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It has been one year to the day since Liesl had repair surgery for her cruciate ligament rupture. I thought I'd post an update FYI.

First, I posted a few times about this last year. You can get the information about our research and the novel approach my vet used from that thread: http://www.germanshepherds.com/forum/health-issues/376009-help-need-advice-torn-acl-surgery-not.html

Liesl is doing very well after her LFR. She is approximately 4 years old and weighs 80 lbs, and is of standard height for a GSD. She has been on a raw diet all of her life and has no significant health problems other than this repair.

We slowly increased Liesl's exercise regimen after observing the restrictions during the first 3 months post op. During the spring of 2014, progressing from longer walks and straight-line light running (with me jogging) she did well. She did not put significant weight on the leg for several months, which I could easily tell by lifting one or the other of her legs to dry them. When I lifted the non-surgical left leg almost all of her weight stayed on it to the point it was difficult to lift. She also very much favored the surgical right leg.

I began to throw the ball with her in early summer and had several successful outings with her chasing it aggressively. Unfortunately, she relapsed in June while doing this, returning to me limping on the right leg. I was concerned that we had broken the strong figure 8 suture discussed in my previous post. However, we elected to reduce her activity and see what happened. We did not have it re-xrayed so I do not know the condition of the repair surgery today.

We stopped any running activity (ie ball) and resumed longer and longer straight line walks and running (1-2 miles at the longest, twice a day). She also trotted around the back yard a lot, and tried to jump off the back porch to chase squirrels, but we held her collar and forced her to walk. She also went up and down our stairs inside a lot, and I think this was beneficial in altering subtly the stress planes of her knee and thus overall strengthening the surrounding muscles.

We have gradually resumed ball throwing, with great success. She is definitely stronger and putting almost equal weight on the right leg (I can tell when I lift the left leg). She walks and runs with an even gait and good paw placement and stride. Occasionally she will stand still with the knee of the right leg turned slightly out away from her body, but not to the extent it is particularly noticeable or at all disfiguring.

She has roughhoused once in the back yard with a friendly dog her size, about 2 months ago, requiring lots of stop and start and spinning motion, and strained something in her leg causing her to yelp and limp on the right leg. Fortunately, she recovered from that almost immediately, walking it off within an hour, and has been fine ever since.

In conclusion, I am glad we chose the LFR with the 100 lb test suture material. I cannot guarantee it will work for you, but it seems to have helped Liesl recover from her cruciate tear. I trust you understand that I am NOT offering vet advice or making a recommendation here--just sharing with you our experience for you to consider if you are trying to make this decision.

My vet for this was Dr. Kenneth Bockhorn at the Waller Veterinary Clinic in Waller, TX. It is a small office, and Dr. Bockhorn was very clear with me that he is not a vet orthopedic surgeon. However, I found him and the office to be very good, conscientious, friendly, and reasonably priced. IMHO they would be worth discussing this with if your dog suffers from a cruciate tear.

Waller Veterinary Clinic - Veterinarian In Waller, TX USA :: Meet Our Doctors
 

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Great story and glad your dog is doing well.
Just wanted to post that a lateral fabellar repair wouldn't really be considered "novel" since its been out for a number of years now and many vets do them including myself :)
 

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Ugavet, you are correct, and thanks for the post!

I guess I wasn't clear in expressing that (my understanding is) the LFR has been done for years but with lighter (80 lb.) suture material that could not withstand the stresses of an 80-120 lb. dog, and inevitably failed. Some companies began recently making stronger, braided materials that had higher test strengths, and vets who had done LFR on smaller dogs began considering using these materials for larger dogs. That is, to my knowledge, the "novel" aspect of what we had done.

I would love see more from you and your colleagues posted about your experiences with these stronger materials in large dogs, as it is a little difficult for the average dog owner to tease that information out of the torrent of data available online about TPLO. For the average pet owner of a family pet GSD, the prospect of spending $3500 to $4000 for a TPLO can be daunting, if there is a $1500 procedure that has a reasonable chance of success.
 

