ACL "Tightrope" Surgery (Dog)- Experiences
Quite some time ago my dog partially tore his ACL in his rear, left knee and has occasionally re-injured then favored the leg since then. He used to have a few bad days periodically at which time he would be put on limited duty to heal up and then resume normal activity in a few week. Recently it has gotten worse and he no longer carries weight on that leg, even when on an anti-inflammatory (meaning it hurts enough that he can still feel it with the pain medication). We have done what we can with non-surgical measures, but decided it is time to have the knee surgically repaired (plus I want to mitigate how long he spends on only three legs so he does not stress out the knee on the other leg).
There are several different options for ACL repair but the one recommended and performed at my vet’s office a “Tightrope” repair. Based on my research, I am satisfied with choosing this procedure over others but would like to see if anyone one else has had this procedure done and can give me some information about their experience. Per the assessment at the vet today, he is in very good health with no hip or kidney issues and is very lean (50 lbs but no extra weight putting stress on his knees) but has definite ligament damage and slight arthritis in his “bad” knee. He is only three and half years old so I am particularly interested in the long-term progress or issues (which may be limited as this specific procedure is fairly new).
Thanks!
Happy Homemaker I can't help, but I want to wish you and your pup the best, and a speedy recovery :)
Lori...since '73 Thanks Lori!
I know he will be in good hands, but I am worried anyway:). He had to be anesthetized today for the x-rays and thorough examination and I was super nervous- I am going to be a mess when he actually has the surgery. I am also worried about keeping him from overdoing it afterwards because him and my new guy, Primo, run around like idiots. I have a feeling I will need to keep the two of them separated for a few weeks while Twizz heals up.
Our vet sent us to a specialist at http://www.gsvs.org/index.html She said she only uses them for ortho surgeries.
Our dog is 30 lbs, so he was right on the weight limit of the "little dog" surgery vs the "big dog" surgery. We went with the big dog surgery - a "notching" of the bone, I believe. I don't remember them mentioning anything about "tightrope" in the options.
Our dog recovered perfectly and is 100% fine (thank God). $4,000. Yes, painful, but we accept the responsibility.
Garden State was wonderful. Very professional, terrific after care. I recommend them completely.
4of4Take a trip to the UPenn vet center for that - it's well worth it and they've done a million of these.
My 14 pound mini poodle had the tightrope surgery on his back leg in July and the removal 6 weeks later. Right now, we are 15 weeks after the removal, and he's doing great.
Dr. Henrich at Tranquility did the surgery along with tightening the patella and cleaning up the torn meniscus. I think his luxating patella (Grade 2) caused the complete CCL rupture with torn meniscus. We tried 5 weeks of conservative management, but he still could not use the leg at all.
After the surgery, we were unfortunate to have bad luck with the mesh. My dog has issues with allergies, so he is more susceptible to having an immune response to things (my thoughts). Six weeks after the tightrope surgery, there was 1 spot on his leg that wasn't healed. Also, the leg wasn't growing fur in the surgery area and skin looked dark. Vet thought it was an inflammatory reaction to the sutures, but he traced it to the mesh. Luckily, my dog had developed a significant amount of scar tissue, so he was able to use the leg after the mesh removal. Went through about 2 months of re-hab (exercises and walking), and we are now only using Rimadyl occasionally (only if he bites at it from overuse or bad weather).
Even though we had issues and he isn't an ortho doc, Dr. Henrich did a great job. He's been doing surgeries for about 30 years. The cost was over $2G, but I think it was worth it.
Keeping them calm until they heal is most of the battle. We only have 1 small dog, and we still had a few "whoops!" moments. We kept him confined in a dog beg in our kitchen with carpets everywhere. I initially thought my dog was low energy and wouldn't be a problem, but when he started feeling better, he became harder to handle. Unfortunately, he's a back leg bouncer. I will still keep him off stairs and couches for another few months, but we were told no restrictions about a month ago.
The Orthodogs group on Yahoo is a great group for lots of information, but most have the TPLO or TTA done. They've seen too many problems with the tightrope, so they don't recommend it. My vet was pretty confident the surgery would be successful and had no surgical problems in the past, until our dog.
