51kg dog with ruptured ACl

RE: 51kg dog with ruptured ACl

Julian Earl — Wed, 11 May 2016 10:48:01 GMT

Maybe this should be a tangent but on the human front, I know one vet who sustained this playing football about thirty years ago, mind you and did not receive surgery but was sumply told to swap to playing tennis instead; less twisting I suppose.

At Lincs BVA we had a talk about stem cell therapy for joints and platelet-rich plasma led to questions about the use of blood for cruciates. This was frowned on because blood is a rich source of pro-inflammatory mediators, it was noted. So all those dogs in which Iinjected 10-20mls blood have arthritis because of the blood aggravating the initial lesion and instability? Oops!!

RE: 51kg dog with ruptured ACl

John Wessels — Wed, 11 May 2016 08:58:05 GMT

In my experience OTT works very well for animals up to 25 kg.

RE: 51kg dog with ruptured ACl

Hannah Wynne Richards — Wed, 11 May 2016 08:11:00 GMT

Years ago I pointed out that that was an option when the dog wasn't suitable for the behind the fabellae approach, and referral wasn't an option.

I attracted the wrath of Malcolm.

Wynne

RE: 51kg dog with ruptured ACl

John Wessels — Tue, 10 May 2016 19:42:44 GMT

So.. any users of the modified over the top fascia lata strip in the UK?

RE: 51kg dog with ruptured ACl

Martin Atkinson — Mon, 26 Oct 2015 09:29:24 GMT

[quote user="David Mills"] Atko, this.is not an invitation to send this one to putney. [/quote]I thought they were closed to new business. Anyway he's not on any income support just poor!

RE: 51kg dog with ruptured ACl

David Mills — Sat, 24 Oct 2015 00:45:54 GMT

[quote user="Kay Varley"]

I have an ongoing case at the moment of a 13 year old, 15 kg crossbreed with a CCL rupture. We were going to refer him for an osteotomy but discovered that, on reading the small print, he was insured for £3000 vets fees but only £1500 for a cruciate problem. (Legal and General). That would cover a lateral stabilisation with us but am I going to make matters worse and should we continue to rest him.......? He has stayed about 6/10 lame and I usually tell owners they should improve after 6 weeks. I have heard about the injecting blood thing and I am old enough to remember the half pence (just!)

[/quote]

It depends where you're based but you can, up north, get a modified mmp which Malcolm has been heavily involved in developing for 1500-2000. My mother's dog (choc lab, Xmas present from me naturally) has had both cruciate done by same procedure and done fabulously. There are places down south offering the same procedure for a fixed price.

Re original question at the RSPCA we see a lot of last chance salooners bug dogs needing cruciate ops. Most seem to do.ok/well with lfs. Atko, this.is not an invitation to send this one to putney.

RE: 51kg dog with ruptured ACl

Rob Loxley — Fri, 23 Oct 2015 22:47:40 GMT

[quote user="Martin Atkinson"]The case I opened this thread with had obviously been left too long as after 6 months it was still lame and had a lot of muscle wastage[/quote]

So what makes one think that continued conservative management will improve things?

RE: 51kg dog with ruptured ACl

stuart mcmorrow — Fri, 23 Oct 2015 20:12:33 GMT

[quote user="Robin Grimmer"]

[quote user="Kay Varley"]

I was under the impression that the small dog = lateral suture argument had been disregarded. I was told that certain breeds such as westies and cairns have steep tibial plateau angles and lateral sutures would probably fail. I probably will operate on this dog next week - just interested in other peoples' opinions since it's such a common problem.

[/quote]

I have heard that re westies, but if lateral sutures aren't good for small dogs, then what are they good for? Also, I would have thought you could get problems with bone healing in an older dog. I'd be interested to know if there is an upper age limit for osteotomy type acl repairs.

[/quote]

The second MMP surgey I did was on a fat 17kg 13 year old dog.

i got advice from Malcom before doing it and he basically said that as long as I did it right it would be fine. Fortunately it has done brilliantly well and now not lame.

