# ACL drawer test



## Justin Allen (Sep 29, 2009)

How accurate is this test when the dog is sedated? Can it show a partial or slight tear? I have a dog with mild rear leg lameness that has persisted over a week now with crate rest. He seemed to get better after a couple of days but it flared up again after I let him have more activity in the yard this weekend. X-rays o the hip didn't show anything per the vet. The drawer test showed nothing either. I assumed a few days of crate rest and all would be good if it was a sprain/strain, muscle pull or what not. How long should I try crate rest before we head back to the vet. How long should a more minor leg injury take to heal with rest. For what it's worth it happened inside on slick floors I believe. There was no indication of injury until he had been inside sliding around the den. I'm assuming he could have pulled something or hyper extended his hip given that he can't keep footing worth a darn in my den. Any input?


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## Breck (Jul 1, 2003)

Have no idea what your dogs issue is or if you need to see another vet to sort things out but good indicators of a CCL tear are.
1) Non Weight Bearing. Dog will not put weight on foot of injured leg. May be more noticeable when they first get up from sleeping.
2) Outrigger Pose and Tippy Toe. While standing still dog will place foot of injured leg way more outward and rearward than normal. They will touch floor on tippy toes.
3) Sit Tuck. When dog sits he will tuck leg underneath his body so ankle is touching ground rather than sitting normally with feet directly under and pads on ground. They will also do this when settling in to lay down.
If you observe any of these things see an ortho vet.


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## Justin Allen (Sep 29, 2009)

His sit does not appear to be altered. He is bearing weight in it but does appear to be favoring it a bit. It would never have noticed if not for the first night when he wouldn't put weight on it. Well be back in the vet by Friday if it keeps up.


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## paul young (Jan 5, 2003)

I recommend that you see an ORTHOPEDIC VET rather than your usual Vet. You could waste a lot of time and money and never get a definitive diagnosis.-Paul


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## JusticeDog (Jul 3, 2003)

paul young said:


> I recommend that you see an ORTHOPEDIC VET rather than your usual Vet. You could waste a lot of time and money and never get a definitive diagnosis.-Paul


I agree. Or a vet who sees a lot of this. If it's a partial tear it can be more difficult to diagnose, but the trick is in the touch. (as with a lot of things in life). If it is a partial, may as well just go ahead and fix it. It's going to finish tearing anyway. Take care of it on your own schedule.


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## Longgun (Sep 19, 2009)

It can also be an injured groin. If it is you will feel heet on the inside of the affected leg. Place a hand on either side so you can feel if there is any difference.
deb


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## terrax (Sep 1, 2011)

In a partial tear, it can be very difficult to diagnose the problem. I have diagnosed many with the anterior drawer and or tibial thrust test on complete tears but was not able to diagnose a partial tear in my own dog while the orthopod that I took her to was able to. She did not show the typical toe-touching and other signs usually seen with CCL tears .
So as others have suggested I recommend taking your dog to a good orthopaedic surgeon for diagnosis.
See the following link for more information.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC339306/

Hope this helps


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## PhilBernardi (Jul 17, 2010)

The drawer test, along with x-rays, was used at Michigan State University Veterinary Hospital (by Dr. Gretchen Flo) to diagnosis .25 Class I tears in both of my lab's knees. 

I need to add is that Nala (my lab) was favoring her right knee, hence the exam. What was unexpected was the .25 Class I tear of her left knee (with no expression on the left side).

If that procedure is good enough for an experienced orthopedic surgeon teaching at MSU, it's good enough for me.


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## David McLendon (Jan 5, 2005)

PM sent Justin


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## Justin Allen (Sep 29, 2009)

Thanks for the help guys. He aired for longer than normal this morning and I could not see anything that suggested he is favoring it. The problem is keeping him calm enough to keep him from breaking into a dead sprint, even airing on a rope. Well stay with the crate rest for the remainder of the week and evaluate with some very minor exercise this weekend assuming he continues to show no signs. I guess my main concern is that an MRI would be necessary to diagnose if it was a pArtial year. I simply can't afford that coupled with surgery if it came down to that. Thanks for all the pm's as well.


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## jeff t. (Jul 24, 2003)

claimsadj said:


> Thanks for the help guys. He aired for longer than normal this morning and I could not see anything that suggested he is favoring it. The problem is keeping him calm enough to keep him from breaking into a dead sprint, even airing on a rope. Well stay with the crate rest for the remainder of the week and evaluate with some very minor exercise this weekend assuming he continues to show no signs. I guess my main concern is that an MRI would be necessary to diagnose if it was a pArtial year. I simply can't afford that coupled with surgery if it came down to that. Thanks for all the pm's as well.



What is the basis for your decision that it would be ok to allow some exercise this weekend? It has been suggested that you see an orthopedic specialist. Have you already been there, done that and received medical advice that it is OK to allow exercise on that schedule?


