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When a dog has been diagnosed with a ruptured, torn or damaged ligament, there
are many vets who routinely recommend immediate surgery. Some dogs do need surgery, but many will recover very well
without surgical intervention if given the chance. It is not wise to let a vet rush you into agreeing to surgery.
The way to determine if your dog needs surgery is to carefully restrict the dog's activity for a period of 8 weeks as described
on the following pages at this website. Ongoing improvement during the 8 weeks will indicate that your dog can almost
certainly restore stability to the joint without surgical intervention. (This does not mean the dog will be fully recovered
in 8 weeks.) If you can look back at week 3 from week 8 and see that your dog has been gradually improving during that
time, Fido is stabilizing that injured joint. If there is not some slow ongoing improvement in your dog's condition, then
surgery probably truly is appropriate unless there has been a misdiagnosis.
---- A non-surgical approach is very often successful and is low risk. With
surgery, the risk of complications and poor outcomes is unavoidable. I regularly get emails from people whose dogs were
worse off after surgery than before. In a great many cases where surgery is recommended by a vet, surgery is not necessary
& a non-surgical recovery would result in the best possible outcome.
A quick decision whether to have surgery is not necessary at
the time of diagnosis. Proper restriction of activity will minimize the risk of further injury to the joint while answering
the question "Does Fido really need surgery?" Any vet who pushes you to quickly agree to surgery should
not be trusted. There are vets who want to get your dog into surgery immediately because they are concerned
that if you wait and see the dog's condition improving you will begin to doubt the surgeon's claim that surgery is necessary.
Some vet-surgeons try to push people into agreeing to immediate surgery by telling them that without immediate surgery their
dog will be crippled with arthritis. This is not true. Surgery does not prevent arthritis. Controlling
the dog's activity during recovery is the key to minimizing future arthritic risk. Please see the page 'Arthritis
Risk?' here at this website for more detail on this.
When your dog has a ligament injury, the most comfortable thing to do is to
accept the vet's recommendation for surgery. It can be a relief to hand over the burden of decision-making to someone
who seems to be an expert. But it is not wise to be so trusting. You need to be cautious and skeptical, not blindly
trusting.
A vet may have talked to you about your dog's injury as though surgical intervention
is a universally accepted medical necessity whenever there is a ligament injury. This is not true. For
reasons brought out elsewhere at this website, many vet-surgeons recommend immediate surgery as their preferred treatment
for canine ligament injuries despite the fact that non-surgical recovery using careful activity restriction is usually the
best first-choice treatment option for dogs of all sizes. If non-surgical treatment is not successful, surgery will
still be available as a treatment option.
Many surgeons make claims like this:
---"Large dogs always require surgery when they tear these ligaments"
--- "If a complete rupture rather than a partial tear is diagnosed, then
surgery is necessary."
--- "Research shows that only a very small percentage of dogs over 30 pounds
can recover without surgery."
----- You may see other websites which unquestioningly accept such statements
and repeat them as though they were proven facts. But these are not facts. When I dug into the research literature
looking for evidence that would back up such statements, I found that these statements are based on low quality
Class III & IV articles written by surgeons promoting the surgeries they sell. These 'studies' are full of methodological
flaws and outrageously sloppy reasoning which would be laughed at by anyone familiar with scientific method and the accepted
norms of medical research. (See the page "But the Vet Said..." which is linked in the column at left.)
---- Many large dogs recover well without surgery, as do many dogs
diagnosed with complete ligament ruptures. These dogs' non-surgical recoveries disprove the claims that dogs-over-so-many-pounds
always require surgery or dogs-diagnosed-with-complete-ligament-tears always require surgery. The fact that vets make
sweeping statements like "Large dogs require surgery" in the absence of any solid evidence, and in spite of numerous
successful non-surgical recoveries by large dogs, shows that these vets are either incompetent or primarily interested
in selling high-profit surgical procedures.
---- Small dogs almost never need surgery for these injuries, so it is true
that large dogs with severe injuries are more likely to require surgery than small dogs. But hefty percentages
of large dogs and those diagnosed with severe injuries do also recover well without surgery. The only way to
know if a particular dog really needs surgery is to restrict activity and see if the dog can re-stabilize the joint.
This kind of injury does not require a quick decision. Give your dog 8 weeks of careful restriction, then judge whether
he is improving or not. If Fido is not improving after 8 weeks then surgery or a brace will be appropriate.
The suggested 8 weeks is the time to wait (with proper restriction)
before deciding whether the dog is re-stabilizing the injured joint. If he is improving by the end of 8 weeks, he will
almost certainly continue to improve in the following months as you carefully & gradually increase activity. Eight
weeks is not the total time of restriction. Recovery is not complete in eight weeks. Recovery
from joint injuries is very slow. Many vets who recommend non-surgical recovery fail to appreciate how slow, and tell
people to resume normal activity after 8 weeks or 12 weeks. This will often result in re-injury. There is no certain
length of time for recovery. The time needed varies with the severity of the injury and the size and age of the dog.
By increasing activity gradually, watchfully, and cautiously, you will eventually come to the best possible recovery, but
no one can know how long that will take. Be patient.
Has a vet told you he is certain that your dog must have
surgery? I have heard from thousands of people who successfully helped their dogs recover without surgery from
ligament injuries. A large proportion of non-surgical success stories begin "The vet told me my dog must have surgery."
