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I Don't Know Which CCL Procedure Is Best

2/19/2019

1 Comment

 
Thank goodness for brand-new shiny stuff, right? New products and new surgical techniques are invented all the time. We're led  to believe they're better and that we'd be foolish not to choose the latest, greatest thing. If you've got a new cellphone or computer, you appreciate innovative products. You're okay with the fact that they might have little bugs or glitches can easily be fixed with a simple update.

But what if we're talking about a new surgical technique being recommended for YOUR dog? That changes things, doesn't it? If you're wondering why, keep reading.

The usual surgical procedures for CCL surgery are the ones you read about and hear about most often. Each has earned its reputation based on the number of times it's been performed and the surgical outcomes it provides. The most commonly performed ones are: TPLO, TTA, Extracapsular Lateral Suture Technique and tightrope repair. No matter which one you choose, new or time-tested, understand that complications can occur with any of the procedures. No surgery comes without risks. We just want to minimize them as best we can.

What if it's time for your surgical consult and the doc recommends CBLO or another newer procedure? If this happens, you should ask lots of questions. 

Technique refinement, assessing the benefits and risks of using newer metal implants, screws, etc... means there likely aren't as many surgeons performing those procedures or using the newer type/s of implants. This means less dogs are having these surgeries and the data is lacking compared procedures to that of procedures that are considered the "gold-standard" of care. 

If a newer type of procedure is recommended, ask the surgeon these questions:
  • Are you Board-Certified?
  • How many times have you performed this procedure?
  • How new is this procedure?
  • How many veterinary abstracts have been published to prove its efficacy (get the abstract link to read for yourself)?
  • How do dogs do long-term after this procedure?
  • How many dogs have undergone this specific procedure?
  • Why do you prefer this technique over one that is claimed to be the gold-standard (the best options) of care for CCL surgery?
  • What are the risks and possible complications associated with this procedure?
  • Who will pay for follow-up visits, additional blood work, medications, diagnostic studies and surgical correction/s if this procedure results in complications for my dog? 
  • May I speak to a couple pet owners whose dogs have had this procedure?

I have read about non-Board-Certified doctors who learned how to perform advanced orthopedic procedures who then offer reduced surgical costs. Perhaps they charge less in exchange for their inexperience? While I can't speak for them, my opinion is to choose a doctor whose expertise came from years of rigorous, specialized training. Please do your homework, and don't be too quickly swayed by that which is bright, shiny, new (or less expensive).

I am compelled to share the ideas in this post based on conversations I've had with others who were misinformed at the expense of their dog's lives. Have you had experience with a new technique? What was the outcome? Do you have words of wisdom to share with others? Your comment will inform other dog owners of your experience, so please share your thoughts. 
1 Comment
Jodi Ware
2/19/2019 12:32:23 pm

Very wise words, Dr. Spinelli! I will further underline them by quoting an April 2007 article in Computer Weekly, “Legacy is not synonymous with inferiority. Rather, it shows maturity, stability and best practices honed from years of experience. Legacy works.” (And, we're not talking computers but our beloved dogs who deserve only the best!)

In my opinion (in part, derived from a bad experience with a “cutting edge” CCL surgical technique), treatment decisions for our canine companions should be based on the best available evidence (ie, mature, robust, reproducible data) not to mention best practices honed over years of experience.

Thank you for stressing the importance of this in your piece! I wholeheartedly agree!

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  • Start Here
  • CCL Tear Recovery Tips
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