Re: Breakdown of cruciate extra-cap repair

[Guest guest]

I see no reason to remove the suture-it will not create any issues-the suture repair breaking down would suggest to me that another type of repair may be in order- however, before giving any real strong opinion/advice, may I add that you always remember to give us a signalment-age/breed/gender/body wt, etc, and what you rxam findings are with regard to the joint and surrounding tissues

Freedman CCRT

 

I've recently been referred a post-cruciate dog for rehab in uwtm. Extra-capsular surgery was done in late Nov 2011 but dog did not do well post-surgery due to an infection and now the suture repair breaking down - but she has started to weight bear (has been for uwtm four times and is doing well in the treadmill). It is intended that the suture material is removed - anyone willing to offer a comment on whether or not this should be done sooner or later? I was asked but honestly do not know with my thought being that if the dog was not progressing then sooner would be the answer but if the dog is then is later an option?

Many thanks

Vicki

CCRP-student

-- Regards,

[Guest guest]

by the way that should read Freedman VMD CCRT

 

I've recently been referred a post-cruciate dog for rehab in uwtm. Extra-capsular surgery was done in late Nov 2011 but dog did not do well post-surgery due to an infection and now the suture repair breaking down - but she has started to weight bear (has been for uwtm four times and is doing well in the treadmill). It is intended that the suture material is removed - anyone willing to offer a comment on whether or not this should be done sooner or later? I was asked but honestly do not know with my thought being that if the dog was not progressing then sooner would be the answer but if the dog is then is later an option?

Many thanks

Vicki

CCRP-student

-- Regards,

[Guest guest]

Anytime there is an infection and an implant, removing the implant is usually necessary to totally clear the infection

Kim Knap BS, CVT

Certified Canine Rehabilitation Practitioner

Rehabilitation Specialist

University of Illinois Veterinary Teaching Hospital

170 SAC

1008 W. Hazelwood Dr

Urbana, IL 61801

office:

fax:

knap@...

http://vetmed.illinois.edu/vth

Warning: the information contained in this message may be privileged and confidential and is only intended for the person

to whom it is addressed. Redisclosure of this information is prohibited unless permitted by federal and state laws and regulations. If you are NOT the intended recipient, or agent for the intended recipient, you are hereby notified that any dissemination,

distribution or copying of this information is strictly prohibited. If you have received this message in error please notify the sender by reply e-mail and delete this message.

From: VetRehab [VetRehab ] on behalf of richard freedman [richard.freedman836@...]

Sent: Thursday, January 26, 2012 9:20 AM

To: VetRehab

Subject: Re: Breakdown of cruciate extra-cap repair

I see no reason to remove the suture-it will not create any issues-the suture repair breaking down would suggest to me that another type of repair may be in order- however, before giving any real strong opinion/advice, may I add that you always remember

to give us a signalment-age/breed/gender/body wt, etc, and what you rxam findings are with regard to the joint and surrounding tissues

Freedman CCRT

On Thu, Jan 26, 2012 at 4:31 AM,

cordier@... wrote:

I've recently been referred a post-cruciate dog for rehab in uwtm. Extra-capsular surgery was done in late Nov 2011 but dog did not do well post-surgery due to an infection and now the suture repair breaking down - but she has started to weight bear (has

been for uwtm four times and is doing well in the treadmill). It is intended that the suture material is removed - anyone willing to offer a comment on whether or not this should be done sooner or later? I was asked but honestly do not know with my thought

being that if the dog was not progressing then sooner would be the answer but if the dog is then is later an option?

Many thanks

Vicki

CCRP-student

--

Regards,

[Guest guest]

In my past experience, if the suture is removed prior to the six month mark, then there is not enough joint stabilization to have taken place to ensure the surgery to be successful.  After six months, it doesn't seem to matter.  In this case, as it seems to have failed anyways, I would just get it out AND as a separate surgery from whatever else might be planned, to give time for resolution of the infection. 

I have been using fishing leader line as my implant for the past 15+ years and it has never caused an issue other than a seroma where the knot might shift and rub on the underside of the skin.  No infections at all.  In the bad old days, when I used Vetafil, infection/reaction was a major issue.

