ACL Surgery Information - TTA va TPLO surgery

The most common knee injury in the dog is rupture of the Cranial Cruciate Ligament (CCL), also frequently referred to as the Anterior Cruciate Ligament (ACL). This injury can occur at any age and in any breed, but most frequently occurs in middle aged, overweight, medium to large breed dogs. This ligament frequently can suffer a partial tear, leading to slight instability of the knee. If this damage goes untreated, it most commonly leads to complete rupture and possibly damage to the medial meniscus of the knee. The meniscus acts as a cushion in the knee. Complete rupture results in front-to-back instability, commonly called Tibial Thrust, and internal rotation of the lower leg, commonly called Pivot Shift. Untreated legs usually become very arthritic and painful from the instability.

An injured Cruciate Ligament can only be corrected by surgery. There are numerous surgical corrections currently being performed. The most common are 1) External Capsular Repair, 2) TightRope Procedure (a variation of the External Capsular Repair), 3) Tibial Plateau Leveling Operation (TPLO), and 4) Tibial Tuberosity Advancement (TTA).

The forces within the knee are very complicated and change as the knee is rotated through its range of motion. In a normal standing position there is a tendancy for the lower end of the Femur to slide backwards on the tilted Tibial Plateau, this is called Tibial Thrust. This force can be corrected by either cutting the Tibial Plateau and rotating it into a more flat position (TPLO) or by counteracting this force by changing the angle of pull of the very strong Patellar Tendon by advancing the Tibial Tuberosity (TTA).

Some researchers think that the TPLO procedure can still allow rotational instability (Pivot Shift) and this may lead to the progression of arthritis as the dog ages. This Pivot Shift does not seem to be a problem with the TTA procedure because it results in more control of rotation by the large quadriceps muscle which pulls on the Patellar Tendon.

Anyone interested in the details can easily find them by doing an internet search on “TTA vs. TPLO”.

Water Treadmill Therapy - underwater video

Here's a video of what it looks like under the water when the dog is walking on the treadmill. You can see all the legs working independently and he's unable to hop or skip and avoid using the back leg that had the surgery.

Warm water provides an ideal way to work the leg without putting undue stress on the knee (stifle) joint. Range of motion and strengthening can both be accomplished with less risk of re-injury through swimming. The warmth of the water itself helps relax stiff muscles. Underwater treadmills are also an excellent way to encourage your dog to gait properly and weight-bear on the affected leg, either post-surgery or in lieu of surgery.

Water Treadmill Therapy

Well, it's five weeks since the surgery and Niko is still limping quite alot. Apparently the meniscal tear has the ability to possibly make him lame if we don't take his recovery very slow. The TPLO surgery combined with the meniscus tear is what makes his recovery so slow. He was walking the other day and stepped off a curb at an angle and his leg gave out and he hurt himself. Even the simple task of walking him slow is difficult. You have to make sure that he walk up and down a curb at a 90 degree angle so as to avoid his placing his feet wrong.

Yesterday at physical therapy VOSM (the surgery center) checked to make sure that he didn't re-injure himself and that the pins weren't jarred lose. Fortunately, nothing serious happened and he was ready to try his water treadmill therapy.

It was pretty cool as the water quickly frilled the treadmill booth and when they turned on the treadmill he had to keep up with the speed or his rear end would hit the back wall. All in all, I think he loved it.

TPLO X-rays at 4 weeks

Healing is going very well and Niko is responding well to his physical therapy. However, it amazes me that we still have to keep him on the leash at all times, he can be alone with the other dog and we have to continue blocking off the stairs as well as the couches. It's not easy walking him because he sometimes refuses to move forward and I have to use lots of treats to get him to walk. He'd much rather run so he can hike up the bad leg and I have to constantly slow him down to a walk to force him to use all 4 legs.

Here are some x-rays of the plate and pins from the TPLO surgery. In the x-ray to the right here you can see where they cut the bone and it still has the vertical crack from the incision. That's what we are waiting to be filled in by bone

before he can do anything. We're still talking 12-14 weeks recovery time before the bone fills in.

The leg is a bit atrophied and I'm going to have to reall focus on more exercises to build up his muscles. We don't want the bone to heal and then have the leg be too weak to stand on.

Next week we start the under-water treadmill.

