# CCL / ACL Tears



## Brave (Oct 26, 2012)

Bear is almost 9 months old and has been diagnosed with an CCL / ACL tear in his left knee. The orthopedic vet suggests TTA surgery, but I want to research this before I jump head first into surgery. 

Has your dog torn their ACL? What did you do? Do you have any advice for what to consider? Any pros or cons for specific treatments? 

I've been told the TTA is the least invasive, with a quicker recovery time than the TPLO. The vet warned against repairing/replacing the ligament because she says over the long-term, most have failed and the dog is back to where they started. 

How long can we wait before having the surgery without risking additional damage to his joint?? The vet said one month and he is to be on STRICT restriction until the surgery and for the 4 months after post-op. 

Where did you do rehab? How did you do rehab? I got a phamplet that said to swim and do incline walks or walking in the sand. What should I expect before, during and after the surgery? Did you get second opinions? We also need to do PT at home... the vet gave me a CD-ROM that walks me through the PT moves. 

Has anyone opted AGAINST the surgery? Used a brace instead? I was reading this site, which warns AGAINST ANY SURGERY, but I could not find credentials so idk if I should actually read all of it. 

Please chime in with what you know... and if you think of any questions I should ask my vet or any second opinion vets... feel free to share them.


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## Nairb (Feb 25, 2012)

Wow. I had not seen this on the other thread. Sorry to hear about the diagnosis. At least you know what it is now.


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## dborgers (Dec 7, 2011)

We've experienced two ACL _tears _(as opposed to a 'rupture' where it's completely torn):

Katie, our little bichon, had the surgery, and the ortho used titanium wire instead of fishing line type. 6-8 weeks of following the post op instructions to the letter and she's been good as new for nearly 4 years.

Andy got an ACL tear while he was doing chemo, so surgery was out of the question. Scar tissue built up and he got around OK after 12 weeks, which would have been 6-8 had he not been an 11-12 year old senior and on chemo. He had to be on a tight restriction, then we followed the protocol Katie had post-ACL surgery. Also helped him get around and do his business with a bath towel under his belly like a sling, and the same for the rest of his life when climbing stairs. We'd always done lots of swimming, so when it got warm enough we did plenty of it at the lake. That's excellent for rehab. 

For a dog Bear's age I'd definitely do the surgery. Until you do I might suggest icing it down with a big cold pack a few times a day. 

Katie's surgeon was Dr. Paul Newman, a veterinary orthopedic surgeon. He's excellent and has done literally thousands of ACL repairs since 1980. We opted for the Fiberwire over nylon, which, as he explains on the linked page, can stretch or break. Nylon leaves the possibility of more arthritis over time where the FiberWire is strong enough to pull a Mercedes.

Below is a link from his website on ACL injuries and surgery. Very informative. There are a lot of PDF's at the bottom of the page that explain the various options, rehab schedules, choosing a surgeon, etc. He's first rate, so I'd take anything he says as gold. Like I said, Katie has been 100% since her surgery about 3 years ago. He and his nurse did the surgery in their mobile operating room in the parking lot of Katie's regular vet.

*Here's the link to the info on ACL tears at his website. Remember the PDF's at the bottom of the page:*

*Mobile Veterinary Surgical Services
*
I know how upsetting this is. Fear not. Bear will be OK. That should provide all the research you need for info. From there, find the best surgeon for you in your area. I think Katie's surgery was about $1400. Most vets and specialists offer *CareCredit payment plans* if helpful.

I'd suggest using a beach towel like a sling - folded in half under his belly - to help him to his business. And keep his movements restricted inside. You don't want him injuring it further before you can get it fixed.

In light of this, and despite his youthful age, I might suggest starting him on Glucosomine-Chondroitin (you can buy a big bottle at the supermarket) after he has the surgery - 1000-2000 mg a day, depending on his weight. Andy was 78-85 pounds all the years he lived with us and took 2000 mg after the ACL tear. Once it healed he got around just like before, although with a big lump of scar tissue. had he not been on chemo I'd have opted for the surgery, but that wasn't an option for him. I have to think the swimming and GC helped. The pills don't taste like anything. Just put them in his food. If he had one ACL tear, the other could be vulnerable in time. GC helps rebuild cartridge, keeps it strong, and lubricates joints too. 

Sorry about the novel, but I wanted to share as much info as possible. Check out Dr. Newman's site at the links above.


