Author Topic: ccl vs iliopsoas  (Read 903 times)

Edraith

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ccl vs iliopsoas
« on: February 11, 2021, 05:23:40 PM »
Thought I would share what I've learned over the last like six weeks in case it helps someone else...

So SAR folk in general are pretty aware of ccl injuries as it is common for us too like the agility world. When my pup came back from a run, napped, got up and wouldn't put her leg down at all for a minute, despite no issues before then, but limping then, I rested her, tested it, came up same again in 2 weeks when she ran fine for about 10 minutes and then starting visibly limping, and the same as soon as laid down to nap - got up and wouldn't put the leg down for a bit. So went to our vet who is also a rehab specialist who Dx partial ccl tear full rest for two weeks come back and if meniscus is ok said we can avoid surgery. So I did - it was about 3 weeks in the end actually. The limp did go away, but I was not convinced of the waitandsee approach because CCL's don't just heal, they will continue to tear, and even if I retired her from SAR there was no way her activity would decrease with her energy level. Rest-Lame cycles just do more and more damage, and I didn't want to end up with early arthritis when we could avoid that with earlier surgical intervention. She isnt an old calm dog, after all! So I asked for the referral to the orthopedic surgical specialist - we have a really good one here - and kept the appointment to get a specialist's opinion even though she stopped limping. Although cleared for an easy run in between the follow up and specialist and she did get a slight limp after that run - but nowhere near as bad as what had been happening.

He saw her and said there was zero evidence of a CCL tear. No slip, no clicking, full correct range of motion, no limp, literally nothing from the tests to point to even suspecting a partial. He told me something I had no clue and not heard people mention before: Iliopsoas injury can present like a lowgrade partial CCL tear. He added that many of times when someone goes in to do TPLO and finds the CCL is fine, that it is practically *always* actually the iliopsoas! A cutter who doesnt want to cut certainly convinced me. We ofc discussed options and have plan in place in case the leg withdraw or limp comes back, and he agreed with not doing rest-lame cycles for CCL issues in a dog like her, but we have treated it under his direction as if it is a recovering iliopsoas injury and so far, so good. We did bigger run on easy terrain last weekend and ZERO limp or issues. This week we are allowed low impact directed exercise (no directed jumping/weaving/tight collection turns type stuff) so did some tunnel courses, ZERO issues. This weekend going to do a full SAR run to push out the time and terrain more, and I expect it to be fine. Next week we are back to no restrictions.

So...just figured I would post this. He mentioned iliopsoas injuries are commonly under and miss-diagnosed so thought I would share this knowledge. Certainly far easier to deal with and recover from than a CCL tear! His comments about people going in for the TPLO to find the CCL totally intact and only then figuring out it was iliopsoas was particularly interesting to me. In cases where it is suspected but unclear, he told me sends people to another specialist place that has a scope setup - so it's just a tiny incision to "put eyes on" the CCL - very easy to recover from if it isn't, and if it is damaged they can open it up further to do the TPLO.
« Last Edit: February 11, 2021, 05:29:32 PM by Edraith »
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Amy McGovern

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Re: ccl vs iliopsoas
« Reply #1 on: February 11, 2021, 07:03:03 PM »
We actually saw the vet a month ago for the exact same issue.  We are supposed to go in for re-eval Monday (except for the horrible snowstorm forecast!) and we are just ending the 4 months of rest.  We have all hated it but especially her since she's very active.  But the vet checked both CCL and ilipsoas for me and showed me why it was CCL but a small tear.  I guess we will find out more Monday or soon anyway, depending on the weather.  She's supposedly cleared to run at the show next weekend...
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Edraith

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Re: ccl vs iliopsoas
« Reply #2 on: February 12, 2021, 08:53:28 AM »
Good luck!
I find rehab vets tend to want to rehab, but ccl's don't heal, they can stay same or get worse. Rehab route may be great for an older less active dog that you don't need a sound knee on, but that isn't my case - Which is why I insisted on a specialist surgical consult. My vet only recommends surgery if they are sure the meniscus is torn, but once it tears, the arthritic process starts, so for my situation I'd made the decision that even a partial w/o meniscal damage i would jump to surgery. (I pulled a lot of case studies and journals, 'twas my science background, but this is a nice public access overview https://www.acvs.org/small-animal/cranial-cruciate-ligament-disease ). She only sent my friend to the surgeon when my friend insisted on a second xray which showed the arthritis after lame/rest/rehab cycles for a year, and I did not want to do that! Rather ONE rest cycle for a sound knee and no permanent OA for my case. But mine passed the cranial drawer test & tibial compression test no issues, and that taken with all the other tests and data is why he dx iliopsoas instead but we were already far down he recovery road by the time we saw him.
« Last Edit: February 12, 2021, 08:57:04 AM by Edraith »
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Joyce Roessner

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Re: ccl vs iliopsoas
« Reply #3 on: February 12, 2021, 12:18:46 PM »
Thanks for that information, always good to have. 
Joyce Roessner
Calgary, Alberta

dogrsqr

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Re: ccl vs iliopsoas
« Reply #4 on: February 12, 2021, 12:38:27 PM »
Clean Run recently had a CCL webinar with the Knapp.  Its probably still available.  They talked about PRP therapy as well as surgery.  When my 10 year old BC appeared to have a partial CCL tear PRP was offered as an alternative but knowing her activity level even at almost 11 years old I decided on a surgical consult.  By the time we got in her tear was no longer partial..  Given it was the year of COVID I had already decided on surgery.  She has made a full recovery and is back to running agility with lots of hydrotherapy and walking to rebuild muscle.

Gina Pizzo