We thought the TPLO or TTA was too invasive for a small dog, since I'm not a fan of bone cutting. Plus, if the tightrope fails, you can remove it and try regular extra-capsular. But if the TPLO or TTA fail, your options are limited. Not sure if I would recommend the tightrope over the extra-capsular in hindsight.
Good luck!
Anon. Anon-
After the removal of the tightrope apparatus, what type of procedure was used to repair the knee?
I am also planning to use Dr. Heinrich. I recently switched to Tranquility because I was extremely dissatisfied with my original vet but am really pleased with Tranquility thus far. The staff is great and my dog actually likes them (he was terrified at the other vet). I do like the idea of being able to simply remove the device if it fails and still have the bone intact so other measures can be used. I guess in a worst case scenario, if the tightrope procedure was not successful I could go with a more invasive approach like TPLO or TTA.
It is very frustrating not being able to find many “Customer reviews” on this procedure because it is fairly new. I am the type of person that needs to do a ton of research to feel comfortable about my decision and there is simply a lack of information (other than how the procedure is performed) out there. I appreciate the link to that Yahoo group- I am certainly going to take a look at it.
Happy Homemaker,
I don't have any info. that would help you as far as the surgery, but just wanted to wish you and Twizz the best and a very speedy recovery. Glad to hear you like Tranquility Vet. I have used them for years and have been pleased. Dr. Henrich and his staff are great!
Good luck and let us know how everything goes.
JRT Also wanted to add a good luck ,and support for Tranquility Vet. We've used them for over 7 years now and really like how wonderful they are with our pets. They are very attentive to concerns and any questions you have, so your pup is definitely in good hands. Hope for a fast and non-eventful recovery.
Trying to Help JRT & Trying to Help-
Thanks for the good wishes! I have gotten some good feedback about Tranquility and feel quite a bit better with the decision. I just want to see him up and running by spring because he loves hiking and swimming so much but his leg just can't handle it in this condition.
Thank you all and I will certainly let you know how it goes!
"After the removal of the tightrope apparatus, what type of procedure was used to repair the knee? "
I was very wary of this type of surgery, and I did tons of research, too. I kept hearing about failures, mesh infections, and even bone tunneling issues with the mesh. They do have to drill small holes in the bone for the mesh to be threaded through, but they don't actually cut the bone like in the other surgeries. Dr. Henrich was really nice about it and was willing to answer all my questions. He told us he has been doing the procedure for a couple years (since it was introduced) and didn't have any problems with it. Unfortunately, my dog probably had the the first issue with it, with his inflammatory reaction.
Once they took the mesh out, we were 6 weeks after the initial surgery plus 5 weeks for the conservative management. Dr. Henrich felt that my dog had built up enough scar tissue that the joint was stable. I think the knee tightening helped a lot as well. Basically, after the removal, my dog was left without any support except his scar tissue and the fastener that he used for the tightening of the patella. We went slow with physical therapy after that, and I treated him as if we were doing Conservative Management again.
Since my dog is a smaller breed dog, I was able to carry him around, but you don't have that option. I was very relieved to have the mesh out, since he never would have healed no matter what inflammatory meds we tried. I would rather have gone with the traditional surgery, but I'm not sorry about having him treated at Tranquility.
I agree about the staff there. They are very friendly and knowledgeable. We usually see Dr. Christensen, but the other vets are great, too.
Good luck! It's a long road to recovery, and having faith in the surgeon and procedure is key. Ask lots of questions until you feel confident about everything.
I just dropped Twizz off at Tranquility for his surgery. I am so nervous, but hopefully everything will go well and we will be hiking as usual by Springtime. I really appreciate all of your feedback and good wishes and hope that you can cross your fingers for us today. I will let everyone know how it goes and also post periodically on his post-surgery progress in case anyone else is in this situation and is considering this type of surgery (as there is such limited information out there).
Thanks!
Calico696 Twizz is in excellent hands. Tranquility Vet clinic has been there for all my pets' needs over the past 30 years! I would never trust anyone else. Wishing Twizz a speedy recovery!
lola Good luck Twizz! I hope you get to come home today. Tonight he should sleep and not want to do anything. Tomorrow is when the fun begins (worrying and loss of sleep for you). If you have to use a leash in the house to keep him confined, that's ok.
