Re: Cruciate ligament rupture in bulldog

[Guest guest]

Try this Jolanta, http://www.caninefitness.com/resources/docs/Full-Cruciate-Tears-Owners.pdf Cheers, Laurie From: VetRehab [mailto:VetRehab ] On Behalf Of rishiSent: February-03-11 6:54 AMTo: VetRehab Subject: Cruciate ligament rupture in bulldog Couple weeks ago we saw 3 year old male bulldog. He was diagnosed with cruciate ligament rupture on right leg. Owner doesn't want to do surgery, affraid of anesthesia. Orthopets can't make a brace for him. Do you know of any other options? Thank you.Jolanta Kandefer CCRAViera East Veterinary Center5405 Village DriveRockledge, Fl. 32955 __________ Information from ESET NOD32 Antivirus, version of virus signature database 5843 (20110203) __________ The message was checked by ESET NOD32 Antivirus. http://www.eset.com __________ Information from ESET NOD32 Antivirus, version of virus signature database 5843 (20110203) __________ The message was checked by ESET NOD32 Antivirus. http://www.eset.com __________ Information from ESET NOD32 Antivirus, version of virus signature database 5844 (20110203) __________ The message was checked by ESET NOD32 Antivirus. http://www.eset.com __________ Information from ESET NOD32 Antivirus, version of virus signature database 5844 (20110203) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com

[Guest guest]

My own bulldog underwent 2 cruciate surgeries (extracapsular)

without any anesthetic problems…just pick your clinic wisely and make sure they

have good anesthetic monitoring. Three years old is a bit young to consider

using an assistive device for potentially another 8-9 years. Many bulldog

owners have heard horror stories about bulldogs dying on the table and it gets

a bit out of proportion in their mind! I own experience with braces has been a

bit nightmarish with pressure sores and infections.

Thanks,

Amy Gerst, RVT, CCRP

Bright Eyes and Bushy Tails Veterinary Hospital

See Spot Run Canine Rehabilitation

From:

VetRehab [mailto:VetRehab ] On Behalf Of rishi

Sent: Thursday, February 03, 2011 7:54 AM

To: VetRehab

Subject: Cruciate ligament rupture in bulldog

Couple weeks ago we saw 3 year old male

bulldog. He was diagnosed with cruciate ligament rupture on right leg. Owner

doesn't want to do surgery, affraid of anesthesia. Orthopets can't make a brace

for him. Do you know of any other options? Thank you.

Jolanta Kandefer CCRA

Viera East Veterinary Center

5405 Village Drive

Rockledge, Fl. 32955

No virus found in this message.

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[Guest guest]

Good morning all

Patsy Mich here I am the DVM at OrthoPets.

I just wanted to clarify on the topic of an orthosis for this bulldog. We

received photos of this case. The reason OrthoPets can't fabricate a device is

limb structure on this boy. Unfortunately, there is a small population of dogs

falling into this category. Since our device works off the principle of force

coupling, the issues in these patients are 1) available thigh length (groin to

medial joint center) 2) malleoli structure (low versus high profile in the

medial/lateral dimension) and 3) standing tarsal angle (very " straight hocked "

dogs vs more normal 135-160 degrees).

The latter two issues relate to device suspension on the limb (no distal

migration) and can be managed with a number of custom solutions; this takes a

little extra time and tweaking to " dial in " the answer for each dog. In the

case of this bulldog, from the images we had, he appeared to have a very short,

triangular thigh. Short thigh means a short lever arm. Short lever arm means

much less ability to restrict rotational force and shearing force across the

tibial plateau. Considering this with the additional issues at the tarsus makes

us reluctant to try an orthosis. Our concern is putting a dog in a device that

just won't meet clinical goals.

We look at these on a case by case basis. There are bulldogs that can wear

stifle orthoses. Unfortunately this guy doesn't appear to be a candidate.

Now from an anesthesia perspective (I'm also an anesthesiologist) there are a

number of ideas and options that may help answer some of the clients' concerns.

I'd be happy to offer some ideas if it would be useful in creating a therapeutic

plan for him.

Enjoy the weekend all.

