What do you do if your dog needs surgery…

I asked Fred Pike, DVM, DACVS from Veterinary Specialty Hospital in San Diego, California to answer a few questions about surgical management of the canine cranial cruciate ligament injury.

AD:What are the current surgical options available?

FP: Common surgical options include tibial plateau leveling osteotomy, tibial cranial closing wedge osteotomy, tibial tuberosity advancement, lateral suture, and the tightrope technique.

AD: How do you decide which procedure to use?

FP:Several factors are considered when recommending a specific surgical procedure for a patient including patient age, preoperative activity level, family lifestyle, breed, tibial plateau angle, tibial geometry (anatomy) and body weight / body condition score. One of the most important intraoperative findings that influence the recommendation for a given procedure is the integrity of the meniscus.

AD:Do you see a pattern with certain breeds that do better with one procedure over another?

FP: Personal experience suggests that certain breeds do better with certain procedures. For example, in my experience, a TPLO is the surgical treatment of choice for Rottweiler and terrier breeds appear to recover faster with the TTA technique. It is important to note that this statement is a personal opinion and controlled studies are not currently available to support superior outcomes with one procedure over another within a given breed.

AD: What are realistic expectation for returning to sporting activities after surgery?

FP: The prognosis for return to activity is dependent upon factors including preexisting arthritis, partial versus complete CCL rupture, concurrent meniscal pathology and the surgical procedure performed. With appropriate surgical intervention and postoperative physical therapy, a return to sporting activity should not be considered an unrealistic goal.

AD: Do cranial cruciate ruptures accounts for 25-30% of stifle lameness?

FP: The percent of lameness is dependent upon the breed and size of the dog. I would agree that CCLR accounts for approximately 25% of stifle lameness in small breed dogs but the percentage is closer to 90% in large breed dogs.

AD: Can these injuries be acute (caused by an athletic or a traumatic event – 20% of cases) or chronic (degenerative)?

FP: Traumatic tears are very rare and are generally only seen in competitive or working dogs. In several cases of acute tears (thought to be traumatic), histopathology frequently supports a degenerative (chronic) process.

AD: Are females are affected more than males, but all dogs are susceptible to them. Can a ligament can usually stand up to 4 times the dog’s weight before breaking.

FP: In 20% of the acute rupture cases, the cause is exceeding the strength of the ligament. The literature is conflicting on the influence of sex as a risk factor for CCLR with recent studies not supporting sex as a risk factor. With respect to traumatic tears, the load / force placed on the ligament is only part of the etiology for ligament failure. Other factors include torque, degree of preexisting collagen degeneration, trochlear notch size, etc.

AD: Is it true that ruptures left untreated show degenerative changes within a few weeks and severe changes within a few months.

FP: This is true and well documented in several studies; however, the rate of progression of degenerative change is related to the severity of the rupture.

AD: Will medial meniscal damage from abnormal joint mechanics occurs in about half the cases.

FP:  X-rays are rarely diagnostic — diagnosis usually requires an MRI to see ligament and meniscal pathology and possibly an arthrocentesis (pulling fluid from the joint – joint cytology) to rule out sepsis and immune-mediated disease. The percent of medial meniscal damage is dependent upon the method used to evaluate pathology (MRI, arthroscopy, visualization, probing). The best method of evaluating meniscal pathology is with probing AND arthroscopic evaluation. MRI may be considered in patients where CCLI is suspected but stifle instability is not present. The small size of the canine CCL (relative to the size of the human ACL) is the limiting factor for the diagnosis of CCLI using MRI.

AD: Is is true that conservative therapy (rest) can be used for dogs under 33 lb, but surgery is recommended for larger/heavier dogs because it speeds recovery, prevents degenerative changes, and improves function.

