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Don’t be shy… Post on our NEW Dog Knee Injury Forum!

In response to the high volume of comments a lot of the post have been getting, I’ve opened up the forums as a way for dog owners to connect and discuss their dog’s orthopedic issues with one another.

How to post on the Dog Knee Injury Forum:

1) You must register for a user name to post on the forum.

2) After you’ve registered and retrieved your password from your email, log in (I recommend changing the password to something you’ll remember) and start posting!

3) Keep the comments on topic, and be nice. If anyone encounters any issues on the forum please post in the comments on this page/use the contact form, and I will look into it.

CCL Repair Forum for Dogs is a post from: Dog Knee Injury

Our ten year old Husky, about 75 lbs. went lame in her back leg after repeatedly climbing our new chain-link fence and chasing neighborhood cats. Our vet recommended the new tightrope surgery to repair her torn CCL as less costly and less invasive. To keep our options open he did tell us about all the procedures currently being done. However, since he did not actually preform TPLO and we’d have to go to a board of surgeons to have this more expensive TPLO surgery done we opted to have the tightrope procedure done at the end of March ‘10.

We thought we were prepared for the restrictions, and had no idea the extent of the complications, as we had not done our homework. We just took the word of the expert. Statistically, I think we had all the bad Tightrope surgery complications, and then some.

At the end of the 2nd week post-operatively we discovered when we went to get her stitches out, there was instability in the leg again. Something about the tightrope had failed and failed quickly. In addition, three, what appeared to be seromas or limpomas, had formed at various places along the incision. One on the upper inside, one on the outside just along the stitch, and the final further back on her outside hip. The one along the stitch continued to grow.

The vet at week 3 post-op recommended a second surgery saying, “Let’s go in see what is happening with the tightrope and look at the seroma”. (it turned out not to be a sermoa as it was not fluid filled and must be something else) We prepared for a 2nd tightrope ligament repair surgery, in case it was needed. Sure enough the first tightrope was “loose” with no explanation. It had been tight during surgery and one week post op. The buttons were fine and the knots tight. It was just loose. He removed the loose tightrope, drilled new holes at a slight angle this time, put in the 2nd tightrope and removed the largest growth – a golfball sized granuloma laying along the lateral side of the tightrope but not directly encasing it.

The granuloma was caused by a foreign body (triggered by either the suture material or tightrope) and it had a highly resistant staph infection in it. We found out 7 days after the second surgery when the pathology report came back. All the little antibiotics we’d given her for the past month had no effect. We had to start her on clindemycin which was one of two antibiotics that the staph was not resistant to. My concern was the whole week the new tightrope was in, and we did not know a staph infection was present.

Three weeks out after this second surgery her leg again tested with a draw sign that it had become unstable again. Why? The vet recommended a third surgery. He went in and the tight rope was secure and tight, so what was the instability? Her menicus on one side in her knee had torn and flipped. She’d not exhibited the normal pain this should have caused so the vet had no reason to suspect prior to this 3rd surgery. This slight damage to this cushion is what had shown up as instability when he did the drawer sign before the 3rd CCL surgery.

He was also glad that at surgery #2 he’d not opened the knee joint to look because for sure he would have spread the staph infection to the joint when so far it had been along the surface of her leg. We didn’t know that at the time, but looking back it was probably a good thing. He cut and removed the damaged menicus and released the lateral one. Then he also put in another stabilizing feature – the original Extracapsular Technique, also known as a traditional repair. This would give our girl two stabilizing features: the second tightrope that was still intact and the new lateral stabilizing suture (extracaspular) and they would not interfere with one another. We had high hopes.

For another month (this would be two months of antibiotics, a total of 3 different kinds before we got to the 4th for the staph infection) we had her on antiobitics following this 3rd surgery. At week 3 post op, of the 3rd surgery, she was still stable but she developed a horrible yeast infection in her ears that we also had to begin treating her for. We think this was probably caused by all the antiobitics. We finished the third and final round of antibiotics at week 4, believing the staph infection totally destroyed. How could it not be after that hit with antiobitics… 30 days?!