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## Karen519 (Aug 21, 2006)

*Brave*

Brave

My Smooch was 10 years old when she had the TPLO and everything went beautifully and recovery wasn't bad at all. I remember we had to keep her contained, like in a crate or small room, so she couldn't run and jump and keep her off the furniture, bed, stairs for say 6 wks. The Doctor felt at her age and weight the TPLO would be the more secure surgery.

Unless the Doctor said she thinks it could repair itself, I would definitely get it done as soon as possible. As far as TPLO goes, I know only certain vets are certified to perform it. 

Check to see if your vet has CARE CREDIT or some credit, where you can take out the loan for one year or 18 months, with no interest. That's what we had to do with our Smooch.


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## Tayla's Mom (Apr 20, 2012)

I have to give another shout out for Care Credit. We put Tayla's rock surgery on it and part of Jesse's end of life hospital stay. You should get at least a year to pay it off if the amount is over a $1,000. You can sign up on line and I just told them how much I needed and I was approved then. It was a God send.


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## Brave (Oct 26, 2012)

I know about care credit. My problem is if we are unable to pay it all off by the end of the promo period we get hit with 27% interest on everything from the beginning. I need to call them and see how long of a promo period we would get. 


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## mylissyk (Feb 25, 2007)

A torn ligament can't repair itself. A partial tear might with very extended strict inactivity, but usually the dogs, being dogs tear the ligament completely. Bear is too young to leave him handicapped the rest of his life. Robbie had TPLO at 2 years old, he has never had a problem with the knee since.


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## Brave (Oct 26, 2012)

mylissyk said:


> A torn ligament can't repair itself. A partial tear might with very extended strict inactivity, but usually the dogs, being dogs tear the ligament completely. Bear is too young to leave him handicapped the rest of his life. Robbie had TPLO at 2 years old, he has never had a problem with the knee since.


Thanks. This is why I ask. I've never dealt with this before and I want to do what is best for Bear. I think we tried rest for a few weeks but didn't see a difference so the vet advocated exercise.... I wonder if that was a mistake and we made it worse. I need to ask the vet if we should brace it until we can get they surgery done as a precaution.


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## love never dies (Jul 31, 2012)

Hugs to Bear --------Big Hugs.


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## cgriffin (Nov 30, 2011)

My Toby had TPLO surgery on his right knee at age 8. He recovered nicely from it and never had a problem with that knee again. 
I had to keep him on a leash for 8 weeks, no running, no jumping. It is hard but doable. When I was not home, he was confined in a small room without anything he could jump up on. I used doggy gates to keep him from getting to anything he could jump up on like the couch. 
Surgery is your only option at this point and the longer you wait, the more damage to the knee will occur and the chances of getting arthritis in the knee are going up. Besides, the muscle mass will keep getting diminished, making recuperation from surgery longer. 
I know nothing about the TTA method, so no info on that. You should get the surgery done by a specialist if you can. Other than Carecredit, I also have no advise if you are in a pinch. 
As to rehab, Topdog health and rehabilitation has a website where you can download a rehab guide, they also have a facebook community where people can interact who have been through orthopedic surgeries with their pets and can exchange info and ask a vet online.
Here is a link to downloading Dr. James St.Clairs Cruciate Guide:
CRUCIATE Guide - by Dr. James St.Clair, DVM


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## Brave (Oct 26, 2012)

Thank you! I really appreciate the info.  I wonder if we can get a blow up pool that is big enough for him swim but low enough that I can lift him into it easily.

I am working on getting the money situated so we can do the surgery. I believe my vet is a board certified orthopedic surgeon. So that at least is covered. I also am working on talking to a second board certified vet to get their opinion. 

The TTA has only been around since 2004 so it's a relatively new procedure. 


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## Brave (Oct 26, 2012)

Has anyone had the TTA done? I hear a lot about the TPLO but our vet said the TTA uses titanium which has no risk of causing cancer, whereas the TPLO uses stainless steel and evidence is coming out that extended implantation causes bone cancer??? I have nothing to back it up, just what the vet said. I will see if she can tell me what evidence there is. 


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## Tayla's Mom (Apr 20, 2012)

Brave said:


> Thank you! I really appreciate the info.  I wonder if we can get a blow up pool that is big enough for him swim but low enough that I can lift him into it easily.
> 
> I am working on getting the money situated so we can do the surgery. I believe my vet is a board certified orthopedic surgeon. So that at least is covered. I also am working on talking to a second board certified vet to get their opinion.
> 
> ...