RE: 51kg dog with ruptured ACl

Kay Varley — Fri, 23 Oct 2015 19:58:19 GMT

I didn't expect such positivity! I find the same thing- I don't expect it to work but the clients seem to think it does.

RE: 51kg dog with ruptured ACl

Evelyn Barbour-Hill — Fri, 23 Oct 2015 19:18:18 GMT

[quote user="Kay Varley"] Can I throw cartrophen into the discussion?[/quote]

By all means.

It works very nicely in the right cases.

RE: 51kg dog with ruptured ACl

Martin Atkinson — Fri, 23 Oct 2015 19:10:55 GMT

[quote user="Kay Varley"]Can I throw cartrophen into the discussion?[/quote]Presuming you don't mean for our dodgy knees. IME works very well in early cases of OA but not so well in advanced cases and its useless in mechanical lameness like ACL disease. I started using it quite cynically years ago to stop clients buying NSAIDs and nutriceuticals off the internet but discovered that it actually worked very well. And its seems even more useful in cats than dogs. Be wary of using it animals with renal disease - I made one dog worse although it recovered and it is probably no more of an issue than using NSAIDs in that situation, but I've never had any problems with vomiting or bleeding. Clients love it as well as there's no pills or liquid to give!

RE: 51kg dog with ruptured ACl

Kay Varley — Fri, 23 Oct 2015 18:30:48 GMT

Sorry to hear about your dodgy knees everyone! I remember playing rugby when one of our team tore her cruciate and fell over screaming. Proper put us all off. Can I throw cartrophen into the discussion?

RE: 51kg dog with ruptured ACl

Martin Atkinson — Fri, 23 Oct 2015 18:18:49 GMT

[quote user="Robin Grimmer"]So you had the whole meniscus removed? [/quote]Not quite sure TBH, It was a bucket handle tear of the lateral menisicus so he probably just remove that and left some behind. Any way the knee is fine.

[quote user="Robin Grimmer"]My human OS said that taking glucosamine was bit like eating hair to cure baldness[/quote]Opinions are divided on this but placebo effect apart, and I'm determined not to fall into that trap, I have stopped and started glucosamine/chondrotin several times and each time I've stopped my knees got worse and then improved again when I restarted. I find Synoquin is best!! When I started Omega 3 supplementation there was another marked improvement. I can only report my experience.

RE: 51kg dog with ruptured ACl

Robin Grimmer — Fri, 23 Oct 2015 18:02:05 GMT

[quote user="Martin Atkinson"]

Incidentally I take shed loads of glucosamine/chondroitin and Omega 3 supplements - anyone care to start a discussion on that?

[/quote]

OK. My human OS said that taking glucosamine was bit like eating hair to cure baldness

RE: 51kg dog with ruptured ACl

Robin Grimmer — Fri, 23 Oct 2015 16:50:31 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"] Ironically I've had more problems in the other knee due to non traumatic meniscus tears. I've lost 2/3 of the meniscus now. Walking and cycling are fine, but I get some gib running.[/quote]Funny you should mention it but after I had a meniscus removed from the knee in which I tore the ACL I've had no problems and can do anything, i just wear a brace skiing as a precaution. However the other knee gives me some problems from time to time and 10K is the most I'd want to push it running. Sometimes it is acutely painful after a mile or two cycling but if I push on it settles down and I can do 100 miles. I get the impression that it is a patella tracking problem but I do also suspect I have a partial ACL tear and meniscal problem that side. But hey-ho I'm not going to volunteer to go under the knife again unless if becomes intractable as the left side took months to recover after meniscal surgery.

Incidentally I take shed loads of glucosamine/chondroitin and Omega 3 supplements - anyone care to start a discussion on that?

[/quote]

So you had the whole meniscus removed? My OS did say he could do a new operation where they replace the meniscus with pig cartilage and also do an osteotomy to transfer the load off the medial side. I can run 10k ok 2-3 times a week but if I do more it gives me jib. With cycling I was getting problems in this knee, but have solved it by reducing the saddle height to sljghtly lower the normal recommended. Since then have had no problems cycling and have done a lot of miles,

RE: 51kg dog with ruptured ACl

Martin Atkinson — Fri, 23 Oct 2015 16:40:44 GMT

Incidentally I take shed loads of glucosamine/chondroitin and Omega 3 supplements - anyone care to start a discussion on that?

