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TPLO a bunch of garbage surgery?


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#1 MrSnappy

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Posted 11 May 2012 - 02:17 PM

I fear my Dexter has torn his ACL. He's non weight bearing on his hind leg. We're off to the vet to diagnose for sure, but in the meantime I'm doing everything I tell people not to do (panic) and making it worse (reading things that make me panic even more).

Looking through stuff on the interwebz about how to perform the drawer test, and likelihood of success of returning to competition after surgery and such, I came across this article that tells us that TPLO is an essentially useless surgery and has no greater chance of recovery to the dog than conservative treatment. I lack the medical knowledge - and currently, the sane deductive power of reasoning - to form an opinion on its validity. Does anyone have any feedback / personal experience to share? This dog owner is very poor and cannot begin to fathom where I will come up with the $3500 to so TPLO if it comes to that, but will find the money if need be. But is it really pointless??

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#2 PSmitty

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Posted 11 May 2012 - 02:26 PM

I have no input on TPLO, but I'll keep my fingers crossed that it's not an ACL, but maybe an iliopsoas strain/tear, instead? I know two agility border collies that had this injury and I think it presents like a possible ACL issue. Hard to diagnose, but quite recoverable with time.

http://www.vetsports...byistOwner.html

http://www.michvet.c...opsoas_tear.pdf

Good thoughts for Dex!
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#3 Alchemist

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Posted 11 May 2012 - 02:33 PM

No input, either, but I do want to offer my best healing mojo to Dexter. As well as my best vibes to you!!!!

#4 MaryP

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Posted 11 May 2012 - 02:54 PM

No personal experience, but a good friend of mine has a lab that tore her ACL before she was even a year old. Her vet did a lateral suture technique as opposed to TPLO or TTA. I don't remember what the cost was. Her dog is now 5 years old and competes in agility. She hasn't had any further issues with her knees and the suture has held up so far.

Hopefully, that's not what you are facing with Dexter, though.

Edited because I called it the wrong thing.

Also, I thought this was interesting regarding TPLO.
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#5 Pippin's person

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Posted 11 May 2012 - 03:37 PM

Sorry, to hear. I have nothing to share on the TPLO--but, you can hold out hope that it's not a tear. My dog acted like he had a torn ACL--several people with dogs who'd had them told me that it was almost certainly that when they saw him walk.

But, in the end, it was at most a strain. Took two months to heal. This year, he again came up lame on a hind leg and it turned out to be a muscle strain (and in fact the rehab vet who saw him said that she wondered if the first one had been a muscle strain as well). Again, two months to heal, but conservative care did the trick.

Grenzehund had something very similar with one of her dogs--and in her case the regular vet even referred to an ortho vet, who determine that there was no tear. The regular vet thought it was a torn ACL.

So, fingers crossed it's not that and if your vet says it is, it'll probably be worth getting a specialist opinion.
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#6 emilyfalk

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Posted 11 May 2012 - 04:14 PM

I am headed out the door for the weekend, but I wanted to quickly respond that the TPLO is turning out to be a bit of a controversial technique. I have heard very knowledgeable and experienced orthopedic surgeons say that they will not do the procedure because "when it goes bad, it goes REALLY bad." In other words, when complications arise, they are difficult to fix because of the extent of the cutting/plating/re-aligning that was done during the original repair.

The TTA is another technique that many surgeons perform. It also is rather invasive and extensive as far as cutting/plating/re-aligning.

The Tightrope is a newer procedure that fewer surgeons perform. I've watched videos of the surgery and it is fairly non-invasive, yet reported to provide a lot of stability.

I would not recommend a lateral suture in an active border collie. That procedure works best in very small dogs. The Tightrope is a souped-up version of the lateral suture that I'd be more inclined to recommend in a medium to large dog.

There are so many ways to repair a torn CCL...which tells us that no one way is going to be the be all, end all for every dog. I've known dogs who have undergone each of these repairs...some have done well, others not-so-well. I'd recommend finding an orthopedic surgeon that you are comfortable with and following their plan. And a second-opinion never hurts.

And it may not be a ruptured cruciate. A number of soft-tissue injuries could present as such, but would take a skilled set of hands to accurately diagnose.

