TPLO Info Step 4: Treatment Options

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Welcome to step four where we will discuss treatment options for a dog with either a partial or complete ACL tear. In general, the treatment can be broken down into two major categories, one, non-surgical management, or two, surgical management. There are critical aspects of each individual case that determine which of these options is best for any given pet. In this video, we're going to describe the components of non-surgical management and the different surgical options available rather than tell you which option is best for your pet. Let's start with non-surgical management. I like to break non-surgical management down into five basic categories. Number one is having an ideal body condition or weight. For most pets, this means weight loss is of utmost importance. Category number two I term proper exercise. For most pets, this means exercise modification. Exercise restriction is an okay term for a pet before and after surgery, however, exercise modification is probably a better long-term idea. A real important concept here is to avoid a weekend warrior lifestyle and promote a consistent leash walk lifestyle. This is also a good place to mention that incorporating a professional rehabilitation program into your pet's recovery may be beneficial. Talk with your veterinarian surgeon and see if they recommend that. In some cases, doing too much exercise before treatment, especially of a complete ACL tear, may cause more harm than good. Category three is what I like to term joint supplements or joint diets. We do have evidence that supplementing with omega three fatty acids, chondroitin sulfates, glucosamine, and other supplements can be a benefit. Each surgeon has specific ideas on which things work best for their patients, and we suggest you seek their advice for this category. Category number four is what I like to term alternative therapies. There are therapies such as stem cell therapy, platelet-rich plasma treatment. Some people prefer chiropractics or acupuncture. Again, these are alternative therapies that can be used either in addition to or instead of surgery for some ACL injuries, not all ACL injuries. And finally, the last and fifth category is the use of drugs. Now sometimes we use drugs early on in this condition and sometimes it's ideal not to use drugs early on in this condition. In general when your pet is on pain management or anti-inflammatory drugs, they should be rested or restricted. We like to use this category last because some side effects can occur. One concern that many veterinarians have about non-surgical management is the progression of arthritis and damage to the knee. In these X-rays, you can arthritis progression to the point where the opportunity for maximal benefits of surgery has been lost. Having said that, surgery of the knee in the image on the right can still be beneficial in producing good function for this pet. If a pet is going to be managed non-surgically, there must be rechecks and reassessment. To start non-surgical management and never reconsider could be a failure. If muscle atrophy is progressing or severe arthritis is progressing, there can be decreased range of motion. If an ACL injury is partial and then progresses to a complete rupture, surgery should certainly be reconsidered. Or if a meniscal injury occurs through the non-surgical management process or during the non-surgical management process, the plan needs to be reassessed. For surgical management, we generally break the repair techniques down into several categories. One category that we'll talk about here is an extracapsular repair. The other category is an osteotomy repair. Extracapsular refers to the fact that the ACL injury is going to be treated by using a strengthening technique outside of the joint capsule. Osteotomy repairs refer to the fact that the bone will be cut in order to treat the ACL injury. Three major extracapsular cruciate repair techniques that are commonly used are the lateral fabellar suture, which is generally a monofilament nylon that's anchored around the fabella and through a hole in the front of the tibia. Another procedure is the TightRope procedure. This uses a very strong braided material to mimic the ACL ligament outside of the joint capsule. Finally, bone-anchoring techniques such as the SwiveLock procedure shown here utilize similar braided materials and bone anchors to support the repair. We're gonna talk about three of the most common osteotomy procedures. The procedure that's been around the longest of these three is the TPLO or tibial plateau leveling osteotomy. Another procedure as shown here is the TTA or tibial tuberosity advancement. And then finally, the third osteotomy procedure presented here is the CBLO or CORA-based leveling osteotomy. It's shown in the picture on the far right.