Species: dog
Breed: Crossbreed
Sex: f, neutered
Weight: 37.3 kg
Birth date: 2018-05-03 00:00:00
Primary diagnosis: Cranial cruciate ligament disease left
Situation: Pre-surgery
Medical history: The dog was presented to our clinic on 11.11.2024 for a consultation and with a TPLO surgery already planned on the 12.11. The dog was presented to the private vet on 21.10.2024 for acute lameness of the left hindlimb. On 23.10.2024 radiographs were taken under sedation, the drawer test was positive and there were signs of osteoarthritis of the left knee. Therapy with Canidryl (Carprofen) 4 mg/kg PO SID was started. In spring/sunmmer 2024 the dog showed a lameness, so on 31 July 2024 the dog underwent a series of x-rays of the hips and knees which revealed bilateral osteoarthritis of the knees and hip dysplasia; therapy with Fortiflex 525 mg was then started. At our clinic on 11.11 x-rays were taken --> report: Moderate increased joint distention stifle left with mild stifle joint osteoarhtrosis; Severe cranial subluxation of the tibia; Mild tarsocrural osteoarthrosis; Focal well defined mineral opacity in the soft tissue craniodistal to the tibia and medial to talus; Irregular new bone formations tibial tuberosity --> Findings compatible with cranial cruciate ligament disease, with complete rupture; Well defined mineral opacities in the soft tissues could represent dirt or some dystrophic mineralization; New bone formations at the tibial tuberosity may suggest a enthesiopathy tibialis cranialis. On 12.11 an arthroscopy + TPLO was performed and on 13.11 the dog went home.
Medication: Before presentation: Fortiflex PO SID (in the evening), Carprofen 4 mg/kg PO SID (in the morning). 11.11 as premedication for x-rays at 12:45: Medetomidin 0.015 mg/kg IM, Methadon 0.2 mg/kg IM. 11.11 at 14: Acepromazin 0.005 mg/kg IV. 11.11 at 15: Meloxicam 0.2 mg/kg IV. 12.11 (no medication before observation 3): Ampicillin 30 mg/kg IV TID (started during surgery), Meloxicam 0.1 mg/kg IV SID, Trittico 5 mg/kg PO at 17, Gabapentin 10 mg/kg PO at 17, Methadon 0.1 mg/kg at 15 then switched to Buprenorphin 0.015 mg/kg TID (started at 17). 13.11 (nothing given before observation 6): Ampicillin 30 mg/kg IV TID, Meloxicam 0.1 mg/kg IV SID, Buprenorphin 0.02 mg/kg IV at 09, Paracetamol 10 mg/kg IV at 13, Gabapentin 8 mg/kg PO TID.
Anesthesia: Intervention on 12.11.2014: Arthroscopy & TPLO left. Premedication at 08:15: Methadon 0.2 mg/kg IM, Medetomidin 0.007 mg/kg IM, Acepromazin 0.007 mg/kg IM. Induction: Propofol 2.7 mg/kg IV. Maintenance: FiO2, Isofluran. Analgesia: local anaesthesia Femoralis / Ischiadicus block Ropivacain 8.4 mL. Antibiotics: Ampicillin / Sulbactam 30 mg/kg IV. Wake up phase: postoperative sedation Medetomidin 0.002 mg/kg IV.Intervention duration: 210 min. Anaesthesia duration: 300 min.
Orthopedic exam: On 11.11.2024. Forelimbs: unremarkable except for slight pain on both sides while testing the Coronoid. Hind limbs: slight muscle atrophy comparing left to right; Knee moderately filled on left side compared to right, with also medial buttress, drawer test left positive, right negative, tibia compression negative on both sides while awake, hip rotation while awake clearly uncomfortable on both sides (R>L), hip extension only possibly uncomfortable on both sides; Under sedation tibial compression and drawer positive on the left, negative on the right, ortolani signs on both hip joints.
Pain type: acute, chronic, orthopedic, somatic
Pain origin: hind legs
Pain duration: More than 7 days
Estimated pain severity: 31