After the patch medicine wore off in a couple days, we needed both the Rimadyl and Tramadol for a good week until he was outta major pain.
My dog was only out for potty breaks 4 times a day. No running, jumping, stairs, or rough play.
Also, Post Surgical instructions didn't include anything about icing. I thought they overlooked this excellent treatment, since it's done all the time for human knee surgery. I used frozen/cold gel packs (in a towel) on the wound to help the swelling go down. Every 4 or so hours for 5-10 minutes gave my dog some relief. No heat until all swelling goes down.
Good luck!
Twizz is home and resting uncomfortably:). I was unprepared for the size of the incision and almost cried when I saw it. I decided to try an inflatable e-collar instead of the standard cone but he is too drowsy to try and bother the incision so I am not sure yet how that will work out. The vet said he is already trying to overdo it so he needs to be watched very carefully and of course he cried like crazy at the vet as soon as his anesthetic wore off. The next few weeks will be interesting. I am prepared with tranquilizers if need be.
Thank you everyone!
WOW! just saw this! Glad the surgery went well! Twizz is in great hands with you mommy, you did your research and seem to have all your bases covered with home recovery and therapy. It's hard the first few weeks, keep up the good work! Looking forward to the spring hiking pics! :)
Luckygirl Glad he got through it ok and hope he will be an agreeable pup during his recovery. Thanks for keeping us updated.
Our dog did not have that particular surgery, but had hip dysplasia diagnosed at 7months old. She could not put any weight on her hind leg at all and being so young, we HAD to do something about it. She ended up with the Triple Pelvic Osteotomy (TPO) procedure on both hips. It was terrible and we questioned if it was the right decision...we felt like we were taking some of her puppyhood away by doing it and keeping her crated and not able to play with her brother. Not to mention the astronomical expense of getting an orthopedic surgeon to to this work. Now she is turning 5 in January, and let me tell you - it was the BEST decision we have ever made. Besides the fact that she runs a little goofy, she can keep up with any dog and shows zero signs of any discomfort. She is one happy doggie.
So I know this does not directly address your question or situation, but I just wanted to relay to you the positive experience we had to reaffirm your good decision in getting this done for your dog. Recovery will be tough, but in a few months from now, your dog will be sprinting through the yard and you will be smiling from ear to ear knowing that you did the best thing! Good for you and best of luck on the recovery! xoxoxo to your pooch =)
Glad to hear that it went well. So sorry he's in pain :(
Rest east Twizz <3
Natalie-
I hear you about wondering if it was the right choice. My guy could still get around alright but I could tell he was in pain although he is a tough guy and didn't show it outright and I was on the fence as to whether or not he really needed surgery or if this was the right time. I really had my doubts when I picked him up yesterday and saw his leg all icky and how blah he was. I set up the air mattress in the living room and slept there with him last night. He seems in better spirits this morning, was able to go to the bathroom and is hanging out on what he thinks is his giant new bed. I think that he is fine but it is me that is hurt and stressed out:). Luckily he is a bit older now and out of that puppy stage so he is fine with laying around most of the day- I could not imagine trying to get through the recovery phase with a 7 month old puppy! I am crossing my fingers that long term this was the way to go as he is not even 4 years old yet and needs those legs for many to come.
I do feel a bit guilty that I am neglecting my other guy. They cannot be out together because I am too afraid of Primo crashing into Twizz so he is crated a bit more than usual. But, Primo will get plenty of walks and training sessions to keep him from running around the house for the next few weeks. It is hard because time is limited and it is tough to split it between the two. I feel it is still too early to leave Twizz alone because he is feeling a little better and I think he will get tired of the staples and try to take them out himself:). Luckily I have off until Wednesday for Christmas so I can keep an eye on him 24/7.
Merry Christmas all! Be safe and enjoy the time with your families!
I'm glad Twizz made it through! We freaked out from the looks and size of the incision, too. Apparently, it's better to let it heal without any bandages on. The swelling will go down slowly, and I think it took about a week. Red means it's bruised, not just purple. But seeping around the sutures is bad, so keep it clean.
For our second surgery (mesh removal), he had minimal sutures, so we had a small walking cast on his leg. Not sure which is better, since it's harder to walk with the cast.