Mike

 

Anytime there is an infection and an implant, removing the implant is usually necessary to totally clear the infection

 

Kim Knap BS, CVT

Certified Canine Rehabilitation Practitioner

Rehabilitation Specialist

University of Illinois Veterinary Teaching Hospital

170 SAC

1008 W. Hazelwood Dr

Urbana, IL 61801

office:

fax:

knap@...

http://vetmed.illinois.edu/vth

 

Warning:  the information contained in this message may be privileged and confidential and is only intended for the person

to whom it is addressed.   Redisclosure of this information is prohibited unless permitted by federal and state laws and regulations.  If you are NOT the intended recipient, or agent for the intended recipient, you are hereby notified that any dissemination,

distribution or copying of this information is strictly prohibited.   If you have received this message in error please notify the sender by reply e-mail and delete this message.

 

From: VetRehab [VetRehab ] on behalf of richard freedman [richard.freedman836@...]

Sent: Thursday, January 26, 2012 9:20 AM

To: VetRehab

Subject: Re: Breakdown of cruciate extra-cap repair

 

I see no reason to remove the suture-it will not create any issues-the suture repair breaking down would suggest to me that another type of repair may be in order- however, before giving any real strong opinion/advice, may I add that you always remember

to give us a signalment-age/breed/gender/body wt, etc, and what you rxam findings are with regard to the joint and surrounding tissues

Freedman CCRT

On Thu, Jan 26, 2012 at 4:31 AM,

cordier@... wrote:

 

I've recently been referred a post-cruciate dog for rehab in uwtm. Extra-capsular surgery was done in late Nov 2011 but dog did not do well post-surgery due to an infection and now the suture repair breaking down - but she has started to weight bear (has

been for uwtm four times and is doing well in the treadmill). It is intended that the suture material is removed - anyone willing to offer a comment on whether or not this should be done sooner or later? I was asked but honestly do not know with my thought

being that if the dog was not progressing then sooner would be the answer but if the dog is then is later an option?

Many thanks

Vicki

CCRP-student

--

Regards,

-- President, International Veterinary Academy of Pain ManagementCertified Veterinary Pain PractitionerCertified Veterinary Medical AcupuncturistCertified Canine Rehabilitation Therapist

Certified American Academy of Pain Managementwww.animalpaincenter.com

[Guest guest]

kimYour comments hold true for metallic implants because antbtx cannot penetrate the biofilm created by the bacteria on the implant. Most infections with extracap. are soft tissue, thus it is not as imperative to remove the so called " implant " material.

freedman VMD CCRT

 

Anytime there is an infection and an implant, removing the implant is usually necessary to totally clear the infection

 

Kim Knap BS, CVT

Certified Canine Rehabilitation Practitioner

Rehabilitation Specialist

University of Illinois Veterinary Teaching Hospital

170 SAC

1008 W. Hazelwood Dr

Urbana, IL 61801

office:

fax:

knap@...

http://vetmed.illinois.edu/vth

 

Warning:  the information contained in this message may be privileged and confidential and is only intended for the person

to whom it is addressed.   Redisclosure of this information is prohibited unless permitted by federal and state laws and regulations.  If you are NOT the intended recipient, or agent for the intended recipient, you are hereby notified that any dissemination,

distribution or copying of this information is strictly prohibited.   If you have received this message in error please notify the sender by reply e-mail and delete this message.

 

From: VetRehab [VetRehab ] on behalf of richard freedman [richard.freedman836@...]

Sent: Thursday, January 26, 2012 9:20 AM

To: VetRehab

Subject: Re: Breakdown of cruciate extra-cap repair

 

I see no reason to remove the suture-it will not create any issues-the suture repair breaking down would suggest to me that another type of repair may be in order- however, before giving any real strong opinion/advice, may I add that you always remember

to give us a signalment-age/breed/gender/body wt, etc, and what you rxam findings are with regard to the joint and surrounding tissues

Freedman CCRT

On Thu, Jan 26, 2012 at 4:31 AM,

cordier@... wrote:

 

I've recently been referred a post-cruciate dog for rehab in uwtm. Extra-capsular surgery was done in late Nov 2011 but dog did not do well post-surgery due to an infection and now the suture repair breaking down - but she has started to weight bear (has

been for uwtm four times and is doing well in the treadmill). It is intended that the suture material is removed - anyone willing to offer a comment on whether or not this should be done sooner or later? I was asked but honestly do not know with my thought

being that if the dog was not progressing then sooner would be the answer but if the dog is then is later an option?

Many thanks

Vicki

CCRP-student

--

Regards,

-- Regards,

[Guest guest]

Dr. Freedman-

Another important question to ask would be what type of “extracap” was performed, as I think that term is used very broadly. We frequently perform extracapsular

repairs using a corkscrew anchor or a similar implant and a bone tunnel with a button. We recently had an “extracap” with a corkscrew anchor that had a chronic lameness. The bone anchor was removed and cultured, and the patient had a recurring methicillin

resistant staph intermedius infection. The patient’s lameness resolved after implant removal and antibiotics. We have also had this same result of lameness resolving after removal of traditional extracapsular suture material in a suspected infected stifle

joint with concurrent antibiotic therapy.

