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Thank you for taking my question....I have a 4 year old, 75…

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.Thank you for taking my question....I have a 4 year old , 75 lb. Cane Corso Mastiff Mix, male dog ...has been seen by my vet x rayed, and found that he has torn BOTH his CCL on both his knees ...doctor suggested TPLO Surgery, I went online and saw that those Surgeon's need 4 more years of special training and buy very expensive equipment for the surgery...so most place are suggesting the procedure ...now there is more options ...TTA, knee braces, physical theory, and I think others too ...my questions are what are ALL MY OPTIONS? and he also has othoridtis in both knees as well (not sure how to spell it..lol) and he limps 95% of the time and at times hard for him to get up , since one of your interests is pain management is there an pain killer that is strong but less or not bad for long term (do not want liver failure??

Veterinarian's Assistant: I'll do all I can to help. Could be a lot of things that cause lethargy. The Veterinarian will know how to help your surgeon's mastiff. What is the mastiff's name?

Hello Dr. Andy! Thank you for taking my question....I have a 4 year old , 75 lb. Cane Corso Mastiff Mix, male dog ...has been seen by my vet x rayed, and found that he has torn BOTH his CCL on both his knees ...doctor suggested TPLO Surgery, I went online and saw that those Surgeon's need 4 more years of special training and buy very expensive equipment for the surgery...so most place are suggesting the procedure ...now there is more options ...TTA, knee braces, physical theory, and I think others too ...my questions are what are ALL MY OPTIONS? and he also has othoridtis in both knees as well (not sure how to spell it..lol) and he limps 95% of the time and at times hard for him to get up , since one of your interests is pain management is there an pain killer that is strong but less or not bad for long term (do not want liver failure??

Veterinarian's Assistant: I'll do all I can to help. Is there anything else the Veterinarian should be aware of about Andy?

Hi Pearl ...sorry at the top of page says Dr Andy, My Mastiff's name is Rome

Submitted: 8 months ago.Category: Dog Veterinary
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Answered in 2 days by:
6/16/2017
Dog Veterinarian: Dr. Kara, Veterinarian replied 8 months ago
Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 17,758
Experience: Over 20 years of experience as a veterinarian.
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Hello, my name is***** and I have over 20 years of experience. I am sorry to see that you have been waiting a bit for a response. You have a complicated request for a fair bit of information, but I will do my best to address your concerns. If my response isn't clear on something feel free to ask about what I have written.

I am sorry to hear that your fellow has sustained bilateral cruciate injury ruptures and suffers from arthritis in both knees.

About half of the dogs that have one ACL tear have the other side tear at some point in their lives, regardless of whether they have surgery or not. These pups have the predisposition and anatomy that led to one tear and the same effects will lead to the second tear. I suspect that is what has occurred with your fellow.

Surgery is almost always the best treatment as that allows the best return to function and leads to less arthritis in the future. All dogs with cruciate injuries will get arthritic later in life but those that have surgery, and the knee stabilized properly, will have the best function and the least arthritis long term. This is especially true in big dogs as the more weight on an injured joint the more secondary arthritis forms.

As far as which procedure is best that will depend upon the surgeon's preference as well as the dog's anatomy. Either a TPLO or a TTA (Tibial Tuberosity Advancement) seems to be preferable to the external lateral suture stabilization technique in large dogs. That's because with large dogs the external suture technique has a higher failure rate due to the dog's weight placing more stress on the suture. Here is a link to an excellent article that discusses the two techniques (TPLO and TTA) and why one might be better for the other depending upon the dog's anatomy: http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=561157

Both techniques have been very successful though and if your surgeon is more comfortable doing one over the other then that is the best one as it has the best chance of working for your dog.

The only time I recommend a support brace for a dog is for an old dog that is too sick for other reasons to have surgery or for dogs that tear both cruciate ligaments at once and cannot get around otherwise. They do give the dog support but don't really help healing at all, restrict proper flexibility and can lead to rub sores from the brace as the dog changes throughout its life.

If you elect to have surgery I highly recommend that you consult with a veterinary orthopedic surgeon as with a dog this big you need someone with plenty of experience that can do an excellent job and get him back where he should be.

If you decide that surgery isn't an option then there are some things that we can do to at least make him more comfortable and allow some sort of healing to occur.

He needs to crated for a good 3 to 4 weeks minimally, 6 to 8 weeks would be even better unless he is out and laying down with you. This will let the leg stabilize and allow the body to form scar tissue around the joint so some stabilization occurs. Without this sort of rest he will start to feel better, try to do more and reinjure himself leading to worse problems down the road. No running, jumping or stairs, leash walks to go out to eliminate so he doesn't overdo. I know this will be hard but it is what he needs.

Please realize that even after his rest period if he seems back to normal his knees will never be as stabile or strong as it should be. Re-injuring a weak knee is very possible so avoid jumping exercise or stairs if possible.

Whether he has surgery or not I also recommend a glucosamine/chondroitin supplement like Dasuquin or Cosequin as well as an omega 3 fatty acid supplement like 3V Caps or Derm Caps. These reduce inflammation, improve cartilage and joint fluid health and help relieve some of the pain and slow arthritis formation. Arthritis is inevitable with this sort of injury but these supplements do slow it down and they should be given for life.

If possible perhaps your veterinarian can prescribe a nonsteroidal anti-inflammatory to reduce pain and swelling at least for a week or two. I understand wanting to avoid the side effects with a nonsteroidal but your poor fellow sounds very painful and a short course is rarely an issue. Usually we get into trouble with long term use. We can also use Tramadol in combination with a nonsteroidal. That improves pain control and may allow lower doses of both drugs to be used.

Once he's rested for 2 to 3 weeks if you have access to a pool, and he likes to swim that is the ideal exercise for him. It is non-weight bearing but allows him to maintain his musculature and flexibility.

You may also want to discuss referral to a physical therapist, whether he has surgery or not. This will help keep his flexibility, and muscle strength but not overtax the joint.

I also want to stress how important keeping him on the thin side is. The more weight he carries the more stress on either knee will be present.

Best of luck with your fellow, I hope that you can at least keep him comfortable.

Please let me know if you have any more questions.

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Dog Veterinarian: Dr. Kara, Veterinarian replied 8 months ago

Hello, I wanted to make sure that you didn't have any further questions for me, and I'd like to know how things turned out for your pup. If you could give me an update that would be great, thank you, ***** *****

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