Ares TPLO Surgery and Recovery

This is going to be more of a diary tracking Ares TPLO surgery and recovery, than a number of blog articles.  I'll be adding updates on a regular basis, but I will be updating this article each time, versus making new posts. 

First a little history.  Ares (Dantero's Ares – FRIII, PSA2, NADF1, CSAU) is a 9.5 year old male Belgian Malinois who has trained and competed most of his life in protection sports.  When he was approximately 1.5 years old he fell backwards off the palisade (an 8 foot high scaling wall) and landed badly on his back right leg, injuring the hock joint.  He's had on and off issues with that joint ever since.  Generally it's fine, but on occasion it pops out a little and he will favor the leg, sit slow, etc.  A quick trip to the chiropractor and he's good as new again.  For the last year or so he's been actively competing in PSA3, training in nose work, and helping me with my livestock on occasion.  Between PSA and nose work he's trained an average of 4 days a week.  Otherwise his main activity is running up and down the hills on my property, swimming, and hiking.  Over time he has lost some muscle tone in that back right leg, and had begun to favor it more.  Approximately a year ago we started giving him Adequan injections and they were a game changer.  Initally he was moving normally but toe touching when standing on a semi-regular basis, and having an obvious limp to being on 3 legs on a bad day.  After we got through the loading doses he was normal the majority of the time and only showing minor signs of soreness if he really overdid it.  That soreness would go away with a few days of down time.
Ares has been on Adequan for approximately a year now, every 2-3 weeks.  He eats a combination of kibble and raw, I would estimate his diet is 70% kibble and 30% raw.

March 28, 2021 – Ares finished up 3 days of PSA3 competition.  The first day, Friday, was a mock trial, but he did a full PSA3 routine.  Saturday and Sunday were real trials, and he did full routines both days.  On Sunday he walked off the trial field after protection looking good.  Some very minor favoring of the back right leg, but he was weight bearing.  We spent about 20 minutes hanging out while I talked to people and he got pets and scratches before I put him in his crate.  Approximately an hour later I took him out of the crate for a quick potty break, and he was 3 legged.  Did not want to put any weight on the back right leg.  He did start using it a little bit during our walk, but was favoring it strongly.  When I went over him, I noticed the knee was warm, although it didn’t feel swollen.

Ares PSA3 routine, at some point during the protection is when he tore his cruciate, I'm thinking in the building on the cement (slick) floors.

I made an appointment for Ares with his chiropractor and put him on “house arrest” until he could be seen.  He wasn’t on full crate rest, but was only allowed to go outside supervised to potty, was not allowed to be out with the other dogs running and playing fetch, etc.  As Ares is a house dog, he’s generally pretty calm in the house.  The first few days after the trial he didn’t want to get up from the dog bed, except for a quick bathroom break.  After a few days he was moving around more but limping badly on the back leg.  The chiropractor was able to see him in early April, diagnosed him as having “drawer movement” in the knee, and recommended a specialist.  Their earliest opening was mid-June so I booked it, then talked to my regular vet to see if he had any other recommendations.  He recommended another specialist who comes into his office on a regular basis to do surgeries for him, so we set up an appointment.

Video taken 1 month post injury

April 27, 2021 – Ares spent the day with the specialist, Dr. Ganz, getting sedated, x-rayed, poked and prodded.  Final diagnosis is a total cruciate tear and a recommendation for a TPLO.  Until then just continue to keep him quiet and give him pain meds as needed.  There is some remodeling on the right knee.  While the Adequan has done a great job with the hock issues, he has had some on and off lameness still.  It looks like there may have been some micro-tears of the cruciate happening on and off the last year or so, and that is what caused the occasional lameness. I thought we’d just gone to long between injections.   After thinking about it for a few days, I went ahead and schedule the TPLO surgery.

For more information on exactly what the CCL does, what happens when it is torn, and possible techniques to fix it, check out this video Cranial Cruciate Ligament Rupture – 3D Animation for Veterinary Undergraduates 

Right Knee

Left Knee

Video taken 6 weeks post injury

May 20, 2021 – Ares had his TPLO surgery.  The surgeon said that he did have threads of the cruciate ligaments left, but they were very thin and stretched out, basically not doing anything to help stabilize the knee.  The meniscus was in good shape, and did not need to be fixed.  Overall surgery went well and now it's crate rest, on leash bathroom breaks, and we start rehab in a few weeks.  I set up a 4×4 ex-pen for him, with a lid on top since the first day in there I walked outside and when I came back in a few minutes later he greeted me at the door SMH.  It's got a dog bed in there, which takes up almost all the floor space, and some room for food and water bowls.  