RE: 51kg dog with ruptured ACl

Martin Atkinson — Fri, 23 Oct 2015 16:32:33 GMT

[quote user="Kay Varley"]I was under the impression that the small dog = lateral suture argument had been disregarded. I was told that certain breeds such as westies and cairns have steep tibial plateau angles and lateral sutures would probably fail.[/quote]I did one on a Shih-tzu a few months ago and found it was very difficult to get the suture needle round the lateral fabella through the arthrotomy incision and felt that the length of the suture in relation to how flat I could lay it didn't give me much confidence in its mechanical advantage and there was still some residual anterior drawer. The dog has done OK but it might have been just as good with nothing.

RE: 51kg dog with ruptured ACl

Robin Grimmer — Fri, 23 Oct 2015 16:13:39 GMT

[quote user="Martin Atkinson"]

[quote user="Kay Varley"]How long do people tend to rest them for before they decide to operate in house?[/quote]I would probably give it time for the acute inflammation and pain to subside so about 2 weeks. It then depends on the level of instability, if its rocking all over the shop I'd get on with it, but if it was pretty stable, if it was improving then for as long as it continued to improve. The case I opened this thread with had obviously been left too long as after 6 months it was still lame and had a lot of muscle wastage.

In humans they will often operate within hours of an acute trauma (well they do in ski resorts) but I didn't have mine repaired after tearing it skiing and 15 years later its still going strong. No-one believed I'd done it until I had an MRI as there was virtually no instability but I knew I had because I felt it go pop!

[/quote]

In people acl tears are usually associated with significant trauma. I tore mine playing football. I heard it snap, the pain was severe and it swellled like a balloon. (A&E sent me away and said it was just a sprain!) I did have it repaired some months later, but I did push for it. We have a naturally flat tibial plateau so they don't always operate - depends on your activities, age etc. This knee had a very good result. Ironically I've had more problems in the other knee due to non traumatic meniscus tears. I've lost 2/3 of the meniscus now. Walking and cycling are fine, but I get some gib running.

RE: 51kg dog with ruptured ACl

Robin Grimmer — Fri, 23 Oct 2015 16:07:17 GMT

[quote user="Kay Varley"]

[/quote]

RE: 51kg dog with ruptured ACl

Martin Atkinson — Fri, 23 Oct 2015 16:00:01 GMT

RE: 51kg dog with ruptured ACl

Kay Varley — Fri, 23 Oct 2015 15:58:50 GMT

RE: 51kg dog with ruptured ACl

Robin Grimmer — Fri, 23 Oct 2015 15:50:49 GMT

[quote user="Kay Varley"]

maybe worse was the wrong phrase- reading the discussion above I am only wondering if the dog is eventually going to get better anyway without me operating. How long do people tend to rest them for before they decide to operate in house?

[/quote]

Depends how unstable, how lame dog is etc. If pretty unstable and dog lame then I would operate straight away. Can't see why you would want to refer a 13 yo smallish dog for a much more invasive surgery when a lateral suture would suffice.

RE: 51kg dog with ruptured ACl

Kay Varley — Fri, 23 Oct 2015 15:37:05 GMT

RE: 51kg dog with ruptured ACl

Kay Varley — Fri, 23 Oct 2015 15:32:15 GMT

sorry Martin, I meant that £1500 wasn't enough for a referral osteotomy. Our lateral stabilisations are about £400 plus drugs

RE: 51kg dog with ruptured ACl

Martin Atkinson — Fri, 23 Oct 2015 15:30:08 GMT

[quote user="Kay Varley"] £1500 for a cruciate problem That would cover a lateral stabilisation with us[/quote]Sorry Kay but I think that is exorbitant for a lateral stabilisation which would take an hour at most with no special kit, 30 minutes if you're experienced. That is a £500 operation at most, get on with it.