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Charlie 快九岁了， 上周四突然在dog park 玩的时候腿不好用了， 第一时间去见了Vet, 医生怀疑是韧带有问题了， 开了消炎药。今天一早， 给我们发了长长d的email, 很高心有这样负责的医生。 把email 贴这里， 分享给有furry baby的家庭. Thank you for bringing Charlie in to the clinic last week to investigate her sore right back leg. Based on the palpation of Charlie's leg, I believe that Charlie has torn her cruciate ligament (like the ACL ligament in a human knee) and that this is causing the knee to be inflamed, painful and will predispose it to developing arthritis. To further confirm this diagnosis, we can take an xray to assess the knee for other underlying changes that would indicate likely ACL tear. Please see below the options available for management or treatment of Cranial Cruciate/ACL rupture in dogs: Cranial cruciate ligament tears and knee disease is very common in dogs and is largely due to microtears that gradually happen in the knee over a long period of time. As the ligament gets thinner and thinner it has less ability to cope with the strain of weight bearing and exercise. Eventually, the ligament tears as it is unable to heal itself. This is quite different to human ACL tears, which are more commonly associated with sudden trauma or excessive force being applied to the knee. There are a number of management and treatment options available for helping the knee become more comfortable and to also slow down arthritic change in the knee. MANAGEMENT OPTIONS: The below management options will not heal the torn ligament at all but may help to manage the pain and inflammation associated with the knee being unstable and lax. 1) anti-inflammatory tablets. This provides pain relief as well as anti-inflammatory support to help slow down further arthritic change in the knee. Whenever joints move abnormally or have inflammatory disease in them, there will inevitably be arthritic change and this is always progressive. We know that in dogs that rupture their cruciate ligament, that there is a 60-70% chance that they will rupture the other leg's ligament in the next 12-24 months. This is probably due to the same underlying micro-tears and degenerative process in the ligament but also because of the increased weight that the animals put on their 'normal' leg following a cruciate tear. If we continue these tablets indefinitely, there is a significant risk for patients to develop gut ulcers, vomiting, diarrhoea and kidney disease. 2) This is why the second option for management is strongly suggested; CARTROPHEN injections. Cartrophen is an injectable anti-inflammatory that is very specific for joint disease and helps cartilage to remain as healthy as possible to slow down the arthritic process. It will not help the ligament heal itself however will keep the joints as comfortable and healthy as possible. The starting course of these injections is 1 injection once a week for 4 weeks, followed by once a month injections. If ever a patient plays or runs vigorously though, there is a very high likelihood that they will become non weight bearing again. If this occurs, it is strongly recommended to consider surgery. TREATMENT OPTIONS: These treatment options allow the knee to be as stable as possible and to prevent any lameness or soreness in the knee in the future. It will prevent arthritic change and will mean that the patient has the best chance of being able to exercise and play fairly normally. You will always need to be monitor your dog during play though to make sure she doesn't suddenly change direction, jump or run too unpredictably. 1) EXTRA-CAPSULAR repair. This surgery aims to replicate the weight bearing and biomechanical function of the cruciate ligament by inserting an implant ligament/wire around the knee. This helps to stabilise the knee, prevent it from sliding forward excessively and therefore minimises the pain and arthritis associated with cruciate rupture. Immediate healing time for the stitches is 2 weeks with complete rest; no walks, running, playing, jumping. After the 2 weeks, we recommend a very gradual re-introduction to exercise over 6-8 weeks, ideally accompanied by physiotherapy or hydrotherapy to ensure that the muscles around the knee are as strong as possible There is a chance with this procedure that if your dog is too active, that she can 're-tear' the implant and therefore go back to being lame. Cost of this procedure is $2000-2500 2) TIBIAL PLATEAU LEVELLING OSTEOTOMY (TPLO); this surgery changes the angle of the knee so that the knee no longer needs a cruciate ligament to stabilise the joint. This is done by cutting some of the shin bone and rotating forward a little. By doing this, your dog will have less chance of re-injuring the knee in the future and can be a little more active than if she had the extra-capsular repair. The healing time is very similar to the extra-capsular repair however there has to be slightly greater care for the first 8 weeks as this procedure requires bone to heal back together (like a fracture wound). This process generally takes 8 weeks before we are confident that the leg wouldn't fracture or destabilise the moved piece of bone. Cost of this procedure is $4000-5000 and is performed by a specialist surgeon at our clinic. I know that this is a lot of information to take in via email and am certainly happy to discuss these in greater detail over the phone or in consult. I would recommend considering either the Extracapsular repair or TPLO surgeries. |