Ares was sent home the day after surgery with pain meds (Tramadol and Rimadyl) and sedatives (Acepromazine).  He is allowed 4 SLOW walks a day, for up to 10 minutes.  The sedatives haven't knocked him out completely, but he is mainly just chilling in his pen once he realized the top is securely on there.  I used the Ace for a couple days post surgery, then started using only the pain meds.

Video of Ares walking the day after surgery  The chickens are giving him moral support πŸ™‚

After surgery there was minimal bruising, I was actually surprised at how little there was considering how invasive the surgery is.  

2 days post surgery

Over the course of the next few days, Ares did develope a fair amount of edema, which all went down the leg and settled in his hock.

3 days post surgery

For the most part though the edema had resolved by day 5 post surgery.  The minimal bruising is almost completely gone, and he just has some razor burn left that is bugging him.  He's doing well with his daily walks, and handling the crate/x-pen time well so far.  I am letting him out whenever possible and just having him lay on a dog bed next to me while I telecommute.  I also incorporate at least 2 of his walks with my chores with the livestock.  He doesn't get to do anything with them, but he can wander around in the chicken pen with me while I collect eggs, stand near the gate when I let the goats out to browse, follow them SLOWLY as they meander up to their browse area, etc. so he gets some mental stimulation each day.

5 days post surgery

Ares walking 1 week post surgery

May 28, 2021  Ares had his first post-op checkup.  The vet was super happy with where he's at, how well he's using the leg, the incision site, etc.  Unfortunately sometime during the trip to or from the vet's office we had a setback.  Ares was riding loose in the middle of my van, as my crates are in the back and up on a platform, necessitating me lifting him in and out which could easily go bad as he tries to "help".  I suspect while he was turning in circles to make himself a “bed” in the blankets, he may have twisted the leg a little.  By the time we got home, he was showing more of a limp when walking, and was back to doing more toe-touching instead of weight bearing when standing.  The next day he had a small pocket of edema right at the top of the incision site, over the knee.  It looked like it was swollen, but when I pressed on it was obviously fluid.  This cleared up within a minute or two during his first walk.  The next time I let him out of the crate for another walk, he had another slightly larger pocket of edema, which also cleared up once he started walking.  It took 2-3 days, but then he was back to where he was pre-setback in terms of weight bearing when standing, and walking with only a minimal limp.

June 3, 2021 – 2 weeks post surgery.  Ares is walking well, weight bearing when standing still, and using the leg during the sudden unauthorized trots.  No, he is not supposed to be trotting at all yet, but there have been a few moments of "yahoo" where he trots a couple steps before the leash stops him.  I will also admit he has randomly jumped up on me a couple of times.  But so far he hasn't managed to do any obvious damage. He is still taking Rimadyl and Tramadol every day.  I have him out of the ex-pen when I'm working on the computer, he just chills on a dog bed and chews on a toy.  Any attempts to do more and he goes back into the pen, but this is actually his "normal" so he knows if I'm working it's "down time".  2 week video

June 10, 2021 – 3 weeks post surgery, Ares is still moving well.  He is no longer taking the Tramadol, and I plan to take him off the Rimadyl in a few days.  I'm hoping the lack of pain meds will make him think a little more about the leg.  He's doing well with the restrictions, but starting to want to "go" a little more.  Still letting him hang out with me during the day while I work, if I have to step outside, go into another room, etc. he goes back into the ex-pen or a crate.

June 17, 2021 – Not much has changed.  Walking up and down slopes now, doing more flexing exercises with him, and reminding him that he's supposed to WALK.  He's off all pain meds, and he definitely wants to do something.  Have been doing some little searching/nosework games with him to help exercise his brain.  Am giving him a little more freedom in the house, ie if he gets up to walk around the room I don't freak out and immediately tell him to lay down πŸ™‚  I should probably add I have no immediate neighbors, close foot or vehicle traffice past my place, etc. so chances of him jumping up to bark at something are very slim, as there really is nothing to bark at.

