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Cranial Cruciate Ligament Rupture

freddyp

Member
A quick story about my (my dog's ) experience with rupture of CCL.

Tank was diagnosed with CCL rupture 4 years before he was euthanized for unrelated issue.

My local vet said he needed a TPLO and the sooner the better.

Took Tank to local university for second opinion from orthopedic specialist. same diagnosis, ruptured CCL but recommended the less invasive tightrope procedure.

I asked my local vet about the tightrope and he would not do it. He claimed that procedure has a high incidence of infection and he had only done a couple. he was trained in TPLO and clearly makes his money on the TPLO.

He claimed the TPLO was a "better" procedure.

Now we all know the protracted recovery following this surgery and I was a bit confused as to what was best.

it was not a money issue. if the surgery was a 100% guaranteed "cure" I would have paid whatever it cost. And I do mean whatever!

After much research i came to the following conclusion:

Do not put Tank through the procedure (s).

From what I have learned invasive surgery is not always needed. Now Tank weighed in at about 120 so he was no lightweight. We have all been told surgery is needed in heavier dogs.

Long story short I did nothing ! No NSAIDs, no narcotics, no bracing. 4 years post diagnosis Tank was running along the fence line chasing goats. He was pivoting like a cutting horse. On rare occasions he was toe touching but overall was happy and i saw so sign/symptom of discomfort aside from these infrequent toe touching periods (which were not present the next morning).

My vet and the university specialist were certain of the diagnosis and it's funny when I brought Tank in for euthanasia I mentioned that I did not opt for surgery to treat the CCL four years prior and Tank had done quite well. The vet just shrugged his shoulders and had nothing to say about the CCL.

Anyway, I am not saying never do surgery but rather give the body a chance to heal itself. I believe what happened in Tank's case was he developed a degree of arthritis and scar tissue and this helped to stabilize the joint.

I have great respect for veterinary medicine but let's be clear it is a business and a big one at that. Surgery is a money maker. so is dog food. Look at the Science Diet display at your local vet's office.

I'm a believer in the BARF diet and never had any problems. My vet to this day insists it is dangerous. I don't see how kibble with fillers is safer. My dogs are carnivores NOT omnivores !!!.

Anyway, I digress.

Here is a link to an interesting article about treatment of ruptured CCL. i imagine the veterinarian who wrote this got some flack from her colleagues

Questioning Canine Cruciate Ligament Surgery - Veterinary Practice News - November 2012



Also here is a link to several articles dealing with CCL rupture.

Search results, filtered by RELEVANCY DESC, search term: cruciate ligament surgery



In the end you must make your own decision as to what is in the best interest of your dog. What I am suggesting is do not make a quick decision at the time when you are most vulnerable. I almost made that mistake. Glad I put more thought into it.
 

freddyp

Member
Great post!

I appreciate that.

I am in the medical field and i see the same thing in human medicine. People are preyed upon at the time they are most fragile.

I still love medicine but every day i am more disillusioned!

As in veterinary medicine if you buy a piece of equipment you need to pay for it. Nice new $800,000 MRI unit. i guess everybody is getting an MRI this year. Insurance will pay for it and i need to pay off the MRI unit. Besides no radiation with the MRI so no harm to patient. Maybe I'll buy that boat after all. Sorry a bit over the top but medicine is no longer what it was in days past. I really liked the "good old days'.

You helped people, pets whatever out of a true passion. A drive, a desire to make this a better world.

Sorry I'll get off the soapbox.
 

LizB

Well-Known Member
I too had a BM with the same issue at 15 months and we never did anything, since she didn't really seem to be limited too much by it, and was comfortable. She passed away from cancer at age 4.

I'd also like to interject, however, that medical people (I am one) do the procedures they do because they believe in them, are comfortable with them, and have the best training in them. If they become dissatisfied with the outcomes, they look into other procedures that might produce better results. If they get good results they'll likely stick with what they're doing. It doesn't necessarily have to do with the cost or making money, or ripping people off. I know that DOES go on, but not always.

You need to trust your vet and your doctor. If you are always second-guessing them and suspicious of being manipulated by them, then you need a new person you can trust. You/your dog won't do well, won't recover as well, won't heal up as well without trust in your caregiver.
 

freddyp

Member
I too had a BM with the same issue at 15 months and we never did anything, since she didn't really seem to be limited too much by it, and was comfortable. She passed away from cancer at age 4.

I'd also like to interject, however, that medical people (I am one) do the procedures they do because they believe in them, are comfortable with them, and have the best training in them. If they become dissatisfied with the outcomes, they look into other procedures that might produce better results. If they get good results they'll likely stick with what they're doing. It doesn't necessarily have to do with the cost or making money, or ripping people off. I know that DOES go on, but not always.