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## Justin Allen (Sep 29, 2009)

I thinkreassign the thread will answer your questions. He is showing no signs of lameness right now. If that continues the remainder of the week he will be allowed to be on his feet a bit moreat his weekend. If that goes well with no lameness well ease back into some swimming at some point. If at any point he becomes lame again I will assume its a partial tear and see dr. Milton. I never said I was going to mark him this weekend. If you're that concerned send me a blank check and off to a specialist well go. Otherwise find another thread to be "helpful" in. Thanks for the folks who have offered advice in a non condescending way.


jeff t. said:


> What is the basis for your decision that it would be ok to allow some exercise this weekend? It has been suggested that you see an orthopedic specialist. Have you already been there, done that and received medical advice that it is OK to allow exercise on that schedule?


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## Ted Shih (Jan 20, 2003)

claimsadj said:


> Thanks for the help guys. He aired for longer than normal this morning and I could not see anything that suggested he is favoring it. The problem is keeping him calm enough to keep him from breaking into a dead sprint, even airing on a rope. Well stay with the crate rest for the remainder of the week and evaluate with some very minor exercise this weekend assuming he continues to show no signs. I guess my main concern is that an MRI would be necessary to diagnose if it was a pArtial year. I simply can't afford that coupled with surgery if it came down to that. Thanks for all the pm's as well.



I have dealt with several partial tears. The leg looks better with rest. But, if the joint is stressed, the partial tear will become a full tear. If you have a partial tear, you are flirting with disaster. Then you will have to pay for surgery or have a dog with three legs for the rest of its life.


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## jeff t. (Jul 24, 2003)

I apologize if I sound condescending.

I'm just trying to understand the basis and rationale for your treatment plan to deal with your dog's lameness.

I can't imagine dealing with lameness without consulting someone who sees it, accurately diagnoses it, and successfully treats it every day.

To do otherwise puts my dog at risk.

I sincerely wish you and your dog the best of luck.


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## Justin Allen (Sep 29, 2009)

If it turns out to be a tear of any kind he will have surgery. Is it worth it to see a specialist when there is no longer a sign of discomfort? I assumed if it was a partial year even mild activity would aggravate it. My plan is to give him at least 4-5 more days of strict rest in a crate. He will air on lead. If he shows any sign of discomfort or limp with mild activity then well see dr. Milton. When I say mild activity I mean airing off lead in a 30x30 fence alone. I'm not goin to let him rip and roar any time soon. I'm just Trying to give him plenty of time to get over it in case it's something minor. If lameness occurs any time in the next couple of weeks then I'll know it's not something minor


Ted Shih said:


> I have dealt with several partial tears. The leg looks better with rest. But, if the joint is stressed, the partial tear will become a full tear. If you have a partial tear, you are flirting with disaster. Then you will have to pay for surgery or have a dog with three legs for the rest of its life.


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## Justin Allen (Sep 29, 2009)

I'm not trying to be rude. I'm just not in a place right now to spend money i don't have. Between trying to sell a house, buying land and moving I'm about spent out. Is the prognosis for a partial tear any different than a full tear? I just assumed they are created equal, maybe they aren't. I'll update when I air him this afternoon and throughout the week. If we see a specialist I'll update with that info as well. That will take place next week if I see any further lameness.


jeff t. said:


> I apologize if I sound condescending.
> 
> I'm just trying to understand the basis and rationale for your treatment plan to deal with your dog's lameness.
> 
> ...


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## Howard N (Jan 3, 2003)

> Is the prognosis for a partial tear any different than a full tear?


Years ago, back when they fixed cruciate tears with fish line, I brought in a young dog with hind leg lameness to my old vet. He couldn't feel anything on the drawer test. Heck, the dog didn't show anything with all kinds of poking, prodding and twisting. Doc told me it could be a partial tear. He told me to give crate rest and go ahead run the dog when he wasn't limping anymore. Doc said when I started working him again if it was a partial tear it would get worse and worse eventually becoming a full tear at which point they'd have to fix it. In my case Tracker got better after a week of crate rest and became my first FC/AFC.


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## Justin Allen (Sep 29, 2009)

Thanks Howard, your old vet gave you the same plan of action I am taking. If there is anything to it I will know soon. At the first sign of lameness after this crate rest we will see the specialist however, not going to wait for it to go completely south on us.


Howard N said:


> Years ago, back when they fixed cruciate tears with fish line, I brought in a young dog with hind leg lameness to my old vet. He couldn't feel anything on the drawer test. Heck, the dog didn't show anything with all kinds of poking, prodding and twisting. Doc told me it could be a partial tear. He told me to give crate rest and go ahead run the dog when he wasn't limping anymore. Doc said when I started working him again if it was a partial tear it would get worse and worse eventually becoming a full tear at which point they'd have to fix it. In my case Tracker got better after a week of crate rest and became my first FC/AFC.


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## Ted Shih (Jan 20, 2003)

If you have a partial tear, the symptoms (lameness, etc.) can go away with rest, only to re-occur later.
If you have a partial tear, and fix the joint, your dog will have less cartilage damage (and arthritis later in life) with surgery now, rather than waiting until you have a full tear.