June 24, 2021 – 5 weeks post surgery we are walking up and down hills, I'm letting him trot slowly if he wants to, and starting to do some sit/stand/down exercises on an incline.  He tends to want to throw the leg out a little so the knee doesn't have to bend quite as much so I have been having him stand next to a wall.  The door of a crate, with me on one side of the door and him on the other, while I encourage him to tuck more into heel position, has worked quite well.  The more he tries to "tuck" into heel against the door, the more he has to get that leg tucked up under him.  I'm also having him walk in circles, and he's walking over some PVC pipes on the ground.  Not to mention just natural terrain changes.  He's still in an ex-pen any time he's unsupervised such as when the other dogs are outside play fetch, if I'm not home, when I'm sleeping, etc.  Otherwise he has access to whatever room I'm in.  If he tries to do something to excessive I will stop him, but otherwise I let him wander around, play with a toy, etc. pretty much at will. 5 week videos

July 1, 2021 – 6 weeks post surgery, still making good progress.  Ares is still wanting to sit and "flare" out his knee to avoid bending it completely, so we've been working on more stretching and tuck exercises.  I've been allowing him to do some slow trotting, and we are working the hills more to help stretch things and build up more muscle.  Haven't really noticed any improvement in the last week, but we haven't back slid so … 6 week videos

July 9, 2021 – we are now 7 weeks, and a day :-), post surgery.  Don't see much of a difference between 6 weeks and 7 weeks, other than he's allowed to do a little more now.  Still moving pretty good, there is a little hitch in his step but not an actual limp, he puts full weight on the leg, stands on it to pee, etc.  He does try to avoid sitting unless I've got a cookie or toy, then the drive kicks in and he sits right down.  Still wants to flare that leg out, we've been working on him sitting tucked in.  I suspect he just needs more stretches and working out of that leg, which we will hopefully get the green light after next weeks x-rays.  Right now I do see a difference between how he sits and lays down at the beginning of a session and at the end, so the stretching is helping, just need to get him to where that flexibility is the norm, not only after recent stretches.  7 weeks videos

July 16, 2021 – Ares had his 8 week x-rays, which will be posted below.  His general vet is very happy with the healing that has happened so far, and is sending the x-rays off to the surgeon to get his opinion and recommendations for exercise levels, PT, etc. going forward.  He is moving well on the leg, but does show some stiffness still.  You can see it when he is walking/trotting, and also when he sits.  He still wants to flare the surgery leg out instead of tucking it under him, although that has improved and he doesn't flare it quite as much.  He also tends to tuck it easier when against a barrier, and is quicker to get into a sit position.

July 29, 2021 – I've been allowing Ares to spend most of his time outside off leash.  Still controlling how fast he goes, no explosive movements such as fetch, he's on leash initially if the other dogs are outside also so they can get their "yahoos" out without him joining in, etc.  But when we go for short hikes or are just hanging out, once the initial craziness is done, he gets to join them without the leash.  He is slowly building up muscle and stamina.  On the 24th I took him to a friends house and let him swim laps in their pool.  Pulled him out after about 8 laps, he still wanted to do more but I didn't want him to over do it.  It seemed to be about the right amount, and he was not showing any signs of soreness afterwards.  

August 3, 2021 – for the last week or so I've noticed an odd "twist" in Ares leg on occasion when he's walking.  It seems to come and go.  After doing some research on the TPLO FB group, it's called "pivot shift".  

  • The pivot shift is an abrupt cranial shift of the lateral tibial condyle relative to the femoral condyle (internal stifle rotation). When you observe the gait of a dog with a pivot shift from behind, the stifle appears to suddenly buckle laterally.
  • The reevaluation revealed a jerking lateral movement of the left stifle joint during walking and a "pivot-shift phenomenon" was revealed on orthopaedic exam.(Just to note, the veterinary world is using the term ‘pivot shift’ entirely contrary to its original definition in human sports medicine.  This phenomenon is poorly described in the veterinary literature.)
  • The pivot-shift phenomenon is being described (in dogs) as "a cranial subluxation of the tibia associated with internal tibial rotation, resulting in a sudden lateral change in direction of the stifle joint during weight bearing."

A video showing pivot shift, the dog had surgery on it's back right leg, and with each step you can see the knee twist outwards.  In this video it gets progressively worse as the walk continues, Ares on his worst day so far has been similar to the very beginning of the video, possibly not even that bad.  

Many of the online discussions indicate that this can be caused by lack of muscle in the surgery leg, and will resolve itself as the dog gains back the lost muscle.  In some cases though the dogs required further surgery(s) to correct it.  As it seems to come and go with Ares, the lack of muscle tone and stamina theory would hold up.  I tried to get a video of it when I first took him outside, ie no prior exercise, and he wasn't exhibiting any signs of it.  It is currently my theory that as he exercises and begins to get tired, he begins to exhibit signs of pivot shift.

