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Cruciate Surgery - (Torn ACL)

"Fredric R. Cornell"

On Thurs, 15 Apr 1999 22:02:01 -0400 Molly Moldovan & Jim Thomson of Tallanwood Northern Dogs wrote:

One of my Malamutes has a torn anterior cruciate ligament and is scheduled for surgery next week.

I'm having second thoughts, because the surgeon stated that he only uses one technique-- he uses nylon fishing line to replace the ACL until the scar tissue grows up over it. I might add that this surgeon has operated on another of my dogs (a completely different procedure) and I have a fair degree of confidence in his ability.

I've seen some posts on this list about a relatively new procedure, invented by Dr. Barclay Slocum (Tibial leveling Osteotomy), which is supposedly a "better" procedure for working dogs. While my Mal has never been on a racing team, I'd like to think that she could still pull a sled alongside her brother... Can anyone tell me if this new procedure is being performed in Ontario, Canada, or direct me to someone who would know? Thanks, Molly

The below is my re-post: Yes, Dr. Barclay Slocum's (supposedly patented) surgical technique is, indeed, truly remarkable! It was performed on my 11 year old Siberian champion bitch, Ch. Sahara's Artyk Anika (now 13), and she has done splendidly. She has always been most active, and even at 13, and having undergone this radical surgery, to watch her, I defy anyone to even suspect that she had completely torn her cruciate. In the ring, her down gait was absolutely above reproach, and it remains so today. She is absolutely unaffected!

Two years ago, I sent the following to another list, and it sets forth my lay understanding of the procedure:

<< In the literature, Dr. Slocum's technique is termed, "TIBIAL PLATEAU LEVELING TECHNIQUE and OSTEOTOMY", and uses the lateral collateral ligament to resist cranial translation and internal rotation of the tibia instead of the original cranial cruciate ligament (or replacement of same), and is made possible only by the disarticulation, repositioning, and leveling of the tibial plateau. Apparently the latest research finds this technique vastly superior to either of the other techniques previously employed (as below described), and so far this is confirmed with "The Fruitfly". To date, I am most pleased with her progress.

HISTORY: For the previous ten days, I noticed that when she first got up

from a reclining position, she slightly favored her left hind leg, but within sixty seconds or walking, her movement was again perfectly normal. The vet said that I should keep a close eye on her, and if the situation worsened, that I should call him. It remained the same until Monday evening when she bounded upstairs to get me from my study to let her outside, but she made it only half-way up the stairs. She let out a resounding yip, and sat down midway up the stairs. Not knowing what the

problem was I carried her up the rest of the way, and gently put her down. She refused to put any weight on her left rear leg, and hobbled into my study on 3 legs. I immediately called the vet, and he said to take her in for diagnosis. Upon observation and palpation, his preliminary diagnosis was the condition as is above cited. He said that he could perform the necessary surgical procedures, but recommended the second opinion of a

board certified Orthopedic Surgeon, so he gave her some pain medication, and off we went Tuesday morning to the Specialist, and sure enough the condition was as feared. Monday night was miserable; even with medication, she whimpered and whined the entire night with me sleeping on the floor

next to her. After examination, the Surgeon Specialist gave her another injection for pain, and took her to his specialized hospital in Seattle for surgery Wednesday afternoon.

SURGICAL PROCEDURE: It seems that there are three methods of dealing with this matter, and all three require surgery. Once this ligament is ruptured (severed), it can not be repaired; it must be removed. Her slight limp did nothing to worsen the condition since the ligament, likened unto a rope,

once began to tear, it continued to do so little by little like a fraying rope. Once the fraying process has begun, it will rupture. This ligament is so short that, even if caught before the final rupture, it can not be repaired, so earlier surgery would not have prevented the situation. The first procedure involves removing the ruptured tissue and replacing it with

a strong muscle from elsewhere in the leg. The second method is to remove the ruptured tissue and replace it with synthetic material. These two procedures are methods employed currently, but both require a cast for one

full month, and sometimes produce some lasting arthritis. A new and better solution was discovered by a Dr. Barclay Slocum of Eugene, Oregon,, and involves substituting no replacement material at all, and can be utilized as long as both Medial Collateral Ligaments (those on either side of the

joint) are intact and undamaged, but it is much more time consuming, demanding and expensive. It likewise involves the removal of all damaged Cruciate Ligament tissue, but instead of replacement, the upper Tibial plateau is disarticulated (broken), repositioned to a more level position (a slightly forward position), and plated and screwed into place, and the

