Does my dog need surgery or not?

Herein lies the burning question and the one fraught with so much debate. All you want is direction, some quality advice to help you carve out a clear path to help your dog. You put it out there, and that's where things go a little haywire.

Biases are bandied about, and it seems like one person's advice negates the next. People say: Conservative Management (CM) is the best solution. TPLO is the strongest fix. Lateral Suture has less complications. Just say no to CBLO. Medications have too many side effects. Don't waste time with CM because your dog will become arthritic. Arrrrgggh! 

Stop. Take a breath. Exhale. You'll figure it out.

Consider your dog's activity level: Is she a couch potato who loves lounging on her bed in a sunny spot or is she happiest running and playing? A sedentary dog's pain might be controlled well enough with prescription meds, joint support supplements and some physical therapy modalities. An athletic pup might do better with some conservative measures but might also require a more permanent surgical repair.

Have you gone for surgical consultations yet? I highly recommend this, and not just for one type of procedure but two. I was fortunate because the first vet I consulted with is honest. Dr. Karen Kohler described the lateral suture repair in depth. That's the procedure she does most often. But she didn't stop there. She recommended that I go for a second consult with Board-Certified surgeon, Dr. Catherine Popovitch, to discuss the TPLO procedure. I took Dr. Kohler's advice. I learned about TPLO.

Armed with facts rather than opinions, I had the tools to make an informed decision. Although my dog isn't one of those agile flying frisbee catchers, he's an adorable, spazzy little bruiser who weighs 80-pounds. I felt better about the stronger fix - the one that would be strong from the start, so I opted for TPLO. 

Has your dog's lameness worsened over time? This happened to my boy. His left CCL was the first one to go. I tried everything: a custom fitted brace, physical therapy, medications and supplements and cold laser treatments. He got short-lasting results. But some dogs do really well with these conservative methods, so it's not a problem to give it a try for one or two months. Then you can re-assess to decide whether surgery is needed. 

What might happen if you hold off surgery: When one CCL tears, the biomechanical stressors your dog places on the opposite hind leg is what can begin the degradation of the other CCL. There's a 60% chance that the other CCL will tear, and that's the reason some docs recommend surgery right away for CCL tears. Even if you have surgery right away, it's no guarantee that the opposite CCL won't tear. 

What about arthritis? When the CCL tears arthritic change happens as a result, so yet another consideration is the amount of arthritis your dog has. Arthritis and some degree of soft tissue swelling can be seen on X-rays. Contrary to beliefs, X-ray cannot be used as a 100% diagnostic indicator of a CCL tear. This is because ligaments, which the CCL is, don't show up on X-ray. It's the presence of Drawer Sign (an orthopedic finding that shows instability or the degree of slippage in the knee joint), the presence of medial buttressing (swelling near the inside of the knee joint), rear-leg lameness and the way that the dog sits with the injured knee winged-out to the side that indicate CCL tear. You do not need to pay for an expensive MRI to prove your dog's CCL is torn.

Consider possible complications: When you go for surgical consults, ask about the benefits AND negative outcomes such as: plate rejection, the incidence of secondary traumatic fracture, infection, and material breakage such as suture material failure, screws backing out or screws that break... As with any surgery, there can be serious problems afterward so you want to be sure that you're thoroughly informed.

I hope this article answers your most pressing questions. Are you struggling with the decision between moving forward with surgery or trying CM instead? Leave a comment below.