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Question
Posted by: Vicky | 2011/02/11

CCL injury (second opinion)

Hi,

My 3-year old boxer female has injured both her knees (ligament injuries) a few months ago. I''ve taken her to the vet in September (at this point it was only her right knee that were giving problems). A few days'' rest + rimadyl was prescribed. She was better (only a bit stiff after overdoing the running and playing), and by keeping her as still as possible she seemed to be recovering.

After about a month of no symptoms she slipped while chasing a strange cat that entered our property. This was in early December. Now both knees were injured, the right one worse than the left. Took her back to the vet, and he recommended prolotherapy (injecting her own blood into her knees to encourage healing). She received the injections and after a couple of days in pain, she seemed better. We still kept her still. The right knee was definitely better after the prolotherapy treatment. About 10 days after the injections (most days of which she didn''t limp and walked more-or-less normally on both legs most of the time), she stepped on a loose stone - re-injuring the left leg. At this point the left leg became worse than the right and she started favouring the left rather than the right. The right continued to get better.

I''ve read on the internet that prolotherapy should preferably be repeated 3 - 6 times at 4 to 6 weekly intervals for maximum benefit and healing to take place. Since she continued limping on and off on the left leg since the re-injury, we took her back to the vet in January for another round of prolotherapy (blood injections). Unfortunately he (the vet) was very busy that day and there was no proper consultation resulting in him misunderstanding what we were requesting and he injected her with an anti-inflammatory substance instead (which shouldn''t be given during prolotherapy as it interrupts the healing process). Since she felt so well after the anti-inflammatory injection, she re-injured the left leg yet again.

For the past two weeks she has been walking normally 98% of the time, stepping with the foot " flat"  on the ground rather than just touching the toes to the floor and not limping, but in the evenings just before bed time she''s a bit stiff and favouring the left leg a little bit.

I''ve consulted the vet again today (without the dog present) to discuss treatment options. He said since there isn''t much movement in the knee joint, he''s willing to do one more round of prolotherapy, but if it doesn''t respond to that (which I take to mean " heal completely"  ) then he wants to do surgery.

I don''t really want to let her have surgery for the following reasons:
1. The injury doesn''t seem that bad - she''s still using the legs normally most of the time, can even play and run a little under controlled conditions without making it worse.
2. She''s not going to like being crated for 3 months after the surgery. I''m convinced she will become depressed if being restricted to that extent for such a long period. She''ll probably also drive us crazy with her complaining about it - she''s very good at communicating her dislike about anything :-)
3. I don''t think 2 rounds of prolotherapy (interupted by an anti-inflammatory injection) is enough to give the knees enough chance to completely heal.

Of course, if surgery is really necessary (which would be the case if she''s torn the ligament and cannot walk on the leg at all) I will let her have it, but it seems too invasive a treatment for a problem for which there are other options available.

What do you recommend? Insisting on more rounds of prolotherapy as long as the injury doesn''t become worse or going the surgery route?

If surgery, which one is the least invasive and has the quickest recovery time - the one that uses the surgical wire to stabilize the joint or one of the others?

What do you think of Photizo light therapy to help the ligament heal - is it worth pursuing this avenue in addition to whatever treatment she''s getting at the vet?

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Our expert says:
Expert ImageCyberVet

If it is a TOTAL rupture of that cruciate -surgery would be the best way to go despite the problems post op that you have mentioned I would recommend a TPLO op done by a specialist not a ligament reconstruction . If it is a partial rupture that consider a course of tavan +- anti inflammatories and some hydrotherpy.

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Our users say:
Posted by: CyberVet | 2011/02/17

If it is a TOTAL rupture of that cruciate -surgery would be the best way to go despite the problems post op that you have mentioned I would recommend a TPLO op done by a specialist not a ligament reconstruction . If it is a partial rupture that consider a course of tavan +- anti inflammatories and some hydrotherpy.

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