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So what are the pros cons applications for the LFR vs the TPLO? One of our team dogs just had the TPLO another just tendon repair on a partial tear but I am concerned about it holding and also the concerns will be the "other" legs. These are air scent dogs so off lead, off trail, running through the woods with all their holes and dangers. Is the LFR just the tendon repair? A third just had rest but is retired so....

Prevention? ..........in all cases we have learned it was not a sudden snap but there were warning signs.
 

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Thanks for weighing in with your decision and how it worked out.

my choice ended up being different because the original one didn't work (and I had been talked into by the vet - it sounded so much more benign after all.)

There are several cruciate "repair" options out there. I started with the LFR on the late Barker the Younger. Didn't work. Waste of time and money. The vet then tried to talk me into a TPLO with a novice surgeon. I with the third option from a board certified surgeon - got it done right and it held. That knee never gave her any subsequent problems. (the other one did go & I opted for the same board certified surgeon and the same repair - maybe called a TTA?? - ) She was a heavy active dog and I wanted her to be able to continue to be active.

For other people facing this decision (what option to choose) I recommend evaluating the options available, the vets available to you and what you want your dog to be able to do in the future. Then you make a choice and hope for the best.
 

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Ranger, 2 yr old male WL (lacking self preservation )is doing great 13 months post TPLO. Our regular vet also does the the tight rope version, but with Ranger he thought it best we opt for the TPLO. The surgery was $2,700 and about $130-ish for the follow up X-ray. We found a vet who only does PT and was very reasonably priced per session. We took his recovery very slow following the PT vets outline, I think 6months in all.
 

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I see what you meant OP :)
We often do it on fat heavy dogs so for me that is normal LOL
So far they have all held except one really super fat older very large lab and the suture did not break, it was the hardware :)
I would not have this procedure done on a very active large dog, I would do a TTA or TPLO and a lot of PT & swimming afterwards :)
The things that are shown to be risk factors would be heavy large dogs, "weekend warrior" types who do not exercise during the week at all then run wild on the weekends, low thyroid levels, and I think cushings disease. There is also thought to be a genetic component. Therefore I personally would look for a new puppy from parents who did not have this issue. I am probably missing some risk factors.
Many people try to say things like "frisbee play" etc but frankly not one single cruciate injury I have see has been from playing frisbee. Most are fence runners, fat dogs jumping off the porch, chasing wild animals or playing with other dogs. Actually none have been any toy play.
 

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None of our 3 dogs were at all overweight and were active during the week with handlers who had them out daily. The one thing they did say was they were not as tuned into occasional limping as they should have been and we have all had some free sessions with a rehab vet who stresses warming up and stretching before work.
 

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None of our 3 dogs were at all overweight and were active during the week with handlers who had them out daily. The one thing they did say was they were not as tuned into occasional limping as they should have been and we have all had some free sessions with a rehab vet who stresses warming up and stretching before work.
I could see how not resting a mild back or front end lameness even could lead to this for sure. If these dogs have had not thyroid levels checked I would do it to be safe, they don't all have obvious symptoms or have to be over weight. Wonder if there was a genetic component here? I do not see SAR dogs really so I am basing my opinion on the general population.
 

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I could understand obesity contributing, or only occasionally exercising hard (weekend warrior), but as for Ranger, he was hit by our other dog while he was jumping up for a ball. It sounds more like risk factors rather than genetics.
 

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I could understand obesity contributing, or only occasionally exercising hard (weekend warrior), but as for Ranger, he was hit by our other dog while he was jumping up for a ball. It sounds more like risk factors rather than genetics.
My dogs play super hard, constantly slam into each other, slam into trees and even brick walls in the past going after toys. Except for right now in extreme weather conditions, this is basically a daily occurrence, only I try to really limit the tree or wall slamming ;) So that could be why there is believed to be a genetic component. :).
Some dogs barely exercise at all, or just go on walks and don't have any of the other risk factors either, then one day jump off the stairs into the back yard and suddenly they injured the CCL. So I definitely believe in a partial genetic component.
 

