dog's pain after meniscus removal?
 

Hi -- I'm completely new here -- I hope I'm doing this right! To start, my question is: can a dog live comfortably without their meniscus? My 5 1/2 year old Labrador, Bridie, is scheduled to have meniscus surgery (removal) on Feb. 11th, and I am terrified that her pain is going to be worse after the surgery than it is now. I can't imagine a dog being able to walk without severe pain with no cushioning in their knee. She had ACL surgery on this leg one year ago, and at that time the vet said her meniscus was fine. I was very careful during the recuperation, and everything seemed to be going beautifully till she began holding her leg in the air and hopping as she had before the surgery. I took her to the vet several times over the last six months but each time she said nothing was wrong with the surgery, and sent me home. Finally the vet started her on Prednisone, thinking it was some kind of inflammation. For six weeks (up until a few days ago) she was on Prednisone, responding well but relapsing each time we tried to taper it off. Now the vet is almost positive she has a damaged meniscus, and has scheduled Bridie for surgery.
In the meantime, I can hardly bear the thought of putting her through another surgery. Now that the Prednisone is completely out of her body, she seems almost fine some of the time, and I wonder whether the Prednisone actually helped, and she may continue to get better on her own. Then again she looks very low, holding her leg in the air, and is obviously NOT fine. I'll see how she does over the next week. I keep hoping for a miracle, but I don't think there's going to be one. The vet said today that if she can get better without surgery, that is certainly the best. But she said that in the case of surgery, the pain of being left without a meniscus is much less than the pain of having broken pieces of meniscus in there.
Has anyone had experience with this, who can reassure me (or not) that Bridie could live happily after having a meniscus removed? Thanks so very much -- (I hope I can find my way back to this forum after I turn off the computer. As I say, I am totally new at this.)

I personally can not help you out, but one of our members had a partial removal done on her dog Chase, here is the thread maybe you will find some information that you are looking for:

[url]http://www.pets.ca/forum/showthread.php?t=57606[/url]

What kind of ACL surgery did your dog have? How has the vet determined that the problem is now the meniscus and not a failure of the original acl surgery? Is this vet an experienced orthopedic vet? Have you thought about getting a second opinion?

In answer to your question, yes a dog can live without a meniscus, BUT degenerative arthritis will set in just that much quicker because the bones are constantly rubbing against each other. The reason that the dog seems to be getting better for periods without the prednisone is because the inflammation stablizes the joint. However, I am a bit confused as to how the meniscus has suffered further damage AFTER acl surgery. Is your dog on a g/c supplement? What kind of activity restriction did you impose after the surgery and for how long?

My newfie girl had ACL surgery (a TPLO) in August of 2007, and my son's newf has elbow displaysia - so I have done quite a bit of research into bone issues. :)

Thanks for your replies.. the ACL surgery was the standard external suture type. (can't remember the exact term) I also am confused as to how a meniscus damage could occur after the surgery! -- that is one of my main questions, and the one that makes me feel a bit of doubt about the vet. She is not a board certified orthopedist, but she does all the orthopedic surgeries in the group practice she's part of.. Bridie had a second set of xrays and her leg manipulated under sedation a couple of months ago which verified that the original surgery is totally intact. Yes, she's been getting Glycoflex all year long, and a good diet -- and I've just begun trying a raw meat & bones diet for part of her food. She is in magnificent health overall, except for this leg thing. The months of recuperation were the standard gradual increasing length of leash walks -- no running, no jumping, etc. it's hard for me to remember exactly, but each time I took her for checkups they always commented how incredibly well she was doing. I think a visit to a specialist for a second opinion would probably be a good thing at this point. I admit I'm feeling more than a bit overwhelmed by this, which makes it hard to make decisions.

Since you are a new member and do not have enough post to "private message" I have pm'ed Dr. Lee, hopefully he can have some answers for you.

I would definitely suggest seeing an orthopedic vet for a second opinion. ACL replacement in a dog that weighs more than about 50 lbs has a very high rate of failure, and subsequent examinations could have been affected if there were any inflammation, giving the impression of stability. Did the vet do an MRI to make sure the suture itself is holding?

From what I've read about damage to the meniscus, although it doesn't technically 'heal' itself, scar tissue forms and will eventually take on the characteristics of the meniscus - although that process takes years. Everything I've read agrees that you need to leave as much meniscus as possible but that many vets practice the "when in doubt, cut it out" philosophy.

I would suggest that you look for a veterinary teaching hospital for your second opinion. The teaching hospitals are good because you get a whole team of folks working on your dogs case and they normally have the best equipment.