Patsy

Patrice M. Mic, DVM, MS,

Diplomate American Board of Veterinary Practitioners

Diplomate American College of Veterinary Anesthesiologists

Specializing in pain management and mobility

OrthoPets

886 E. 78th Ave

Denver, CO USA 80229

www.OrthoPets.com

>

> Couple weeks ago we saw 3 year old male bulldog. He was diagnosed with

cruciate ligament rupture on right leg. Owner doesn't want to do surgery,

affraid of anesthesia. Orthopets can't make a brace for him. Do you know of any

other options? Thank you.

>

> Jolanta Kandefer CCRA

> Viera East Veterinary Center

> 5405 Village Drive

> Rockledge, Fl. 32955

>

>

[Guest guest]

Patsy,

Thank you for taking the time to address both the orthotic issue and the " fear

of anesthesia issue " . While I think that there was a time years ago when we

were all afraid of the increased anesthetic risk associated with bracheocephalic

breeds, especially English Bulldogs, improved anesthetic protocols and

anesthetic monitoring has definitely changed my opinions and approach.

Jolanta,

This is a young patient that maybe headed to life of chronic pain without

surgical repair, especially if the rupture is complete and adding to the joint

instability and dysfunction. I tremendously respect Laurie and the time and

effort that went into the preparation of her detailed document, however, I have

concern with the promotion of conservative therapy for the CCL deficient canine

stifle. Regarding this subject, drawing conclusions from the rehabilitation of

the knee in people, a joint with completely different biomechanics than its

canine counterpart, is difficult to justify.

The stability of the stifle joint is dependent upon both static and dynamic

factors. Static joint stabilizers, that include the bony geometry and numerous

passive structures such as the joint capsule, ligaments and menisci, cannot be

influenced by rehab therapeutic modalities. The dynamic structures, the muscles

and related fascia, can be greatly influenced by many of those exercises that

were mentioned in Laurie's paper. In the canine we have recognized for years

that CCL disease is more commonly a chronic degenerative process leading to

rupture rather than an acute event like people. Histopathology of even the

acute ruptures in dogs reveal hyaline degeneration, dystrophic calcification and

disruption of ligament fibers. These findings suggest repetitive microtraumas

resulting in rupture, a much different pathophysiologic process than that in

people. These findings suggest a force or stress that the canine CCL undergoes

that is most likely not present in people.

Slocum, developer of the TPLO, was perhaps the first to discuss the presence of

a more constant shear force in the stifle related to the static joint factors of

tibial plateau angle and its role in cranial tibial thrust. Later Tepic, one of

the developers of the TTA described tibiofemoral shear forces created when the

static factor of the tibial plateau was not parallel to the force of the

patellar ligament. So regardless of amount of rehabilitation and strengthening

of the dynamic factors (muscles) nothing will change the static factors short of

surgery to alter the geometry of the knee.

Additonally, in the Bulldog in question, the " straight hock " described by Dr.

Mich adds to the list of static stability factors that would not be influenced

by rehab. The Achilles tendon reacts with a force F(A) that results in a net

force on the tarsal joint F(JT) when the limb is loaded with force F (G) or

ground force. This would all be effected by the conformation described by Dr.

Mich. The patellar ligament reacts with a force F (P) to stabilize the stifle.

I would suspect that this patient is very upright in the stifle as well.

With clinical research, clinical observations and the development of our

rehabilitation discipline certain patients maybe recognized and criteria maybe

established to dictate those that may have long term favorable outcomes with

conservative therapy but I question if we are currently at that level of

awareness. Of course I am always interested in discussion on topics such as

this because i know that some of you recommend conservative therapy. Thank you

for your considerations.

Rick Wall, DVM

Certified Canine Rehabilitation Practitioner

Diplomate, American Academy of Pain Management

Certified Myofascial Trigger Point Therapist

Center for Veterinary Pain Management and Rehabilitation

The Woodlands, TX

www.vetrehabcenter.com

1 of 1 Photo(s)

[Guest guest]

Hi Jolanta

I agree with the previous post that this dog is young to consider conservative

management in. I think this dog would do well with a TPLO.

