Surgery Clients

The first 8 weeks

The first 8 weeks until follow-up recheck and radiographs have a few mandatory rules to ensure a comfortable recovery and avoid more surgery:

• Never go outdoors without a leash. No exercise off-leash at all.
• No running or swimming for 8 weeks
• No chasing animals or play fighting with other dogs. Time outside needs to be on his or her own to avoid play instigation from other dogs.
• Avoid bolting. Have a person go outside before you let your dog out to clear your yard of squirrels, deer, or whatever your dog likes to chase, then bring out your dog quietly.

In addition to the 8 weeks rules

First 14 days:

• No licking of the incision. Wear the cone.
• No stair climbing up or down. If stairs are unavoidable, the dog will need to be carried for now.
• Walking about the home on one floor is fine as he or she feels confident to do and the footing is not slippery. Cage confinement is not necessary in most cases while you are home but is encouraged when no one is home to supervise.
• Stay indoors all the time except outside for potty breaks, on-leash, and without other dogs, as needed.
• No jumping onto the bed or couch.
• Home care can include ice packs over the incision area for 5-10 minutes 3-4 times a day for the first 5 days if the dog enjoys it. If not, do not push it. Healing will still happen, but ice makes the first few days a little more comfortable and reduces swelling.
• Heat pads or hot water bottles should be avoided. Even modest heat sources can cause thermal burns especially with no hair to protect the tender skin.
• Give medications as prescribed.

Second 14 days:

• The cone should no longer be needed.
• The skin incision should be healed; after 14 days it is time for a revisit to the veterinarian for a progress assessment and remove skin sutures if present.
• No stair climbing. Going down a few non-slippery stairs may be OK if weight bearing is strong at a walk but avoid it if you can.
• Go outdoors on a leash. Weight bearing at a slow walk is helpful to maintain muscle tone and keep the joints moving so we need to start to walk more now. Over this 2-week period slow walks should gradually increase from minimal to 20 minutes or so. Increase distance according to your dog’s comfort. If he or she is lamer after walks, take it easier for another week before increasing again.
• No jumping onto the bed or couch.
• Medications as prescribed

Third 14 days:

• Do not overdo it at this point; healing is happening but not complete. Some patients will appear to be 90-100% at a walk but do not be complacent. Trouble can still happen if you are not careful.
• Slow stair climbing can begin if needed with short flights of stairs of 2-3 steps but it is still best to avoid stairs if you can. Be there to give a boost along the way. Avoid longer stairways with no landing
• Leash walks should increase from 20 minutes to about 45 minutes. If your dog seems to be lagging at the end or more lame after longer walks, rest a few days and resume at the previous comfortable distance. Increase distance later.

Fourth 14 days

• Unlimited leash walks if comfortable.
• Still no running or wrestling or chasing animals.
• Make an appointment for final recheck and radiographs, likely under sedation, at 8 weeks post-operatively.

After final recheck and radiographic healing is confirmed

• Start to run and play. Go easy at first- too much too soon will hurt until strength is back and inevitable lost muscle mass is returning.
• You will still see some lameness after vigorous exercise for a few months but it should be transient and less evident as time goes by.
• Keep your anti-inflammatory on hand and continue to use it when you see lameness as needed for the first few months
• Physiotherapy or other rehabilitation techniques can now be employed if desired but are not mandatory. Ask your veterinarian for advice on options available in your area

Prognosis

The great majority of dogs will return to acceptable function. These joints will never be “normal” as they were before ACL disease, however, because osteoarthritis is naturally initiated by the body early in the course, in many cases before there was even detectable lameness. Those changes are permanent and will progress.

Surgery is thought to minimize osteoarthritis progression compared to non-surgical approaches to ACL disease, meaning surgery vs. conservative or non-surgical treatment greatly improves the long-term prognosis.

Performance or working dogs should be trained progressively to reach performance levels no sooner than 6 months following repair. 100% peak performance may be achieved but should not be expected.

