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ACL question--to operate or not?

742 Views 9 Replies 9 Participants Last post by  Manena
JUst to cure me of my recent bout of dog-lust, my 12.5 year old shar-pit, Clay, has been diagnosed with a blown ACL (anterior cruciate ligament) on his left hind leg. Now we have a dilemma: to operate or not?

He gets around fine, and even puts weight on the bad leg, but gingerly. You can just start to see the difference in the musculature of the two legs. IT doesn't seem to be cramping his style in any way.

Our vet said that, left untreated, the joint would develop arthritis that would stabilize it a little bit. The big issues are pain (which he doesn't seem to be experiencing much of) and the risk of blowing the ACL on his other hind leg, since dogs that have this problem in one leg sometimes also have it on the other.

The surgery would be expensive and involve at least 6 weeks of pretty intensive rehab where his activity would have to be stringently controlled. As an older dog, he is considered a higher risk for surgery, but my vet said that he seems very "young" and fit for his age. Of course, they would do bloodwork first to make sure he was a good anesthesia risk.

If it seemed to be bothering him at all, this would be an easy decision, but other than a little hopping, he seems completely unconcerned. In fact, we have had to take him off of the painkillers the vet prescribed, since he seemed to lose all sense of pain/caution and was doing crazy things that would have gotten him hurt, blown ACL or not. (like ripping off crawlspace vent covers with his teeth and leaping through 1.5 square foot vent holes onto bushes....repeatedly.)

Restricting his activity is going to be very difficult, due to his separation anxiety and claustrophobia. He is the opposite of crate-trained, having destroyed several crates and hurt himself in the process of escaping them. We have a small mud room that he could be confined to, possibly, or he might eat through the door (says the voice of experience). We would probably have to keep him sedated. I would hate to put him through surgery and then screw it all up in rehab. If I waited until the end of the school year, I could just keep him leashed to me and be very sedentary, if I weren't due to have a new baby right at that time.

I am leaning towards not operating, because his quality of life seems so good, He's 12 and a half, he seems unconcerned, and, when not on Rimadyl, his activity level is actually pretty low. On the other hand, it would be horrible to have him blow out his other knee.

Advice from anyone with experience with older dogs or ACL issues in dogs would be most appreciated.
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You're talking TPLO, right?

At his age I would not do surgery, but I am far from a Pei expert. In geriatric Danes, even if we can get them through the surgery the recovery period usually signals a pretty severe decline. After all those weeks of rest the back end is pretty weak, and the surgery makes things worse. I would not hesitate in doing TPLO for a young dog or a lightly built dog of medium age, but it's pretty traumatic for oldsters.

This: (you'll need to keep clicking "next installment" to follow the whole saga) is the story of one Dane who had TPLO at age six; he struggled for a year with surgery-related complications and the TPLO ultimately failed. Due to infection and his limited mobility, he was put down. (By the way, ginnie's dadane is the ultimate eye candy for Dane lovers, so browse around.)
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At his age, I wouldn't do TPLO. In a younger dog, absolutely. My 9yo Rottie has a ruptured ACL repaired 4 years ago and the recovery wasn't too bad- but he was a younger dog with lots of muscle mass to spare, so to speak. Leaving them unrepaired in smaller (or just not really large dogs) dogs is easier- less weight on that leg and even with arthritis, they can compensate. A very large dog has a harder time compensating and the arthritis can be really debilitating. One of the vets I work with is fine with older, non-giant breed dogs going unrepaired- he recommends letting the dog choose his/her exercise and whatever anti-inflammatory or combo of them works the best for that particular animal, plus hydro therapy if possible.
I am sheepish that I don't know the name of the surgery. It would involve attaching cables to either side of his knee to stabilize the joint. After doing some reading, it sounds more like traditional stabilization surgery than TPO.

Clay is about 50 pounds (he has only varied between 49 - 51 pounds in the 11 years I have had him), and has very good muscle mass and tone. He is a shar-pei/APBT cross, so is muscular in that way, and is in really good shape for his age, but I am really wary of the recovery cutting into his quality of life more than the injury does.

Thanks for the dadane link--she's in my town! The Jasper story seemed like all of my fears realized, although obviously there's a big difference between a dane and my little (relatively) mutt! Of course, now I'm looking at all of the dane rescue pages in SC.
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My 10 year old has a blown acl and we will not do surgery. He gets around fine- it seems to be the end of the day that he slows down. The expense is a part of it, plus he's older and if he's doing ok then I am not going to put him through that.
My dog had the surgery 1 1/2 to 2 years ago. So, that would have made him... 9ish I guess. He is 65 pounds, so 9 years old is definitely not young.

I am very glad we had it done. The recovery was long and annoying to all involved, but it did help stabilize the joint and decrease pain/limping. Like your dog, my "old" dog is very fit and healthy for his age. So, that had something to do with our decision. He came through the surgery and recovery just fine and the only complication was that, because he was older, he started developing arthritis in that knee more quickly than a younger dog would. He is now doing fine and is on no maintenance drugs (besides glucosamine/chondroitin). We give aspirin when he is seeming especially achy but that has only been a couple of times this year.

All that being said, had Jake been much older or not as healthy as he was, both my orthopedic and regular vets said that they would not have recommended surgery. They would have just let the joint heal as it could and supported with painkillers as needed. At 12.5 years old, I would probably lean toward that.

Is your vet saying that, by leaving the blown ACL untreated, that you are putting the dog at increased risk of blowing the other ACL? Because, that is not the info that my vets have given me. They told me that the reason that so many dogs (I think it is like 50 percent) blow a second ACL is just because of the anatomy and history of the dog - that it has nothing to do with the other leg. In other words, whatever forces and musculoskeletal abnormalities caused the first ACL to blow are often present in the other leg.
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I agree with others and wouldn't do it. At that age, I'd do what can be done to strengthen the joints non-surgically and treat for pain when needed, but it's too old for surgery, IMO.
See if you can find someone who does cold laser therapy. It has an incredible success rate with ligament and tendon trauma. It's not cheap but it's WAY cheaper than surgery and totally non invasive. If you call this company They may be able to put you in touch with either a human practioner willing to work with animals or a horse vet or horse chiro who is using it (its becoming incredibly common for race horses)
My dog had that surgery at 2 years old and I had to keep him on a leash with me during the healing process so he couldn't run and jump around...

But I don't think I would do it at 12.5 years old.
I don't recommend surgery on your dog. He is too old.

I have had two agility dogs that required surgery, but they were young.

Make sure that your dog is comfortable and as pain free as possible. Ask your vet to prescribe a pain med and some sort of anti inflammatory medication. Remember, dogs are very stoic when it comes to pain. ACL tears are painful, even more so if the meniscus is torn. Don't let your dog suffer unnecessarily.
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