If you have the space there are a lot of blow up pool options for you. Depending on how much you want to spend here is a link that shows several models at Walmart. 

Swimming Pools : Swimming Pools & Waterslides - Walmart.com


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## OutWest (Oct 6, 2011)

A question for all the experienced folks... Did your vet do an MRI to arrive at the diagnosis? If I recall correctly, Bear hasn't had one done yet. Is it possible that this is something else that won't require surgery? Not trying to stir everything up... but thought it was worth asking.


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## Brave (Oct 26, 2012)

OutWest said:


> A question for all the experienced folks... Did your vet do an MRI to arrive at the diagnosis? If I recall correctly, Bear hasn't had one done yet. Is it possible that this is something else that won't require surgery? Not trying to stir everything up... but thought it was worth asking.


Ironically this has been on my mind as well. I was going to ask if we should have an MRI done and how much it'll cost. I did ask the vet what if you open him up and it isn't torn or ruptured. And they vet said she is 100% certain it's torn because she feels movement (I think this is called a drawer test???) when she palates the joint. 


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## Karen519 (Aug 21, 2006)

*Brave*

Brave

I think our Doctor took xrays of Smooch's tear, plus did the DRAWER TEST and palpated the knee before surgery. 

I never heard anything about TPLO's and bone cancer-Smooch did very well and we had to do something. She wouldn't use her back leg at all and it was hard for her to get around.

What I read quickly on the internet about the TTA is that it is a shorter recovery time, than the TPLO. Smooch's recovery didn't seem to take that long.


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## cgriffin (Nov 30, 2011)

I never heard of TPLO and increased cancer risk either. Actually, sorry, but it does not really make sense to me. 

Brave, does your dog's knee make any popping or clicking sounds? Does he put any weight on the leg at all?


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## Brave (Oct 26, 2012)

cgriffin said:


> I never heard of TPLO and increased cancer risk either. Actually, sorry, but it does not really make sense to me.
> 
> Brave, does your dog's knee make any popping or clicking sounds? Does he put any weight on the leg at all?


I hear popping noises when he climbs up and down things (like getting in bed and up on the couch) but I can't tell if it's coming from his front legs or back legs. Dr. Hampel used x-rays and a drawer test to diagnosis the tear. We also did a joint tap and cytology on the fluids to rule out other possibilities. 

He is bearing weight on both legs, but intermittenly he doesn't put weight on it for a second or two. We're keeping him confined and on strict activity restriction until we're able to do the surgery. It seems like the knee is getting worse because his left knee if significantly more swollen than before and compared to this right night. I am following up with Dr. Hampel to see how much a TPLO would cost --- perhaps that is a better option for us financially.


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## cgriffin (Nov 30, 2011)

If you saw an orthopedic surgeon and he confirmed the tear, I would also not second guess anymore. The main thing now is to get Bear some relief from the pain and getting him back to running like a normal dog again no matter what procedure you are choosing to have done.
Good luck, keep us posted.


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## Brave (Oct 26, 2012)

We have a second opinion appointment on Monday. More so to discuss treatment options than diagnosis. I want to see if we can find a more affordable treatment. 

Danny - that link you listed is amazing!!!! It explained things more clearly and in one spot. 


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## Brave (Oct 26, 2012)

Here is the link to the paper about Osteosarcoma and TPLO

http://www.acvs.org/Symposium/Proceedings2011/data/papers/094.pdf


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## fostermom (Sep 6, 2007)

My Jasmine (black dog in my signature) partially tore her CCL in 2007 or 2008. We didn't really realize it until 2009 when her limping became more pronounced. She was 8 years old at the time and an extremely active dog. After meeting with two different specialists, we decided to try rest first before putting her through another orthopedic surgery (she had 2 FHOs when she was younger). 

It worked for her. She's 12 1/2 now and a bit slower, but not by much. I'm pretty sure that's because of her age and not her knee. She never limps on it anymore. Every once in a great while I'll hear it click, but that doesn't seem to bother her or slow her down at all.

There is a Yahoo! group called Conservative Management. It gave me some good ideas and hope that she would heal up. Luckily she did.


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## Brave (Oct 26, 2012)

I am researching into management, but so far the doctors say because he is so young, it is a matter of time before he tears it again IF we are able to successfully rebuild the stability with scar tissue. 

I wish it was a option.  


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## Brave (Oct 26, 2012)

Here's the Q&A I played with the surgeon....



> Is Dr. Hampel board certified?
> *Yes she is*
> How many TTAs has she performed?
> *We have about 8-10 per month since 2004 ; we’ve done over 550*
> ...


