Chronic patellar tendonitis

[lehughes]

I'm posting this for discussion:

Hi Laurie,

I came across your blog through an internet search, and I was hoping you could offer some advice. I am desperate. My dog Braylee, a five year old golden retriever, has been battling issues with her left leg for years (yes, years). I am mentally, emotionally, physically, (not to mention financially), drained. Very long story short, she was diagnosed with a partial CCL tear at VOSM via arthroscopy in July of 17. I opted to treat her with stem cells/PRP to avoid TPLO. It did not work. She had TPLO surgery in October. Recovery did not go well, she never got back to even being comfortable on her leg, and around the 10 week mark she suddenly got much worse out of nowhere. X-rays showed a potential chip fracture of her patella (or osteoarthritis), and an extremely thickened patellar tendon. We opted to "throw the book at her"...her plate was removed, her knee was injected with PRP, they did arthroscopy again to confirm there was no meniscal tear (there wasn't), and her plate and a screw were cultured. They did come back with bacterial growth, although VOSM suspects the sample was contaminated with normal body flora during the process of removing it. She was treated with antibiotics for a month anyway. Since the plate removal (which was about 7 weeks ago), she has been getting weekly laser therapy and e-stim, and sometimes the Assisi loop. This past week she took a turn for the worse and has been more sore on the leg. I haven't even allowed her to do anything crazy, she has been on leash in the yard, I use the sling when it snows so she doesn't slip, and I don't allow her to do stairs. Her most recent X-rays show that her patellar tendon has not improved at all. I am so frustrated I just feel like crying all the time. From what I understand, most cases of patellar tendonitis post TPLO self-resolve, and I don't understand why hers will not. She's worse off now than she was before any of the surgeries, and it feels like nothing I try to do helps her at all. She has been on Galliprant and tramadol since the last surgery. Our local orthopedic surgeon (who is not her operating surgeron, as we are in PA and VOSM is Maryland) is recommending shock wave therapy. I just do not have the resources at this point to spend on something very expensive that isn't going to help her. Please, if you have any suggestions, I would be very appreciative.

Thank you so much,

-KM

(P.S. I have attached her most recent x-ray if that helps at all.)

[lehughes]

Hi Kim,

My apologies for the tardy reply. Life is crazy busy these days.

Okay… so, all in all, I think you need to have her looked at with a fresh set of eyes and hands. (Perhaps a set of eyes and hands not ‘vested’ in the surgery.) If your dog was in front of me… I’d look at the back, sacroiliac joints, hip and hip flexor muscle. I’d test for meniscus as well.
If the source of lameness truly seems to be coming from the stifle & patellar tendon in particular… then I’d actually work on strengthening. Tendonitis cases in the human world (and research world on animals) are treated with specific targeted exercise. That’s how a tendon knows how & where to heal!

I’m going to give you two protocols 1) for conservative cruciate management… I know your case is post op… but the later stage exercises might be helpful, and 2) for patellar luxation… again, I know that’s not the case… but this one has nice pictures to show you what some of the exercises look like. (Sit to stands on an incline, step ups, and squats are ones that I think would be particularly good!)

Check out these two sites to try to find an independent practitioner near you:

http://www.caninerehabinstitute.com/Fin ... apist.html
https://shop.utvetce.com/ccrp-practitioners


And I’m so sorry you’re going through this!

All the best,

Laurie

[David Lane]

Your response covers my 1st burning question - has anyone confirmed that the patellar tendon is the source of the pain? That is a honking big tendon on the radiograph, but is it the source of the poor response?