From: VetRehab [mailto:VetRehab ]

On Behalf Of richard freedman

Sent: Thursday, January 26, 2012 1:01 PM

To: VetRehab

Subject: Re: Breakdown of cruciate extra-cap repair

kim

Your comments hold true for metallic implants because antbtx cannot penetrate the biofilm created by the bacteria on the implant. Most infections with extracap. are soft tissue, thus it is not as imperative to remove the so called " implant " material.

freedman VMD CCRT

Anytime there is an infection and an implant, removing the implant is usually necessary to totally clear the infection

Kim Knap BS, CVT

Certified Canine Rehabilitation Practitioner

Rehabilitation Specialist

University of Illinois Veterinary Teaching Hospital

170 SAC

1008 W. Hazelwood Dr

Urbana, IL 61801

office:

fax:

knap@...

http://vetmed.illinois.edu/vth

Warning: the information contained in this message may be privileged and confidential and is only intended for

the person to whom it is addressed. Redisclosure of this information is prohibited unless permitted by federal and state laws and regulations. If you are NOT the intended recipient, or agent for the intended recipient, you are hereby notified that any dissemination,

distribution or copying of this information is strictly prohibited. If you have received this message in error please notify the sender by reply e-mail and delete this message.

From:

VetRehab [VetRehab ] on behalf of richard freedman [richard.freedman836@...]

Sent: Thursday, January 26, 2012 9:20 AM

To: VetRehab

Subject: Re: Breakdown of cruciate extra-cap repair

I see no reason to remove the suture-it will not create any issues-the suture repair breaking down would suggest to me that another type of repair may be in order- however, before giving any real strong opinion/advice, may I

add that you always remember to give us a signalment-age/breed/gender/body wt, etc, and what you rxam findings are with regard to the joint and surrounding tissues

Freedman CCRT

On Thu, Jan 26, 2012 at 4:31 AM,

cordier@... wrote:

I've recently been referred a post-cruciate dog for rehab in uwtm. Extra-capsular surgery was done in late Nov 2011 but dog did not do well post-surgery due to an infection and now the suture repair breaking down - but she has

started to weight bear (has been for uwtm four times and is doing well in the treadmill). It is intended that the suture material is removed - anyone willing to offer a comment on whether or not this should be done sooner or later? I was asked but honestly

do not know with my thought being that if the dog was not progressing then sooner would be the answer but if the dog is then is later an option?

Many thanks

Vicki

CCRP-student

--

Regards,

--

Regards,

[Guest guest]

'you are corrrecty-in your recent case, the infection was in the joint? In this case, can we really say we needed to remove the implant?

 

Dr. Freedman-

Another important question to ask would be what type of “extracap” was performed, as I think that term is used very broadly.  We frequently perform extracapsular

repairs using a corkscrew anchor or a similar implant and a bone tunnel with a button.  We recently had an “extracap” with a corkscrew anchor that had a chronic lameness.  The bone anchor was removed and cultured, and the patient had a recurring methicillin

resistant staph intermedius infection.  The patient’s lameness resolved after implant removal and antibiotics.  We have also had this same result of lameness resolving after removal of traditional extracapsular suture material in a suspected infected stifle

joint with concurrent antibiotic therapy. 

 

From: VetRehab [mailto:VetRehab ]

On Behalf Of richard freedman

Sent: Thursday, January 26, 2012 1:01 PM

To: VetRehab

Subject: Re: Breakdown of cruciate extra-cap repair

 

kim

Your comments hold true for metallic implants because antbtx cannot penetrate the biofilm created by the bacteria on the implant. Most infections with extracap. are soft tissue, thus it is not as imperative to remove the so called " implant " material.

freedman VMD CCRT

 

Anytime there is an infection and an implant, removing the implant is usually necessary to totally clear the infection

 

Kim Knap BS, CVT

Certified Canine Rehabilitation Practitioner

Rehabilitation Specialist

University of Illinois Veterinary Teaching Hospital

170 SAC

1008 W. Hazelwood Dr

Urbana, IL 61801

office:

fax:

knap@...

http://vetmed.illinois.edu/vth

 

Warning:  the information contained in this message may be privileged and confidential and is only intended for

the person to whom it is addressed.   Redisclosure of this information is prohibited unless permitted by federal and state laws and regulations.  If you are NOT the intended recipient, or agent for the intended recipient, you are hereby notified that any dissemination,

distribution or copying of this information is strictly prohibited.   If you have received this message in error please notify the sender by reply e-mail and delete this message.