TPLO surgery recovery at 3 weeks

Niko is doing extremely well at 3 weeks. I took him back to the surgery center to have them check his progress. He's started to walk faster now, although I have to slow him down so he walks instead of runs. When he picks up his pace, he tends to run on three legs, so walking is very important because it forces him to use all 4 legs. He's allowed to go up and down one or two steps and I can increase his walk time from 5 minutes to 10-15 minutes.

I took a video of the physical therapy that they suggested be done twice a day after the surgery.

These are special exercises to help restore optimal movement to his knee joint. First, have your dog lay on his side, with the affected leg on top. To perform flexion, grasp the leg just above the knee and just below the ankle (hock). Holding the thigh steady, gently push the lower leg up toward the thigh, so that the upper and lower legs are fully touching. For extension, grasp the leg just above the knee and just behind the hock. Keeping the thigh steady, gently push the hock until the leg is straight. Perform both motions for 2 sets of 10 repetitions. Be careful never to force the leg, and never push past your dog's comfort zone.

Day 12 after TPLO surgery

Ahhhhh. Life is the new normal, and everything is ok. I was terrified of the changes we were going to have to endure with Niko's surgery. Don't let him climb on the couch, he has to wear the cone 24/7, can't allow him and the other dog alone together, no walking up or down stairs, have to put rubber mats on all of the wood flooring and kitchen areas, can't let him go outside except for a few minutes at a time, has to be monitored constantly to make sure he's not doing something destructive to his injured area... on and on and on.

I 'm happy to report that the "other dog" loves the crate when we are gone. Niko could care less about the cone and just lifts his head when it's time to put it on, he's not interested in going up or down the stairs and the mats all over the floor provide a variety of sleeping areas for him.

The staples come out on Monday in two days and we'll move into the physical therapy stage of recovery. It really hasn't been too bad at all. His incision is almost totally healed and his hair is growing back and he's occasionally starting to use his leg to stand on and sometimes to walk on.

I have to admit that preparing the house was the best thing I did. When he came home from the surgery center, everything was ready and all I had to do was give him lots of love and attention - that part was easy.

Day 6 after TPLO

Ok - so I'm dense. Niko was doing so well and he was healing like a champ. He didn't mind the cone and was into his new schedule. Everything was going great until we started to get a little lax on the cone thing.

We first started taking the cone off to give him a break when we were sitting right there. Then we left the cone off while we were in the other room for a few minutes. Then we left the cone off for a little longer period of time. He never was bothered or even interested in his stiches....

Always, always listen to the Doctor !!! I left the cone off and walked away, when I came back into the room, Niko was licking away. I nearly fainted. They warned us that this would happen. Thank goodness he didn't remove any staples. But the area is all red and raw from his licking and now I'm going to have to watch it for infection like a hawk. I'm sooooo stupid ! Everything was going so well, and we got careless. The amazing thing is that the Doctor could not have been more explicit about this particular instruction.

Rule #1.... Never leave the dog unattended without his cone on. Grrrrrr !

Day 2 - a little fresh air

Brought Niko outside for an hour or so yesterday to lounge around in the shade. He's feeling pretty good about things...

Day 2

Before the surgery I searched the internet to get information and pictures of what I could expect when I brought Niko home. Some of the pictures of bruising and ankle swelling after surgery were terrifying. I was so anxious about the aftermath that I worried myself sick. Now, day 2... look at the leg. So far, there's no swelling of the ankle (which would be normal) and there doesn't appear to be any bruising (which would also be normal). Niko is moving around great and occassionally is resting his leg on the ground.

Day 2 - I couldn't have asked for a more laid-back dog. He's doing super fabulous.

The Cone

For those of you who don't know what a cone looks like, here's a picture of Niko's cone. They've changed over the years. Cones used to be non-see thru white and a little thicker than this clear version. Another nice change is that the newer cones have velcro instead of flaps that you have to fool with. The only disadvantage of the velcro is the noise it makes when you are removing it. But at least the dog can see where he's going and can look through the clear plastic to see everything around him. It's working out well and doesn't seem to be bothering him at all. He doesn't even squirm when we put it back on him. So far so good !

