Dr. Katherine Meyers performs orthopedic surgery
During a casual conversation, a dog park friend once advised New York City resident Leslye Alexander to take her dog Olivia to Penn Vet in an emergency. “I never thought I would need it,” said Alexander. “But then Olivia was injured.”
In early April, the tiny nine-year-old mixed breed landed badly after jumping off the bed. “She was walking gingerly. I thought maybe she’d bruised her leg,” explained Alexander.
A visit to an orthopedic specialist in Manhattan said otherwise. Olivia had torn her cruciate ligament (CCL) — the dog version of an ACL (Anterior Cruciate Ligament).
Her veterinarian recommended surgery. Alexander considered having the procedure done in the city, but remembered the prescient words of her dog park friend. “I just felt more comfortable at Penn Vet, especially with Olivia’s history of seizures as a pup,” she said. “And the hour and a half drive was easy breezy, as was parking, so it was an easy decision to call Penn Vet.”
Alexander and Olivia traveled to Philadelphia to meet with surgeon Dr. Katherine Meyers, Lecturer in Surgery at Ryan Veterinary Hospital. “I felt immediately comfortable with Dr. Meyers,” Alexander recalled. “She had a surgery slot open the next day, and Penn Vet even had a list of nearby hotel rooms. Everyone was just so incredibly nice and helpful.”
Because of Olivia’s health history, Alexander also “liked that Penn Vet has multiple specialists and an anesthesiologist on staff to tailor the anesthesia to Olivia’s specific needs.”
Meyers confirmed the Manhattan vet’s original diagnosis. “Olivia was acting fine — bright, alert, responsive, with a normal temperature and heart and respiratory rates,” said Meyers. “But she was really hesitant to bear any weight on her right hind leg. My exam indicated a CCL tear, as well as a suspected tear to the medial meniscus, which is a part of the knee that often gets torn in conjunction with a CCL injury.”
On this x-ray of Olivia's knee, clinicians were looking for evidence of fluid in the knee, seen by cranial displacement of the infrapatellar fat pad; cranial subluxation of the tibia in relation to the femur; and osteoarthritis, also know as degenerative joint disease.
A healthy CCL stabilizes the knee and enables full mobility. When the ligament tears, it’s painful for the dog and causes joint instability. Such trauma is among the most common reasons dogs develop arthritis in the knee.
The Right Way
Meyers reviewed different treatment options with Alexander, including medical management and surgery to stabilize the joint. “Medical management entails strict activity restrictions, pain meds, and rehab for about eight to 10 weeks,” she said. “The thought is that the body will develop enough scar tissue to stabilize itself. But the concern with Olivia was that the meniscal tear usually doesn’t respond to medical management alone.”
Alexander opted for surgery.
“For the procedure, there are many different options. The ones we do most commonly are a lateral suture and TPLO or tibial plateau leveling osteotomy.” explained Meyers. “TPLO is a bone-cutting procedure that’s a great option. Given Olivia’s size, age, and activity level, the owners elected lateral suture.”
Back on Her Feet
During the surgery, Meyers placed a loop of nylon around Olivia’s fabella, a small bone at the back of her knee, and through her shinbone. “The goal is for the suture to sit on the outside of the knee and mimic the function of the cruciate,” she said. “Ideally, scar tissue will develop around the suture, helping to prevent instability caused by the tear.”
Meyers also removed remnants of the broken medial meniscus to prevent further damage, pain, and inflammation, and the surgery went without a hitch.
“The whole goal with any type of surgery to treat a CCL tear is to slow the progression of uncomfortable arthritis that will develop over time from the injury,” Meyers explained. “After this type of injury, the knee will never be completely normal again. Our hope is to alleviate discomfort and get the patient back to regular activity.”
The typical recovery for surgeries like Olivia’s is activity restriction for six to eight weeks, as well as physical therapy. Well passed the eight-week mark, Olivia is progressing nicely and carefully returning to her everyday routine.
“Everyone at Penn Vet is so knowledgeable and the treatment is cutting edge,” said Alexander. “I’ll happily make the trip from New York City to Philadelphia for Olivia’s care — and I’m so thankful for the tip off from a fellow dog mom a while back!”
Dr. Meyers consults with Leslye Alexander during a check-up for Olivia.