PRP for patella issues

[dinkster]

Hi, I've always found such good info and advice on YT in the past and here I am again.
Dinky is close to 7 years old. Over 2 years ago, he had LP surgery after he tore the ligament on his leftrear knee. The surgery was a success, but now here we are facing problems with his right rear leg. The vet told us today that there is a ligament tear.
We have move 800 miles from the last vet who did surgery only. So sadly, that will not work.
Also, this bet is recommending that we consider PRP which is stem cell therapy. This injury is not as bad as the last one was. Dinky can still walk and is not having as much discomfort as he did last time. But it's not getting better.
They have one vet in the practice that does the injection. It is one injection. The procedure involves Dinky being put under for an injection. We bring him in at 8am and he can go home around 2 or 3 pm. The vet says that the success rate is pretty high.
Of course, if it does not work, Dink will be getting the surgery anyway. But I like the idea of no surgery, no 8-12 week recovery period. And far less trauma for Dink. The PRP costs about 300-350. And here the patella surgery will be around 1500. And if we do the LP surgery, we will probably go to a surgeon.
Anyway, any feedback on PRP? We would be taking him in on Monday. So we have a couple of days to consider this. Thanks!

[Lovetodream88]

If you don't fix the ligament tear he will have debilitating arthritis. Once one ligament has torn in 1 leg its generally within 18 months that the other tears. I would go to a bored certified orthopedic surgeon and have the surgery.

[Buddylove86]

Do not waste your money on stem cell for dogs with an ACL tear. Either find another GP vet that does a lot of orthopedics or go to ideally a board certified surgeon for surgery. There is no research supporting it in dogs for ortho repairs, only in some performance horses.

[dinkster]

It's new, but the BEST orthopedic veterinary surgeon in Asheville, NC is now doing it. That would be Crouch. We would be there with Dinky now, but we've moved 900 miles north of there.
I also have a word in to a friend whose husband owns a vet clinic in a nearby state to get his take on it.
The only real problem I see with the choice for PRP is that the outcome cannot be predicted. What can be predicted is a much much easier recovery.
Still, We are working out to research it.
The pain and trauma and recovery from LP surgery is tough. If we have to do this again, we will. I can afford it. I just don't want him to go through it, and if there is a chance he could heal without going through LP surgery, I want to give it to him.
ON the other hand, I don't want him to go through 2 procedures.
So we haven't decided yet.

[ladyjane]

The price of $1500 for a CCL tear indicates that this is not a boarded surgeon....or you are just getting a really good price.

I have an excellent surgeon in Houston who does stem cell ... but have not heard of it for LP. He is the one I use for all of my ortho issues with my pups and fosters. I am going to ask him out of curiosity.

Once these pups have a CCL tear there is a 50% increased chance of the second knee tearing.

[dinkster]

I would love to hear what the vet in Houston has to say! Thanks.
As for price, I believe region also plays a part. The vet in Asheville was a board certified orthopedic surgeon. THe cost there was 1800. The cost in a closer more rural area by a vet who was not board certified in anything was over 2K and she wanted our dog to stay in the clinic for a week! Prices can be vary for many reasons.
My biggest reason for pursuing info on PRP is the reduced stress on Dinky. It's killing me to think about him going through any of this.
Anyway, I am looking for board certified surgeons in this area now.
sigh.

[ladyjane]

Originally Posted by dinkster

I would love to hear what the vet in Houston has to say! Thanks.
As for price, I believe region also plays a part. The vet in Asheville was a board certified orthopedic surgeon. THe cost there was 1800. The cost in a closer more rural area by a vet who was not board certified in anything was over 2K and she wanted our dog to stay in the clinic for a week! Prices can be vary for many reasons.
My biggest reason for pursuing info on PRP is the reduced stress on Dinky. It's killing me to think about him going through any of this.
Anyway, I am looking for board certified surgeons in this area now.
sigh.

What type of repair was $1,800?