I do not know of any partial tear that got better with time

You could do an arthroscopy of the knee ($500) and if the scope shows damage progress directly to surgery
- 1.5 - 2k for DeAngelis
- 2.5 - 3.5k for TPLO
- 3-4k for TTA

Don't assume that because the dog is better with rest that you do not have a partial tear
If the problem recurs, I would be very suspicious of cruciate damage


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## Justin Allen (Sep 29, 2009)

That's what I'm doing Ted. If any further lameness occurs I'll assume it's ligament damage and get with a specialist.


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## PhilBernardi (Jul 17, 2010)

claimsadj said:


> I'm not trying to be rude. I'm just not in a place right now to spend money i don't have. Between trying to sell a house, buying land and moving I'm about spent out. Is the prognosis for a partial tear any different than a full tear? I just assumed they are created equal, maybe they aren't. I'll update when I air him this afternoon and throughout the week. If we see a specialist I'll update with that info as well. That will take place next week if I see any further lameness.


I had prolotherapy on my lab's right knee. I decided to retire her even after that, knowing that I only strengthened the stifle and remaining CCL tissue (at best). I have hunted her in water this fall, but all land training is done for good and she is, for all intents and purposes, retired. 

Prolo is an alternate to surgery, but you are also making a decision to retire your dog, which seems not to be an option for you. Cost of surgery was a factor for me, as both knees would have to be done (left knee probably within a year). Rather put money into a new dog.


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## Breck (Jul 1, 2003)

PhilBernardi said:


> I had prolotherapy on my lab's right knee. I decided to retire her even after that, knowing that I only strengthened the stifle and remaining CCL tissue (at best). I have hunted her in water this fall, but all land training is done for good and she is, for all intents and purposes, retired.
> 
> Prolo is an alternate to surgery, but you are also making a decision to retire your dog, which seems not to be an option for you. Cost of surgery was a factor for me, as both knees would have to be done (left knee probably within a year). Rather put money into a new dog.


That's the old Needling crap used to numb the joint pain in beat up race track horses. It's Not an alternative to surgery for CCL rupture. In people prolotherapy it's considered Quackery.


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## PhilBernardi (Jul 17, 2010)

Breck said:


> That's the old Needling crap used to numb the joint pain in beat up race track horses. It's Not an alternative to surgery for CCL rupture. In people prolotherapy it's considered Quackery.


I agree it's not an alternative to surgery IF you plan to keep training and running your dog. It is if you don't plan on it. 

The studies done on humans are about 3 (if I recall correctly). Each design was criticized on sample size being too small, but results were significant. There have been no studies done on canines - to my knowledge. 

I'm happy with the results on my Nala's right knee; but my decision isn't one that others would probably make. 

To each his/her own.


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## JusticeDog (Jul 3, 2003)

Ted's pricing is interesting. It really varies by location. In this area, TPLO Is 3600 to 4000 dollars. That is Chicago. Pricing is similar at the University of Illinois and the University of Wisconsin. Tightrope is about 2500, which includes some initial rehab. I can get TTA done in Sheboygan Wisconsin by an experienced vet for 1500. Decisions about the type of procedure should be based upon the age and temperament of the dog, goals for the dog, etc. Obviously, price is also a factor. Good luck with your dog.


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## Justin Allen (Sep 29, 2009)

Juice Saw dr Milton today. He pulled fluid and feels confident we have a partial tear. Surgery Monday. Can dogs typically Bourne back from this and continue their career? Derbies are obviously over now but just hoping we can get him back to full speed and continue running strong in the future.


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## Ted Shih (Jan 20, 2003)

claimsadj said:


> Juice Saw dr Milton today. He pulled fluid and feels confident we have a partial tear. Surgery Monday. Can dogs typically Bourne back from this and continue their career? Derbies are obviously over now but just hoping we can get him back to full speed and continue running strong in the future.



Unless this dog is a super star, I would retire him from competition and start over. You will lose at least 4 months of this dog's career to rehab. He is likely to blow the other cruciate, and you will lose another 4 months of his career. I would cut my losses and run - unless I was convinced that the dog was going to be a super star - which is hard to predict at his age.


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## jeff t. (Jul 24, 2003)

claimsadj said:


> Juice Saw dr Milton today. He pulled fluid and feels confident we have a partial tear. Surgery Monday. Can dogs typically Bourne back from this and continue their career? Derbies are obviously over now but just hoping we can get him back to full speed and continue running strong in the future.


I'm sorry the news isn't better.

As far as bouncing back is concerned, some dogs recover better than others. Much will depend on the quality of the rehab. 

If it was my dog, I'd give it my best shot to achieve as much as possible and see where that takes me. My goal is to train each dog I have to reach its potential, whatever that may be.

Your goals may be different. 

Regardless, I'm glad you were able to get a diagnosis and can get him back on the road to recovery as soon as possible.


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## JusticeDog (Jul 3, 2003)

claimsadj said:


> Juice Saw dr Milton today. He pulled fluid and feels confident we have a partial tear. Surgery Monday. Can dogs typically Bourne back from this and continue their career? Derbies are obviously over now but just hoping we can get him back to full speed and continue running strong in the future.


yes they can. There are many dogs running on TPLO's.