However, one week after she went off antibiotics in week 5 the instability seemed to be coming back, and each day we watched her use that leg less and less. She walked in a stilted way with a hitch and thunk look (no sound). It began to shake as she lifted it. Day after day we watched this get worse… thinking surely not, surely it’s just today. Finally we called and the vet said only time, let’s give it more time. Week 6 post-op of the third surgery she refused to use the leg at all and it was a little puffy. The next day it was more firmly swollen from the hock to the crest of her knee. She hiked it up and hopped on the other… something she had not done since before the first surgery.

Back to the vet who said that the leg was again more unstable and that apparently both stabilizing features had failed. We put her back on antibiotics and steroids for the swelling.

Our options going forward:

1) TPLO
We don’t have an additional $3500 for a more invasive surgery on a less than pristine leg that has already had 3 surgeries and known complications from infections including staph. I don’t know that bone healing or foreign body reaction would be any better with metal plates and cutting her bones.

2) (Another) Tightrope
Why do another tightrope surgery when we’ve failed each one. No one can tell me why it failed and failed quickly. She’s remained totally restricted, very very very little activity… walks to eat and leash walking to the bathroom. There was some talk about her soft tissue not healing well and that’s just her so that’s the cause of the failure and instability. That’s the guess. It still seems strange that soft tissue could cause an fibrous material like the tightrope which is supposed to be so strong and durable to weaken after a couple weeks in her body more than once.

3) Conservative Management – Rest and Medication
Time and medicine we can do, but the problem is her leg, the bone to bone action is again unstable. So give her antibiotics for two weeks and fix the swelling or infection. But when she goes off of it the instability is still there to again cause damage that would cause swelling again requiring more medicine. The endless cycle. I also wonder if the tightrope itself does not now have staph in it and will continue without constant antibiotic to infect her leg every time.

I don’t know that it would have been any different if we’d gone with the TPLO first. Our vet has helped us with the cost of the second and third surgeries, but the cost to our family emotionally had been huge. As someone else in here said… any surgery has risks. My vet has done 10 tightropes in the past spring and ours was the only failure… 10% chance doesn’t sound like much until your dog is the 10% one.

It is disheartening. It has taken time off work. Patience from everyone in the family who have had to pitch in to help. It hurts to watch your dog-companion in pain, not understanding and restricted. A friend told me my dog was tough and just to hang in there. She said if my dog has to be a lap dog and hang out in the house for the rest of her life that’s okay. Besides she’s just about to turn 11 so she’s not in the prime of her life. And I worry… what if she’s in the 50% who blow out the other leg? My mother would say I’m borrowing trouble to even think about it. She’d also be one of the first realistic ones to say it may come to putting her down. Gosh it would be easier to not have to go through this. But we love our furry friends. And that’s not so easy. We don’t give up that easy do we? It has been one of the most horrible long-term experiences of my life.

We are at 6 weeks post-op surgery #3 with a swollen, infected and mostly useless leg. But we’re giving medicine, food, love and prayers. I believe the medicine will help. I’m not sure what next steps will be. But today. That’s all we’re really promised anyone. Today – we’re hanging in there together.

UPDATE – 7 Weeks Post Op
During the third surgery, they did add the Extracapsular repair. When we talked with the vet this week he believes the Tightrope & Extracapsular are still intact, but that the isometry of her leg causes a shift that keeps them from holding the knee completely stable. It will make the scaring, tightening process slower. Her swelling has gone down on this round of antibiotics and steroids, which we’ll decrease over the next week. She’s walking on it a little more in this post op week #7 and resting a lot.

Tightrope Surgery Complications – Husky is a post from: Dog Knee Injury

Ben is doing extremely well at 2 weeks.

Day 2
Ben is feeling much better. On our walk, he actually lifted his good leg and stood on his leg with the surgery to go pee. Never thought I would be excited watching a dog pee, but that was amazing..

Days 3-4
Ben starting walking more and more. I actually caught him a few times standing on his hind legs looking out the window.

Days 5-6
I believe he started walking better than the day before surgery. Also, he is walking and standing normal. It is barely noticeable he is favoring his leg.

Days 7-8
Ben is starting to get his “gait” back. If you every watch a Standard Schnauzer, they kind of glide effortlessly across the room. He is actually getting it back. It has been months since I have seen him walk like that.

Ben is having a reaction to the staples. His incision is starting to swell and become red. The Vet has us come in and she gives him some ointment that will soothe his reaction. The Vet is amazed as to how well he is walking.

