The Good. The Bad. The Ugly.

First: Why do we first offer surgery?
> The CCL (called ACL in people) stabilizes the knee, without it the joint is loose.
> It is painful to repeatedly walk or run on a joint when it is unstable due to ongoing damage.
> The TPLO surgery or a TTA surgery is designed to stabilize the joint.
> Most dogs who have knee surgery at the onset of clinical signs can come back to being athletic dogs after about 12 weeks!

Surgery does not solve all of the issues related to a knee injury and can have complications.
> The number one reason dogs do not do well after surgery is because they have INADEQUATE PAIN CONTROL!!
>> Most dogs do best with 3-4 weeks of an anti-inflammatory and with an NMDA blocker as part of their protocol. 
>> See the clinical papers section at the bottom of my Resource Hub Page.
> The second reason they don't do well is too much activity before they are healed. Expect 12 full weeks of restriction.
> TPLO surgery DOES NOT prevent arthritis - we will still have to deal with that.
> Surgery does not normalize the muscles and tendons around the joint - rehab exercise is essential and it takes 12 weeks!
> If your dog is not weight bearing well 4 weeks after surgery and you have not found a rehab pro - find one near you!!

Non-surgical stifle recovery is not for the faint of heart.
> Dogs with a partially torn CCL can still tear it more or fully later - despite rehab!
> The Non-surgical approach to full recovery is not necessarily less expensive than knee surgery.
> It will take longer for your dog to be strong, comfortable, and to come back to play, most dogs are doing well at 6 months.
> These dogs will always have higher risk of re-injury and more arthritis due to instability.
> These dogs will not have the same athletic ability long-term as a dog who has had stabilization surgery.
> We do sometimes pursue arthroscopy to remove debris from the joint.
> These dogs do the best with care that includes physical medicine and regenerative medicine - that means, Shockwave, Stem cells, acupuncture + Rehab exercises!!
> IF WE GO THROUGH ALL THE RECOVERY STEPS - THESE DOGS CAN LIVE A GREAT AND COMFORTABLE LIFE AS LONG AS WE MANAGE THEIR ARTHRITIS, AND WE WILL NEED TO DO THIS CONSISTENTLY THROUGHOUT THEIR LIFE.

The non - TPLO surgery path.

Cranial Cruciate Disease (ACL disease)
2.

Delilah is an angel.  I have had the pleasure to love her many years.

Her first symptoms of knee trouble started as a 2 yr old dog, she had symptoms of a partial tear with soreness intermittently for years.

By the time I met her at 10 yrs old, she had significant arthritis in both of her knees and in her back from trying to protect her knees all those years.

We suspect that she has Degenerative ACL disease, this means though it may show up like an injury, it is part of her biology.

We pursued her surgery for the first knee as a 10 year old dog, because she really needed some stability in at least one knee. and she really had a lot of pain from a meniscal tear on that side.  She recovered well, but it was a challenging process for all involved for about 4 months.

When she started to have pain and was limping in her other knee, her mom asked if we could try medical management.  We have managed her well with a GREAT quality of life for 4 years now.

See the steps to her recovery below to see if this is a fit for you and your dog.




ACL disease: How to Avoid Surgery and Manage Arthritis

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03.

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01.

Delilah's Therapy Goals: 

Control her pain

Eliminate the need for daily pain medications (NSAIDS)

Give her strength for daily walks and to help her play with the other dogs in the house

We did it!
She is going on 4 years of great active life!

> Many dogs see me monthly for acupuncture and chiropractic to keep the pain cascade from amping up and for a check up.
> Most dogs do need and will benefit from shockwave for the compensatory muscle soreness and to reduce overall fricition in the knees, back and hips on a 3-6 month interval.   We will see how it goes.
> Most dogs need more intervention with stem cell therapy to modulate inflammation and with a joint injection for shock-absorption every 1-2 years.
> Dog with very mild arthritis may benefit from a platelet rich plasma injection instead of Synamid.  We will discuss your particular dogs needs.

phase 5: regular pain prevention in the clinic and home exercise

> Exercises start to include stairs, circles, step ups, circles and things to prepare for jumping.
> We do a slow intro to trot in the treadmill, then on land, and gradually work up to running and playing!
> We transition off of pain meds if possible and to anti-inflammatory supplements (see the bottom of my Resource Hub page).

phase 4: working up to play and maintenance to be off drugs and prevent re-injuryday 90-120

> Weekly therapeutic exercise at the clinic and home exercise 3 days per week to work on balance and stability
> Massage, stretching, and water therapy in the clinic in some sessions to work on flexibility and comfort of her spine and knees
> Exercise restriction from running or jumping to prevent negative progress

PHASE 3: REHABILIATION EXERCISE AND REBUILDING SYMMETRY - DAY 60-90

> Anesthesia for diagnostics: Ultrasound to evaluate the ACL and the joint + to do her physical treatments
> A Joint injection with a lubricant that also improves shock absorption within the joint called Synamid
> Stem cell therapy to modulate inflammation: Anicell - one subcutaneous injection (or consider Gallant or Vetstem for multiple doses
> Shockwave therapy to reduce myofacial pain (pain from muscle spasm), treat patellar tendonitis, and stimulate cartilage healing (more info on my You Tube video)

phase 2: MYOFASCIAL REPAIR + REGENERATIVE MEDICINE - day 30-90

> Medications to control the inflammation from arthritis
> Medications to reduce maladaptive pain
> Home Laser therapy rental for two weeks - 15 min daily treatment

phase 1: Pain Management - day 1 to 30 days

"Every year of great quality of life we get for Dee, I am amazed.  The rehab therapy and stem cell therapy have given her a new leash on life. "

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Delilah's Mom says: 

DR. MARIES HEALTHY DOGS provides INFORMATION AND TRAINING TO RECOGNIZE PAINFUL CONDITIONS IN DOGS AND RECOVER THEM TO THEIR BEST ACTIVE LIFE.

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