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## JusticeDog (Jul 3, 2003)

Ted Shih said:


> He is likely to blow the other cruciate, and you will lose another 4 months of his career.


This is what most say, however, the surgical practice I deal with in Buffalo Grove IL. has statistics that are quite a bit different from that, when I recently posed the question. Gettting the operated leg fixed and strong quickly is the key, so they are not favoring the injured leg, and putting more stress on the "good" leg. The practice has easily performed over 100,000 TPLOs in the past 10 years.


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## Ted Shih (Jan 20, 2003)

JusticeDog said:


> This is what most say, however, the surgical practice I deal with in Buffalo Grove IL. has statistics that are quite a bit different from that, when I recently posed the question. Gettting the operated leg fixed and strong quickly is the key, so they are not favoring the injured leg, and putting more stress on the "good" leg. The practice has easily performed over 100,000 TPLOs in the past 10 years.



General population or Field Trial dogs
Plus, if you get TPLO, you are buying into a lot of rehab time and/or money
If I had a proven dog, I would probably do it
If I had a young, unproven dog, I would move on
It's just alot of heartache


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## Justin Allen (Sep 29, 2009)

Not doing the surgery isin't an option. He will be a hunting dog at the least. I hope to get him back to running tests/trials. I don't know that you would call him a superstar. He made the derby list in 4 starts but other than that he hasn't seen much competition. I'm not a serious trialer, more of a hunt tester that dabbles at this point. My plan was to run Q's and finished/master with him this spring--obviously that is no longer the plan. Well take it in stride and hopefully everything goes well and he can get back in action.


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## Mark (Jun 13, 2003)

JusticeDog said:


> . The practice has easily performed over 100,000 TPLOs in the past 10 years.


That calculates to about 40 TPLO's a day or approx $140,000 revenue per day. 

seems a little high


Mark


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## jeff t. (Jul 24, 2003)

claimsadj said:


> Not doing the surgery isin't an option. He will be a hunting dog at the least. I hope to get him back to running tests/trials. I don't know that you would call him a superstar. He made the derby list in 4 starts but other than that he hasn't seen much competition. I'm not a serious trialer, more of a hunt tester that dabbles at this point. My plan was to run Q's and finished/master with him this spring--obviously that is no longer the plan. Well take it in stride and hopefully everything goes well and he can get back in action.


Here's hoping the surgery and rehab go smoothly and the two of you are back in training next year.


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## paul young (Jan 5, 2003)

claimsadj said:


> Not doing the surgery isin't an option. He will be a hunting dog at the least. I hope to get him back to running tests/trials. I don't know that you would call him a superstar. He made the derby list in 4 starts but other than that he hasn't seen much competition. I'm not a serious trialer, more of a hunt tester that dabbles at this point. My plan was to run Q's and finished/master with him this spring--obviously that is no longer the plan. Well take it in stride and hopefully everything goes well and he can get back in action.


I think you can plan on competing in the spring. However, that means a big commitment from you to do the rehabilitation faithfully and fully. I have rehabbed 2 of my dogs myself after TPLO surgery and they both went on to be top-notch HT dogs and both won licensed Q's. Neither dog had problems with the other knee. Good luck! I'm glad to see you took everyone's advice seriously.-Paul


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## Howard N (Jan 3, 2003)

Mine had the first one done and was back to training in 2-3 months and trialing in 4-5 months. She went 3 years before she partially tore the other one. I had the tplo done as soon as I saw the limping when she was tired the 2nd time. She was back in training in 2 months and trialing right afterward. She's still trialing as a 6 year old, and I expect she'll continue to do so for a few more years.

The first one there was no rehab vet in Anchorage then. The second one we had a rehab vet and I took the dog to her twice a week and then once a week.


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## Justin Allen (Sep 29, 2009)

Can someone give me a brief summary of what to expect with the rehab?


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## JusticeDog (Jul 3, 2003)

Mark said:


> That calculates to about 40 TPLO's a day or approx $140,000 revenue per day.
> 
> seems a little high
> 
> ...


 No. That would be about right.


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## terrax (Sep 1, 2011)

There is an ebooklet that you can download for free at the following site that goes through the rehab for TPLO plus others types of surgery. It will give you a good play by play of the rehab procedure. I went quicker than recommended in the booklet with my girl and took her for underwater treadmill program beginning the day after the sutures were removed. There are some adds in the booklet but you can disregard them if you wish.

http://topdoghealth.com/home-rehab-guides/tplo-tibial-plateau-leveling-osteotomy-guide/

Hope this helps and if you have any questions just ask. Many here will help.