Wow -- thank you, Chris and Kandy, especially for your point about how inflammation can make a joint seem more stable than it is. I didn't know that. I think the next step will be to see a specialist. There hasn't been an MRI yet. I will let you know how things develop -- I will be talking to the vet later today about a referral to a specialist not too far away. (not a teaching hospital, but they do have a good facility.) In the meantime, this morning Bridie's pain was bad enough that I would have taken her in today for surgery if I could have. I gave her a very small (25 mg.) dose of Tramadol to ease the pain. Your notes have reminded me that I do need to wait and be really sure about what's going on, before doing any surgery. I'm going nuts thinking about surgery. Seeing the specialist, and probably getting an MRI, will ease my doubts. The cost scares me, but the cost to Bridie would be unthinkable if she didn't get the right treatment... I'll keep you posted -- thanks again. Julia (jdlimabean)

Good Vibes for Birdie jdlimabean and please do keep us posted on her prognosis :)

[QUOTE=jdlimabean;742132]Thanks for your replies.. the ACL surgery was the [B]standard [/B]external suture type. (can't remember the exact term) I also am confused as to how a meniscus damage could occur after the surgery! -- that is one of my main questions, and the one that makes me feel a bit of doubt about the vet. She is not a board certified orthopedist, but she does all the orthopedic surgeries in the group practice she's part of.. [/QUOTE]

A couple of thoughts. When kandy asked about the type of ACL surgery, there are typically three types that are commonly used: 1) external 2) TPLO and 3) TTA. I would call the external method 'standard' as of 20 years ago but if I had to pick a 'standard' ACL surgery today, it would be the TPLO. The external method is still recommended for pets under 40 lbs but for larger dogs (i.e. Labrador) it typically does not work as well. Were you offered other options at the time of surgery? An orthopedic specialist? The external method relies on providing support through the prosthetic. It has been common to use high tensile strength fishing line. Regardless, the reason that it has problems with larger dogs is that the dog places large amount of force on the prosthetic which can stretch it out and compromise the delicate alignment of the stifle joint over time. The TPLO and TTA (pictures attached) reorient the angle of articulation and are held together with plates. For larger dogs it is typically a better surgery.

As far as the meniscus, there is an orthopedic specialist that teaches at a well known university that removes the meniscus on every ACL surgery for the simple reason of not having to go back in on a second surgery. In the past he had done many surgeries for patients of mine and they have all done very well. Most of the other surgeons, including the ones I refer my patients to now, typically will inspect the meniscus and leave it if possible. In general, I believe, that having an intact meniscus is better than not having a meniscus but both of these situations are better than the presence of a torn meniscus that is causing pain. There is controversy over the use of glucosamine and chondroitin in the absence of a meniscus however for the benefits of anti-inflammation I think they can be beneficial. I am also a strong supporter of the use of Eicosapentanoic acid EPA from the Omega 3 Fatty Acids (fish oils) for reduction in joint inflammation. Additional use of prescription NSAIDS like metacam, previcox, rimadyl or deramaxx will also help reduce pain and inflammation.

Recommendation: while your veterinarian appears to be very familiar with orthopedics, it would not hurt to obtain a second opinion from an orthopedic specialist. It would be money well spent, even if she or he tells you that your veterinarian is correct and that Bridie should have this surgery.

Thank you, all of you, so much. I have just made an appointment with an orthopedic specialist for one week from tomorrow, the 11th. I do feel relieved. There is much in your reply, Dr. Lee, that I did not know, and I'm grateful. Before Bridie's surgery a year ago, my vet recommended against the use of TPLO in general, (not just for my dog but for any dog.) saying that it had not proven to be any better than the external suture, so I didn't even consider it. Bridie weighs 66 pounds. The vet felt very confident in doing the ACL surgery, and did not suggest I see a specialist. I'm really fascinated by what you say about the one who routinely removes the meniscus on every ACL surgery! That seems kind of drastic -- but it certainly demonstrates that the meniscus CAN get damaged post ACL surgery. At any rate: I'm glad I'm going to see the specialist, and very grateful for everyone's support and encouragement in that direction. I was beginning to wonder whether I was being silly, worrying so much about my vet, a second surgery, meniscus removal etc. (I was unable to mention every single detail in my original post, but for a number of reasons over the months I have had less than full confidence in my vet's ability to see the whole picture, though I think she's a competent surgeon.) This way, when Bridie has surgery (which I'm pretty sure she will, of one kind or another) I will have peace of mind about what's being done. Thank you all!!! Julia

Good luck to Bridie, and please let us know how it goes with the ortho specialist. :)

Meniscus removal
 

I am new to this forum. I have a difficult decision to make. My dog, Laredo, a 6 year old Shih Tzu had luxating patella surgery last April with removal of the ACL that was ruptured. He has started to limp again and the surgeon has recommended removal of the meniscus. I see many conflicting opinions. Has anyone else had a similar situation? I'd really like to chat with you. Thanks in advance.