Nov 2021 – It's been awhile since I updated this, since Ares was given the "all clear" by the vet I slowly worked him back to free running on the property with the other dogs.  Meaning he can run the hills, play fetch, etc. while finishing building back the muscles he had lost.  His muscling on his back legs is visually even now, however, I've started having a very hard time keeping him sound on the front end.  Discussing this with people in the TPLO FB group this is not an uncommon issue.  I believe that in part due to the pivot shift, which is still minor but hasn't gone away completely, he is bearing more weight on his front end than he should be.  Initially it was the front left leg, where he turned on a rock that rolled under his foot, and re-injured an old ligament/tendon injury.  A couple weeks of crate rest and that was OK again, at which point I thought we were "home free".  Instead, shortly after being released from crate rest he began limping on and off on his front right.  Sometimes a minor limp, but other times a very heavy limp.  The chiropractor indicated both his shoulders were "jacked up", he also had heat and swelling in the wrist/elbow on the front right.  4 more weeks of crate rest and on leash bathroom breaks, multiple chiropractic visits, and he is slowly being allowed to spend more time walking/trotting.  He has lost what muscle, on both legs, we were able to regain after the initial "all clear" so now we'll work on rebuilding that. He still has the pivot shift, but hasn't gotten to the point in muscle building that I can say it won't go away once he's back to a pre-surgery level of muscles.

Jan 13, 2022 In Dec I was finally able to get Ares sound on all 4 legs, and slowly worked him back to "life as usual".  That lasted for about 2 weeks, and while playing fetch one day he got the ball then just stood there.  When I called him to come back, he was hobbling like he didn't know which legs to put the weight on because everything hurt.  He is now strongly favoring his "good leg", ie the non-surgical leg, and I suspect he's got a partial tear.  At the time of surgery the vet said this leg was 100%, he found no indications of any tears, stretching, etc. so I can only assume the weakness in that leg has been caused by the TPLO surgery on the other leg, the change of angles, and over compensating.  So we are back to crate rest to see what happens next.

Jan 18, 2022 after a few days of solid crate rest Ares was moving well again.  I am not letting him play fetch, but he is aloud to go out and "motor around" while I'm doing outside projects, feeding the livestock, etc.  

Jan 20, 2022  While Ares was walking through my cabin I realized I can hear a rythmic clicking or popping noise.  Kind of a deeper pitch.  I couldn't see what step was causing it, but it does seem to be linked to a step as it stopped when he did, the speed of the click followed the speed of his walking, etc.  Per the FB group this generally indicates a meniscus tear, although there can be a few other causes.  It doesn't seem to be causing him pain so for now I'll just keep an eye on it.

Mar 25, 2022 Haven't noticed the clicking noise recently, so …  Ares seems to be doing better with staying sound, but I do put him up any time I'm going to play fetch with the other dogs and just let him be outside with the other dogs when everyone is just hanging out.  He still comes up lame once in awhile when he decides to do something "stupid" (chase another dog, take off after a rabbit, etc.) but it seems to be more something that he can walk off vs something that requires extended crate rest.  I don't think he'll ever be sound enough again to return to protection sports or anything that requires any sort of serious jumping, but we will start doing some nose work again, and hopefully barn hunt once I get an area set up.  I do think we've gotten most of the muscle built back up, he looks equal on both back legs.

May 30, 2022 Took Ares to the PSA club and let him have a little bit of fun.  Kept most of the bites fairly basic, ie level surfaces, not jumping, etc. but we did do one bite in the bottle pit.  Also some basic obedience.  He enjoyed himself and didn't seem to be sore that night or the next day, so hopefully he can continue to go out and have some fun once in awhile in a controlled setting.

Nov, 2022 Ares has been on and off lame on the non-surgery leg, more on than off πŸ™ Doing more limited activity, letting him run around outside after all the other dogs have finished playing fetch and are ready to just hang out to prevent Ares doing to much racing around with them.

Feb, 2023 Ares has been diagnosed with a meniscus tear in the non-surgical leg. No drawer movement, he feels the ligaments are still solid. The vet does not feel it is surgical, he thinks there is a flap in there that is sometimes out of position (hurts) and sometimes where it belongs (less painful) and feels it’s better handled with pain management. Ares is on daily Rimadyl which helps, but does need to be monitored more closely. IE no fetch with the other dogs where he might get ran into, rugs placed in strategic locations so he doesn’t slip and fall racing around a corner in the house, etc.

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