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## Steven V Zugg (Jul 12, 2006)

I just had the TTA done after my 6 and 1/2 year old tore his cruciate in the third series of the AM in St Louis a few weeks ago. I took him into the clinic after the trial, sunday night and left him, they performed the surgery on the following tuesday. I left him at the clinic for the first 2 weeks of rehad which consisted of about 20 hours in the kennel and 4 hours spred out thought the day (24 hrs), of him walking on a very tight lead.
When the staples were removed, he was brought home - his rehab no consists of about 14 hours in his kennel and 10 hours of tight lead walking - including up and down hills, and swimming. This will continue for 6 weeks, at which time he will return to the clinic for x-rays and manulipation to determine if hs is healed up enough to go "off lead" for walks and swimming and light running until he is back to 100 percent - Note - lots of fun as he is a Cosmo son and his idea of moving at all is at full speed.
To date all is going well and he swam about 300 yards the other day. Looking forward to the next check up!!!!!!!!!!!!!!!


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## Justin Allen (Sep 29, 2009)

Thanks for the link. Rehab scares me with this dog more than anything. He believes he is a rodeo bull. I have steps going into the house. Should I make him a ramp?


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## Breck (Jul 1, 2003)

terrax said:


> There is an ebooklet that you can download for free at the following site that goes through the rehab for TPLO plus others types of surgery. It will give you a good play by play of the rehab procedure. I went quicker than recommended in the booklet with my girl and took her for underwater treadmill program beginning the day after the sutures were removed. There are some adds in the booklet but you can disregard them if you wish.
> 
> http://topdoghealth.com/home-rehab-guides/tplo-tibial-plateau-leveling-osteotomy-guide/
> 
> Hope this helps and if you have any questions just ask. Many here will help.



Well, I'm not sure of the quality of the entire document but looking at the table of contents it probably contains more useful rehab info than is available to the average owner anywhere else. Probably worth paying for the download.


Also, the guys topdoghealth website has a rehab directory map that shows rehab facilities around the country in Maps.Google. Not entirely accurate but a good start.


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## Breck (Jul 1, 2003)

claimsadj said:


> Can someone give me a brief summary of what to expect with the rehab?


Yes.
First there have been many field champions made after TPLO so if you like the dog and rehab goes good go for it. I agree with what Ted says but if your not the type of person that parts with dogs easily there is still hope for yours. Just be aware that at any time the other leg may blow. On the other hand it may not.

It will be a big big plus if your Dr. does the TPLO using Non Invasive Arthroscopic techniques. If he is not up to date and does the old fashion lay the knee open technique your dog will take longer to recover. Also there is a bone healing amendment (a goop I forget the name of that applied to the otomy speeds bone healing) Ask about it.

As for rehab.
It takes 7-10 days for suture site to heal. Great care should be taken to avoid infection.
It takes 8-10 weeks for the otomy to heel. (This is where the bone was cut in two).
You must be careful during the first 8 weeks of rehab so not to risk breaking the repair. The first week or so require you support the dog with a sling when airing so it can be a chore.

Bone pain is the worst kind of pain so the first week make sure you have the meds you may need on hand and make sure dog is as pain free as possible.

If you have a good rehab plan and are diligent about taking care of your dog everyday you could be back to training in around 4 months.

The most difficult procedures for an owner to do at home are the early post surgical care and early rehab.
Given a choice, if you could leave dog with a rehab pro for at least 4 weeks 24/7 that would be helpful. Then you could take over.

If you have a land treadmill handy or one you can borrow you will need one in a few weeks.


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## terrax (Sep 1, 2011)

I found ice packs and massage of great benefit during the early stages, about 7-10 days post surgery. Massage from the toes towards the hip and knead any areas where fluid has built up in the tissue.
As for stairs, they are not a problem if you can control your dog enough to go slowly, one step at a time, but if not then a ramp would be recommended so he will not possibly damage the healing bone. 
Also the sling under the posterior abdomen is a good idea to help support the dog while walking in the early stages post-op. I needed it for my last dog, both hind legs but not with my present dog.
Take it slow and steady.


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## Ted Shih (Jan 20, 2003)

I did most of the rehab myself from the TPLO.

First, I would recommend buying a harness. I like the ones made by Ruff Wear. http://www.ruffwear.com/Web-Master-Harness_2?sc=2&category=1131

The harness makes it easier to make sure that the dog does not bear unnecessary weight on the repaired leg - like when you air the dog 4x a day. It also helps to when you have to lift the dog into the car to take it to the vet.

Second, I dedicated the kitchen to the dog. I left a bed in the kitchen. At my house, the kitchen feeds into the back yard, so it was easier to help her into yard when she had to air. Also, it made it convenient when I had to ice her leg down 4x a day.

Third, once a week, I took her to the rehab facility, where they put her on the underwater treadmill. 

Fourth, I walked her 4x a day (increasing the length gradually) and stretched and iced her afterwards. 

If you want to do it right, it's alot of work.

Ted


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## Breck (Jul 1, 2003)

Ted Shih said:


> First, I would recommend buying a harness. I like the ones made by Ruff Wear. http://www.ruffwear.com/Web-Master-Harness_2?sc=2&category=1131
> Ted



If I may make a suggestion regarding the harness. 
Ruffwear makes a dog Backpack with pockets you can add weight to. The backpack is very similar to the Harness so I think could serve both purposes. During rehab you will want the dog to carry more weight while on the treadmill and on walks. For weight ask your vet for a bunch of bags of saline solution to use.
http://www.ruffwear.com/Approach-Pack?sc=2&category=13


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## Justin Allen (Sep 29, 2009)

Thanks guys. It sounds like rehab is key. I work an hour from home now but I can take juice to work with me everyday and get his rehab in that way. My work vehicle is an suc so I can lift him in and out pretty easily. I could always leave him at home during the day but if he needs walks and ice/heat multiple tines a day he needs to be with me. Thanks for all of the input and help. Can't wait to get him back rolling.


