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ACL drawer test

16K views 74 replies 15 participants last post by  Jthweatt 
#1 ·
How accurate is this test when the dog is sedated? Can it show a partial or slight tear? I have a dog with mild rear leg lameness that has persisted over a week now with crate rest. He seemed to get better after a couple of days but it flared up again after I let him have more activity in the yard this weekend. X-rays o the hip didn't show anything per the vet. The drawer test showed nothing either. I assumed a few days of crate rest and all would be good if it was a sprain/strain, muscle pull or what not. How long should I try crate rest before we head back to the vet. How long should a more minor leg injury take to heal with rest. For what it's worth it happened inside on slick floors I believe. There was no indication of injury until he had been inside sliding around the den. I'm assuming he could have pulled something or hyper extended his hip given that he can't keep footing worth a darn in my den. Any input?
 
#2 ·
Have no idea what your dogs issue is or if you need to see another vet to sort things out but good indicators of a CCL tear are.
1) Non Weight Bearing. Dog will not put weight on foot of injured leg. May be more noticeable when they first get up from sleeping.
2) Outrigger Pose and Tippy Toe. While standing still dog will place foot of injured leg way more outward and rearward than normal. They will touch floor on tippy toes.
3) Sit Tuck. When dog sits he will tuck leg underneath his body so ankle is touching ground rather than sitting normally with feet directly under and pads on ground. They will also do this when settling in to lay down.
If you observe any of these things see an ortho vet.
 
#3 ·
His sit does not appear to be altered. He is bearing weight in it but does appear to be favoring it a bit. It would never have noticed if not for the first night when he wouldn't put weight on it. Well be back in the vet by Friday if it keeps up.
 
#5 ·
I agree. Or a vet who sees a lot of this. If it's a partial tear it can be more difficult to diagnose, but the trick is in the touch. (as with a lot of things in life). If it is a partial, may as well just go ahead and fix it. It's going to finish tearing anyway. Take care of it on your own schedule.
 
#7 ·
In a partial tear, it can be very difficult to diagnose the problem. I have diagnosed many with the anterior drawer and or tibial thrust test on complete tears but was not able to diagnose a partial tear in my own dog while the orthopod that I took her to was able to. She did not show the typical toe-touching and other signs usually seen with CCL tears .
So as others have suggested I recommend taking your dog to a good orthopaedic surgeon for diagnosis.
See the following link for more information.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC339306/

Hope this helps
 
#8 · (Edited)
The drawer test, along with x-rays, was used at Michigan State University Veterinary Hospital (by Dr. Gretchen Flo) to diagnosis .25 Class I tears in both of my lab's knees.

I need to add is that Nala (my lab) was favoring her right knee, hence the exam. What was unexpected was the .25 Class I tear of her left knee (with no expression on the left side).

If that procedure is good enough for an experienced orthopedic surgeon teaching at MSU, it's good enough for me.
 
#10 ·
Thanks for the help guys. He aired for longer than normal this morning and I could not see anything that suggested he is favoring it. The problem is keeping him calm enough to keep him from breaking into a dead sprint, even airing on a rope. Well stay with the crate rest for the remainder of the week and evaluate with some very minor exercise this weekend assuming he continues to show no signs. I guess my main concern is that an MRI would be necessary to diagnose if it was a pArtial year. I simply can't afford that coupled with surgery if it came down to that. Thanks for all the pm's as well.
 
#11 ·
What is the basis for your decision that it would be ok to allow some exercise this weekend? It has been suggested that you see an orthopedic specialist. Have you already been there, done that and received medical advice that it is OK to allow exercise on that schedule?
 
#14 ·
I apologize if I sound condescending.

I'm just trying to understand the basis and rationale for your treatment plan to deal with your dog's lameness.

I can't imagine dealing with lameness without consulting someone who sees it, accurately diagnoses it, and successfully treats it every day.

To do otherwise puts my dog at risk.

I sincerely wish you and your dog the best of luck.
 
#16 ·
I'm not trying to be rude. I'm just not in a place right now to spend money i don't have. Between trying to sell a house, buying land and moving I'm about spent out. Is the prognosis for a partial tear any different than a full tear? I just assumed they are created equal, maybe they aren't. I'll update when I air him this afternoon and throughout the week. If we see a specialist I'll update with that info as well. That will take place next week if I see any further lameness.
 
#17 ·
Is the prognosis for a partial tear any different than a full tear?
Years ago, back when they fixed cruciate tears with fish line, I brought in a young dog with hind leg lameness to my old vet. He couldn't feel anything on the drawer test. Heck, the dog didn't show anything with all kinds of poking, prodding and twisting. Doc told me it could be a partial tear. He told me to give crate rest and go ahead run the dog when he wasn't limping anymore. Doc said when I started working him again if it was a partial tear it would get worse and worse eventually becoming a full tear at which point they'd have to fix it. In my case Tracker got better after a week of crate rest and became my first FC/AFC.
 