Here at ASEH we anesthetize many bulldogs, and we have extensive anesthetic

monitoring equipment and very experienced surgeons and technicians to monitor

the anesthesia, making the risks of anesthesia low.

Dr Darien Lawrence

BVSc, MS, Diplomate ACVS, CCRT

Animal Specialty and Emergency Hospital,

5775 Schenck Ave,

Rockledge FL 32955

>

>

> For some reason when I attached the picture to my previous post it eliminated

my closing statements.

>

>

> With clinical research, continued clinical observations and continued

development of the this discipline of rehabilitation we may one day be able to

identify CCL deficient patient that may do well long term with conservative

therapy however I am not certain we currently have that ability. I very much

enjoy discussions such as this and hope is that my questioning of others

opinions and statement produces discussion that ultimately improves our

abilities to help our patients. I look forward to those discussions and I

appreciate your consideration. I would like very much to hear from those of you

that are recommended conservative therapy for CCL dogs, i.e. case selection,

outcomes, goals, client's expectations, etc.

>

> thank you!

>

> Rick Wall

>

[Guest guest]

Patsy, It isn't so much that I have difficulty in fitting the brace. It more relates back to my physical therapy human practice experience in which we may (but rarely) use a brace. When we did choose to use one it was temporary. We would prefer to use appropriate exercises to strengthen the leg to help provide the stability needed rather than have them rely solely on a brace for stability. I agree that they can be used in conjunction but we just have chosen not to and have had great success. My two cents on braces that I have seen are that in stifles a custom brace is the only way to go and that a brace made out of any type of "fabric" will in no way be able to stabilize anything. So the braces I have seen from both OrthoPet and Ace Ortho are good quality custom braces which are the only ones I would ever consider for bracing a stifle. Amy Kramer, PT, DPT, CCRTCalifornia Animal Rehabilitationwww.CalAnimalRehab.comSender: VetRehab Date: Sat, 05 Feb 2011 16:17:26 -0000To: <VetRehab >ReplyTo: VetRehab Subject: Re: Cruciate ligament rupture in bulldog Rick Thanks for the detailed explanation of the forces generated within the canine stifle. Helpful image too. Yes this little guy has the common bulldog conformation of rather upright (straight) stifles. Also thanks for reiterating that anesthesia in brachycephalic dogs requires careful attention to the respiratory system; as you noted, this alone should not prevent surgery when anesthesia is approached and appropriately planned cognizant of the special needs of these patients. The American College of Veterinary Anesthesiologists (ACVA) has a website with a list of diplomates one of whom may be in the region and able to consult or perform the anesthesia for Jolanta's patient. and AmyI was interested to hear more about your frustrations with fitting stifle orthoses. Despite decades of diligent work (surgical, rehab, orthoses) there remains no perfect answer for the cruciate deficient canine stifle. I suspect the answer involves some combination of these modalities (and others yet described) which varies from case to case based on breed, conformation, body condition, lifestyle, job/sport, co-morbidities, client goals, among others. Certainly orthoses are not the answer for every case. Even so, it seems that for those who absolutely will never be surgical candidates for a number of legitimate reasons, or for those who need to delay surgery, developing an orthotic device that meets functional and quality of life needs is a valuable endeavor. Any experiences out there shared with the group, or offline if you prefer, can only serve to improve the options available for these patients. How can the orthotic option be better? Patsy Patrice M. Mich, DVM, MS, DABVP, DACVAOrthoPets Medical director and ownerSpecialist in pain medicine and mobility>> > For some reason when I attached the picture to my previous post it eliminated my closing statements.> > > With clinical research, continued clinical observations and continued development of the this discipline of rehabilitation we may one day be able to identify CCL deficient patient that may do well long term with conservative therapy however I am not certain we currently have that ability. I very much enjoy discussions such as this and hope is that my questioning of others opinions and statement produces discussion that ultimately improves our abilities to help our patients. I look forward to those discussions and I appreciate your consideration. I would like very much to hear from those of you that are recommended conservative therapy for CCL dogs, i.e. case selection, outcomes, goals, client's expectations, etc.> > thank you!> > Rick Wall>