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## Justin Allen (Sep 29, 2009)

FWIW I talked with someone at dr Milton's clinic about the possibility of doing both knees now. I got a no. They said even if both were torn they would prefer to do one then do the other in 6 weeks or so. I do know that it can be done however. Has anyone done both at once when only one was injured?


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## Howard N (Jan 3, 2003)

claimsadj said:


> FWIW I talked with someone at dr Milton's clinic about the possibility of doing both knees now. I got a no. They said even if both were torn they would prefer to do one then do the other in 6 weeks or so. I do know that it can be done however. Has anyone done both at once when only one was injured?


I talked to my vet when Missy was getting ready for her second TPLO. I was wondering if I had to do it with another dog if getting both done when the dog had to get the first done. My doc said he preferred to do it that way and there was some literature supporting that. That was a couple of years back. I don't know what he would suggest now but if I have to do another one I think I'd go that direction.


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## Justin Allen (Sep 29, 2009)

Howard are you saying he preferred to do both at once or space them out? My reading comprehension is about a 5th grade level.


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## EdA (May 13, 2003)

claimsadj said:


> Howard are you saying he preferred to do both at once or space them out? My reading comprehension is about a 5th grade level.


Most surgeons would be reluctant to do both at once fearing the consequences of complications the odds of which are effectively doubled. My dog lost one year at a very critical point in his training because the second tear occurred after he was fully recovered from the first. If I have the same scenario again, a relatively young dog with a CCL tear, I would try to get my surgeon to do both at the same time. In a young athletic dog I suspect the likelihood of a second tear may approach 75%. 

You can definitely do the rehab yourself, the underwater treadmill is helpful but not essential. I much prefer weight pulling to weight carrying as Breck suggested. Weight carrying loads the spine and alters the gait to some degree. Also it does not directly target the rear limb muscles the way weight pulling does.


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## Breck (Jul 1, 2003)

Right Dr Ed I didn't mention weight pulling. But both using backpack with weight indoors on the treadmill and pulling heavy chains outdoor are useful. After a serious rehab my dog looked like Arnold! An important aspect of rehab is to develop balanced mussel mass.
For weight pulling later on outdoors I have a Pull Harness, tie down bungies with caribiner clips. Make sure you setup lengths of bungies and clips so they won't rub on dogs ankles. and a I cut 10 3' lengths of heavy chain each length weighing 5 pounds. Start with 1 length clipped on per side the increase as needed. 
I would slap on the harness a few lengths of chain an go for a walk.


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## Justin Allen (Sep 29, 2009)

Will this harness support the tear of the dog very well?


Ted Shih said:


> I did most of the rehab myself from the TPLO.
> 
> First, I would recommend buying a harness. I like the ones made by Ruff Wear. http://www.ruffwear.com/Web-Master-Harness_2?sc=2&category=1131
> 
> ...


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## Breck (Jul 1, 2003)

If Ted used this harness I would say yes go ahead and order one. Looks like you can support dog by holding onto the loop on top and clip a lead onto the D ring.


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## Ted Shih (Jan 20, 2003)

claimsadj said:


> Will this harness support the tear of the dog very well?



After surgery, you will initially need to keep weight off of the repaired leg. The harness has a handle that makes this easier up and down steps. I bought (2), rotated them, and always kept one on the dog, so that I never had to rush and put one on if the dog needed to air. You can also hook chains on the harness for weight pulling exercises.


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## Ted Shih (Jan 20, 2003)

EdA said:


> Most surgeons would be reluctant to do both at once fearing the consequences of complications the odds of which are effectively doubled. My dog lost one year at a very critical point in his training because the second tear occurred after he was fully recovered from the first. If I have the same scenario again, a relatively young dog with a CCL tear, I would try to get my surgeon to do both at the same time. In a young athletic dog I suspect the likelihood of a second tear may approach 75%.



If you did two, you could minimize anesthesia cost, and consolidate rehab. Downside, insurance probably wouldn't pay for the second.


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## Justin Allen (Sep 29, 2009)

I'm assuming the ligament should be stronger after repair? If not I wouldn't see why you have it done in a knee with no injury. I would be willing to do both at once if dr Milton would go for it. That's assuming the chance of another tear is decreased by doing so. Can someone shed light on why do both other that the decreased cost of two separate operations and less rehab time. How for it benefit the I injured leg?


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## Justin Allen (Sep 29, 2009)

Should the ligaments be stronger post repair? I'm more concerned with the good ligament. Will it be better off post surgery? If not why even touch it?


Ted Shih said:


> If you did two, you could minimize anesthesia cost, and consolidate rehab. Downside, insurance probably wouldn't pay for the second.