Day 10
Ben has his staples removed and his incision looks good after using the ointment.

Day 14
Ben is at the 2 week mark and is doing great. For the most part, Ben is standing and walking normal. However, he does still favor his leg on occasion. Per the Post Op instructions, Ben is walking a 1/4 mile twice a day. Muscle definition in his leg is starting to come back.

As he is getting better, it is getting harder to keep him under control. He wants to play at every chance he can get. He is feeling better than he has felt in months and is showing it!!!

TTA Surgery, 2 Weeks Post Op – Ben is a post from: Dog Knee Injury

Ben’s Story:

Ben is a 4 year old Standard Schnauzer. We believe he suffered a partial tear in his Left CCL in December 2008. We didn’t give CM (Conservative Management) a chance until about July 2009, when he was diagnosed with a CCL tear. Prior to that, it only appeared to be a minor injury. Since July 2009 when we started CM, Ben would start walking and standing normally, but would often suffer set back after set back. I will be the first to admit that most of the set backs were due to my stupidity. I guess it could be argued we never gave CM a chance.

A few weeks ago, we gave up and did some more research. The Vet indicated that he could be healed through CM, but if we wanted him to be the athletic dog he used be, then he would need surgery. Ben was/is my hiking buddy and used to go on 7-8 mile hikes in the Utah Mtns all the time. He could run for hours and hours without taking a break. The Vet believed he would never be able to do that through CM without being down the rest of the day and/or next day. We scheduled him for TTA surgery with an Orthopedic surgeon that is believed to be the best in Utah, if not the best in West. From our research, the TTA surgery appears to be far superior to the TPLO. Dogs tend to be healed within 3-4 months. Also, they tend to be weight bearing on the leg within 24-48 hours. Within 2 weeks, some dogs are pain free.

Ben made it through surgery just fine today. The Orthopedic surgeon called us and indicated to our surprise that Ben had a complete tear in his CCL and the Meniscus was completely torn as well. If I knew he had that much damage, I think we would have scheduled surgery much sooner. The Orthopedic Surgeon did tell us that he does not believe Ben will suffer anymore arthritis than normal because of our delay in scheduling surgery. His joint appeared to be clean with only minor swelling. The surgeon believed his recovery will be just as good as if we scheduled him back in 7/09.

At this point it is anyone’s guess if he would be better or worse with CM. As of now, we have the peace of mind that knowing the end is near. With CM, we never knew when the road would end. I will post updates on Ben’s recovery over the next several weeks.

Day 1 (after TTA surgery)
When I picked Ben up from the Vet, he was completely opposite from what I expected. I expected a dog that looked like he had been to hell and back. Instead, Ben was dragging the Vet tech into the room. As we were talking to the Vet, he sat on his leg that just had surgery. The Vet was impressed with the very little swelling around Ben’s leg. As we walked outside, he was practically dragging me to the car. His spirits are completely high, and looked like he wanted to go play.

As we were getting into the car, I was planning on picking him up and placing him inside the car. Instead, I opened the door and he leaped into the car. He missed and gave me a complete heart attack. I caught him as he was falling to the ground. I expected him to cry out in pain, but he acted like nothing was wrong. Once inside the car, he was jumping from seat to seat like nothing was wrong. Once he was home, he immediately went for his food.

At this point he is just toe touching on the leg with the surgery, but he is getting around fabulous on his 3 legs. About 5 hours later, I took him for his first walk. We walked past a few houses before we turned around. As we got close to home, I noticed he started walking on his leg. He continued to walk on it (with a limp) the rest of the evening!!!!!! It looks like my biggest challenge at this point will be keeping him under control so that he can heal properly.

TTA Surgery and CM – Ben’s Story is a post from: Dog Knee Injury

Potato’s Story:

Potato tore her knee muscle in winter. I had insurance, but because she was limping prior to a minor sprain, they didn’t cover it. I couldn’t stand seeing her limping around anymore so i paid the $3000 for the kind of surgery where they cut the bone so the leg isn’t bowed anymore and so it stabilizes the knee (TPLO). She is doing ok and today is the second day after surgery.