My dog freaked out when we used the hard plastic one, and he ended up hurting himself trying to thrash it off. We didn't have any luck with the soft cone or the inflatable one either, so I ended up just watching him 24/7 for about a week.
They start licking at it if it really hurts or itches, so we made sure to use meds and ice packs for that. For keeping it clean or itching later on, instead of watered down hydrogen peroxide, we used a wash of a solution of Nzymes Ox-E-Drops. It's an antibacterial, antifungal, antiviral product that helps healing. We've been using it for years on our pets and ourselves.
I'm sure Primo will understand. He knows Twizz is down for the count and needs extra TLC.
Good luck!
Dear Anon-
I truly appreciate your insight on this and hope you can provide just a few more details. What were the signs that your pup had rejected the mesh?
We had a vet appointment this past Monday and Twizz was progressing ahead of schedule (incision looked good, he was putting weight on the leg). While I was home, I had been taking off the e-collar and he was being very good about not bothering the incision. On Christmas morning (of course), I walked out to the kitchen and by the time I got back to the living room (just a minute or two), Twizz had removed one of his staples. The incision did not bleed much but did open a tiny bit. I put the e-collar right back on so he could not mess with it any further. I had called the vet and since he only got out one staple, it should be alright but I am cleaning it and keeping a close eye on the incision in case there is any kind of infection.
We were running in and out on Christmas and Twizz was getting excited and being too active. We decided to give him the sedative that had been prescribed. He got very loopy and fell several times, even though we tried to get him to just lie on the air mattress we had set up for him. Yesterday morning I realized that he is no longer putting any weight on his leg and is holding it up very high instead. His back is "hunchy" and his tail is down which are the signs that he is in quite a bit of pain. I scheduled a vet appointment for tomorrow afternoon, but am so worried that he either hurt himself badly when he fell, dislodged the implant used during the surgery or is rejecting the implant.
I really hope that he only bruised himself when he fell and it is not something more serious. I am pretty sure I have never been more stressed out in my life than I am now:).
HH,
I am so sorry to read this about Twizz. I will definitely keep you all in my thoughts!
PorkChop sends him a "feel better soon" tail wag <3
Thanks Lori:)
I was sooo disappointed because he was walking really well and his incision looked awesome and then he goes and plucks a staple and backtracks on his progress walking.
Primo had developed a cyst on the salivary gland on his neck which popped on Christmas and was oozing some clear stuff. We are hopeful that it will drain itself out because if not, a drain will need to be implanted to help it out. Worst case scenario he would need surgery to remove the gland. The vet is probably starting to cringe every time I call (which is several times a week now).
We had several dogs growing up and I don't remember having so many accidents and medical issues with them!
I wish the best for both of them, and YOU! Don't worry about the vet cringing, he/she is there for just that. I know those pups of yours are in good hands. Just hang in there :)
Ohhh poor Twizz :( Hopefully it isn't anything terribly serious and can easily be treated to get him back on track.
After we got the staples out, the rejection signs included the skin staying darker (black almost), no hair growth in the area (even fine hairs), and some redness (bruising that did not go away). Also, after the vet removed the staples, there had been a scab on one of them. When the vet picked the scab off, the wound didn't form another scab and remained red and puffy looking. That's why the vet thought it was a suture problem. But when he opened him back up, he traced the problem back to the mesh. Please keep in mind, we did not see rejection until after 6 weeks. Supposedly, that's when the internal sutures start to dissolve and their bodies launch an immune response to a foreign body. The mesh does not dissolve, so it had to be removed.
Sorry about the pain he is in. That's definitely a sign of pain...not using the leg. We made sure to keep our guy on a steady dose of Tramadol every 8 hours whether or not he needed it for a good 3-4 days. We started him on the maximum dosage until we saw improvement, then smaller doses after that. Also, Rimadyl every 12 hours and ice for the pain. Tramadol didn't make our guy sleepy and we didn't have any other sedatives, so I don't have any experience with them.
Please don't beat yourself up about any "Ooops moments". This is a touch and go surgery. I always felt we went 1 step forward and 2 steps back. It's a slow healing process and takes a lot of patience. They say it's one of the worst injuries your dog can get because of the recovery process. Plus, you have to deal with the cold weather, which we didn't have.
