Garm is the Best Dog

[凤凰来仪]

Any opinion/knowledge/experience with dog orthopaedic or CCL injury?

[Mark Rippetoe]

It's always expensive. I think it's a breeding problem. If Garm is a good dog, get it done.

[凤凰来仪]

Too many physical and health problems from unintelligent or vain breeders. This dog comes from very high quality working dog lines and good breeders though.

It'll be done whatever the expense. Just have to figure out the right course of action. Doesn't seem to be much consensus among vets about specific procedures or even if surgery creates a better outcome and I can't find reliable quantified outcomes. Radiography and behaviour indicates partial tear.

[Mark Rippetoe]

Where are you?

[凤凰来仪]

Utah, the majority of the time.

[Mark Rippetoe]

Where is their vet school?

[Bill the vet]

Hi,I’m a veterinarian in Houston,Tx. I’ve been practicing for 45 years in a one man practice. What size is your dog? For larger breeds ( over 50#ish), the gold standard is TPLO( tibial plateau leveling osteotomy) for anterior cruciate ligament rupture. It needs to be performed by a board certified orthopedic surgeon.Should be a few in major cities in Utah. It’s a major surgery,but it’s a permanent fix. Best of luck to you and your buddy.

[凤凰来仪]

Could you point me to any well-constructed meta analysis or comparative outcome data analysis in this area?

She is a very athletic 50lb dog. I understand the theory, anatomy and practice of TPLO. What I do not have a good idea of (have tried a couple of vets, but not the university vet school) is comparative outcomes, effect on gait/movement patterns, why allografts are not used to reconstruct a ligament and the ability of a properly rehabbed sprain to stabilize and heal over time (I understand the OA development theories too, but in the absence of even substantial anecdotal data among vets, that is just a hypothesis).

In addition, from a physiological and evolutionary perspective many of the prevailing premises for TPLO do not completely add up; Even if it still may be the best procedure.
I have yet to put together a quantitative biomechanical analysis of the forces exerted on the canine CCL, but we do know the decreased angle of incidence compared to a human's does not seem to cause problems in the majority of high quality dogs including those of the very heavy/athletic varieties or older dogs. My suspicion is that shear stress will be the main damaging agonist and should not vary greatly in magnitude when the tibial angle is leveled by 15 degrees. The angle of the tibia with respect to the knee joint should also be capable of at least a 15-30 degree change during movement depending on the specific anatomy of the dog. Hence, if the absolute tibial angle is reduced relative to the ground when at rest, the angle will still likely be at least 5 degrees during a walk or trot and much more during higher intensity activities. On the evolutionary side, if tibial plateau angle were a major aggravating factor, you would expect it to be selected against over time unless it provided a huge biomechanical advantage. However, if it was a major injury risk that provided a huge advantage, you would expect to either see: 1. High variability in the angle among dog breeds or 2. Structural differences in the CCL across breeds or relative to intra articular structures.