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## Karen519 (Aug 21, 2006)

*Bear*

Praying for Bear and you.
Do you have any family that might be willing to lend you some money that you can pay back.


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## Brave (Oct 26, 2012)

Karen519 said:


> Praying for Bear and you.
> Do you have any family that might be willing to lend you some money that you can pay back.


Nope. Dad is tapped from battling cancer for 5+ years. Mom is unemployed. Brother is already helping by getting me to Oregon to visit my Dad this year. 

I will find a way. I promise. I won't let Bear suffer needlessly. I have reached out to his rescue. I have a list of organizations to call for aid. I am working on selling my junker of a car. I am reaching out to my friends to see if there is any help there (even if its just sharing my story.... Networking does wonders). I will get the money come Hades or high water. 


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## Karen519 (Aug 21, 2006)

*Brave*

I am so sorry for all your family is going through, too!
I know how it is to struggle with money!
If it weren't for care credit, we wouldn't have been able to pay Smooch's bill.


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## cgriffin (Nov 30, 2011)

Keeping my fingers crossed that all turns out well for you and Bear. 
He is still so young and has so much living to do, I am sure that he will recover nicely and be able to run again, like a dog his age should.


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## SheetsSM (Jan 17, 2008)

I know it's unlikely the rescue will assist financially with the surgery, but do they network or work with any other orthopedics that would be willing to charge you the "rescue rate"? While it won't likely get you the Dr of your choice, it may make the cost of the surgery more readily attainable?


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## Brave (Oct 26, 2012)

SheetsSM said:


> I know it's unlikely the rescue will assist financially with the surgery, but do they network or work with any other orthopedics that would be willing to charge you the "rescue rate"? While it won't likely get you the Dr of your choice, it may make the cost of the surgery more readily attainable?


Yep. I have reached out to them last night asking that exact question. I spent most of the night writing essays for individual organizations I am reaching out towards. I hope they get back to me. I made it very very clear that he will get the surgery. That we will NOT put him down over this. That we will NOT relinquish him because we are and forever shall be Bear's forever home. Come what may. 


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## Brave (Oct 26, 2012)

My day just brings more and more confusion and uncertainty. I am calling different vets for quotes and everyone has an opinion over what works best, what operations they themselves perform, etc. Its worse than the food debates!!! 

I got a second quote for a TTA for $4500

The third place I called refuses to do a TTA or a TPLO and only does a tightrope (they are sending me a quote). They told me TTA and TPLO fails too often that the vet refuses to use them. They say they do too many TTA repair surgeries. So I asked them how many did they do? 2 in 2 years, but they don't know why the implant failed. Dr. Hampel was very specific that the only reason she has ever seen a TTA fail is from owner non-compliance by pushing the dog too fast during rehab/recovery

/confused 


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## cgriffin (Nov 30, 2011)

I feel for you, I am so sorry.
It sounds to me like the original surgeon you talked to, is your best choice and you seem to trust her/him. But of course, there is the matter of cost. 
It does not help that you live in a high cost area. I paid $2500 for Toby's TPLO.
I really wish you luck, that you find a way to pay for the surgery, Bear is lucky to have you, that you are fighting for him.


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## Tayla's Mom (Apr 20, 2012)

Maybe it would be cheaper to drive to another state and have it done.  I hate it when it gets confusing. Maybe you are better going with who you trust, even if it is expensive. I know that we are going to have a hard time paying off our Care Credit in time, but at least we have the time to try to figure it out.


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## HiTideGoldens (Dec 29, 2009)

I am going to email a friend of mine in SD whose husband is a veterinarian and see if she has any suggestions. Those prices just sound ridiculous...


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## Brave (Oct 26, 2012)

Thank you!!
A member of his rescue's BoD is referring me to PESC (Pet Emergency & Speciality Center) in La Mesa. Once I get more info, I will let everyone know. 


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## Brave (Oct 26, 2012)

What is rehab like? Does it take more than 4 months? The sheet they gave me only covers up to 4 months post-op. 


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## Karen519 (Aug 21, 2006)

*Brave*

This looks like good info on the two surgeries
http://www.medvetmedicalcenterforpets.com/pdf/TPLO_TTA_Procedures.pdf
and I THINK most of the physical therapy can be done at home-maybe your vet has a pool or knows of one Bear can swim at.

I wouldn't worry too much about the recovery.