I thought I had sedated her enough, but I left the room for two seconds, and somehow she got off her chair. I was going to let her sit in it with my help but now that is off limits. Then today, I left her in my bedroom with her cone on, I thought she wouldn’t be able to get on the bed…but when i got home she was on it. I have no idea how.

The most important thing I have learned from this is…THEY WILL DO WHAT YOU DON’T WANT THEM TO DO. She doesn’t understand that these two attempts could have easily ruined her newly operated knee, and me underestimating her also almost wasted that $3000. I’ve learned that i can’t leave her for one second, and that she is going to have to be crated. She really scared me.

Also, her ankle is a little swollen, but thanks to this web site i might not have to pay another $200 to see what it is. One of your contributors said that their dog had just fluids trapped there and that massage and ice helped with them. I called the vet, and they are calling the specialist who did the surgery for me and recommended heat. If it continues past the weekend I will go back to the vet, but this website helped me with the initial panic.

Thank you so much!

TPLO, 2 Days Post Op – Potato is a post from: Dog Knee Injury

It has been 1 week since Tim’s TTA surgery, and she is now starting to get very playful. It’s going to be difficult to keep her quiet. Her surgical line from the TTA is beautiful, bruising and swelling are completely gone.

Days 8 and 9 were uneventful. Timber is enjoying the great weather, and she is putting more weight on her leg with each day.

Days 10 and 11 we had been working around the outside, so I decided to let Timber on the deck; I had both sets of stairs baby gated so she could enjoy the outside. Well… I suddenly hear my husband yelling, so I quickly run to the back of the house to find that Timber jumped over the gate!! She seemed to be fine but back in the bathroom she went.

I gave her a pain pill and her anti-inflammatory and she rested for the remainder of the day.

Day 12, Timber seems to be okay since she decided to jump the baby gate. She is definitely becoming more active…I am reminding her and myself that its only been 2 weeks, and she still has a good 4-5 weeks to go until fully healed from the TTA surgery.

Day 13-14, it’s been 2 weeks since surgery. Timber will be going in for suture removal on Thursday, and I am very pleased to say that she never once licked or bit at her incision – mommy is so proud of her!

TTA Surgery Recovery – 2 Weeks, Timber’s Story is a post from: Dog Knee Injury

What is a dog TPLO surgery?

TPLO stands for Tibial Plateau Leveling Osteotomy, which in simple english means that they are changing the bones of the knee joint to make them work in a different, more “level” manner.  The veterinary surgeon will start by making an incision in your dog’s injured leg, and the cut will be made down the length of the leg.  Through this incision the veterinarian will then access the injured acl (or ccl as it is more properly called in dogs) and begin by removing the severed, torn and/or ruptured ends of the ligament.  Once the cranial cruciate ligament damage has been removed, a cut is made in the top of the tibia.  Measurements are then taken and compared to those from the pre-op x-ray, and the tibial plateau is positioned to make the slope of the knee level.  A plate is then screwed into the top of the bone to allow the bone to heal in its new angular position; the metal plates can be removed later, although this involves another procedure.  To read more about this surgery click TPLO Surgery Procedure.

TPLO Cost?

A Tibial Plateau Leveling Osteotomy is a difficult veterinary procedure, and you should expect to be billed accordingly.  While prices vary across the US, I can tell you first hand an estimate I received for my 90 pound dog.  The estimate came with both a high and low price, and included all of the pre and post operative care, barring any complications, which are not included.  This estimate was from a veterinary speciality hospital, and my dog would have stayed overnight following the surgery with monitoring and pain control.  The low end of the estimate was $3,892.79 and the high end of the estimate was $4,03.58 for TPLO surgery.  The lowest quote I have seen for a TPLO knee repair was $2,500 at a rural veterinary clinic in one of the midwestern states, and I have heard up to $6-7,000 for a TPLO acl surgery at one of the leading veterinary school’s affiliated clinics.  Vets are aware that the cost of a TPLO surgery for your dog can be a difficult burden, and many are willing to work with you to cut out on extra costs and/or create payment plans.

