Just like in Football players and Athletes, cranial cruciate injuries are common occurrences in dogs as well. Anterior cruciate ligament (ACL) aka Cranial Cruciate ligament (CCL) is a band of tissue in the knee joint, responsible for stabilizing the joint during movements. Trauma (sudden jerk, jumping from the bed, running ad making sudden turn etc) can lead to cruciate ligament tears in dogs. It is very important that anterior cruciate ligament injuries are treated surgically in dogs. Tibial Plateau Leveling Osteotomy, or TPLO surgery is the most common surgical procedure to improve the joint’s long-term stability. Compared to other ligament repair procedures, TPLO surgery usually provide more rapid recovery, a better range of motion, less arthritic development and more athletic performance ability.
BREEDS PREDISPOSED TO ACL TEAR:
Pit-bulls, Labradors, Boxers, Rottweilers and Newfoundlands are highly predisposed to ACL injury.
WHO SHOULD GET TPLO:
We strongly recommend TPLO surgery for any dog over 20 pounds with torn ACL. In our experience TPLO surgery has better outcome in dogs over 20 pounds as compared to traditional Extra Capsular Imbrication procedure.
The results of TPLO have been far superior to those of other surgeries. Additional follow up needs to be performed; however, in our practice >95% of dogs return to full function. Additionally, dogs are often able to return to athletic exercises such as hunting or field training.
Before surgery, an x-ray of the stifle is taken to measure the angle at the top of the shin bone, called the tibial plateau angle. The goal of the surgery is to reduce this angle so that dynamic joint instability (cranial tibial thrust) is eliminated. This is usually accomplished by creating a post-surgical angle of between 4 and 10 degrees, an angle not much different than is found in the human knee. In most cases the surgical procedure starts with an exploration of the inside of the stifle joint. This can be done arthroscopically or with open joint surgery. The purpose is to assess the meniscal cartilages for any possible damage. Damaged cartilage must be removed if the dog is to regain normal pain-free function. The TPLO procedure itself involves the use of a curved saw blade to make a curved cut on the inside, or medial, surface of the top of the tibia. The cut top portion is then rotated to create the desired tibial plateau angle. A stainless steel bone plate is then placed on the bone to hold the two pieces in their new alignment.
POST OPERATIVE INSTRUCTIONS:
- WEEK 1 and 2: When you are not at home or your pet is not directly supervised, please keep your pet in a crate, pen, or small room. When you are at home, it is preferable to keep your pet confined. It is absolutely essential to keep her on a LEASH when going to the bathroom outside. At the end of the two weeks your pet should have its incision checked by us or your family veterinarian.
- WEEK 3: The same as weeks 1-2 except, you can allow 5 minute leash walks 2 to 3 times a day. Walk them outside very slowly which will allow them to start to toe touching or to begin to use the leg.
- WEEK 4: The same as weeks 1-3 except you can increase the leash walks to 10 minutes 2 to 3 times a day. You can also start swimming for 10-15 minutes once or twice daily. A pool will work best rather than a lake or beach. Do not allow your pet to jump in the water- assist him or her in or out.
- WEEKS 5: The same as weeks 1-4 except you can increase the leash walks to 15 minutes 2 to 3 times a day.
- WEEK 6: The same as weeks 1-5 except you can increase the leash walks to 20 minutes 2 to 3 times a day.
- WEEK 7: The same as week 1-6, except you can increase the leash walks to 25 minutes 2 to 3 times a day.
- WEEK 8: We recommend a recheck at our clinic at this time. Pending the recheck you may start off leash activity after this next visit.
Remember during these 8 weeks there should be no running, jumping, playing, or using stairs off a leash. Proper confinement is critical in the healing of your pet and over activity can result in implant failure or delayed healing that often requires a second surgery.
Monitor the incision daily for signs of progressive redness, swelling, discharge, or excessive licking. Mild redness and swelling are part of the healing process and should be expected for the first few days after surgery. For orthopedic surgeries the swelling can also travel down the leg and gather around the hock. After the first 3 to 5 days, the swelling and redness should subside and the incision should look better each day. Please call us for advice if you notice excessive swelling, redness, heat, or discharge that is cloudy (pus).
For the first 48 hours after surgery you may ice the incision. To do this use a bag of frozen peas or an ice pack and wrap it in a clean wash towel. The pack may then be applied directly over the incision for 10 to 15 minutes. Only do this if it is well tolerated by your pet.
- Passive Range of Motion: Your pet may benefit from Passive Range of Motion therapy. To do this place your pet with the unoperated side down and flex and extend all the joints in the operated limb as far as what is comfortable. Do not do this if your pet seems to anxious or uncomfortable and tries to “fight” the exercises. You can do this 3 to 4 times a day for 10 to 15 minutes.
- Other rehab exercises maybe recommended as healing progresses. Your pet may also benefit from a formal rehabilitation session. There are many centers available and please let us know if you would like a local referral.
Please give all medications as prescribed by your family veterinarian. Examples of common post operative medications are included below:
- NSAID: This is a non-steroidal anti-inflammatory medication. It is meant to help with pain and inflammation during the healing process. Side effects include gastrointestinal upset and very rarely liver or kidney problems. Please stop the medication and notify us if you see any vomiting or diarrhea.
- ANTIBIOTIC: This medication is an antibiotic and can cause gastrointestinal upset in some patients. Please call u for advice if you see any vomiting or diarrhea.
- TRAMADOL: This medication is a morphine like medication used for pain. The major side effect seen is sedation.
- FENTANYL PATCH: This is a transdermal pain patch. It can be very harmful or fatal is ingested by a person or your dog. Please monitor the patch closely and do not allow your pet to lick or chew at it. It can be removed in 3 to 5 days here at our clinic or at your home.
- Your pet may continue on its normal diet at home. Some pets do not want to eat well for a couple days after anesthesia and surgery but please call us for advice if your pet has not eaten at all in 2 to 3 days.
- Because of the medications and hospitalization dogs can often become constipated after anesthesia or surgery. It is not abnormal for your dog to go 3 to 5 days without a bowel movement. If you notice straining to defecate or your pet has not had a bowel movement in 5 days please call us for advice.
Please make an appointment for the rechecks before you leave today to ensure availability.
- Please bring your pet back for a recheck in 10 to 14 days to check the incision.
- Please bring your pet back in 8 weeks for recheck radiographs to assess the healing of your pet. Please fast your pet the morning before this visit in case sedation is needed.
Please monitor your pet at home for any vomiting, diarrhea, extreme lethargy, or increased respiratory effort. If any of these are seen please call us for advice or bring your pet in for a recheck exam.