We had a couple setbacks (the e-collar thrashing incident and spinning on his back legs in his bed), so maybe the vet can do another laser treatment while you're there. They're great for pain and will take some swelling down. Not sure if you had any meniscus removal, but you can still have a meniscus tear to complicate things. Dr. Henrich cleaned ours up a bit, since my guy definitely had a tear before the surgery.
Poor Primo. Sometimes I think our other pets get jealous about the extra attention and they get these weird medical issues that need help. Probably just a coincidence, but it never fails.
Good luck! I know how you feel. During the re-hab process, you feel like you're living there since you're there so much. The staff is so friendly and it's great to get to know everyone.
From your description, it doesn't sound like rejection yet. If the wounds don't heal, then that's a possibility.
It also doesn't sound like the implant dislodged. The implant/mesh is installed pretty tightly through the holes in the bone. There could have been some rubbing or side to side movement in there making it uncomfortable, but the mesh won't be broken.
Others on the Ortho list have seen problems with bone tunnelling, but I think that happens later on in the process.
Hopefully, he didn't bust the meniscus. That's painful.
They can also get various soft tissue injuries if they overdo it...so resting the muscles is good for that.
If it's necessary, treat him like he just had the surgery until he feels better. Rest and ice.
Sorry you have to go through this.
Anon-
I read your post and a HUGE weight lifted off of my shoulders! I certainly appreciate you reminding me that things will happen regardless of the precautions we take:).
I know the recovery process cannot be perfect, but I am trying so hard and things were going so well that as it very defeating to see the backslide. I am crossing my fingers that the vet diagnoses just a minor setback tomorrow instead of a real issue.
In addition to the stress of trying to keep Twizz on light duty, the house is a DISASTER. Our house is very small and we keep Twizz confined in the dining room when no one is home (although I am contemplating confining him to the living room instead because there is carpet in there in case he slips again). Right now, the air mattress is blown up and taking up the whole living room floor, there are blankets strewn about because everyone has been camping out in the living room with the pup, the dining room has been disassembled and moved to various parts of the house (the chairs are in the middle of the kitchen, the table is propped on its side as a barrier between the living and dining room) and the kitchen is just disorganized from Christmas cooking. I never realized how much I valued my nice, clean, organized house until now and there isn’t much I can do about it until Twizz is able to have full house privileges again. He is very good and will just lay down if I sit with him, so I have been super lazy the past few days:). He is so lucky I think he is worth all of this, lol!
Thanks again for the comforting words!
Also, he REFUSES to let me near him with ice. He panics and tries to run and will flail about if I try to hold him still so I have been unable to ice him. The swelling itself seems pretty minimal and the incision looks pretty decent. I would post a picture, but I am not sure if it would be considered too graphic for this site (although there is really no bruising or swelling, just some staples).
Oh no HH!! I haven't been on here in a while and just saw your posts about Twizz ~ poor guy. I wish I had some info. that would help, but I know you're a great mommy and Twizz is getting the best care possible :) Try not to worry too much ( Trust me I am the same when it comes to my babies, so I know how hard it is) I'm sure he is healing fine probably just got a bit sore from the fall. Sorry to hear about Primo as well.
I agree with you I don't remember any of the dogs from my childhood ever having health issues.
Good luck at the vet tomorrow and let us know what happens. Oh, and who knows I may even see you there since Sage had a bit of a mishap. We hit her in the eye lastnight quite hard while playing around with her and Samson. She wouldn't open her eye the rest of the night. Today it is open, but she is still squinting quite a bit. I know it happens, I just wish they could talk to let us know exactly where the pain is, how bad it is and if they think they need to see the vet Ha!Ha! That would save me a lot of vet bills!
Thank you Calico:)
JRT-
Since I now live at the vet's office, I would not be surprised if I ended up seeing you there. Twizz would go ballistic because he loves Sage and has not seen her in forever. Poor girl! Its all fun and games until someone gets hit in the eye. Hopefully she will wake up all good in the morning.
I am keeping a progress log with pictures, so in the future I can share it with other people looking into this type of surgery.
Awww, I hope Sage feels better soon too. What these pups put us all through. But they're certainly worth it <3
It turns out that the only thing wrong with Twizz is that Mommy is paranoid:). It looks like he was just a bit sore from falling the other day while sedated, but he seems much better now. He is putting weight on it again and is in good spirits. He LOVES the air mattress and is going to be very disappointed when we take it down.
