Choosing a surgeon (acl rupture Questions To Ask)

Experience versus Credentials

The The Shouldice Hospital outside Toronto is a group of surgeons who specialize in hernia repairs. They have the shortest surgical time and least percentage of recurrence. All they do are hernia repairs and not one of them is a board certified surgeon. Why go through all that training to learn all aspects of surgery when all they do is hernia repairs?

Some non-boarded surgeons who do the same type of surgery over and over again are very accomplished at what they do and have similar outcomes to their boarded counterparts. Be wary of anyone who calls themselves a “surgical specialist” without clearly declaring whether they are boarded or not. Boarded surgeons are highly trained and qualified and no one should be “masquerading” as a boarded surgeon when they are not. All boarded surgeons will have the designation DACVS after their name.

Here are some important questions to ask anyone offering to do surgery on your pet:

1. 
   Are you a board qualified or certified surgeon?
   
2. 
   Did you complete any advanced training?
   
3. 
   Which procedure will you be doing on my pet? (See handout Cruciate Surgery Options)
   
4. 
   How many of these procedures have you done?
   
5. 
   How long have you been doing this procedure?
   
6. 
   What complications have you had and in what percent of the cases?
   
7. 
   Do you run a pre-anesthetic blood test to screen for underlying conditions?
   
8. 
   Do you wear a cap, mask and gown during surgery?
   
9. 
   Will my pet have an IV catheter and fluids during surgery?
   
10. 
    Do you give intravenous antibiotics for the surgery and if so, before, during or after?
    
11. 
    Will my pet be on a warming blanket or fluid warmer during surgery? (Electric heating pads can malfunction and burn your pet)
    
12. 
    Do you monitor my pet while they under anesthesia with pulse ox, CO2, ECG, blood pressure and temperature? (Blood pressure and CO2 are the most sensitive to anesthetic problems that can arise and many veterinarians do not have these expensive monitors)
    
13. 
    What pain management do you utilize? Do you offer epidurals with morphine?
    

1. 
   Are you using nylon or Fiberwire for your repairs? (Nylon stretches and breaks and many specialists are now using Fiberwire which does neither.)
   
2. 
   Where are you drilling the hole in the tibia, in the tibial tuberosity or under Gerdy’s tubercle? (Gerdy’s tubercle is the new position for the hole as the old location was not isometric and led to suture stretching and breakage and loss of range of motion.)
   
3. 
   Are you doing an arthrotomy to check the meniscus, check the synovium, and clean out the torn ligament? (Some surgeons cut costs by just placing the suture outside the joint not inspecting the joint, which is critical to success.)
   
4. 
   Will you inspect the synovium for inflammation and biopsy it if necessary to rule out immune mediated synovitis?
   
5. 
   Are you performing a meniscal release? (This can prevent future meniscal tears but also increases post-operative osteoarthritis)
   
6. 
   Do you have specialized equipment like a stifle retractor, meniscal mini-blade (6400), meniscal clamp, and tensioning device if using medical grade fishing line?
   
7. 
   Do you do an epidural with preservative free morphine before surgery to help control pain?
   
8. 
   Do you dissect away the biceps femoris muscle before placing the suture around the fabella bone? (Not doing this entraps muscle in the suture which causes loosening post-operatively.)
   
9. 
   Do you remove any osteophytes that may have formed? (Many surgeons believe this helps the tissues glide smoothly over the joint by removing them and it is done in people.)
   
10. 
    Do you utilize magnification and head lamps to improve visualization of the inside of the joint during surgery?
    
11. 
    Do you offer physical therapy after surgery?
    
12. 
    Do you have a go home handout for me with detailed home care?
    
13. 
    How well are your patients using the leg at suture removal in ten to fourteen days? (Most should be minimally weight bearing by this time)
    

Since studies have shown that most of the twenty two (22) techniques available for cruciate rupture have identical outcomes at six months, you should focus on cost and complications as well as how quickly they return to function. Additionally, for agility or working dogs, long term osteoarthritis must be considered and TPLO and Tightrope seem to have the best outcome for minimal OA.