In your area you have a great hospital:

BluePearl Veterinary Partners, Grand Rapids
1425 Michigan St NE
Grand Rapids, MI 49503-2027

[ladyjane]

Originally Posted by ladyjane

What type of repair was $1,800?

In your area you have a great hospital:

BluePearl Veterinary Partners, Grand Rapids
1425 Michigan St NE
Grand Rapids, MI 49503-2027

Too late to edit the above post. I said great because Blue Pearl has a great reputation in different states. I do not know first hand about the vets at the place in Grand Rapids....but there are board certified surgeons there. You can search for others at:

www.acvs.org

[pstinard]

There is scientific evidence to support the use of platelet therapy to treat osteoarthritis. I'm not sure about torn ligaments, though. Here are links to a couple of scientific articles about the use of PRP (platelet-rich plasma) to treat osteoarthritis:

Effects of administration of adipose-derived stromal vascular fraction and platelet-rich plasma to dogs with osteoarthritis of the hip joints

A randomized controlled trial of the efficacy of autologous platelet therapy for the treatment of osteoarthritis in dogs

I couldn't find anything about it being used to treat CCL tears, so I'd be cautious and skeptical about whether or not it will work. That said, there are no major dangers other than the regular (minor) risks of being put under anesthesia, so the most you would be out if it doesn't work is time and money.

[pstinard]

Originally Posted by pstinard

There is scientific evidence to support the use of platelet therapy to treat osteoarthritis. I'm not sure about torn ligaments, though. Here are links to a couple of scientific articles about the use of PRP (platelet-rich plasma) to treat osteoarthritis:

Effects of administration of adipose-derived stromal vascular fraction and platelet-rich plasma to dogs with osteoarthritis of the hip joints

A randomized controlled trial of the efficacy of autologous platelet therapy for the treatment of osteoarthritis in dogs

I couldn't find anything about it being used to treat CCL tears, so I'd be cautious and skeptical about whether or not it will work. That said, there are no major dangers other than the regular (minor) risks of being put under anesthesia, so the most you would be out if it doesn't work is time and money.

I forgot to add, if you go through with the procedure, let us know how it turns out. We're always curious about the effectiveness of new treatments.

[Lovetodream88]

I don't think I would be trying something experimental and would do what I know works. Even if for some reason it fixed the CCL it won't fix the LP so you could be at risk for another tear. We know that not fixing the tear can cause debilitating arthritis so do you want to risk that with something unknown?

[dinkster]

Thanks for all of the input. We are putting together all the info. I think we are going to go with a second opinion with a board certified surgeon and see what happens there. The question about the cost of 1800 for his first surgery is that it covered the procedure on one ligament repair and all follow up visits. I think his fee is based on the fact that the majority of his day is filled with surgical patients and surgery, meaning that on the days that he does surgery, he is making far more than a non surgeon would make on those days. He can afford to keep his fee under 2K. Also the region is significant. Asheville is booming right now, but this is still Appalachia. I also want to add that our experience with pricing really underscored my belief that price is not always an indication of quality. Yes, you get what you pay for, but you can also pay more and not get what you paid for. The rural doc was not board certified, not a board certified surgeon, and wanted us to keep Dinky in the clinic overnight for 5 nights after surgery. And her fee did not cover everything.
IN our new situation cost is not the deciding factor. My only issue is that I do not want to have Dinky put under twice because the PRP does not work for him. I also do not want to put him through the pain and recovery of ligament surgery if it can be avoided. I do understand that the surgery offers a mechanical fix. It's done. The PRP can be effective, but it might not be.
Now when it comes to getting another Yorkie...If I did that I would pay for the best bred dog that I could find. The teeth, the knees,,, you'll end up paying anyway and the dog goes through so much. Also, good breeders pay attention to disposition and the way mother dog nurtures them. Well, that's another thread.
I pray, so I'm going to pray for wisdom and clarity on this ligament situation.
In the meantime, Dinky is feeling good. He limps more or less depending on how long he's been resting. Yesterday, I opened the door to let him out and he tried to make a run for it when he saw 3 deer running by in the woods. Well, I was able to grab him, and he was quite sure he scared them off. It did his spirit good. We've had to hide all of his squeaky toys because when he "kills" them, he twists and turns on that leg.