1st night home

Niko did great. I heard him bumping into the walls with his cone around 2am and came down to let him go outside - making sure that I used the sling to prevent his back leg to "hit" the down when he went down the step outside the front door. The sling, by the way, is working wonderfully. I used a towel and sewed handles on to the ends - it works like a charm when he has to go down step. I take the cone off to go outside and usually after he has done his business, he likes to sit down and experience life without the cone. I sat outside with him for about 10 minutes, brought him in and re-coned him before heading back off to bed.

The ride home

The technicians went over so many details with us about the recovery over the next 12 weeks that my head is swimming. All I can remember is that for the next two weeks we are to keep him quiet. Cone on at all times, no walks and lots of medications. On day 5 we are supposed to start the at home exercises. I'll worry about that in 4 days. Right now I'm trying to keep him comfortable. He opted to go into his crate an hour ago and I took the cone off so he could get into it. However, I'm sitting here watching him to make sure he doesn't roll over and go after the staples in his leg. He's sound asleep and laying on his bad leg - so I think I'm safe as long as he doesn't JUMP up and switch sides. One of the best things that I did to prepare was to put rubberized rugs all over the first floor so he wouldn't slip on the wood floors. That's working very well. The other thing that I did was to make a "sling" to help lift his rear leg off the ground when he goes down one step to go outside to pee. They said that it isn't unusal for them not to poo for 5 days - so I'm not too concerned about that. When we got him home from the hospital, he must have had to pee every hour. He was given fluids over the night and they warned us that he'd have to go alot. They sent him home with Tramadol for pain - give to him for 7-14 days to keep him comfortable. Oh crap, I forgot to do the ice thing on him 2-3 times a day - I KNEW I'd forget something.

Day 1 after surgery

We got to the VOSM surgery center at 11am as planned and the technicians went over all the details of Niko's 1st night at the hospital. Apparently he was a star patient and very calm. They couldn't believe that he was actually allowing his foot to touch the ground. When a dog has had this kind of surgery, they typically hold their leg all the way up so it doesn't touch the ground. Niko is allowing his foot to touch the ground and he's even allowing some weight on the foot already. This is great because they want the dog to put weight on the foot and start building up the tendons and muscles. The picture here was taken in the car just after we loaded him in. He's comfortable and very calm. The leg looked great - it's not as red as the picture, that must be because it's my iPhone instead of a real camera. The bandage that you see is to cover the incision and staples. It only stays on for a day or so. It can come off anytime.

The surgery Center

The surgery center was very plush - guess it should be for all that money. But, I felt from the moment we walked in with Niko that we were receiving individual attention and that Niko was going to be handled with kid gloves. Everyone was friendly and helpful and the Doctor took an extreme amount of time with us to explain everything and examine Niko.

Niko was sweet and quiet the whole time and when they led him away, it was painful to see him look back. I had read so many horror stories about how the animals were treated by un-caring technicians and cold-hearted doctors, I was pleased that so far I had a good feeling about leaving Niko in their hands.

They gave us a tour of the facility - they have underwater treadmills, a pool for physical therapy, an exercise room. Great place for a dog to get the after-care he needs so healing can progress at a faster rate.

The risk is always that he'll get an infection - so we'll have to be careful and watch to make sure that he's quiet and doesn't do any licking of the stiches when we bring him home.

FeeFee, our other dog, is wondering where he is.

Evening of surgery

Well it's 6pm and I just got a call from the Doctor. Niko is resting quietly and everything went smoothly during surgery. He had a full cruciate rupture as well as a medial meniscus tear. I'm glad that we didn't wait to have it done. That would have only put more pressure on the opposite side and he would have been in terrible pain. It's always hard to know whether we are over-reacting or not. Niko will spend the night at the center and we'll pick him up tomorrow.

Day of surgery

Well, this is the day of surgery and we got up at 6am. It was a little difficult feeding FeeFee and distracting Niko because he can't eat before surgery. They're being walked right now and FeeFee will be dropped off at Grams house for the duration of the day. Yesterday we went to Home Depot and I had a piece of wood cut 17" x 36" to make a ramp for the car. Because we have an SUV, it's a little high for Niko to climb into with the injured leg. He needs that back leg to lift himself into the car and he hasn't been able to go for a ride since the injury. Then I stapled some rubber pads to the board to act as traction strips so he wouldn't slip on it as he walks up into the car.

I'm just trying to prepare the house and make sure that I have everything I need for when we bring him home tomorrow morning. I read somewhere that if you hold a towel around their mid-section and lift them up - you can to help them lift their rear end when they go up or down the stairs. So I cut up a towel and put on handles.

