Navigating the Twist: Pivot Shift After TPLO

Haka’s Story and Understanding Pivot Shift 

Hey there, fellow senior dog parents! If your wonderful companion has recently had TPLO surgery, you’re likely hyper-focused on their recovery, celebrating every little milestone. I remember those days so well, especially with my own amazing lab mix, Haka. He’s the reason I eventually dove headfirst into the world of canine rehabilitation and became a CCRT. His journey after his TPLO years ago taught me firsthand about a tricky little thing called “pivot shift.”

Things seemed to be going well initially after Haka’s surgery. We followed all the instructions, did our best with the limited knowledge I had back then, and cheered him on with every tentative step. But then I started noticing something… odd. When he’d put weight on his left leg – the one that had the TPLO – his knee would do this strange swing out to the side, away from his body. It was almost a wild, uncontrolled movement.

Honestly, it worried me sick. He didn’t seem to be in pain at that point, but he’d definitely shift his weight onto his right leg. As many of you know, once a dog tears one cruciate ligament, the chances of them tearing the other one skyrocket – somewhere in the 50-60% range. Seeing his weight shift so dramatically was a huge red flag.

For over a year and a half, I was on a mission to figure out what was going on with Haka’s knee. I went back to the surgeon multiple times, tried different things, but nobody could quite pinpoint why his knee moved that way. It was frustrating and honestly, a little heartbreaking watching him compensate. It wasn’t until I started my journey into canine rehab that the term “pivot shift” finally came across my path, and suddenly, during the first portion of my CCRT training it was off-handly mentioned and suddenly everything clicked!

That’s why I’m so passionate about sharing this information with you. Understanding what pivot shift is and knowing the right questions to ask can make all the difference in your senior dog’s recovery journey. Think of your canine rehabilitation therapist as your experienced guide in navigating these potential post-surgical puzzles. We’re here to identify and manage any hurdles, including pivot shift, to help your beloved senior dog live their best, most comfortable life.

Decoding Pivot Shift: What Exactly Are We Talking About?

Let’s get down to the nitty-gritty with a question I know many of you are asking:

What is pivot shift in the context of a dog who has had TPLO surgery?

Imagine a drawer that’s designed to slide neatly in and out. Now picture that same drawer having a bit of wiggle room, allowing it to also slide sideways as you try to pull it out. That’s kind of what pivot shift can be like in your dog’s knee after TPLO.

While the TPLO surgery does an amazing job of leveling the top of the tibia (the big bone in the lower leg) to stop that forward sliding of the femur (the thigh bone), it primarily tackles front-to-back instability. Pivot shift is different. It’s a more subtle rotational instability within the knee joint. Even with a perfectly leveled tibia, there can still be this slight abnormal movement where the femur twists inwards on the tibia, causing that feeling of the knee “giving way” or shifting sideways, just like I saw with Haka.

It’s so important to know that pivot shift happening isn’t necessarily a sign that the surgery failed. It can be due to a bunch of different things – your dog’s individual anatomy, how their muscles are trying to compensate, or even how severe the initial ligament tear was. The key takeaway is that it’s about this subtle instability beyond just the forward and backward motion we initially focus on after surgery.

Recognizing Potential Signs

You know your dog better than anyone, and your observations at home are pure gold. This leads us to a crucial question:

What are the signs or symptoms I should watch for at home that might indicate a pivot shift?

Keep a close eye out for these clues – they’re the things I wish I’d known to look for with Haka:

• Subtle lateral (sideways) movement or “giving way” of the knee: This might be most obvious when your dog is turning, especially at a slower pace. It might look like a little shift or wobble in the knee joint, just like Haka’s wild swing.
• Muscle wasting (atrophy) around the affected knee, especially on the outer side: If certain muscles aren’t being used correctly because of the instability, they can start to shrink.
• Persistent or intermittent lameness that doesn’t seem to fully go away with standard post-operative recovery: While some stiffness is normal, a recurring limp or reluctance to put full weight on the leg could be a red flag.
• Reluctance to put full weight on the leg in specific situations (e.g., turning): You might notice your dog favoring their other leg more when they’re navigating turns or walking on uneven ground.
• An unusual gait or way of compensating: They might develop a slightly different way of walking or running to try and protect that unstable knee.

Please, trust your gut. If you see something that just doesn’t look right, don’t hesitate to bring it up with your veterinary team. My experience with Haka taught me that those little observations can be incredibly important.

The Bigger Picture: How Common is This?

This is a question I know is on many of your minds:

How common is pivot shift after TPLO surgery in your experience?