Possible Complications

Like any surgery, things don’t always go perfectly, but problems are relatively infrequent. Serious problems requiring remedial surgery are highly unlikely but could occur, such as:

• Injury to the meniscus after surgery that was normal at surgery. This is uncommon but not rare. The patient is likely progressing well in the weeks after surgery, bearing weight well, then becomes much lamer suddenly. After a few days of rest lameness persists. This may necessitate surgery to examine the meniscus and remove any damage, via either conventional knee surgery, or by referral to a boarded surgeon for arthroscopic surgery.
• Infection involving implants or bone. Titanium implant infection can necessitate their surgical removal. This is a rare complication. Infection in the bones around the implants could occur but very rarely.
• Infection inside the joint. This would be a rare complication.
• Fracture. It is possible to have a fracture of the tibial shaft or the tibial tuberosity near the site of the surgery since surgery weakens them until the TTA site has healed. Adherence to the home care plan makes this a rare occurrence.
• Breakdown of implants such as bending or breaking the titanium plate or retaining forks or screws can occur but rarely. It is more likely if too much activity happens too soon in the case of owners not being careful during the 8 weeks after surgery.
• Delayed healing of the bones. This could occur in dogs with co-existing diseases or taking medications such as corticosteroids that might impede healing.

Other possible complications that may require additional medical care or attention:

• Infection can result in delay in healing of the skin and soft tissues if the dog is allowed to lick the incision after surgery. This could necessitate return to the clinic to be repaired.
• Failure of skin sutures allowing the skin incision to open up
• Medication Side effects. Loss of appetite, vomiting, or diarrhea can occur with any medication however in most cases there are none. Please contact your regular veterinarian to discuss if side effects are of concern.
• Seroma, or pockets of fluid around the surgical site. Seroma will generally resolve without treatment
• Bruising or hematoma in the surgical area. This is not uncommon and will resolve without treatment.

The first 8 weeks

The first 8 weeks have one few mandatory rule to ensure a comfortable recovery and avoid more surgery:

• Your cat must stay in the house at all times.

In addition to the 8 weeks rules

First 14 days:

• Anything high your cat is used to climbing needs to be removed for now
• No licking of the incision. Wear the cone.
• Walking about the home is fine as he or she feels confident to do. Cage confinement is not necessary in most cases while you are home but is encouraged when no one is home to supervise.
• Avoid jumping onto the bed or couch.
• Home care can include ice packs over the incision area for 5-10 minutes 3-4 times a day for the first 5 days if your cat enjoys it. If not, don’t push it. Healing will still happen but ice makes the first few days more comfortable and reduces swelling.
• Heat pads or hot water bottles should be avoided. Even modest heat sources can cause thermal burns especially with no hair to protect the tender skin.
• Give medications as prescribed. Do not give any other medications. Acetaminophen (Tylenol) is poison for cats and a single dose may be fatal.

Second 14 days:

• The cone should no longer be needed.
• The skin incision should be healed; after 14 days it is time for a revisit to the veterinarian for a progress assessment and remove sutures if present
• Lift him or her to get onto the bed or couch.
• Medications as prescribed

Third 14 days:

• Stay indoors
• It is OK to jump onto the couch. For beds leave a stool or chair of medium height beside the bed to help.

Fourth 14 days

• Still stay indoors

After 8 weeks if all is well

• Supervised outdoor exercise is permitted if your cat is accustomed to being outside. Start with short periods; your cat’s stamina and “street-wisdom” are not yet back to 100% and will take time to return to normal.
• Keep your anti-inflammatory on hand and continue to use it when you see lameness as needed for the first few more weeks

Prognosis

The great majority of cats will return to acceptable function. These joints will never be “normal” as they were before ACL disease, however, because osteoarthritis is naturally initiated by the body early in the course, in many cases before there was even detectable lameness, and those changes are permanent.

Surgery is thought to minimize further osteoarthritis development compared to non-surgical approaches to ACL disease, meaning surgery vs. conservative or non-surgical treatment improves the prognosis.

Possible Complications

Like any surgery, things don’t always go perfectly. Serious problems are very unlikely but could occur, such as:

• Infection can result in delay in healing of the skin and soft tissues if the cat is allowed to lick the incision after surgery. This could necessitate return to the clinic to be repaired.
• Failure of the skin sutures allowing the skin incision to open up.
• Medication Side effects. Loss of appetite, vomiting, or diarrhea can occur with any medication however in most cases there are none. Please contact your regular veterinarian to discuss if this is of concern.
• Seroma, or pockets of fluid around the surgical site. Seroma will generally resolve without treatment
• Bruising or hematoma in the surgical area. This is not uncommon and will resolve without treatment.