Ed Note: Cal Cadmus DVM has been involved in
Field Trials for more than 20 years and won the '86 National Amateur
Championship with NAFC-FC Winsom Cargo. His office is located in Oakdale,
California where he specializes in TPLO repair (cruciate injury).
QUESTION
Over the past few months our five year old lab, "Max," has
shown a
slight lameness in his right rear leg. He seems fine in the morning
but after a few retrieves and some time in the crate he comes out
holding it up. Our vet checked him and took x-rays. He says that although
he
can't feel any problems there does seem to be increased water in
the knee on the x-ray. His best assessment is that "Max" has a
partially torn anterior cruciate ligament. He gave us the following options:
wait and see and take anti-inflammatory medication. Have him do a surgery
with fishing line, or take "Max" to a specialist for what is
called a TPLO surgery. "Max" is still young and we hunt test,
field trial, and hunt him. We would I like to continue all of these
activities. What do you think we should do?
ANSWER
Wow, that is a good and unfortunately too often asked question. Assuming your
veterinarian's tentative diagnosis is correct and I suspect it is, your doctor
gave you the correct options. Let us take a look at each, but first let's discuss
the anterior cruciate ligament function in the stifle. The primary role is to
prevent the tibia from sliding forward on each step, a complete tear would allow
significant forward thrust to occur and a partial tear will allow proportionally
less thrust. Therefore, the more stretch and tear, the more thrust.
This thrust results in which instability leads to inflammation and eventually
arthritis and degenerative joint disease. The thrust also allows for a crushing
or pinching of a cushion in the back of the joint called the miniscus. This also
adds to the pain and lameness.
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Rest and anti-inflammatory medication, although at one time was thought to be
the treatment of choice is now considered only palliative and the associated
arthritis will continue to get worse. I see no benefit to the "wait and
see" approach, and the sooner "Max's" joint is stabilized the
better he will do.
The literature has described many surgical stabilization techniques. Some of
these involve ligament graft replacement inside the joint and others involve
tightening of the soft tissues outside of the joint. I think of these as a surgical
ace bandage, the fishing line suture is one of these. It is very important that
the affected joint be inspected either with a scope or a traditional surgical
exploration. All of the damaged ligament be removed and the miniscus be inspected
and treated.
Although all of the above techniques benefit the patient, the larger dogs (lab
size) and up, tend to achieve less than ideal results and arthritis usually will
continue to develop.
In the early 80's, Dr. Barcley Solcum developed a revelotomy technique that actually
changes the mechanics of the rear leg such to eliminate the need for the cranial
cruciate ligament. The details of the procedure have been published in the RFTN
July 2002. The unique quality of the Tibial Plateau Leveling Osteotomy (TPLO)
procedure is that when done properly, it essentially halts the development of
additional arthritis.
The procedure is both technically difficult and patented. Therefore should be
undertaken by an experience certified veterinary surgeon.
Often, I am asked if the patient were my dog what would I do? The answer is easy,
I hunt and trial two labs that have three TPLO surgeries between them. |