Great news Happy Homemaker :) Maybe mommy can find space for a smaller air mattress lol!
Thanks Lori. Sage seems to be back to normal thank goodness. I was worried, but she seems to have her eye wide open today. She is probably glad since I checked her eye about 100x since it happened.
Just saw this thread. Hope your pooch is on the mend! Surgeries are so rough on both the owner and the animal. I'm always pleased to see such dedicated animal lovers on here. I have friends that often ask why I invest so much in my dog and its quite hard at times when situations just like this arise and you need someone compassionate to talk to. This is definitely a great place for positive vibes and info!
Antimony I'm really glad to hear about Twizz. I am just as paranoid about every bump and scratch.
We used a cold gel pack wrapped in a towel for swelling. If it hurts bad enough, they shouldn't mind it. So Twizz must not have too much pain which is a good thing. The vet also said a cold washcloth would work, too.
We still haven't taken down our air mattress after several years with pets. Every time I take it away, one of the animals gets sick again, and I'm stuck sleeping with them. I've come to the conclusion that I'll never have a nice clean house if I have pets.
Keep us posted how things are going!
What a cute pic of Twizz! I can't believe he's OK with the e-collar. That really amazes me.
Also, yes please keep carpets around as much as possible. We covered the kitchen in small rugs for months, and we have carpeting throughout the rest of the house.
Good luck!
Glad to hear that everyone is on the mend! Here's to a safe & happy new year for our 4 leggers <3
I'm curious this far out how Twizz is doing? I have a Rotti, Cricket, who in 2009 had Tightrope on both knees (1 month apart almost to the day - even on strict rest!) and all these years later is still doing absolutely fantastic! She's a gazelle! At 8.5 years now, she acts like a puppy she's so darn springy! I'm so happy that we chose this less invasive, less painful option for her repairs.
I also happen to be a Certified Veterinary Technician who specializes in anesthesia and teaches veterinary students from around the globe. Being on the "inside" I can say that I would absolutely recommend this surgery over TPLO to anyone who asks. There's risk with everything, and not everyone will have my results, but I truly could not be happier.
At nearly a year out, I hope Twizz is doing great and continues to thrive! :)
E.D.Ludwig E.D. Ludwig-
Twizz is doing fantastic! Aside from the scar on his leg (which on any other dog would most likely not be visible, but he has very little hair to cover it), you would NEVER know he had any kind of previous problems with his knee. Hopefully it works out long term for Twizz as well as it is for Cricket!
What sold me was the idea that if the tightrope procedure were to fail for any reason, TPLO was still an option. However, if you go the TPLO route, I don't think there is much more you can do if that were to fail. Plus, it was less expensive and as much as I love my pup, the mortgage needed to get paid:).
Post some pictures of your pup! I love Rotties!
Glad to hear about Cricket!
HH - Any signs with Twizz of issues with the other side yet?
I'm not familiar with the tightrope procedure, I wonder why I haven't heard of that before! When my dog torn his ACL, I researched tons of other treatments and settled on a Woundwear brace. I would recommend it to anyone looking to avoid surgery or to use the brace as post-op rehab. Especially since the likelihood of dogs tearing the opposite ACL ligament is so high. Hope Twizz stays healthy!
Ryan M Twizz had the initial surgery on his knee December 22nd, 2012. Almost a year to the day, I started noticing stiffness in his other knee and he started occasionally favoring it. I stopped taking walks for a few weeks (which he didn't care about because it was cold out anyways) and gave anit-inflammatory meds hoping it was just a muscle tweak, but after observation and based on the symptoms from his first knee problem, it looks like his other knee has a tear. He doesn't seem to be in pain but we will be making a vet visit soon for an official diagnosis. I worry about how much stress the repaired knee can take and although I knew the likelihood of the second knee having problems, I was really hoping it would happen.
I read up on conservative management for dog ACL problems which are long protocols (6-8 months) but the success rates are undocumented and there is not much veterinarian feedback. It can also be very expensive with the various therapies. My biggest worry though is that if it didn't work, it would be a very long period with stress to the repaired knee.
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