 

From:

VetRehab [VetRehab ] on behalf of richard freedman [richard.freedman836@...]

Sent: Thursday, January 26, 2012 9:20 AM

To: VetRehab

Subject: Re: Breakdown of cruciate extra-cap repair

 

I see no reason to remove the suture-it will not create any issues-the suture repair breaking down would suggest to me that another type of repair may be in order- however, before giving any real strong opinion/advice, may I

add that you always remember to give us a signalment-age/breed/gender/body wt, etc, and what you rxam findings are with regard to the joint and surrounding tissues

Freedman CCRT

On Thu, Jan 26, 2012 at 4:31 AM,

cordier@... wrote:

 

I've recently been referred a post-cruciate dog for rehab in uwtm. Extra-capsular surgery was done in late Nov 2011 but dog did not do well post-surgery due to an infection and now the suture repair breaking down - but she has

started to weight bear (has been for uwtm four times and is doing well in the treadmill). It is intended that the suture material is removed - anyone willing to offer a comment on whether or not this should be done sooner or later? I was asked but honestly

do not know with my thought being that if the dog was not progressing then sooner would be the answer but if the dog is then is later an option?

Many thanks

Vicki

CCRP-student

--

Regards,

--

Regards,

-- Regards,

[Guest guest]

In

our case, we removed the implant and cultured the site in the femur where the implant was located. This is where the positive cultures came from. Joint fluid cultures were negative.

Misspellings courtesy of my Verizon Wireless 4GLTE smartphone

----- Reply message -----

To: " VetRehab " <VetRehab >

Subject: Breakdown of cruciate extra-cap repair

Date: Thu, Jan 26, 2012 4:10 pm

'you are corrrecty-in your recent case, the infection was in the joint? In this case, can we really say we needed to remove the implant?

On Thu, Jan 26, 2012 at 2:08 PM, Sessum,

wrote:

Dr. Freedman-

Another important question to ask would be what type of “extracap” was performed, as I think that term is used very broadly. We frequently perform extracapsular repairs using a corkscrew anchor

or a similar implant and a bone tunnel with a button. We recently had an “extracap” with a corkscrew anchor that had a chronic lameness. The bone anchor was removed and cultured, and the patient had a recurring methicillin resistant staph intermedius infection.

The patient’s lameness resolved after implant removal and antibiotics. We have also had this same result of lameness resolving after removal of traditional extracapsular suture material in a suspected infected stifle joint with concurrent antibiotic therapy.

From:

VetRehab [mailto:VetRehab ]

On Behalf Of richard freedman

Sent: Thursday, January 26, 2012 1:01 PM

To: VetRehab

Subject: Re: Breakdown of cruciate extra-cap repair

kim

Your comments hold true for metallic implants because antbtx cannot penetrate the biofilm created by the bacteria on the implant. Most infections with extracap. are soft tissue, thus it is not as imperative to remove the so called " implant " material.

freedman VMD CCRT

Anytime there is an infection and an implant, removing the implant is usually necessary to totally clear the infection

Kim Knap BS, CVT

Certified Canine Rehabilitation Practitioner

Rehabilitation Specialist

University of Illinois Veterinary Teaching Hospital

170 SAC

1008 W. Hazelwood Dr

Urbana, IL 61801

office:

fax:

knap@...

http://vetmed.illinois.edu/vth

Warning: the information contained in this message may be privileged and confidential and is only intended for the person to whom it is addressed. Redisclosure of this

information is prohibited unless permitted by federal and state laws and regulations. If you are NOT the intended recipient, or agent for the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is

strictly prohibited. If you have received this message in error please notify the sender by reply e-mail and delete this message.

From:

VetRehab [VetRehab ] on behalf of richard freedman [richard.freedman836@...]

Sent: Thursday, January 26, 2012 9:20 AM

To: VetRehab

Subject: Re: Breakdown of cruciate extra-cap repair

I see no reason to remove the suture-it will not create any issues-the suture repair breaking down would suggest to me that another type of repair may be in order- however, before giving any real strong opinion/advice, may I add that you always remember

to give us a signalment-age/breed/gender/body wt, etc, and what you rxam findings are with regard to the joint and surrounding tissues

Freedman CCRT

On Thu, Jan 26, 2012 at 4:31 AM,

cordier@... wrote:

I've recently been referred a post-cruciate dog for rehab in uwtm. Extra-capsular surgery was done in late Nov 2011 but dog did not do well post-surgery due to an infection and now the suture repair breaking down - but she has started to weight bear (has

been for uwtm four times and is doing well in the treadmill). It is intended that the suture material is removed - anyone willing to offer a comment on whether or not this should be done sooner or later? I was asked but honestly do not know with my thought

being that if the dog was not progressing then sooner would be the answer but if the dog is then is later an option?