You need to trust your vet and your doctor. If you are always second-guessing them and suspicious of being manipulated by them, then you need a new person you can trust. You/your dog won't do well, won't recover as well, won't heal up as well without trust in your caregiver.

Liz:

I understand the trust issue, however one must ask questions. I was told flat out by 2 vets that Tank needed surgery, and soon !! Yes most vets do what they do out of a love for animals. I'm not suggesting that all vets and/or procedures are a rip off or done solely to make money.

What I am proposing is that economics enters into the thought process when formulating a treatment plan in some, perhaps not most and clearly not all cases.

I trust my vet but ask questions. When I get answers that are not fully explained or explained as "that is just how we do it" I'm not comfortable.

In my profession I will in almost all cases allow the patient to take part in the decision making process unless they have a P.O.A. or just are not at all competent.

Quick example:

"Mr. Smith you have early Alzheimer's dementia. We do have medication that in studies has been shown to slow memory loss . These medicines do not work in all cases and i don't want you to be under the impression that your memory will improve. In time your memory will continue to decline"

I let the patient discuss with family. Some choose to do anything they can to slow the process. others feel they wish to not take medication.

It is a team decision.

I have an issue with a vet who says "you must right now" unless of course it is a life threatening scenario.

Now others look tto their dog's vet for the answer and trust the vet fully. That's fine but for me I will always ask questions and before moving ahead make an informed decision.

Different strokes and all that.
 

NYDDB

Well-Known Member
freddyp- thank you so much for posting this.

My boy was diagnosed with a CCL tear last fall; he failed the "drawer test" and my vet said that it is a "surgical fix." In fact, he was so eager to send him into surgery, he wanted to pull blood from him that day so he could be scheduled into surgery ASAP.

Of course, I was devastated, but plunged headlong into research, as well as taking in others' experience with this injury on their giant breed dogs.

I decided to go the conservative management route and, while there were some setbacks along the way, Mateo always rallied and seemed to be even stronger as time went on.

We just completed 9 weeks of some hydrotherapy (swimming), along with cold-laser (not sure if that helped or not), and underwater treadmill work, and massage.

Now, almost 4 months post diagnosis, I can safely say that Mateo is doing better than ever: no real limp (except a little hitch when he runs, but I believe, with more healing and time, even that will fade away), less toe-touching, and compensation. He is getting stronger and stronger, with no signs of pain or suffering.

I ran into my vet just the other day, in fact, the one who wanted to rush him into surgery. He asked how he was doing, I told him the therapies we were using, and that he was doing really well...he watched Mateo walking and nodded-- eventually saying that the recovery could not have happened to a nicer dog. :)

Now, I would be lying if I said that there weren't moments where he was backsliding, and the limp was back, where I didn't doubt my choice to avoid surgery; like you, I would have figured out a way to pay for whatever he needed. But, the TPLO scared me--- and seemed such a drastic solution to a ligament injury.

You are so right when you mentioned that the moment when we are the most vulnerable, is when we sometimes choose - or are swayed by desperation -into choices which may not be the best one for our animal...
 

angelbears

Well-Known Member
Freddyp, thank you for your post. I have been trying to convey both points since I have been on this forum. It is very well written and thought out.
 

sjdavenport

Well-Known Member
We have just gone through a ruptured CCL with my pit bull Mazey. I actually never felt like I had only one option (surgery) open to Mazey and me. On the contrary, I felt like there were a TON of options, and the incredibly difficult part was trying to figure out which one would possibly be best for her. Conservative management was certainly something I considered, especially hearing NYDDB and QY10's successes so far with Mateo and Angus. I also think I read 40+ studies and journal reviews, and there really isn't a definitive answer as to what results in the best outcome (especially considering that most of the studies that looked at "long term outcomes" only went a year out, which I wouldn*t exactly consider long term). Also, please take this particular article with a grain of salt: Questioning Canine Cruciate Ligament Surgery - Veterinary Practice News - November 2012
I read a post by the author on VIN asking colleagues for studies pertaining to CCL ruptures so she could write this article, and she of course got a ton of articles posted. I notice she only used and cited the ones that supported her side, and none of the opposing articles. So that's something to consider. I only waited a week after Mazey ruptured her CCL before she had the TPLO done. She was incredibly painful, didn't improve any whatsoever after a week of strict rest and pain meds, and seemed completely miserable. She wasn't herself at all and spent a lot of time whining and didn't want to get out of bed at all. That's when I decided I couldn't look at her like that any more and went for the surgery. I think that if she had been handling it a little better like some other dogs do, I would have considered conservative management a little more heavily. This first video is before the surgery, and she was that way for the entire week leading up to the surgery. The next video is her 14 days after her surgery. She's of course still painful, but she's already walking much better (and on less pain medication) than she was pre surgery. So I don*t think there's a "right" answer when it comes CCL ruptures in dogs, but is so important to consider ALL the options (of which there are many). Thanks for sharing your experience, it's another +1 for conservative management. I hope if Mazey ruptures her other (which she may), she will be a better candidate for CM the next time around.