#18 ·
Thanks Howard, your old vet gave you the same plan of action I am taking. If there is anything to it I will know soon. At the first sign of lameness after this crate rest we will see the specialist however, not going to wait for it to go completely south on us.
 
#19 ·
If you have a partial tear, the symptoms (lameness, etc.) can go away with rest, only to re-occur later.
If you have a partial tear, and fix the joint, your dog will have less cartilage damage (and arthritis later in life) with surgery now, rather than waiting until you have a full tear.

I do not know of any partial tear that got better with time

You could do an arthroscopy of the knee ($500) and if the scope shows damage progress directly to surgery
- 1.5 - 2k for DeAngelis
- 2.5 - 3.5k for TPLO
- 3-4k for TTA

Don't assume that because the dog is better with rest that you do not have a partial tear
If the problem recurs, I would be very suspicious of cruciate damage
 
#24 ·
Ted's pricing is interesting. It really varies by location. In this area, TPLO Is 3600 to 4000 dollars. That is Chicago. Pricing is similar at the University of Illinois and the University of Wisconsin. Tightrope is about 2500, which includes some initial rehab. I can get TTA done in Sheboygan Wisconsin by an experienced vet for 1500. Decisions about the type of procedure should be based upon the age and temperament of the dog, goals for the dog, etc. Obviously, price is also a factor. Good luck with your dog.
 
#25 ·
Juice Saw dr Milton today. He pulled fluid and feels confident we have a partial tear. Surgery Monday. Can dogs typically Bourne back from this and continue their career? Derbies are obviously over now but just hoping we can get him back to full speed and continue running strong in the future.
 
#26 ·

Unless this dog is a super star, I would retire him from competition and start over. You will lose at least 4 months of this dog's career to rehab. He is likely to blow the other cruciate, and you will lose another 4 months of his career. I would cut my losses and run - unless I was convinced that the dog was going to be a super star - which is hard to predict at his age.
 
#31 ·
Not doing the surgery isin't an option. He will be a hunting dog at the least. I hope to get him back to running tests/trials. I don't know that you would call him a superstar. He made the derby list in 4 starts but other than that he hasn't seen much competition. I'm not a serious trialer, more of a hunt tester that dabbles at this point. My plan was to run Q's and finished/master with him this spring--obviously that is no longer the plan. Well take it in stride and hopefully everything goes well and he can get back in action.
 
#33 ·
Here's hoping the surgery and rehab go smoothly and the two of you are back in training next year.
 
#35 ·
Mine had the first one done and was back to training in 2-3 months and trialing in 4-5 months. She went 3 years before she partially tore the other one. I had the tplo done as soon as I saw the limping when she was tired the 2nd time. She was back in training in 2 months and trialing right afterward. She's still trialing as a 6 year old, and I expect she'll continue to do so for a few more years.

The first one there was no rehab vet in Anchorage then. The second one we had a rehab vet and I took the dog to her twice a week and then once a week.
 
#42 ·
Yes.
First there have been many field champions made after TPLO so if you like the dog and rehab goes good go for it. I agree with what Ted says but if your not the type of person that parts with dogs easily there is still hope for yours. Just be aware that at any time the other leg may blow. On the other hand it may not.

It will be a big big plus if your Dr. does the TPLO using Non Invasive Arthroscopic techniques. If he is not up to date and does the old fashion lay the knee open technique your dog will take longer to recover. Also there is a bone healing amendment (a goop I forget the name of that applied to the otomy speeds bone healing) Ask about it.

As for rehab.
It takes 7-10 days for suture site to heal. Great care should be taken to avoid infection.
It takes 8-10 weeks for the otomy to heel. (This is where the bone was cut in two).
You must be careful during the first 8 weeks of rehab so not to risk breaking the repair. The first week or so require you support the dog with a sling when airing so it can be a chore.

Bone pain is the worst kind of pain so the first week make sure you have the meds you may need on hand and make sure dog is as pain free as possible.

If you have a good rehab plan and are diligent about taking care of your dog everyday you could be back to training in around 4 months.

The most difficult procedures for an owner to do at home are the early post surgical care and early rehab.
Given a choice, if you could leave dog with a rehab pro for at least 4 weeks 24/7 that would be helpful. Then you could take over.

If you have a land treadmill handy or one you can borrow you will need one in a few weeks.
 
#38 ·
There is an ebooklet that you can download for free at the following site that goes through the rehab for TPLO plus others types of surgery. It will give you a good play by play of the rehab procedure. I went quicker than recommended in the booklet with my girl and took her for underwater treadmill program beginning the day after the sutures were removed. There are some adds in the booklet but you can disregard them if you wish.

http://topdoghealth.com/home-rehab-guides/tplo-tibial-plateau-leveling-osteotomy-guide/

Hope this helps and if you have any questions just ask. Many here will help.
 
#41 · (Edited)
There is an ebooklet that you can download for free at the following site that goes through the rehab for TPLO plus others types of surgery. It will give you a good play by play of the rehab procedure. I went quicker than recommended in the booklet with my girl and took her for underwater treadmill program beginning the day after the sutures were removed. There are some adds in the booklet but you can disregard them if you wish.

http://topdoghealth.com/home-rehab-guides/tplo-tibial-plateau-leveling-osteotomy-guide/

Hope this helps and if you have any questions just ask. Many here will help.