[Guest guest]

i also have many great results with conservative management of cruciate tears(no

meniscal tears) which include proper exercises and the underwater treadmill as

well as low level laser. 80% of these dogs do not tear the other cruciate

ligament. i have done follow up assessments of these dogs for the past 7 years

and the owners are happy with how well their dogs have done. the types of dogs

vary from large lazy dogs, to active herding dogs, all with owners who do not

want to have their dog undgo surgery.

tania

CCRP

[Guest guest]

I too love the never-ending CCL discussions and appreciates

everyone’s points of view. In addition to what Amy Kramer stated, I

want to put in a plug that Bulldogs to me rehabilitate the most

gracefully from CCL tears than the other breeds. Once effusion and range of

motion have improved, they bulk strength (and quantitative muscle girth) so

easily that I think it helps to stabilize the joint. Given this, one of our

boarded surgeons in the area (who is a big TPLO/lateral suture advocate)

started sending Bulldogs with CCL tears to us for rehabilitation without surgery

because she had seen the results. We convinced one person, yeah!

Dr. Waldman

Veterinarian

Certified Veterinary Acupuncturist

Certified Canine Rehabilitation Therapist

Medical Director, California Animal Rehabilitation

W F

www.CalAnimalRehab.com

[Guest guest]

So how do we organize a multi-center study on this topic?

Amie

Amie Lamoreaux Hesbach, MSPT, CCRP, CCRT

Physical Therapist

Massachusetts Veterinary Referral Hospital

20 Cabot Road

Woburn, MA 01801

Phone:

Fax:

E-mail: ahesbach@...

Website: www.IVGMassVet.com

> ,

>

> I am still coming to visit and learn more about conservative therapy for CCL

deficient stifles. I sincerely appreciate the comments of Laurie and Amy and

others regarding this issue. There is no question I have much to learn about

this complicated problem that is seen all to commonly. I spent yesterday morning

doing a literature review on CCL disease,mand came up with about 15 current

articles of interest that I ordered yesterday and received last night. I read a

great paper this morning written by Dr. Cook a surgeon at University of

Missouri, a literature review on the biology and biomechanics of CCL disease and

ended up ordering two more articles from the references.

>

> This is a great subject to discuss and the multi-disciplinary nature of this

group is beneficial to that pursuit. I have many questions that need to be

answered however!

>

> Rick Wall

>

>

[Guest guest]

,

I am still coming to visit and learn more about conservative therapy for CCL

deficient stifles. I sincerely appreciate the comments of Laurie and Amy and

others regarding this issue. There is no question I have much to learn about

this complicated problem that is seen all to commonly. I spent yesterday

morning doing a literature review on CCL disease,mand came up with about 15

current articles of interest that I ordered yesterday and received last night. I

read a great paper this morning written by Dr. Cook a surgeon at University of

Missouri, a literature review on the biology and biomechanics of CCL disease and

ended up ordering two more articles from the references.

This is a great subject to discuss and the multi-disciplinary nature of this

group is beneficial to that pursuit. I have many questions that need to be

answered however!

Rick Wall

[Guest guest]

Amie,

Interesting suggestion but very difficult. What are your thoughts? I thought

it might be interesting to put together a survey, on this subject, for VetRehab

members to complete, I have an account on Survey Monkey.

Rick Wall

[Guest guest]

Hi Rick.

Yes, you're right, it is very difficult to do a multi-site study. This is a

fantastic group of amazing practitioners performing " cutting edge " treatment

with great success. We need to document our successes with objective

measurements. I'm not an academic or a fan of statistics but we've got to put

the info out there somewhere!

Amie

Amie Lamoreaux Hesbach, MSPT, CCRP, CCRT

Physical Therapist

Massachusetts Veterinary Referral Hospital

20 Cabot Road

Woburn, MA 01801

Phone:

Fax:

E-mail: ahesbach@...

Website: www.IVGMassVet.com

> Amie,

>

> Interesting suggestion but very difficult. What are your thoughts? I thought

it might be interesting to put together a survey, on this subject, for VetRehab

members to complete, I have an account on Survey Monkey.