Last week when I realized that it was a serious injury I brought out my doggy gates and blocked the upstairs and downstairs floors so Niko was only allowed to use the main floor. He accidentally came downstairs last week before I did this and it was a disaster. I couldn't lift him up the stairs (73 lbs) and he couldn't walk up the stairs - so I wanted to make sure that didn't happen again.

The other thing that I did to prepare was gather up all the soft doggy mats and beds that I have scattered around the house and put them on the main floor and covered them with blankets. I read that the floor will be too hard for them to lay down and they will prefer a soft bed of some kind. Since I have two dogs and a cat, I had to make sure that I had enough for everyone. Most days, the cat is lounging on the dog bed and they don't kick her off. The other days, FeeFee, likes to lay on the soft padded bed.

So I think I'm set. It's 7am and time to get ready to take Niko in for his consultation and x-rays. Blood work was already taken last week and has been faxed to the surgeon's office. Niko will stay at there and they'll do the surgery this afternoon. He'll spend one night there and we'll pick him up tomorrow morning. So I think: Niko's ready and we're ready.

I've done all I can do to prepare for this and I think of the trials that I've been through in life and remind myself that with the grace of God: "This too shall pass".

A walk before the injury

Enter Sunny aka FeeFee

Sunny aka FeeFee was a sweet, gentle little girl. Yet, she can bully Niko terribly. She's in charge and definately won't let him forget it. When I brought her home, I can remember being worried about how she was going to react to the cat and whether she and Niko would hit it off.

From the moment that she arrived, she walked in and straight over to the cat lounging in the sun. I held my breath as I waited to see what would happen. She bent over my little feline and licked her. I watched her walk over to Niko and nudge him. I knew then that everything was going to be ok. Thank you Moonsong !

Niko, sitting on the left, was born in August 2003. He was one of a litter of Samoyeds that were all turned over to the Mid Atlantic Samoyed rescue when their owner decided that he couldn't care for them.

All of Niko's litter mates were instantly rescued - there's never a problem finding someone who wants a puppy. Fortunately, I was able to adopt Niko at 13 weeks and was able to enjoy the puppy years. It wasn't too long after he settled in that I decided that he needed a companion.

I looked for almost a year for a female to keep him company. One day a friend of mine was at a dogshow and she happened to mention to the owners of Moonsong Kennels that I was looking for a female to adopt. They said that they might be willing to part with one of their older female dogs, if I was worthy !

I met them not too long after that with all the trepidation of someone about to meet a pregnant mother of a baby about to be adopted. I wanted so bad to be "worthy" of this sweet little girl. Sunny aka FeeFee, sitting on the right, was adopted from Moonsong Kennels when Niko was 3. She's a little older than him and is definately the alpha of the two.

ground zero

It all started about 10 days ago. Niko was out walking and playing with Sunny, his sister, when he started to run in the opposite direction. In a split second, he all of a sudden yelped and fell to the ground. It was as quick as that. He wasn't jumping or tearing across the park, he was just doing what all dogs do - playing.

Even though I didn't know it at the time, that single moment determined the course of all our lives for the next 4 months.

He laid down and didn't get up and we had to go get the car to bring him home. He was holding his left rear leg up and walking three legged for the rest of the day. I thought, and hoped, that it was just a bad sprain and that in a couple of days, he would be better. However, after 3 days it was obvious that this injury was more than a sprain and I made an appointment with the vet. When I brought Niko into the vet, she examined him and manipulated his anterior crusiate and determine by the loose movement that he had ruptured it.

She recommended two surgeons that perform TPLO surgery for dogs. Who would have thought that surgery could cost $3,150 and be followed with 8-12 weeks of physical therapy at over $100 a session. Choices? Sure there were choices. I could allow him to be lame for the rest of his life and run around 3 legged, or I could do the surgery.

I opted to do what I felt was best. Surgery to restore him back to all 4 legs.

A blown knee - the beginning

I'm not much of a blogger. I'm way to busy to write things down most of the time. But when I found out that Niko, my samoyed of 7 years, was going to have to have TPLO surgery and that the recovery would be 3-4 months, I decided that it would be a good idea to document it. If not for myself to look back upon what happened, maybe for the next person who doesn't know what to expect.