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ACL injury??


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New here...what are the signs/symptoms for a possible ACL injury..and what's the long term recovery/prognosis??

 

My dog is favoring his back hind suddenly..puts weight on it and seems to get better the loonger he is moving...have an appt with an ortho vet in a week...but of course my stomach is in knots...

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A couple of the signs would be "toe touching" on the affected leg, and swelling in the knee area. When we get dogs comming into the clinic limping, quite often the vet gets behind the dog and feels both back legs at the same time with one hand on each leg. That way he can get a sense of if somewhere is swollen. Hopefully its just a muscle strain.

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The vet will likely check drawer sign (basically, see how much back and forth movement there is in the joint) and take x-rays to rule out other possibilities.

 

Prognosis...not life threatening with a few different treatment options. Re-injury later on is a concern.

 

Treatment...most treatment options are surgical, though some cases can be managed without surgery. A couple years ago when my dog tore her cruciate there were two main types of surgical options:

 

'tie' the bones together - the old way is to basically they tie a piece of surgical 'fishing line' around the joint to keep it from moving a bunch, with the line taking on some of the function that a normal cruciate has. There is a newer way that using a more advanced materials to connect the bones. If I remember correctly, it requires drilling into the bones, but is less invasive. With many weeks of restricted movement, scar tissue builds up around the joint to further stabilize the knee.

 

create stability by altering the angle to the knee - TPLO (Tibial Plateau Leveling Osteotomy): Basically, the tibia is cut and rotated so that the 'slope' between the tibia and the femur is leveled off (so the bones no longer meet at an angle). TTA (tibial tuberosity advancement): modified version of TPLO, less invasive than TPLO, newer

 

There's also conservative management. The goal with conservative management is to basically achieve the same thing as the older 'string' surgery and let scar tissue build up around the joint to stabilize it, only skipping the surgery part. It doesn't work for all dogs, but surgery later on is still an option if you decide to try conservative management first. It requires 6 weeks of keeping the knee stable and strict restrictions on movement. After the first six weeks, you gradually build up to normal activity. A knee brace can also help in recovery and prevent set backs (basically, if the dog goes hog wild one day and tear the new scar tissue, you have to go back and start from square one with strict restricted movement).

 

This is what I chose to do with my dog, who was 9-years-old when she tore her ACL. It worked for her. She tore her ACL in February and was running through fields by late September (after a big set back in May). After I her big set back in May, I opted to try the WoundWear knee brace to prevent further set backs. She only wore it outside, but it let us add a bit longer walks sooner than we could have without it, which was great for our sanity. I don't know how things would have been long term...Matty passed away the following April (bone cancer).

 

There is a great Yahoo! group with tons of information on Conservative Management. I recommend you join and read through the files section while considering your options (if it is in fact a torn acl). Some of the advice there is great for restrictions after surgery too.

http://pets.groups.yahoo.com/group/ConservativeManagement/

 

Matty symptoms were mostly toe touching, sometimes a full limp where she wouldn't put any weight on the leg at all. When excited or nervous about something (ie, at the vet), she'd walk normally.

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Had an experienced person take a look at it before his Ortho appt Friday....doesn't seem to be a full rupture but possibly a partial tear....I've heard this is JUST as bad as a full rupture...that there is nothing that can be done about a partial tear...except for waiting for it to tear all the way so it can be repaired...

 

This sounds horrible....can't imagine continueing to work my dog...waiting for the day for that ACL to fully tear and spend a butt-load of time and money fixing it...

 

Is this the only solution to a partial tear??

 

If he DOES have a partial tear is there any hope for healing, etc?? Any other options??

 

I so appreciate expertise or experience in this area...

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My experience is that many ortho vets will now repair the partial tears which I would recommend. Arthritis will set in from the instability of the joint. 6 plus yrs ago the ortho vets would not repair a partial tear.

 

My acd has had TPLO on both knees at age 7 and 9. Both times she came back to continue playing flyball. She is now almost 13 and was just retired from flyball in March. She also had a reaction to the TPLO from when she was 9 yrs old and that plate has now been removed.

 

You can try the conservative treatment but the tear never really heals. I know some dogs that went that route and it is a crapshoot on whether it works or not. I believe the conservative treatment involved months of crate rest with only leash walks. I know some folks ended up with doing the crate rest for 6-12 months.

 

I personally would plan to save the money and have surgery to repair the tear in the near future. You can go without it for awhile and the lameness will probably come and go.

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If this ACL partial tear is in any way similar to what happened to my BC, who had a left shoulder bicep tear (75% torn), I would also recommend surgery if possible. The way it was explained to me was that if the tear was 30-40%, there would be a chance that it might heal with crate rest/leash walks for about 4-6 months. With a 75% tear, there was no possibility it would heal itself.

 

If you do opt for surgery, try to find a vet that performs arthroscopic surgery. It is much less invasive - the incisions are very small (~ 1/2 inch) and the cutting of the muscle to reach the affected joint is minimal. "Normal" surgery can have a much larger incision because the surgeon has to lay the cut muscles back to expose the joint. Rehab time is much reduced too.

 

Unfortunately, the true extent of the injury is usually not known until they get into the joint.

 

Jovi

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