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My dogs play super hard, constantly slam into each other, slam into trees and even brick walls in the past going after toys. Except for right now in extreme weather conditions, this is basically a daily occurrence, only I try to really limit the tree or wall slamming ;) So that could be why there is believed to be a genetic component. :).
Some dogs barely exercise at all, or just go on walks and don't have any of the other risk factors either, then one day jump off the stairs into the back yard and suddenly they injured the CCL. So I definitely believe in a partial genetic component.
Being a vet, you'll will have far more knowledge and insight into this than Me and certainly genetics could be at play in some cases. I only have one and hopefully the only incident to learn from.

Ranger has little to no self preservation, he too crashes into imovable objects, taking out the railing on our deck at one point, so maybe "mentally" genetics are at play, lol :) Our female hit him like a missle, it was a direct hit to his knee, In this instance, I doubt any dog would fair any better.
 

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Neutering early also has an effect, one that is generally more dramatic in males versus females. There was a study that came out a year or so ago looking at goldens and the rate of CCL tears in them, breaking them into groups of not altered, altered before a year and altered after a year. The dogs who were neutered under a year had a much greater rate of tearing the CCL. I could see a genetic component too. Labs are VERY common dogs for CCL tears for instance lol.

Usually the surgeons I work with do TPLOs. We did a study comparing TPLOs to TTAs. I think I posted it up here somewhere. The study was presented at the year before last's ACVS meeting. Whenever we do a lateral suture, it usually is either on smaller dogs who have CCL tears or in addition to a TPLO if the stifle is still unstable. The first vet I worked with would do them if people didn't have as active of a dog. Most of the time we don't have trouble with the TPLOs that we do. One thing people often forget is that after care is just as important as a well done procedure.

And ouch! I have a feeling few things could handle a slam like that one. My own knee was struck directly from the side so that I ended up injuring the medial collateral ligament fairly badly. Direct blows definitely can cause trouble. Glad your boy is doing well. :)
 

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When my 120 lb newfie x tore his CCL we opted not to do the TPLO. We were warned that the other procedure often fails on large dogs and for it to be successful we needed to follow the rehab instructions very carefully. Glad to say that after what seemed like forever, he healed and was able to enjoy running and fetching again. Then about a year later his other CCL tore.... I decided to try conservative therapy, with the ok by my vet. That healed also. Both times I have him Adequan to help his joints. Now he is nearing 12 years old and not quite as spry as in his younger days, but he still enjoys fetching (with rests in between) and he doesn't run quite so fast, unless there is food involved.
It is good that there are several options for CCL repair. Every dog is different.
 

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3 yr old female TPLO

My 3 year old girl, Belle, had TPLO 2 days ago. She had limped very sporadically for a few months, but it would be a minute or two and then she was fine. Nothing vet could find. In mid-December I told the vet she had stopped sitting all the way and was having trouble/hesitation jumping in and out of the car. Vet diagnosed hip dysplasia. We treated that with laser therapy for two weeks but then she stopped using her leg completely so I took her to specialist who diagnosed the CCL. Three days later she was in surgery.
I have found so much valuable information from reading everyone's stories online, this and other sites. Got us totally prepared to bring her home yesterday.
So far she is still just laying down, looks very sad. I swear I see tears in her eyes when she looks at me. She walks on all 4 legs to go outside for bathroom, has to be carried up and down the stairs to get outside and waits to be picked up. We have not used the cone, she is not licking the wound and the huge hard plastic cone she came home with is so uncomfortable. I have ordered every option available to find something better for when she does start moving around. She is not eating very much, no interest in dog food, but will eat chicken and some rice and treats. Drinking water and eating ice.
She will lift her head and wag her tail when the kids come in from school, but only actually stood up when I brought her "little brother" home yesterday. (I had taken our 1 1/2 year old rescue mutt to work with me to ease her transition home.)
Hoping we made the right decision!
 