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Non-surgical recovery is based on careful activity restriction which
provides the conditions necessary for the dog's body to re-stabilize the joint without surgical intervention. Many dogs
will recover well from ligament injury without surgery if given the chance. More information on non-surgical recovery,
and suggestions on how to decide when surgery is the appropriate choice, are on this website's pages.
I get email daily from people who have succeeded in helping their dogs recover
non-surgically after having been told by vets that surgery was their only choice. For example:
-----Hi Max, I was told
my dog needed TPLO surgery but decided to try the non-surgical approach instead. I am extremely happy with the results.
Thank you for your web site. My dog is able to run, hunt, play, swim, in other words live a complete life and does not limp
or favor his right rear leg. He appears to be totally pain free. I am extremely pleased that I did not subject my friend to
the pain, trauma, and uncertainty of major surgery. Also, saving that kind of money does not hurt my feelings.
From one dog lover to another,
thanks.
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Misdiagnosis
is common. Dogs with other causes for their symptoms may be misdiagnosed as having ligament injuries.
There is a partial list of problems which have been misdiagnosed as ligament injuries here on the 'Looking Deeper Into
a Surgical Recommendation' page.
In cases where surgery is needed,
the type of surgery you choose is important. The 'TPLO/TTA' page here at this website explains further why
you should be skeptical of a recommendation for TPLO or TTA.
Email Question: "I have been going to the same vet for years and I trust him.
He says TPLO is the 'Gold Standard' in treatment. Why shouldn't I depend on his judgment?"
----
There are honest, well-intentioned general practice vets who mistakenly believe that the TPLO & TTA procedures are a good
first-choice treatment for the majority of dogs with ligament injuries. Why is this so? Why do many general practice vets
have a good opinion of these very invasive surgeries?
----
First, the huge profit in TPLO and TTA has resulted in large numbers of ortho-specialists enthusiastically promoting these
procedures. ( A TPLO takes about one hour in the operating room and has costs of a few hundred dollars for the vet-surgeon.
Prices charged average over US$3500. Several thousand dollars profit per TPLO.) These specialists have a great
deal of influence with general practice vets like your regular vet. When your general practice vet hears from specialists
that they prefer the TPLO, he may not ask himself if the thousands of dollars of profit in each TPLO could be the reason the
specialists think highly of the procedure.
---
Also, it is true that improvement in leg use in the first few weeks after TPLO or TTA will be better than with non-surgical
treatment or conventional surgery. Longer-term results are not superior with these very invasive procedures,
and the risks of serious complications are much greater, but this rapid improvement in the short-term influences vets' opinions
of the procedures.
Choosing the Expensive Option Instead of The Best Option.
When our dogs are injured, we are not concerned about cost. We want what's best for our dogs, regardless
of cost. It is easy to trick ourselves into thinking that because a surgery is more expensive it must be better. A better
car costs more; better shoes cost more. The best of anything is usually more costly. When faced with choices where we are
unfamiliar with the options available but want the best, we may assume (or be easily convinced) that the more expensive options
are the best options. But with dogs' ligament injuries, the more expensive options can be the poorer choices. Surgery is often
not the best option for the dog. The more expensive surgeries can be the worst choices of all.
Exaggerated claims by surgeons about the results that should
be expected from the surgeries they sell---
Have you been told that the surgery being recommended for your
dog will return Fido to pre-injury condition? An article
on canine ligament injury surgeries in the 'Journal of the American Veterinary Medical Association' looked into what
results could be expected from the various ligament surgeries in terms of percentages of dogs who regained normal leg function
after surgery. The expectable results determined in this study and published in this article are quoted here at this
website on the 'Looking Deeper Into a Surgical Recommendation' page.
"... 14.9% of dogs treated with lateral suture stabilization (LSS), 15% of dogs treated
with intracapsular over-the-top stabilization (ICS) and 10.9% of the dogs treated with tibial plateau leveling osteotomy (TPLO)
regained normal leg function subsequent to surgery."
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"...There are no studies that I know of that compare [ligament injury] surgery success
to doing nothing over the lifetime of dogs who have one or the other experience. I think that these studies don't exist because
they never looked very good for the surgery and so surgeons weren't too interested in doing them..." -
--- Author
& vet Mike Richards DVM
I don't like
the above reference to non-surgical recoveries as "doing nothing" since this might imply to some readers that the dog can
be allowed to decide his own activity during recovery. But I agree with the implied conclusion that surgeons are in the business of selling surgery, and their preference for surgical approaches
should be viewed skeptically.
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There
are some vets who are admirably selfless in putting the good of the dog first, but for dog owners to assume that all vets
are like that is not realistic. Don't think vets in general are any less interested in making money than anyone
else who sells a service. You should be as skeptical of a recommendation for surgery as you would be in any other situation
where you were being told you needed to purchase a service by the person who would profit by your purchase.
---- Also,
to assume vets are correct in their diagnoses and in their understanding of what are the best treatment options is not realistic.
Don't think any doctor must be right because he is a doctor.
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I hope you will find the information here at this website useful in making the best decision for your dog.
I welcome questions and comments. My name is Max. My email address is on the 'Contact Info' page.