TPLO Surgery Dogs is a post from: Dog Knee Injury

Timber went in for TTA surgery on Tues March 9th, and the surgery went great. I picked her up on Wednesday, the staff said she a had a good night, she was so sweet, she was one of the quiet ones and she didn’t cry or bark. Her first day home was uneventful. She was just so happy to be home and see her brother Tucker (he is my 12 year old male shepard mix). She doesn’t seem to have much pain, her surgical line looks beautiful, and she has moderate bruising and some swelling. She is currently on anti-inflammatory meds, ABT, and pain meds (as needed). The hardest part was taking her to go potty, because she has to be on a leash (which she is not used to), so she would just stand there and stare at me!

Timber is toe touching by Day 3 following the TTA surgery. I think she sometimes forgets and actually puts weight on her leg, but then realizes that it’s still too sore. She has been eating and drinking without difficulty and chewing on her toys (she’s a great patient!!) I forgot to mention that she has taken over my powderoom, that is the only room on our first floor that we can keep her in. She has never been crated, and the other rooms have oversized doorways that we cant baby gait, so the bathroom it is…I think she really likes it!

It’s Saturday March 13, Day 4. We are in the middle of a severe rain/wind storm, so getting Timber to go potty is an obstacle. She wants nothing to do with going outside…UGH! Other than going potty she is doing very good. There is definitely a difference between the two recovery periods, even though she had a great recovery from the TPLO, she had much more discomfort, didn’t eat much, and wasn’t putting weight on her leg at this stage of the game. So far, so good!

Not much to report on Days 5 and 6. Oh yes there is – one thing, I wasn’t paying attention and I forgot to put the baby gait up and the little bugger walked up the entire flight of stairs!!! Mommy was not very happy but she seemed to be okay…thank god!

TTA Surgery Recovery – 1 Week, Timber’s Story is a post from: Dog Knee Injury

Beau at Three and Four Weeks Post Op CCL Repair is a post from: Dog Knee Injury

This week we have seen a big improvement in Beau’s ease in getting around. In fact, he thinks he’s superdog! He clearly isn’t feeling much pain, so we have eased off on the Tramadol, but continue to give him the Metacam and the Acepromozine for sedation. The most difficult part of the week is getting him to just lay around. We’ve invented some little games to keep him busy but still – such as a toy we have that has stuffed, squeaky squirrels hidden in a stuffed tree and he has to work to get them all out. To up that game a bit, we hide a small cookie at the bottom. When he’s really full of himself, a small rawhide chewie settles him down a bit – but they sure don’t last very long. He’s never done well with the big rawhide bones – loves them, but his gums start too bleed. We have some very thick sweet potato chewies that do last longer, but they are expensive.

At the end of the week, Beau had a check up and got his sutures removed. His leg is getting a bit of hair back and the twelve inch incision looks very good. We were very lucky that Beau did not mess with his incision. I was ready with a pair of old boxers and a T shirt, to cover and distract, but they turned out to be unnecessary. The vet was pleased with his progress and indicating we were now entering the physical rehabilitation period. The idea is to build his muscle back up without over stressing the knee joints/ligaments. Her recommendations for the next month:

1. Swim Therapy. The vet hospital has a separate facility with hydrotherapy pool and trainer and is always pushing this. We did this a few years a go when we were first told Beau had hip dysplasia but it’s just too expensive to do it on a regular basis. I’m sure it’s wonderful, but we just couldn’t do that his entire life. However, a limited post op period is doable. We told the vet we could either do it one time a week for a longer period of weeks or two times a week for a shorter period of weeks. She preferred the longer period of weeks, so we’ll be taking him one a week for ten weeks. We do have our own pool that Beau swims in (it’s in ground, so it’s easy for him to get in and out) but we live in Ohio, so this isn’t an option until summer!

2. Stairs. Beau is now to be encouraged to do stairs either once a day for ten minutes or twice a day for five minutes. This is somewhat of a relief to me, since I’m worried that he’ll try this anyway. We’ll still have to keep the stairs blocked off most of the time, however, because the vet doesn’t want him just following us up and down the stairs all day long.

3. Walking on inclines. We are to take him on walks of initially five minutes, increasing an additional five minutes each week to an area with small inclines and zig-zag walk him up and down the inclines. This could have been challenging – Ohio is pretty flat! – but we live a street away from a golf course. We can drive there, get on the path, and walk him up and down the hills. The vet suggested these walks 3 times a week for now.

Beau’s Story – Two Weeks Post Op CCL Repair is a post from: Dog Knee Injury