Mulligan’s Bad Knees: Specialist Collaborations in Orthopedic Disease

Sponsored by VCA

THE CASE

Mulligan, an 8-year-old hound crossbreed, was presented to his primary veterinarian for left hindlimb lameness. On examination, he was diagnosed with a partial cranial cruciate ligament (CCL) rupture of the left hindlimb. At that time, Mulligan’s owners elected rest and pain medications.

Mulligan was presented again ≈1 year later for similar, intermittent signs of lameness in the same limb. Medical management was repeated. Due to the chronicity of the situation, the primary veterinarian discussed the need for further evaluation and additional treatment options (eg, surgery), particularly if signs persisted.

Unfortunately, medical management could not control Mulligan’s signs and disease progression. His lameness persisted, and he began to develop muscle atrophy in the affected leg. Because Mulligan’s owners did not want to elect to perform surgery, the primary veterinarian referred him for physical rehabilitation through a VCA orthopedic specialty center. The primary veterinarian ensured that the owners were well-informed about Mulligan’s treatment options and that they understood that surgery would be needed if rehabilitation did not result in an acceptable level of function and comfort for Mulligan.

During Mulligan’s rehabilitation period, little progress was made. He also suffered an acute CCL rupture in his right leg. However, the owners reported great experiences with VCA during Mulligan’s rehabilitation time, as well as satisfaction with the communication and collaboration efforts among the primary veterinarian, specialty center, and themselves. As such, they were comfortable with the decision to have Mulligan referred for surgery within the specialty center.

A tibial plateau-leveling osteotomy procedure was performed on the acutely affected right leg. Considering the positive experiences Mulligan’s owners had with VCA’s rehabilitation program and staff, the owners and the primary veterinarian elected to pursue additional physical rehabilitation during the postoperative period to further encourage Mulligan’s progress.

After completion of surgery and rehabilitation, Mulligan’s improvement was significant. He demonstrated minimal pain in both stifles and was able to ambulate normally.

Conclusion

Meeting the needs of both owners and the pet can be difficult when primary medical recommendations are not an initial option. Fortunately, in this case, both the primary veterinarian and the VCA specialty hospital were able to work together to provide the best outcome possible for Mulligan and his owners.

During Mulligan’s extended care with the VCA orthopedic specialty center, the primary veterinarian and owners received numerous updates, including his time during rehabilitation and the pre- and postoperative periods. The owners were able to collaborate and follow up with the primary veterinarian for monitoring, medication, and blood work as needed. Both the owners and the primary veterinarian expressed positivity and appreciation for the expertise and ease in working with the VCA specialists.

Mulligan’s owners were happy with his improvement and are now considering surgery for his chronic CCL tear. A significant reason for their level of satisfaction was due to the collaboration and communication efforts from everyone involved. The owners were well-appraised of the extent of Mulligan’s disease and were kept informed so they know what to expect with medical management and rehabilitation. The mutual respect of the referring veterinarian and the specialists aided in maintaining the owners’ trust for knowing when to move forward with tibial plateau-leveling osteotomy.

Outcomes such as Mulligan’s are excellent examples of how collaboration, communication, accessibility, and respect among specialists, the referring veterinarian, and pet owners can lead to improved health and quality of life in patients.