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Old February 3rd, 2009, 12:25 PM
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Dr Lee Dr Lee is offline
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Quote:
Originally Posted by jdlimabean View Post
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..
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.
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Christopher A. Lee, D.V.M., C.V.L.S.
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