AND...even if it is torn, depending on the severity, a conservative approach combined with a dedicated owner can be very successful.

Whichever route you go, rehab is key! But I am biased :)

Sorry to post and run...

Emily (VMD)
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#7 chi chi pup

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Posted 11 May 2012 - 05:32 PM

Hi, my dog had the lateral suture repair last July. He is a very active 40lb lab mix, the orthapedic surgeon said that TPLO is overkill for alot of dogs. All the surgeries rely on scar tissue to build up, re-hab and confinement are the key to success. The lateral suture is a little more delicate in the recovery stage, you have to be very careful, no running, no jumping, just walking very slowly for the first several weeks. After the stitches came out he was cleared for swimming,re-hab work and longer walks. He was allowd to be out of the crate right after surgery as long as he was calm, that did not work so he stayed in the crate for 2 weeks. At 4 monthes I started letting him have some off-leash time, supervised, at 9 monthes I let him go. He is not an agility dog but he is very energetic he can run and do spins with the best of them.
I would suggest you see an orthapedic surgeon, some regular vets don't seem to be able to diagnose ACL injuries, at least mine didn't, he actually told me that my dog was limping because of his back. I rested him a couple for monthes with no results and then took him to an orthapedic. In the 2 monthes that his knee was unstable he had already started to get arthritis. She diagnosed his knee in 2 seconds.
The surgery cost us 1,300, that did not include the re-hab. You can also join Yahoo Ortho-dogs, great info! Good luck! Cindi

#8 Jim Kling

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Posted 11 May 2012 - 06:51 PM

I've heard a lot about dogs having partial ACL tears, and I believe those will heal on their own.

In humans complete tears require surgical repair, but partial tears generally don't. So here's hoping if it is the ACL, that it's partial!
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#9 juliepoudrier

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Posted 11 May 2012 - 07:31 PM

I've used the conservative approach with two dogs (one with two tears), followed up with rehab, successfully (largely because I don't have that kind of $$, nor any way to get it). For one of the dogs, it was the result of an injury (she was under a truck and the owner wasn't aware and started to drive off and caught her hind leg under the wheel) and actually didn't become obvious until the primary injury (to the hip) healed and she still had unexplained lameness (during rehab from the hip injury). Originally the rehab vet was very pessimistic about getting her working again with the knee problem, but we got her back to where she could run an open sheepdog course. (That injury happened when she was around 7. She never had another problem with that leg. I had to put her to sleep last week, a couple months shy of 16, because she could no longer get up. In the end, her hips were her undoing, not from the injury but because she was severely dysplastic and no longer had the muscling to hold her hips in place--the knee stayed good.) If it's a muscle issue instead, then a conservative approach would help that too.

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#10 MrSnappy

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Posted 11 May 2012 - 07:49 PM

Hey everyone, thanks for the info! As my vet visit was not until late afternoon, I had some time to (calm down and) ponder Dexter's tripodding. As the afternoon wore on, I became fairly convinced the problem was his foot, NOT his knee. And to be sure, the vet felt the same. So we x-rayed his foot and he has hyper-extended his 4th digit, and there *might* be a slight fracture on the toe, but she said his knees were fantastic. Apparently, he is all head and sinew, so it was easy to tell that his knees are in fine shape or some such thing (lest anyone fret, my vets are sport rehab vets, so they know their stuff). She also pointed out that he was "very strong for such a slip of a thing" ;-)

Apparently you can't do much for toes but tape them together, so that's what we did. He may heal in time for Regionals even. Thanks for all the info, and the mojo! It's nevertheless good information to have.

RDM (and a pouty taped up D-Mo)
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#11 Beach BCs

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Posted 11 May 2012 - 08:01 PM

Very relieved for you and Dexter that it's not his ACL. And crossing fingers, toes and paws that he heals up quickly!
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#12 MaryP

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Posted 11 May 2012 - 08:17 PM

I'm sorry about Dexter's injures toe, but I'm glad to hear that it wasn't a torn ACL. Hope he heals quickly.
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#13 Cyberdog

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Posted 11 May 2012 - 08:55 PM

I hopped on google scholar to see what the literature said about TPLO. There were lots of studies on complications that can occur, but the surgery seems generally accepted within the veterinary community as a helpful technique. One thing I did find was that there were some concerns about scientifically evaluating the success of TPLO surgeries early, and long term, after the procedure. Owner satisfaction, however, was pretty high in a couple studies a glanced at.