Tibia and the Patella are again positioned to make the joint. One of the beauties of this procedure is that the damaged joint remains pretty much intact during surgery, and is not completely disassembled as is done with the other two procedures, and this new method requires no cast; in fact, nothing more than a two day Band-Aid, and a pain patch is adhered to the

skin for slow release of appropriate pain medication. Since the dog, without a cast, is able to slowly learn to walk on and again utilize the leg, he doesn't use it much during the first post-operative week, more during the second week, and by the third week, he usually walks on it, and during the fourth week, his gait is usually normal with no arthritis, pain, or stiffness whatsoever (unless it was a pre-existing situation), and the dog can again resume pulling by the fourth month. This last procedure is touted as being far superior for Siberians, and working dogs, but the cost is $1,900.00 for the surgery and three day hospital stay, and an additional $400.00 for three subsequent sets of periodic, progressive X-Rays, and follow-up examinations. It is my understanding that vets who do perform this (patented) technique are practicing primarily on the West Coast, and are personally trained and continually mentored by Dr. Slocum, as GREAT care must be taken re Tibial Plateau measurement, and Tibial Torsion alignment. WHEW! I am not a vet, and I hope I have gotten all the medical facts to you accurately; they are stated as I understand them. The condition itself is reportedly quite common, (although this is the first time I have experienced it in my 28 years in the breed).

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PROGRESS REPORT 10 Days post op: I just today got back from the orthopedic surgeon re "The Fruitfly's" first post operative check up. She is doing splendidly!! Her two week post operative physical therapy is to go for 4 walks per day, each progressively longer, with her pulling against the lead. This pulling action forces her to put weight on, and to use, the recovering stifle instead of holding it up and hopping on the good leg. Had she been in a cast, as a result of the other two available surgical techniques, the recovery time would have been much, much longer, and the atrophy of the musculature would have much more debilitating. To prevent her loping, she still needs to be on lead for going up and down stairs, and she should not run outside, but given that her surgery was only ten days ago yesterday, I am most pleasantly astounded at her recovery rate.

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UPDATE 21 Days post-op I have requested authoritative literature on this technique, and when I receive it, I will send a copy of same to you if you would care to privately send me your complete address. Nika is only 21 days post-op, and has made remarkable improvement; she puts bearing weight on the leg now about 95% of the time, though with a slight limp. She wants to play, even run and jump, but outside and on stairs, she still needs to be restrained for the protection and continued healing process of the repaired stifle; she does use the leg 100% of the time on stairs. The striking difference between this surgery and the other two techniques is that, in the latter cases, the ligament is replaced by either natural muscle tissue, or with synthetic material (either method one or two described in my original post), and in Nika's surgery, although the ruptured tissue was likewise removed, it was not replaced with anything at all, and her stifle and leg was at no time placed in a cast; therefore, this procedure allows her to use the leg gradually and without any atrophy whatsoever of the musculature.

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UPDATE - Two and a half years post-op: This procedure has proven itself to be wonderfully effective. The surgeon was professionally the finest in the entire Pacific Northwest (but his bedside manner was the exact antithesis - but all is now happily forgiven ). "The Fruitfly" is now 13, and is equally as spry, and as sound, as she ever was prior to this surgery.

This post has been long, but the procedure is complicated, and my veterinary knowledge is not advanced as is the case with many on this list. Hope it is helpful to those interested.

Regards,

Fredric R. "Doc" Cornell

ARTYK Siberians
Lakewood, Washington USA
mailto:frcornell@artyk.net
http://www.artyk.net/artyk/
ICQ #4863430