Many thanks

Vicki

CCRP-student

--

Regards,

--

Regards,

--

Regards,

[Guest guest]

More on this case (now with detail I omitted earlier sorry) – dog is female

Lab-Staffy-X, 11 years old, history of skin issues and is on meds for bladder

control, cruciate torn `taking corner too fast going out to get newspaper'.

Weight is good for size of dog.

Update on previous question - suture material was removed (traditional extra-cap

repair) second week Feb. By time of suture removal from second surgery a fluid

filled lump had developed under suture line. This has been cultured and results

back today indicate joint fluid.

Owner is away for ten days so dog is boarding with me. Dog is weight bearing

well on surgery leg. She is restricted to short leash walks but has had free

range of home. Boarding situation is that she is confined to a small indoor pen

and will be leash walked only – toileting and exercise. No further veterinary

intervention is intended until owner is back. Grateful for any comments on what

exercise the dog should/should not be doing during these ten days and on

prognosis - this is a first for me ... Thanks, Vicki

>

>

> I've recently been referred a post-cruciate dog for rehab in uwtm.

Extra-capsular surgery was done in late Nov 2011 but dog did not do well

post-surgery due to an infection and now the suture repair breaking down - but

she has started to weight bear (has been for uwtm four times and is doing well

in the treadmill). It is intended that the suture material is removed - anyone

willing to offer a comment on whether or not this should be done sooner or

later? I was asked but honestly do not know with my thought being that if the

dog was not progressing then sooner would be the answer but if the dog is then

is later an option?

>

> Many thanks

> Vicki

> CCRP-student

>

>

> --

> Regards,

>

>

>

>

>

> --

> Regards,

>

>

>

>

>

>

>

>

>

> --

> Regards,

>

>

>

[Guest guest]

Perhaps I am missing something. This was an extra-capsular repair, 3 months

post-surgery? The arthrotomy site (I'm assuming there was an arthrotomy) should

have long since healed. Why has removal of an implant outside the joint caused

a joint fluid swelling? What else has happened? Is there some other pathology?

> >

> >

> > I've recently been referred a post-cruciate dog for rehab in uwtm.

Extra-capsular surgery was done in late Nov 2011 but dog did not do well

post-surgery due to an infection and now the suture repair breaking down - but

she has started to weight bear (has been for uwtm four times and is doing well

in the treadmill). It is intended that the suture material is removed - anyone

willing to offer a comment on whether or not this should be done sooner or

later? I was asked but honestly do not know with my thought being that if the

dog was not progressing then sooner would be the answer but if the dog is then

is later an option?

> >

> > Many thanks

> > Vicki

> > CCRP-student

> >

> >

> > --

> > Regards,

> >

> >

> >

> >

> >

> > --

> > Regards,

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > --

> > Regards,

> >

> >

> >

>

[Guest guest]

Yes, there is something missing from this but I don't know what it is either - your time line is correct. The removal of the suture material should not have caused the swelling. The owner is very compliant and I would be surprised if something else happened (but it's perhaps the most likely cause?). Re other pathology – not at this point.

The swelling has not changed – has not reduced nor increased. Exercise has been restricted however dog has had two gentle sessions in the uwtm.

The owner is back at the end of the week and the dog will have an appointment with her vet next week. If there's an outcome then I'll post an update. > > > > > > > > > I've recently been referred a post-cruciate dog for rehab in uwtm. Extra-capsular surgery was done in late Nov 2011 but dog did not do well post-surgery due to an infection and now the suture repair breaking down - but she has started to weight bear (has been for uwtm four times and is doing well in the treadmill). It is intended that the suture material is removed - anyone willing to offer a comment on whether or not this should be done sooner or later? I was asked but honestly do not know with my thought being that if the dog was not progressing then sooner would be the answer but if the dog is then is later an option?> > > > > > Many thanks> > > Vicki> > > CCRP-student> > > > > > > > > --> > > Regards,> > > > > > > > > > > > > > > > > > --> > > Regards,> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > --> > > Regards,> > > > > > > > >> >>