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My 3 year old girl, Belle, had TPLO 2 days ago. She had limped very sporadically for a few months, but it would be a minute or two and then she was fine. Nothing vet could find. In mid-December I told the vet she had stopped sitting all the way and was having trouble/hesitation jumping in and out of the car. Vet diagnosed hip dysplasia. We treated that with laser therapy for two weeks but then she stopped using her leg completely so I took her to specialist who diagnosed the CCL. Three days later she was in surgery.
I have found so much valuable information from reading everyone's stories online, this and other sites. Got us totally prepared to bring her home yesterday.
So far she is still just laying down, looks very sad. I swear I see tears in her eyes when she looks at me. She walks on all 4 legs to go outside for bathroom, has to be carried up and down the stairs to get outside and waits to be picked up. We have not used the cone, she is not licking the wound and the huge hard plastic cone she came home with is so uncomfortable. I have ordered every option available to find something better for when she does start moving around. She is not eating very much, no interest in dog food, but will eat chicken and some rice and treats. Drinking water and eating ice.
She will lift her head and wag her tail when the kids come in from school, but only actually stood up when I brought her "little brother" home yesterday. (I had taken our 1 1/2 year old rescue mutt to work with me to ease her transition home.)
Hoping we made the right decision!
Sorry you are having to go through it, keeping them "down" when they start feeling better is difficult, especially with other dogs and kids in the house. Are getting set up for pt?
 

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Sorry you are having to go through it, keeping them "down" when they start feeling better is difficult, especially with other dogs and kids in the house. Are getting set up for pt?
Yes, we go on the 27th to get her started on the PT. She seems to be feeling much better today. Had to set her up in the walk out basement since my husband not here to carry her down the stairs and she decided she wanted no part of that, even though I have been 2 feet away all day! I caught her 3 times poised to jump before I let her out of the pen and just blocked off space on the floor. She is eating and trying to move around a lot more. So I guess the fact that she is a total pain in the butt today is very good news!
Luckily my kids are both older so very helpful. However, she has decided the other dog is not allowed on the floor today so that's been fun :)
 

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We built a simple wood ramp and covered it with outdoor carpeting for traction. We only have 3 steps in the front so a 4x8 sheet of plywood provided a safe angle for Range to walk down, he's 95lbs so carrying him was a pita.
 

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Discussion Starter #19
Colie--very interesting! My girl was a rescue so we had to have her spayed at 6 mths.

UGAvet--excellent point about the "weekend warrior" dogs. Liesl probably fell in that category, as we usually did fairly leisurely walks during the week but did some hard ball chasing with twist and turns on the weekends. Now I definitely at least walk and trot her briskly before ball session to be sure she stretches and loosens up.

Belle--yes, it's hard enough to see them miserable the first few days after surgery. But the really hard part is when they start to heal and they don't understand that they have to continue to rest and not be active. It requires us owners to see around corners and tell the future to be able to anticipate and prevent them jumping and running, even on the leash. Be vigilant, and even though you feel horrible preventing their fun, and know that there will be fun days ahead, and your dog will not hold a grudge! :)
 

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Colie--very interesting! My girl was a rescue so we had to have her spayed at 6 mths.

UGAvet--excellent point about the "weekend warrior" dogs. Liesl probably fell in that category, as we usually did fairly leisurely walks during the week but did some hard ball chasing with twist and turns on the weekends. Now I definitely at least walk and trot her briskly before ball session to be sure she stretches and loosens up.

Belle--yes, it's hard enough to see them miserable the first few days after surgery. But the really hard part is when they start to heal and they don't understand that they have to continue to rest and not be active. It requires us owners to see around corners and tell the future to be able to anticipate and prevent them jumping and running, even on the leash. Be vigilant, and even though you feel horrible preventing their fun, and know that there will be fun days ahead, and your dog will not hold a grudge! :)
bill, curious how this turned out for you in the long haul. Sent you a message. Thanks

conner
 
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