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## Ted Shih (Jan 20, 2003)

My experience with Field Trial dogs is that if you blow one, you will blow the other.

The repaired joint is stronger - if you rehab properly and the bone heals properly.
The other joint remains the same.
You repair the other joint as preventative medicine. You repair it because: (a) you believe it is a matter of time before it goes; (b) the dog is much less likely to have arthritis later in life if you repair the joint before there is a complete tear (and the associated damage of cartilage); (c) you want to minimize time off from training

But, I would tell you that rather than talk to me or the others on this board, I would find a couple of orthopedic specialists and ask them for their opinions.

I have spoken with a ton, but you would be better served to do the same yourself


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## Justin Allen (Sep 29, 2009)

Thanks that makes sense. If it will be for the better I'm willing to do both now. Just not sure if dr Milton will go for it. Can anyone that has gone that route comment on how you convinced the doc to go through with it?


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## Breck (Jul 1, 2003)

The whole point of the TPLO technique is to replace the function of the ligament. The remaining torn ligament is probably debrided in surgery because it no longer serves any purpose.
One reason doing two at same time is rehab can be easier as dog can't really "favor" on leg over the other or cheat.
If I chose that route I would use a rehab pro personally.


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## EdA (May 13, 2003)

claimsadj said:


> Should the ligaments be stronger post repair? I'm more concerned with the good ligament. Will it be better off post surgery? If not why even touch it?


Torn or frayed ligaments and torn cartilage are removed at surgery, normal structures are left intact. The TPLO is based on the premise that abnormally steep slope of the tibial plateau puts abnormal stress on the cruciate ligaments hence they stretch, fray, and/or tear. Correcting the slope of the tibial plateau allows the normal ligaments to function as they should. There is no attempt to stabilize the joint as biomechanically that is unnecessary.


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## Ted Shih (Jan 20, 2003)

claimsadj said:


> Should the ligaments be stronger post repair? I'm more concerned with the good ligament. Will it be better off post surgery? If not why even touch it?




I think you need to spend some time reading about the various repairs available for the cruciate - TPLO, DeAngelis, TTA - and get yourself educated about the repairs. Then I think you should talk to some orthopedic surgeons about the pluses and minuses of each. 

As for rehab, if you have the money, you can send to a rehab specialist. But, if money is an issue - and when isn't it - you can do most of the work itself. I did all of the walking, stretching, movement, ice, heat, etc. for my dog. Then took her once a week for underwater treadmill work. The repaired joint gave me no issues. A year later she blew the other and I started all over again.


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## Ted Shih (Jan 20, 2003)

Again, anyone poking around in this area should consult with a specialist. But, if I had a dog that I really liked, I would probably do both.

In 2007, Freeridin Vampire Slayer got her FC/AFC (all points earned by me) at four years of age. She was a finalist in the National Am that year. Blew cruciate in summer of 2007. TPLO. I spent fall rehabbing. Came on hard in winter of 2008. Was running great in 2008 pre-National training. During training, started favoring her other leg. I immediately took her to orthopedic surgeon in New Jersey - he diagnosed partial tear. I scratched her from National Am. Did another TPLO.

She was never the same. Retired her in 2010 at seven years of age in her competitive prime with 60 All Age points.

I think if I had been more aggressive with surgery and rehab, she would have retired with Mootsie this year, and like her, would have had 80 or so All Age Points or more.

But, it is alot of work to rehab a dog. I had a promising young dog, who at a year of age, had an on/off limp. I washed him out immediately and found a nice home for him. Because I was not going to invest in the time, emotion, and money of another rehab for an unproven dog.

I have also done cruciate surgery for a dog that was seven at the time of surgery (eventually both joints) and another at less than a year of age (eventually both joints). So I am more knowledgeable than I want to be about cruciates, and am very leary of getting another. And which I why I now research cruciates together with hips, elbows, eyes, and EIC when I get a puppy.


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## Breck (Jul 1, 2003)

Download these two pdf files Part I and Part II written by a good ortho surgeon about ccl injury. Should get you started on your education.

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&ved=0CDoQFjAB&url=http%3A%2F%2Fwww.akcchf.org%2Fassets%2Ffiles%2Fcanine-athlete%2FCCL-Part-I.pdf&ei=ivmeUNyWIcKB0AHmkoDYBQ&usg=AFQjCNEmqZMzyiJTRpLj1B2zSDcVXBAApw&sig2=u0pR-XtE7qohZLV5e3O71Q

http://www.google.com/url?sa=t&rct=...yNtKcnm2h4w4xIj4Q&sig2=YJU_KxKLg6-dufCsmvcGtg


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## Breck (Jul 1, 2003)

This is interesting technical stuff for tplo technique from Synthes the mfg of surgical equipment and plates for tplo.
download pdf...

https://productlit.synthes.com/prod.../Technique Guides/VET/SUTGTPLOPlateJ6544B.pdf


If you're the mechanically inclined type you'll be interested to read about the saw and how that part of the job works.

http://sites.synthes.com/MediaBin/International DATA/036.000.042.pdf


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## Justin Allen (Sep 29, 2009)

Thanks for the links. Ted do you have someone willing to do both at once when one leg is still fine? I have read numerous threads where people say next time I'll gave both done but can't find any evidence it's been done on this situation. I'm willing to look at going that route if I can build a strong enough case to twist the docs arm.


