Dog ACL CCL Ligament Recovery Without Surgery No TPLO

Treating Canine Ligament Injury Without Surgery

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Canine Ligament Injury and its Treatment

are the subject of this website.

There is nothing being sold here.

My dog's ligament injury led to my interest in this subject. Tigger was diagnosed as having ruptured ligaments in both rear legs in May 2002. He was severely disabled by the injuries. Vets said surgery was the only option for a 100+ pound dog. The orthopedic-specialist vet said it had to be TPLO surgery. In normal circumstances I would have accepted the vets' opinions and agreed to having the surgery. But unusual aspects of Tigger's situation led me to reluctantly decide against having TPLO or any other surgery done.

Tigger recovered wonderfully well without surgery.

The vets had insisted surgery was the only way to treat Tigger's torn ligaments. Tigger's recovery without surgery raised this question:

----"If Tigger could recover so well without surgery from severely disabling ligament rupture, what about all those other dogs the vets are insisting must have surgery?
-- Was Tigger's recovery some kind of miracle?
-- Or could surgery be unnecessary for many other dogs too?"

That question prompted me to look into canine ligament injury and its treatment. I have spent many hours reading the research literature dealing with ligament injury. And I have communicated with many vets experienced in treatment of these injuries, and those who have studied the results of the different treatment options. I have heard from a great many people who have dealt with these injuries in their own dogs using the various surgeries and non-surgically.

I have reached these conclusions:

----That a large number of the surgeries done on dogs diagnosed with ligament injuries are unnecessary and inappropriate.

----That surgery is often described to clients by vet-surgeons as a medical necessity in cases where it is neither necessary nor the best treatment option.

----That the success rates for ligament-related surgical procedures are often misrepresented by surgeons as being much better than they really are.

----That all the ligament surgeries, especially TPLO, have risks which are often not disclosed to clients by surgeons.

----That non-surgical recovery, while very often the best treatment for dogs' ligament injury, is frequently ignored in surgically-inclined vets' presentations to clients of the available treatment options.

----That TPLO has become a cash-cow for a number of veterinary ortho-surgeons who are making huge profits selling this questionable procedure by misrepresenting TPLO's potential outcomes and risks to clients.

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 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 from these injuries is safer and usually the best first-choice treatment option. 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.

---- My Tigger's recovery experience is not unusual. This website was first put up in January 2005 and since then I've heard from thousands of people who have succeeded in helping their dogs recover non-surgically after having been told by vets that surgery was their only choice. Many more dogs would recover well from ligament injury without surgery if given the chance. More information on non-surgical recovery, and suggestions about how to decide when surgery is appropriate, is on this website's page titled 'Diagnosis & Treatment'.

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Question: "I have been going to the same vet for years and 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? There are two main reasons:

-- First, 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. Long-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.

-- The huge profit in TPLO and TTA has influenced some ortho-specialists to prefer these procedures. Specialists have a great deal of influence with general practice vets like your regular vet. When a 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 so highly of the procedure.

---- Also, your vet may not be aware that recent advances in materials have made conventional stabilization surgery a much better alternative than the very invasive TPLO for many dogs who do need surgery. There is information about advances in conventional stabilization on the 'Conventional Surgeries' page here at this website.

The high-profit TPLO is still preferred by many surgeons in spite of the fact that recent advances in treatment options make this very invasive and risky procedure a poor choice for the vast majority of dogs. I am certain that TPLO is recommended and done much more often than is justified. This results in serious complications and poor outcomes for a number of the dogs who have these surgeries unnecessarily. The 'TPLO/TTA' page here at this website explains further why you should be skeptical of a recommendation for TPLO.

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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. 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.)

While surgery is sometimes necessary for a dog's recovery, deciding to have surgery without first trying a non-surgical approach is usually not wise. A non-surgical approach is very often successful and is very low risk. While most dogs do recover at least moderately well after surgery, the risk of surgical complications is unavoidable. I regularly get emails from people whose dogs were worse off after surgery than before. In a great many cases where immediate surgery is recommended by a vet, non-surgical recovery would lead to the best possible outcome for the dog. The way to determine if your dog really requires surgery is almost always to first try the non-surgical approach. If your dog has been diagnosed with a ruptured, torn or damaged ligament and you are being told that immediate surgery is required, please don't act on the vet's recommendation hastily. A period of 8 weeks of restricted activity often shows that a dog can recover well without surgery. If there is not improvement during that time, then surgery probably truly is appropriate.

Please see the 'Surgical Recommendation?' page here at this website for more on why immediate surgery may be inappropriately recommended by many vets for ligament injuries.

When your dog has a ligament injury, the most comfortable thing to do is to close your eyes and trust the vets. 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, not trusting.

"...Medical history is littered with once-popular procedures that subsequently proved ineffective or dangerous. ..." ----------A quote from Consumer Reports 'On Health'

Tricking Ourselves Into Choosing The Expensive Option Rather Than The Best Option.

      When our beloved 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.

What results can you realistically expect from ligament surgeries?

Your vet-surgeon told you he has a great success rate with his preferred surgery, didn't he? Well, what would we expect him to say?

--- What kind of results do objective studies indicate are realized from the various surgeries? Here's a quotation from an article published in the professional journal 'Veterinary Surgery':

"At this time, the application of evidence-based medicine in analyzing the current available evidence suggests that there is not a single surgical procedure that has enough data to recommend that it can consistently return dogs to normal function after CCL injury." This article is quoted further on the page titled 'But the Vet Said...' here at this website.

--- Another article on canine ligament surgery, this one 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. There is a quotation from this article on the page 'Surgical Recommendation?' here at this website.

Sometimes non-surgical recovery from ligament injuries doesn't work, and surgery is then appropriate. But surgery is almost never appropriate when recommended before trying 8 weeks of careful restriction.

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 address is on the 'Contact me' page.

SITE VISITORS:

Update--- Five Years After Tigger's Injury: May, 2007

--- It is five years since Tigger ruptured ligaments in both rear legs. His injury was severe. His non-surgical recovery was very successful. Since his recovery he has had no trouble with his stifles(knees). He has led a very active life, both before his injury and after his recovery.

--- Big dogs like Tigger age more quickly than smaller dogs, and he is showing his age now at 12. He has slowed down and is no longer a frisky young fellow, but the joints that were badly injured and recovered without surgery are still fine.

---- Looking back I am very glad that I rejected TPLO surgery for Tigger. It was difficult to decide to go against the surgeons' advice then. They presented themselves as so certain that surgery was absolutely necessary. Time has proven that Tigger did not need TPLO or any other surgery.

---- I know now that surgeons commonly misrepresent the facts about TPLO in order to sell people on this hugely profitable procedure. Many dogs who are subjected to TPLOs would recover from their injuries without surgery just as Tigger did if they were given a chance to do so.

---- I am confident that the best way to approach a dog's ligament injury is to first try the non-surgical approach. Improvement over the first 8 weeks will indicate that the dog can probably successfully recover without surgery. Agreeing to immediate surgery puts the dog at risk for various complications and imperfect results which could be avoided with a non-surgical recovery. While surgery is sometimes necessary, I believe that surgeries are recommended and done much more often than they should be.

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Tigger died later in 2007. He lived an active life up until his final illness. His stifle joints, which were injured & recovered without surgery in 2002, were still fine when he died.

This website was most recently updated in July 2008.

The information here is current and accurate.

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