[video=youtube;4dQvwcNqs10]https://www.youtube.com/watch?v=4dQvwcNqs10[/video]

[video=youtube;8rD5r9JIbzw]https://www.youtube.com/watch?v=8rD5r9JIbzw[/video]
 

NYDDB

Well-Known Member
sjdavenport-- such a thoughtful post as well. There is no easy answer to this issue, as all dogs present differently, and, really, each situation must be considered on a case-by-case basis, IMO.

That first video of Mazey is painful to watch... Mateo was never in such distress; there were times were his limp was more obvious than others, but he always used his injured leg to walk. I can imagine how you felt seeing her like that. :(

Also, there are no guarantees either way. I pray that my boy's stifle continues to strengthen (he still needs to build up some muscle there), and that his other knee stays healthy. All we can do is our best, whatever course we take...

And Mazey is looking good- I'm sure every day you see progress.
 

sjdavenport

Well-Known Member
I did forget to mention one factor that may have been a big part of why she was so painful. They thought that her meniscii might be torn. Thankfully they found that during surgery that they were intact, but that the ends of her torn ccl were sticking out all willy nilly into the joint, probably acting as a foreign body in the joint capsule, which could have caused her the extra pain. Yet another reminder to treat each case on an individual basis!
 

QY10

Well-Known Member
Angus tore his ACL. His vet said TPLO would be the best option, but I wanted to try conservative management first.

Angus does hydrotherapy and K-laser therapy twice a week. He's also recently started acupuncture. We also do stretches at home and I have him side-step and walk backwards to encourage using the injured leg more (he still does not apply full pressure on it when standing. He kicks it out to the side). When I notice him standing with his leg kicked out, I lean into him and push him over to his bad leg as we are almost thinking its a habitual thing now, more so than anything else.

He's gone from not using his injured leg to going on 45 minute walks on a variety of walking surfaces and inclines/declines. We also do flights of stairs.

We are going to start looking at getting him to do more trotting to challenge him and see where his progress is really at. That means I'm going to have to start jogging (I hate jogging... I suck at it).

His vet at the rehab centre is impressed with his medial buttress and said she can definitely notice a difference in the stabilization of his knee.

From the start, he never looked as miserable or uncomfortable as little Mazey. To me, it says that he only ever had a partial tear.


Sent from my iPhone using Tapatalk
 

Alexus

Well-Known Member
Different injury, somewhat similar message.

One of our mastiff puppies at 7 months was unable to lift himself off the floor, had limited mobility, and pain on exercise. Using Penn Hip radiography and physical examination the diagnosis was made of severe grade 3 bilateral hip dysplasia. We had kept him lean and on a a high protein, low carbohydrate diet (low in calcium and phosphorous) to avoid significant weight gain

Our surgeon was recommending Juvenile Pubic Symphysiodesis, and another surgeon Triple Pelvic Osteotomy.

Another vet recommended glucosamine, chondroitin, MSM which protects the joints by helping to rebuild cartilage and restore synovial fluid, omega 3 oils to reduce inflammation, NSAIDS for 10 days, curcumin, an herb that reduces inflammation, vitamin C, and a program of moderate low impact exercise including swimming and hill climbing, to maintain flexibility and develop muscles to help stabilize joints .

Our pup began showing positive results within 3 weeks. And now almost 4 months later his hip function is normal.

Surgery is sometimes necessary, but I would caution not to rush into it without thoroughly investigating other treatment modalities and obtaining a second opinion.
 

DMikeM

Well-Known Member
Some here may know that Jade was diagnosed with a CCL tear and the vet recommended immediate surgery. I asked around and did some research and found a website all about this injury and how to manage it with conservative treatment. So that's what I did. Now I think that she never had a torn CCL and just had an injury that mimicked it especially when I went back and asked them about the drawer test and they said 3 different vets tried it on her and could not budge the joint, but gave the excuse that she is exceptionally muscular and strong and would not relax her leg, (even though she was sedated).

In less than a month she was walking pretty normal and after a few months I only see an occasional hiccup in her step. She was also diagnosed with ED a few months before that while she was going through pano. When being examed during her pregnancy the Vet commented on how well she had recovered from her surgeries and I told him that she never had either operation. He looked at me like I just told him a lie. So when we xrayed for the pups he checked both the elbow and knees and couldn't see any issues at all.

Now he want to do more xrays to confirm now that she is done with the puppies.
 

