-- Diet and lifestyle: Being overweight and/or engaging in high-risk activities
(such as play involving jumping and landing with a twist like jumping to catch balls or frisbees) predispose a dog to recurring
injury and eventual arthritic problems.
Other factors being equal, dogs who have recovered from ligament injury using non-surgical
Conservative Management and dogs who have recovered after conventional stabilizing surgery, and dogs who have bone-altering
surgery are all equally at risk for future arthritic problems.
see the page 'But the vet said...' for information on false/flawed claims and a journal article on ligament
injury treatment research review). Whichever type of surgery is being recommended, often
the surgeon will say to people "Your dog will be crippled with arthritis if he doesn't have this surgery."
This is a baseless claim. While I have heard of many vets using this argument to support their preference for the surgery
they are selling, there is nothing solid to support this claim. No real research studies have compared Conservative
Management of ligament injury to surgical treatment and found that surgery provides a decreased risk of arthritis.
Proper restriction after injury which prevents further damage to the joint is what minimizes the risk of future arthritic
problems, with or without surgery.
---- I think that
many vets who honestly believe in surgical treatment's superiority are making the mistake of comparing their preferred
surgery's long term outlook to allowing the dog to decide his own activity level rather than comparing surgical results
to the restricted-activity recovery of proper conservative treatment. Their belief in surgery's superiority assumes that
without surgery the dogs will be allowed to repeatedly over-stress and re-injure the leg. Also, some vets are basing
their opinions on the statements of surgeons who make self-serving claims which are not supported by objective studies.
But while there are various explanations for the pro-surgery opinions you may hear, no one is basing a "Surgery-Prevents-or-Reduces-Arthritis"
statement on scientifically done medical research demonstrating a superior outcome for surgery over non-surgical recovery
with regard to future arthritic problems. There isn't any such research supporting such claims. (Please see the
page 'But the vet said....' here at this website.)
The Spinach Ploy -- Years ago some mothers would tell their children that their growth will be stunted if
they did not eat their spinach. This is the same tactic as the 'Arthritis Scare': -- State a frightening but
baseless claim with conviction and depend on the recipients' respect for expert authority to win their compliance. This
tactic used to get a lot of spinach eaten and it gets a lot of ligament surgery sold now. I'm not saying all
the vets (or the mothers) are purposely being deceptive. They may really believe what they say. They may honestly think
these things are true. But when you look for the evidence supporting the claim that rejecting surgery leads to arthritis,
there isn't anything solid there.
Increased future arthritic risk is a fact in all cases.
All dogs who have ligament injuries
are more likely to have arthritis in the injured joints in the future than dogs who have not had ligament injuries.
The fact is that having had a ligament injury leaves a dog with a less than perfect joint
which is going to be more prone to develop arthritic changes as the years go by.
---- But dogs who recover
using Conservative Management and dogs who recover with surgery as an aspect of their treatment are equally at risk for future
arthritic problems. Proper restriction during recovery and avoiding high-risk activities after recovery, together with weight
control, good nutrition, and joint-supporting supplements are what minimize the chances of future arthritic problems.
and Arthritis Risk
When TPLO was a new procedure years
ago, vets who were selling TPLO almost universally claimed that TPLO prevented future arthritis. The fact was that TPLO
had not been around very long, so the dogs who had already had TPLO had not had time to develop arthritic changes in the joint.
The most charitable way to view those claims made then would be that they were optimistic. But as the years
went by it became clear that TPLO dogs were just as likely to have arthritis later as were dogs who had other kinds of surgery
or non-surgical treatment. Today, an honest surgeon will tell you that no surgery reduces arthritis risk. But
in spite of the fact that time has proven that TPLO does not reduce arthritis risk, many TPLO surgeons today will tell people
that the surgery they sell eliminates or lessens the risk of future arthritic problems for the dog. They do this as part of
their sales pitch for the hugely profitable TPLO. There is no substance behind these claims.
Just as great a proportion of dogs who have TPLO develop arthritis in future years.
---- None of the treatment options, including non-surgical recovery and all the surgical options, can
lessen future arthritic changes in the joint.
'Meniscal Release' is often
done as part of a TPLO procedure. 'Meniscal Release' cuts the connection of part of the meniscus, removing it
from what would be its functional position in a normal joint. This decreases the risk of injury to the meniscus at the
cost of removing the meniscus from being a functioning part of the joint. 'Meniscal Release' has been found
to be a factor in dogs' increased development of Degenerative Joint Disease (DJD). There is more about 'Meniscal Release'
on the page 'The Dog Meniscus' found on the navigation bar at left.
a quotation from James M Fingeroth, DVM DACVS, who is a TPLO surgeon and advocate, regarding Meniscal Release.
<<"...Meniscal release was Dr. Slocum's proposed solution to eliminating the vulnerability of the medial meniscus.
He recognized that even with TPLO one could not ensure the elimination of all translational motion between the femur and tibia
in all joint angles and in all phases of stride and weight bearing. Joint biomechanics are far too complex for any single
alteration to account for every facet of motion. His concept was to either transect the caudal meniscotibial ligament (allowing
the caudal pole to retract caudally "out of the way" when the femoral condyle rolled past), or alternatively to
transect the caudal horn of the medial meniscus itself allowing similar mobility to mimic the situation with the lateral meniscus.
The choice of where to perform the release (ligament or meniscal horn) is dependent on the type of arthrotomy used. Meniscal
release can be incorporated into either a conventional reconstructive procedure or a geometry modifying procedure. However,
recent studies done in Germany have suggested that meniscal release may be ineffective at reducing the incidence of late meniscal
tears, and moreover, may, like a spontaneous meniscal injury, actually result in increased arthrosis in the knee. This remains
a controversial area and some surgeons are now abandoning the practice, while others continue to employ it.">>>
far as I can determine there is no reasonable basis for inferring that any of the surgeries would result in a joint less susceptible
to arthritis than a joint which had recovered without surgery. On what basis could such a claim be made? I see none.
However, it's important to restrict the dog during
recovery. If a dog were not restricted while supporting tissue developed (either after surgery or as part of non-surgical
Conservative Management) then the dog would repeatedly re-injure the joint. This would damage the new supporting tissue as
it tried to develop. The joint would never heal properly. Such a dog would certainly be more likely to have serious arthritic
problems in that joint than a properly restricted dog.
To do all we can to minimize arthritic problems, I strongly recommend giving Glucosamine
& Chondroitin daily to all dogs who have had ligament injury, regardless of treatment used in recovery. Not for a limited
period but for the rest of the dog's life. This may be the most important thing we can do for long-term joint support.