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## dborgers (Dec 7, 2011)

Brave said:


> What is rehab like? Does it take more than 4 months? The sheet they gave me only covers up to 4 months post-op.


Stretching exercises, gentle walks, easing them back into using stairs, etc. They fell pretty good after a month, so you want to keep them from jumping and running and making quick turns and all that. 

Katie had a complete rupture. You'd never know she ever injured that knee.


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## dborgers (Dec 7, 2011)

Brave said:


> What is rehab like? Does it take more than 4 months? The sheet they gave me only covers up to 4 months post-op.


He'll feel pretty good after 2 or 3 weeks, but you'll want to prevent him from jumping, running, etc. Stretching exercises, gentle walks, easing them back into using stairs, etc. 

Katie had a complete rupture. You'd never know she ever injured that knee.


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## Karen519 (Aug 21, 2006)

*Brave*



dborgers said:


> He'll feel pretty good after 2 or 3 weeks, but you'll want to prevent him from jumping, running, etc. Stretching exercises, gentle walks, easing them back into using stairs, etc.
> 
> Katie had a complete rupture. You'd never know she ever injured that knee.


Brave:

Smooch had a complete rupture, too, and she was doing pretty good after 2 or 3 wks. As Danny said, keep them from jumping, running and using stairs and vet gave us stretching exercises to do.


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## Brave (Oct 26, 2012)

Keeping him down will be my problem. Lol. Even now, sometimes he catches us and jumps up on us or turns really fast in circles. I feel like he is going to be so unhappy for the next few months with how unrelenting I will need to be on keeping him down. I am working on finding mind games but its on the bottom of the list right now. 


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## dborgers (Dec 7, 2011)

Isn't there a way you can confine him? We had a heck of a hard time keeping Andy confined. He busted down the gates we put up around his bed. We finally gave him run of the house (with dog door closed off) and put him on Tramadol to keep him mildly sedated. It's a cheap drug. 

Like our vet told us " You're going to hate it. They're going to hate it. But it's for the best."


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## Brave (Oct 26, 2012)

Crating or x-pen are the only confinement options. I thought about blocking him in the hallway with baby gates but he jumped those once before (when he was like 5 months old). I can crate him 5 days a week for 13 hours a day (broken up in chunks) and put him in the x-pen and set it up right next to us for the rest of the day. 


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## Karen519 (Aug 21, 2006)

*Brave*

When Smooch had the TPLO done, we had to keep her confined, too.
I wanted for her to be able to see Snobear, and for Snobear to see her.
We have a small powder room on our first level, so Ken took off the door, made a half door or a third of a door from plywood, so that Smooch couldn't get out, but she and Snobear could see one another during the day. It worked like a charm. The powder room was small enough that she could lay down in it, but not big enough where she could run.

Do you have a room like this?


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## Brave (Oct 26, 2012)

Nope. We have a very small house that is built like a circle. Everything is connected. I can put up baby gates to prevent him from traveling from the kitchen to the hallway and from the living room to hallway but that still leaves a large reverse c of places he has access to. I think I will barricade him into the living room at night and sleep on the couch. I will figure it out. 

Even confined, I am sure he will try I play. Ya know? He is so full of energy. Ha! I love him to pieces. I cannot wait until this is behind us. 


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## cgriffin (Nov 30, 2011)

That is what I did, I barricaded any access to the living room and the kitchen with gates at night, when I could not watch Toby and the first several nights, I slept on the couch.
I had the luxury of having a small room to put Toby in, when I had to leave the house.

Brave, if you have any slick floors, you might want to get a non-slip rug or mats, to 
prevent Bear from slipping and falling.


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## Karen519 (Aug 21, 2006)

*Brave*

Brave

I can't wait until all of this is behind you and Bear, too.
*We blocked the couch with chairs so Smooch couldn't try to jump up and also DISCONNECT the DOOR BELL, so nobody rings it!!!!*


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## Brave (Oct 26, 2012)

We just had our second opinion with Dr. Tarvin. He confirmed Bear has a torn ACL in his left knee. He recommends a TTA as well. But he suggests he wait about a month before surgery to allow Bear's growth plates to stop growing. I told him that his growth plates won't close until 18 months but he is confident they won't grow much after about 10 months. He says any arthritis that develops in the month will be insignificant since it is such a short time frame. 


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## Brave (Oct 26, 2012)

Something of interest--- the vet thinks he tore it because of his conformation. He was built weird and his legs put too much pressure on the ligaments based on how they were made. 


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