Alexus

Well-Known Member
Some here may know that Jade was diagnosed with a CCL tear and the vet recommended immediate surgery. I asked around and did some research and found a website all about this injury and how to manage it with conservative treatment. So that's what I did. Now I think that she never had a torn CCL and just had an injury that mimicked it especially when I went back and asked them about the drawer test and they said 3 different vets tried it on her and could not budge the joint, but gave the excuse that she is exceptionally muscular and strong and would not relax her leg, (even though she was sedated).

In less than a month she was walking pretty normal and after a few months I only see an occasional hiccup in her step. She was also diagnosed with ED a few months before that while she was going through pano. When being examed during her pregnancy the Vet commented on how well she had recovered from her surgeries and I told him that she never had either operation. He looked at me like I just told him a lie. So when we xrayed for the pups he checked both the elbow and knees and couldn't see any issues at all.

Now he want to do more xrays to confirm now that she is done with the puppies.

Wonderful news! How did you treat ED?

Thanks & May God Bless, Alexus
 

DMikeM

Well-Known Member
All I did was reduce her calcium intake. Another Boerboel owner told me her dogs elbow looked the same and it was from too much calcium. She really did not have ED.
 

sjdavenport

Well-Known Member
The author of the above article actually came out with an addition/clarification/revision??? to the Questioning CCL Surgery article like two months after it came out (although with a few coauthors). In the interest of representing all sides, here it is: Treatment Options For Canine Cruciate Ligament Disease (CCLD)
Just goes to show how difficult it is to wade through all the changing information out there to make these decisions! It's enough to make me want to pull my hair out, lol.
 

NYDDB

Well-Known Member
The author of the above article actually came out with an addition/clarification/revision??? to the Questioning CCL Surgery article like two months after it came out (although with a few coauthors). In the interest of representing all sides, here it is: Treatment Options For Canine Cruciate Ligament Disease (CCLD)
Just goes to show how difficult it is to wade through all the changing information out there to make these decisions! It's enough to make me want to pull my hair out, lol.

No kidding...:eek: I am with you on that one, LOL.
 

Dan

Well-Known Member
Re: Cranial Cruciate Ligament Rupture - Going though it at the moment

Hi
Thanks for a very interesting post.
I'd like to share my current experience - I'll try to be brief.
My 2 year old boerboel had a TTA on Feb 5th.
XRays and CT scans under sedation showed he has CCL disease and also very bad elbows.
We've had the full range of advice from "euthanise now" through "conservative management" to "spend £8k on surgery".

We opted to have a TTA performed on the leg which has an actual CCL rupture - and to keep an eye on the other hind leg with a view to operating if necessary.

At the moment I am completely worn out and beaten up.
After the op we had 3 days when he couldn't drink any fluid (had to use a dropper and even that he shied away from).
We had 4 days before he would eat anything at all and he dropped from an already very lean pre op 72Kg to 64Kg.
We had 5 days of extreme disorientation with him not seeming to recognise anybody except me - and then seemingly vaguely because of the methadone he was on.
We had 6 days or so of sitting up with him all night whilst he was dysphoric and in pain - literally just cat napping to prevent him from licking the wound and to reassure him.

Although he wound healed ok and the stitches are out, at 12 days in he has worsened - become lame and cannot seem to put any weight on the leg.
He is depressed because he cannot go out and probably because of the pain.
He has a lovely temperament - but if he is in pain he really can be dangerous.
I've had one brief full on challenge from him and vet visits are pretty hair raising.
The breeder has warned me that this will get worse if he is in continual pain.

We are going back to the surgeon tomorrow for his opinion and maybe more XRays (and still more sedation).

Whereas at the outset, I was feeling that I just wanted to keep him going whatever the cost, I am now seriously considering whether it is fair to keep putting him through this.
Its a lot harder on him than I had expected and what with the likelihood that the other leg will need TTA and then that his elbows will become an issue not far after, I am almost at the point of agreeing to euthanise him unless we can avoid further surgery on the current problem.
It's not about money, its just unbearable to seem him almost unrecognisable and facing a seemingly endless series of operations and pain that he has no way of understanding.

I'm just broken hearted.
I'm finding it almost impossible at the moment to tell whether I am acting because it is best for the dog - or because I cannot bear to see him suffer.
The breeder has been adamant from the outset that euthanasia is the right way to go.
I disagreed then, but I'm beginning to see that perhaps he is right.
He just isn't the same playful clown that he was.

I'm hoping for good news tomorrow but right now I feel as if I can hardly breathe.
 

DMikeM

Well-Known Member
Dan, Any update here. How did things go? I am so sorry you are going through this. Often dogs act aggressive when on medications and I am sure his knee hurts like hell after the surgery.

Hoping for the best.