[Lovetodream88]

Originally Posted by dinkster

Thanks for all of the input. We are putting together all the info. I think we are going to go with a second opinion with a board certified surgeon and see what happens there. The question about the cost of 1800 for his first surgery is that it covered the procedure on one ligament repair and all follow up visits. I think his fee is based on the fact that the majority of his day is filled with surgical patients and surgery, meaning that on the days that he does surgery, he is making far more than a non surgeon would make on those days. He can afford to keep his fee under 2K. Also the region is significant. Asheville is booming right now, but this is still Appalachia. I also want to add that our experience with pricing really underscored my belief that price is not always an indication of quality. Yes, you get what you pay for, but you can also pay more and not get what you paid for. The rural doc was not board certified, not a board certified surgeon, and wanted us to keep Dinky in the clinic overnight for 5 nights after surgery. And her fee did not cover everything.
IN our new situation cost is not the deciding factor. My only issue is that I do not want to have Dinky put under twice because the PRP does not work for him. I also do not want to put him through the pain and recovery of ligament surgery if it can be avoided. I do understand that the surgery offers a mechanical fix. It's done. The PRP can be effective, but it might not be.
Now when it comes to getting another Yorkie...If I did that I would pay for the best bred dog that I could find. The teeth, the knees,,, you'll end up paying anyway and the dog goes through so much. Also, good breeders pay attention to disposition and the way mother dog nurtures them. Well, that's another thread.
I pray, so I'm going to pray for wisdom and clarity on this ligament situation.
In the meantime, Dinky is feeling good. He limps more or less depending on how long he's been resting. Yesterday, I opened the door to let him out and he tried to make a run for it when he saw 3 deer running by in the woods. Well, I was able to grab him, and he was quite sure he scared them off. It did his spirit good. We've had to hide all of his squeaky toys because when he "kills" them, he twists and turns on that leg.

I live in Md where everything is crazy expensive. Callie's first LP and CCL surgery was $3000, the LP surgery on the other leg was in the $2000 and then her CCL fix on that same leg was in the $2000. That did include a few physical therapy appointments and rechecks. My surgeon only keeps them one night. They always call me early the next day to come get her early because she won't eat, drink or pee for them. One of the pluses of them being small dogs is one of the night techs would hold her for a long time. You would be surprised to know even some of the best bred dogs can have issues. I'm a big fan of getting pet insurance the day you get the pup. I did that with both of my younger two.

[ladyjane]

Price you pay does not mean you get the best. What I said is that the price didn't sound like what a boarded surgeon would pay....and I said that because I always suggest that people get the opinion of a boarded surgeon. I personally would not allow a general vet to operate on my pup's LP or torn CCLs. . no more than I would allow my family doctor to operate on mine. I DO understand there are some that are better than others...that is why I corrected my post about Blue Pearl....I said that I don't know the surgeons there... and could only say they are boarded and the place has a good reputation.
Good luck with what route you choose to pursue. What I will say is I have had many pups go through knee surgery and they did very well...have not had a failure yet thank goodness. I think it is harder on the parents than the pups.

[dinkster]

So the current status is that We have cancelled the appointment for the PRP injection on Monday.
I talked to two other people about the procedure. Both agreed that this will not mend a ligament tear. ONe was the surgical assistant at the practice where his surgery was done last time. She told me that they never use it to repair ligaments. ever.
ANd the difference in HER knowledge alone was a huge wake up call and reminder about why we went with a board certified surgeon last time.
Now I am working on getting him an appointment for a second opinion at the clinic in Grand Rapids mentioned on the thread. I actually had already found that clinic while searching for board certified vets/surgeons. ANd I appreciate you looking up that info too!
Dinky is not being allowed to walk much. He sometimes does not even limp, but his "improvement" reflects the meds and the rest. I'm sure I won't be getting him in until next week.
I will post what happens next.
Thanks all!
Bottom line: PRP is NOT shown to