Well, I'm not sure of the quality of the entire document but looking at the table of contents it probably contains more useful rehab info than is available to the average owner anywhere else. Probably worth paying for the download.


Also, the guys topdoghealth website has a rehab directory map that shows rehab facilities around the country in Maps.Google. Not entirely accurate but a good start.
 
#39 ·
I just had the TTA done after my 6 and 1/2 year old tore his cruciate in the third series of the AM in St Louis a few weeks ago. I took him into the clinic after the trial, sunday night and left him, they performed the surgery on the following tuesday. I left him at the clinic for the first 2 weeks of rehad which consisted of about 20 hours in the kennel and 4 hours spred out thought the day (24 hrs), of him walking on a very tight lead.
When the staples were removed, he was brought home - his rehab no consists of about 14 hours in his kennel and 10 hours of tight lead walking - including up and down hills, and swimming. This will continue for 6 weeks, at which time he will return to the clinic for x-rays and manulipation to determine if hs is healed up enough to go "off lead" for walks and swimming and light running until he is back to 100 percent - Note - lots of fun as he is a Cosmo son and his idea of moving at all is at full speed.
To date all is going well and he swam about 300 yards the other day. Looking forward to the next check up!!!!!!!!!!!!!!!
 
#43 ·
I found ice packs and massage of great benefit during the early stages, about 7-10 days post surgery. Massage from the toes towards the hip and knead any areas where fluid has built up in the tissue.
As for stairs, they are not a problem if you can control your dog enough to go slowly, one step at a time, but if not then a ramp would be recommended so he will not possibly damage the healing bone.
Also the sling under the posterior abdomen is a good idea to help support the dog while walking in the early stages post-op. I needed it for my last dog, both hind legs but not with my present dog.
Take it slow and steady.
 
#44 ·
I did most of the rehab myself from the TPLO.

First, I would recommend buying a harness. I like the ones made by Ruff Wear.
http://www.ruffwear.com/Web-Master-Harness_2?sc=2&category=1131

The harness makes it easier to make sure that the dog does not bear unnecessary weight on the repaired leg - like when you air the dog 4x a day. It also helps to when you have to lift the dog into the car to take it to the vet.

Second, I dedicated the kitchen to the dog. I left a bed in the kitchen. At my house, the kitchen feeds into the back yard, so it was easier to help her into yard when she had to air. Also, it made it convenient when I had to ice her leg down 4x a day.

Third, once a week, I took her to the rehab facility, where they put her on the underwater treadmill.

Fourth, I walked her 4x a day (increasing the length gradually) and stretched and iced her afterwards.

If you want to do it right, it's alot of work.

Ted
 
#45 ·

First, I would recommend buying a harness. I like the ones made by Ruff Wear.
http://www.ruffwear.com/Web-Master-Harness_2?sc=2&category=1131
Ted

If I may make a suggestion regarding the harness.
Ruffwear makes a dog Backpack with pockets you can add weight to. The backpack is very similar to the Harness so I think could serve both purposes. During rehab you will want the dog to carry more weight while on the treadmill and on walks. For weight ask your vet for a bunch of bags of saline solution to use.
http://www.ruffwear.com/Approach-Pack?sc=2&category=13
 
#46 ·
Thanks guys. It sounds like rehab is key. I work an hour from home now but I can take juice to work with me everyday and get his rehab in that way. My work vehicle is an suc so I can lift him in and out pretty easily. I could always leave him at home during the day but if he needs walks and ice/heat multiple tines a day he needs to be with me. Thanks for all of the input and help. Can't wait to get him back rolling.
 
#47 ·
FWIW I talked with someone at dr Milton's clinic about the possibility of doing both knees now. I got a no. They said even if both were torn they would prefer to do one then do the other in 6 weeks or so. I do know that it can be done however. Has anyone done both at once when only one was injured?
 
#48 ·
I talked to my vet when Missy was getting ready for her second TPLO. I was wondering if I had to do it with another dog if getting both done when the dog had to get the first done. My doc said he preferred to do it that way and there was some literature supporting that. That was a couple of years back. I don't know what he would suggest now but if I have to do another one I think I'd go that direction.
 
#50 ·
Most surgeons would be reluctant to do both at once fearing the consequences of complications the odds of which are effectively doubled. My dog lost one year at a very critical point in his training because the second tear occurred after he was fully recovered from the first. If I have the same scenario again, a relatively young dog with a CCL tear, I would try to get my surgeon to do both at the same time. In a young athletic dog I suspect the likelihood of a second tear may approach 75%.

You can definitely do the rehab yourself, the underwater treadmill is helpful but not essential. I much prefer weight pulling to weight carrying as Breck suggested. Weight carrying loads the spine and alters the gait to some degree. Also it does not directly target the rear limb muscles the way weight pulling does.
 
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