she's coming to the end of 10days anti-inflammatories and is not really improving, She's due back at the vets after the holidays to be x-rayed and have the joint manipulated - I'm obviously concerned that the ACL may well be the problem.

Does anyone have any experience of the various types of repairs TPLO etc etc. and pros and cons of the various types.

I'd be most grateful for any input..

Some Experience

Comment 2: Working for a vet I’ve had great success with the “old fashioned” ACL surgery. The TPLO is risky since almost every giant breed I’ve personally seen and heard about broke it’s leg within 24 hours of the surgery.

We did Laser on our dog aprox. 3 plus years ago now he is 7. He had a heart condition and this is what ultimately lead to Leaser done by the veterinarian

TRY
Royal Veterinary College London
http://www.rvc.ac.uk/Hospitals/QMH/Referrals/ClinicalTrials/Medicine.cfm#diabetes
also TTA vs TPLO
http://www.albemarlevet.com/
http://www.lauriebryce.com/tplo/links.html

Great Experience Working at a Vets Office

Comment 3: I also work at a vet clinic and have seen hundreds of TPLO surgeries with about 2/3 of them being giant breeds and have NEVER seen or heard about any of them breaking their leg.

But I have seen numerous dogs that had the "old fashioned" ACL surgery have to come back in and get TPLO.

I personally had TPLO on 2 of my dogs (a St. Bernard and a Mastiff) with great success.

Comments...

Comment 4: First, according to the vet we take cruciate injuries to in Okemos, MI, he had indicated to us that there is no significant differences in the success rate of a TPLO vs. an MRIT (a specific traditional surgery). This vet is no stranger to large breeds.

Also, the way it has been explained to us is the the TPLO is a riskier surgery of the two, as if there are complications, there is an increased potential for a dog to be permanently crippled. In theory the TPLO may be a better surgery, with no recourse in the event that complications occur.

If there are complications from an MRIT, it is normally possible to repair or redo it, or then even perform the TPLO, if necessary.

According a therapist at the Small Animal Physical Therapy Department at Michigan State, the approach to a TPLO rehab is similar to a broken bone (as they have made cuts in the bone) and takes longer. The approach to the MRIT is more in the manner of rehabing soft tissue.

The question is as the TPLO is a patented surgery and royalties must be paid, is the added expense ( maybe $1000. on the surgery alone) and potential (and probably small) risk worth it? We're not convinced that it is.

TPLO vs an MRIT

Comment 5: First, according to the vet we take cruciate injuries to in Okemos, MI, he had indicated to us that there is no significant differences in the success rate of a TPLO vs. an MRIT (a specific traditional surgery). This vet is no stranger to newfoundlands. (Pat Randle: he did not show me the stats, nor quote any specific studies.)

Also, the way it has been explained to us is the the TPLO is a riskier surgery of the two, as if there are complications, there is an increased potential for a dog to be permanently crippled. In theory the TPLO may be a better surgery, with no recourse in the event that complications occur.

If there are complications from an MRIT, it is normally possible to repair or redo it, or then even perform the TPLO, if necessary.

According a therapist at the Small Animal Physical Therapy Department at Michigan State, the approach to a TPLO rehab is similar to a broken bone (as they have made cuts in the bone) and takes longer. The approach to the MRIT is more in the manner of rehabing soft tissue.

The question is as the TPLO is a patented surgery and royalties must be paid, is the added expense ( maybe $1000. on the surgery alone) and potential (and probably small) risk worth it? We're not convinced that it is.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12619562

The tibial plateau leveling osteotomy (TPLO), a technique developed more than 2 decades ago by Slocum as a treatment for CCL rupture (2), may finally be shedding its “controversial” label. Slocum's initial work with the procedure involved patenting the technique; thus restricting its teaching and the accumulation of clinical data. The data that might have taken only 5 y to generate are only now becoming available after 20 y. While there remains debate over how and why the technique is effective, there is little dispute that the TPLO does work, that it decreases long-term degenerative joint disease, and, consequently, that it may be the treatment of choice, especially in large breed dogs (3). The TPLO procedure is based on the leveling of the tibial plateau to eliminate the cranial tibial thrust produced by axial loading of the CCL-deficient stifle. A radial osteotomy of the proximal extremity of the tibia is made as one looks at the stifle in the mediolateral plane. The proximal fragment of the tibia is then rotated so as to level the cranial to caudal slope of the tibial plateau. The osteotomy is then fixed with a specialized bone plate and screws. The results of over 20 000 TPLO procedures at several institutions worldwide, which continue to provide positive results on the procedure's efficacy, were presented to Congress delegates. However, results do not suggest that other techniques should be abandoned. Data were presented showing that 6 mo postoperatively, weight-bearing in 68 Labrador retrievers, as measured by force plate analysis, was not significantly different between TPLO repairs and extracapsular repairs (5).

Information was presented on the management of partial CCL tears that cast doubt on the wisdom of handling such cases with a conservative “wait and see” approach (6). Without surgical stabilization, complete rupture was found to be a virtual inevitability. The TPLO procedure was shown to prevent partial tears from becoming complete ruptures and to dramatically decrease degenerative joint disease, as compared with joints treated conservatively. The partial CCL tears were confirmed arthroscopically by the authors before they proceeded with TPLO.

Complications do Exist

Comment 6: Study have shown that, yes, bones do break after TPLO. Below you will find portions of several reports that show the different complications that can happen after TPLO. In addition, there is some evidence that the plates used may cause sarcoma: Sarcoma of the proximal portion of the tibia in a dog 5.5 years after tibial plateau leveling osteotomy JAVMA, Vol 227, No. 10, November 15, 2005

It is my understanding that they have changed either the manufacturer or the composition of the plates used and there isn't enough data on the new plates yet.
I have also heard that if a dog has had patella surgery and the has TPLO surgery, there is a strong probability that they will have to undergo patella surgery again. While I have no data, I have been told that if a TPLO fails you have no options. If the old surgery fails you can do a TPLO.

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