#14 arf2184

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Posted 12 May 2012 - 12:22 AM

Glad to hear it not a torn ACL.

For future reference here's my thoughts/experience on surgery vs. conservative management...
There's no harm in giving conservative management a try. If it doesn't work, then you can opt for surgery later.

My Matty tore her left ACL at age 8. At that time, the vet felt that she may have also had a partial tear on the right (either that or she just had really loose knees). After doing tons of research and talking to my vet, and considering costs, I opted to give conservative management a try. The thing that really made sense to me was that if it doesn't work out, surgery is still an option. So while you're working on confining and restricting movement of the knee and keeping the dog entertained, you can also be researching and saving up money for the surgery just in case. The only downside is keeping the dog restricted for such a long period, but you've got to do that regardless of which path you choose.

In Matty's case, conservative management worked. My vet (who had been skeptical at first) was thrilled. We did have a few set backs so I purchased a knee brace for Matty so that she could move around a bit more while still keeping the knee stable. She first tore her ACL in February and was running again by late September. (I don't think it would not have taken so long if I had been more diligent in confining her and/or had bought the brace sooner).

I was not a fan of TPLO. While I know it works in many cases, too much could go wrong and it just didn't sound like a good option to me. I liked the Tightrope option the best because it was least invasive and sounded promising. Really though, apart from TPLO, all the surgical options basically rely on the same thing as conservative management (allowing scar tissue to build up around the joint to stabilize it).

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#15 PSmitty

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Posted 13 May 2012 - 08:22 AM

Glad to hear it's not an ACL!
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#16 rushdoggie

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Posted 13 May 2012 - 10:32 AM

Good news, hopefully he will feel better soon, and thanks for bringing it up because I learned something.

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#17 bc4ever

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Posted 13 May 2012 - 11:35 AM

Happy to read the news about Dexter, although I'm sure he's in some "discomfort" (the medical term for pain)! Now you can breathe a sigh of relief, at least until the next incident. Seems like it's always something that keeps us up at night worrying about them. :rolleyes:

#18 blackacre

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Posted 14 May 2012 - 09:56 AM

Glad to hear it was not the ACL. Just a quick note for anyone else reading this. Anectdotal evidence only of course, but I had the TPLO done on my then-4 year old working collie. He went on to have a long and successful working career. Now, at 14, he does favour that leg slightly, and has clearly developed some arthritis, but overall I'd say he had an excellent outcome. Arthritic changes will occur regardless of the procedure. Of course. the surgery was done by a highly qualified orthopaedic surgeon in a major urban centre, and no doubt that figured in the outcome. In fact, my dog was part of a study comparing this then relatively new surgery to other, more conventional types. I had been promised a look at the study once it was completed, but that never happened. I wonder whether it is now available somewhere? I'd be very interested to see it. In any case, the surgeon was very definitely not in favour of conservative management for a highly active working dog (which I had already tried in any case). But then, he would be, eh?

A

#19 2 Devils

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Posted 14 May 2012 - 12:53 PM

Glad it was not the CCL.

My experience with the TPLO was having it done on my 7 yr old cattledog and then on the other knee at 9 yr old. We had a great experience both times. She was able to come back and compete in flyball without issue. She was retired at the age of 12. She did end up having an allergic reaction to the plate/screws from the second surgery so we removed it when she was 12 (just after her retirement from flyball). For the most part her knees never really have her any problems. We lost her in March which was 9 months after an oral melanoma diagnosis and another tumor that showed up along her spine.

I would do TPLO again in a heart beat. We did spend months doing rehab exercises...
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#20 mum24dog

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Posted 14 May 2012 - 01:09 PM

I chose an extracapsular repair for my 13 year old BC x and it's been great. At his age I didn't think the cost of a TPLO or variant was worthwhile.

My surgeon is one of the best in the country and favours TPLO on current evidence, and he does a lot of work on agility dogs.

A friend's young dog has had 2 TTAs and could have returned to normal competition but he also has an old shoulder injury so he just works over Medium height now.

Take your pick.


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