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## Justin Allen (Sep 29, 2009)

Juice is back in my care now. Surgery went well according to Dr. Milton. He had a complete tear and tore off a small piece of bone as well when it tore. Dr. Milton feels like the surgery went as well as you could ask for and with proper rehab juice should be able to return to normal activity. He was amazed that juice was not favoring the leg--acccording to him the acl was destroyed. We have aired twice so far, with a lead and a sling under his belly. Its not very glamarous, thats for sure. He said juice should begin to bear weight on the let within a week or so but to keep it moderate. Wish me luck with this beast!! Thanks again for all of the helpful advice.


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## Breck (Jul 1, 2003)

Glad to hear surgery went well. With careful rehab he'll be good as new. Pay particular attention to and recognize when aspects of rehab are going well so you can move on to the next step and also recognize when things are not going so well where you might need to back up a step. The chart in the Part II pdf might help.


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## Justin Allen (Sep 29, 2009)

Thanks Breck, the links you provided have some very good info. I also have Dr. Ed's rehab plan in hand to use.


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## jeff t. (Jul 24, 2003)

Hang in there...one day at a time, he'll get better and better.


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## Breck (Jul 1, 2003)

claimsadj said:


> I also have Dr. Ed's rehab plan in hand to use.


Very fortunate for you. You might find out what sort of wine Dr Ed prefers and ship him a case straight away.
cheers


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## Justin Allen (Sep 29, 2009)

Juice feels much better today. He is no longer whimpering unlike yesterday. He is weight bearing on his operated knee already. He hates to take a dump on lead so that's been a chore to this point but overall everything is looking good. I am going to start some range of motion exercises this weekend but dr Milton wants everything kept to a minimum for quite some time. The rehab plan I was given is much more conservative than many I have read. Crate rest and airing is about all he really wants for juice to have for the next few weeks. Looks to be a slow process but I guess it is what it is.


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## terrax (Sep 1, 2011)

There are many surgeons that are ultra conservative in the rehab esp for home rehab as they do not have any control over what happens once the dog leaves their office so to minimize any problems they err on the side of caution.
I sped up the rehab process on my girl and the surgeon was very surprised at her progress but I was careful not to overdo it. I was able to keep her under control at all times. 
If your dog is very high drive then you just need to go slower.


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## Justin Allen (Sep 29, 2009)

Thought I would update the thread in case anyone else is dealing with this right now. Juice is just over 6 months post surgery and is doing great. The other leg may blow any day but he is balls to the wall just like before, possibly even worse. He has been training now regularly since about mid march with no restrictions. He did have two flare ups at about 4 and 5 months post op and we never figured out what the deal was. Dr. Milton did xrays of the leg as well as hips, after a couple of days rest they went away. It was never following training or activity, both came after having some time off from training and being back in the concrete kennel. I believe it was concrete related as it only happened then, he would show extreme lameness if he had to walk on gravel then next to nothing when back on grass. I almost feel it may have been a pad issue, but don't know for sure. Anyway, he is doing great and is back to getting ready to run the Q in the fall. I took it very slow with rehab, the first 6 weeks were just crate rest, air on lead and some moderate leash walks on flat mowed ground. We did some underwater treadmill and I feel like that helped a great deal, it eased my mind having a professional put eyes on him a couple times a week. Rehab was a pain and I don't wish it on anyone but its behind us at least for now. If you need the procedure and are in the southeast, it would be hard to recommend anyone than Dr. Milton and his staff.


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## Jthweatt (Sep 26, 2011)

That's great! I have a 18 month old out of Grady that had a partially torn ccl. Had the tplo done in Memphis at Memphis Veternarian specialist by dr. Maxwell. Everyone told me to go to Birmingham, Memphis was more expensive, but more convenient. 

She had surgery in early january. Upon her 6 week checkup she started limping a day before. The plate had broken the bone where the top screw was located. It became infected. Also 2 of the 6 orthepedic screws are backing out. This has allowed the plate to move slightly. Needless to say, about 4 more trips back and fourth the infection is gone. Her leg is healing up good, but is 12 degrees off of being properly aligned....... Now they want to remove this plate, cut the leg again and realign and install another plate. If all goes well we will be lucky to be back training this fall. This has not been a good experience. The doctor is saying her bone failed and that's why it broke and the screws are backing out. The only 2 screws backing out are the same. The other 4 are a different type (thread) and are holding fine???
I hope no one ever has to go through this. I was never told this was a chance I take when having this surgery. And that I'm the first one this has ever happened to out of the thousands of tplos performed.

She has been confined to a small crate the entire time only allowed out to air several times a day. And then on a short leash. Sedated the entire time. About 700.00 in medication do far. No jumping at all.

Did I mention her name is LUCKY??

What's everyone's thoughts on this?

Thanks


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