>

> Rick Wall

>

>

[Guest guest]

Are there any functional tests that are validated that could be used in each

clinic-- before initiating PT treatment and on discharge? I think that gait

analysis systems are a great idea (and GaitRite should do a traveling " show " in

my opinion) but what is easy to do and to have good compliance? Does client

satisfaction have any merit in the veterinary literature? It's great that we

all think (and our clients and referral sources think) that these patients do

well with conservative management, but I've also met quite a few surgeons who

have been very happy with their surgical outcomes without PT. What is a " good "

response to therapy? It's all very subjective, isn't it?

What about asking questions of the client? Can your dog jump in the car? Can

he run, play, climb stairs, etc? How often is he " lame " (whatever that might

be)? Is he on any pain medications/antiinflammatories?

Just brainstorming with my fried brain.

Amie

Amie Lamoreaux Hesbach, MSPT, CCRP, CCRT

Physical Therapist

Massachusetts Veterinary Referral Hospital

20 Cabot Road

Woburn, MA 01801

Phone:

Fax:

E-mail: ahesbach@...

Website: www.IVGMassVet.com

> So what's the best way to collect objective data as a multi-center study on

these CCL rupture dogs that are getting conservative treatment only?

>

> Not that many clinics have gait analysis systems, but what about some other

alternatives? For example, video tape the dogs at a walk and trot and mail in

to a center that would do computerized analysis? Sponsoring a project like this

would be great for AARV if funds were available. Assuming somewhere around $200

per dog for the analysis, $2,000 would cover about 10 dogs recorded once or 5

dogs recorded at 2 different time points.

>

> Jan

>

> Janet Steiss, DVM, PhD, PT, Dipl. ACVSMR

> Professor, Dept of Anatomy, Physiology & Pharmacology

> College of Veterinary Medicine

> Auburn University AL 36849

> ______________________________

> work ph:

> FAX (departmental):

> alternate email: steisje@...

>

>

>

>

> To: VetRehab

> From: lizwiz4@...

> Date: Tue, 8 Feb 2011 14:37:22 +0000

> Subject: Re: Cruciate ligament rupture in bulldog

>

>

> Hi, I strongly believe that the joint capsule, ligaments, and meniscii CAN be

affected by rehab modalities. For years, the human medical community asserted

that cartilage could not regenerate. Now we have studies that show that this is

not the case. Ligaments that are not completely ruptured have a cellular

structure, in my opinion, that is stimulated by modalities such as electric

stimulation, ultrasound, and laser therapy, and also can heal. The joint

capsule, formed by muscle tendons, fascia, and ligaments, also can be

strengthened with stabilization and the above mentioned modalities. Physical

therapists who do a lot of manual therapy can actually feel the change in an

instable joint capsule, to a more stable joint capsule, over time, with joint

glides. I have no scientific studies, unfortunately, to back up anecdotal

observations, but I have seen a dog with a complete CCL rupture and a very

instable stifle improve so much over a 6 month period (no surgery due to a new

baby) that it was astounding.

>

> Liz Powers, MPT, CCRT

>

>

>

>

[Guest guest]

very interesting topic, conservative management of CCL ruptures....since 50% of

my stifle business is now conservative management, with great results.

since the thread started, today i spent a couple of hours pulling out files of

dogs with conservative management of CCL ruptures, as well as TPLO and Extra Cap

dogs...my preliminary thoughts (and i have absolutely no experience doing

studies but have a gut feeling about what i might expect) i thought about

contacting previous clients...with a survey, and following up with outcomes.

for me i wanted to compare some subjective functional outcomes based on the

above...then perhaps diagnostic imaging of actual outcomes.

finding out initially:

arthritic changes of the joint 1 year post rehab

lameness scores (since i don't have a force plate and it definitely is not in

the budget in the foreseeable future) this will be subjective

did they end up doing surgery despite conservative management

perceived outcomes vs observed outcomes

life style scale...are they doing what they did before the injury

compensational issues (perhaps as a result of initial ccl injury)

these are my initial thoughts but i am sure many of you with more experience and

knowledge in this area could have better input..

just thought i would put it on paper to start the ball rolling. this is why i

love this group, all of us have a common goal and share ideas to help our

patients quality of life.

tania

CCRP, VT, CAAP, CMT, Osteopathy functional indirect