FP: It is important to note that with conservative therapy, the ligament does not heal; stifle support is provided by periarticular fibrosis (scar tissue) that minimizes cranial translation of the tibia thereby decreasing stifle effusion and pain. A body weight of less than 40 lbs has been reported to be associated with a positive outcome without surgery; however, no controlled studies have been preformed to support this subjective assessment. In my opinion patient age, activity level, desired function, degree of instability, and meniscal status are far more important factors than body weight in determining the need (and benefit) of surgical intervention.

AD: Regardless of surgical procedure, is the success rate is about 85%, with 10%- 15% of cases requiring a second surgery because of subsequent meniscal damage.

FP: The subsequent meniscal tear rate ranges from 2-22% depending upon the procedure. The TPLO has been shown to have a “protective effect” on the meniscus and in my experience is the preferred technique for patients with CCLI that do not have meniscal injuries at the time of the initial surgery.

AD: Will 40% of the cases, the second knee will rupture in within 18 months?

FP: In Labradors, the literature states that 50% of patients will tear the contralateral CCL within one year. The risk is not published for other breeds.

AD: Is it reasonable to say that in general, dogs with CrCL injuries should not be bred.

FP: A genetic component is suspected to be involved with the collagen degeneration that contributes to CCL failure and supports the recommendation that affected dogs should not be bred. This genetic component has been documented in Newfoundland dogs but to my knowledge has not been confirmed in other breeds.

For more information click on The Vetpodcast link.

For additional information check out:

Four Leg Rehabilitation Therapy – Monthly Article

http://www.cleanrun.com/images/productfiles/Stretching%20DVD%20Review.pdf

Fido’n Friends | Pet Care Services, Training and Education for Pets and People in motion

Desire Snelleman from fidonfriends.com chatted with me about “Nose Work”.

AD: What is Nose Work? Are there other names for it?

DS: K9 Nose Work is a general term defining that a dog is using it’s keen nose to search for something specific, determined by us. (vs. “leisure sniffing.”) Dogs have an amazing sense of smell and a natural desire to hunt.  The sport of K9 Nose Work is designed to develop your dog’s natural scenting abilities by using their desire to hunt and their love of toys, food and exercise.

AD: How do I know if my dog would be good at it?

DS: All dogs are born with an innate ability to discriminate scent, so it stands to reason that any dog can play the game.

AD: How will my dog benefit from this type of activity?

DS: K9 Nose Work is a great way for your dog to have fun and to create a stronger bond/relationship with you.  It builds focus and confidence and burns lots of mental and physical energy.  Any breed can do it.  All ages of dogs and people can do it.  K9 Nose Work can be done anywhere and uses minimal equipment.  This activity/sports works well for socially challenged dogs (fearful, shy and reactive).

AD: Do dogs work alone, in pairs or as a group?

DS: Dogs and handlers work individually.  (One team at a time.)

AD: Does my dog need to be physically fit to participate in Nose Work?

DS: Your dog does not need to be physically fit to play the game of K9 Nose Work.  We see dogs participate that are physically challenged ie: blind, hearing impaired, and don’t have full use of their 4 limbs.  We see quite a few seniors and retired performance dogs as well.

AD: Is special equipment required?

DS: The equipment that is being used is minimal and are common household items., ie: boxes (any kind: cardboard, Tupperware, plastic containers etc.) A favorite toy or a favorite food.  Once the dog gets on odor we have to add Q-tips to our list and 1-3 familiar odors (essential oils.)

AD: Are there certain skills that can be practiced without an instructor?

DS: All the skills taught in class can be practiced at home w/o an instructor.  Everyone is encouraged to practice in small bouts.  This is easy and it is a positive activity to do with your dog.

AD: How do I get started?

DS: Workshops and classes are formed all the time.  To see if there are any offered in your area, go towww.k9noseworks.com or www.funnosework.com.  If there is nothing offered in your area and you would like to host a workshop, please contact info@k9noseworks.com ordesiree@k9noseworks.com.

AD: How does one locate a qualified Nose work trainer?

DS: Please look under www.k9noseworks.com