From my perspective as a rehab therapist, and reflecting on my own journey with Haka, pivot shift isn’t the most common thing we see after a well-done TPLO, but it’s definitely something that pops up. While research studies might give you specific numbers, my real-world experience tells me it’s something we need to be aware of, especially in certain types of dogs. It can be a bit frustrating when it happens, adding another layer to the recovery, but it’s absolutely something we can work with using the right rehab strategies.

Who’s More at Risk? Understanding Potential Predispositions

Knowing if your dog might be more likely to develop pivot shift is another common concern:

Are there certain factors (breed, size, activity level before surgery, etc.) that might make my dog more prone to developing a pivot shift post-TPLO?

Yes, there are definitely some things that can make a dog more susceptible:

• Breed predispositions: We tend to see it more often in larger, more muscular breeds like Labrador Retrievers (like my Haka!), and breeds like Rottweilers or American Staffordshire Terriers. Their powerful muscles can sometimes generate more significant rotational forces.
• Larger or more active dogs: These guys generally put more stress on their joints, which can potentially highlight any subtle instability.
• Dogs with pre-existing compensatory gait patterns: If your dog was compensating for that torn ligament for a while before surgery, they might have developed movement habits that contribute to rotational instability.
• Potentially the severity of the initial tear or other concurrent joint issues: In some cases, a more complex tear or the presence of other conditions like early arthritis might play a role.

Understanding these potential risk factors helps us tailor the rehab plan from the get-go and be extra vigilant during our assessments.

Inside the Rehab Clinic: How We Assess for Pivot Shift

You might be curious about what happens during your dog’s rehab sessions:

How will you assess my dog for the presence of a pivot shift during our therapy sessions?

As a veterinary rehabilitation therapist, I use a few key methods to check for pivot shift:

• Palpation techniques: I’ll gently manipulate your dog’s knee joint, feeling for any abnormal sideways or rotational movement. This takes a trained and sensitive touch. It’s the kind of assessment that finally helped me understand what was happening with Haka.
• Gait analysis: I’ll carefully watch how your dog walks and moves, looking for any subtle asymmetries, limping, or unusual ways they’re using their leg. That sideways swing Haka had was a big clue.
• Specific functional tests: Certain movements, like slow turns or stepping over low obstacles, can sometimes make the pivot shift more obvious.
• Observation during exercises: I pay close attention to how your dog’s knee behaves during different therapeutic exercises.

If We Suspect Something: The Diagnostic Pathway

If I suspect a pivot shift, here’s what the next steps might look like:

If you suspect a pivot shift, what other diagnostic steps might be necessary (e.g., communication with the surgeon, further imaging)?

Teamwork is so important here! The first thing I’ll do is talk to your dog’s surgeon about my findings. We work together to figure out the best plan. Depending on how much instability there is and how your dog is progressing overall, the surgeon might recommend more tests, like repeat X-rays or even more advanced imaging like an MRI, to rule out other issues or confirm the pivot shift and see how significant it is.

The Power of Rehab: Addressing and Improving Pivot Shift

This is where the magic of rehab really comes in, and it’s what made such a difference for Haka:

Can a pivot shift be addressed or improved with canine rehabilitation therapy? If so, what specific exercises or modalities might be beneficial? What is the rationale behind your treatment plan for this specific issue?

Absolutely! Canine rehabilitation is crucial for managing and improving pivot shift. Our main goal is to build up the dynamic stability of the knee. Think of it like strengthening the muscles and soft tissues around the joint so they become better at controlling movement. Here are some of the things we might do:

• Strengthening muscles that dynamically stabilize the knee (e.g., hamstrings, gastrocnemius, quadriceps): Specific exercises help build strength in the muscles that control rotation and prevent that unwanted sideways movement. For Haka, exercises like controlled weight shifts and resistance band work were key.
• Proprioceptive exercises to improve balance and awareness of limb position: These exercises, like having your dog stand on slightly wobbly surfaces, help their brain better know where their leg is in space, which improves their ability to stabilize the joint during movement.
• Controlled, low-impact exercises to encourage proper movement patterns: Activities like slow leash walks and underwater treadmill work help retrain a normal way of walking and reduce any compensatory movements.
• Modalities like laser therapy or manual therapy: These can help with any pain, inflammation, or muscle imbalances that might be contributing to the instability.

The whole idea is to create a strong “muscular brace” around the knee that can compensate for any lingering mechanical instability. It’s what helped Haka regain so much stability and confidence in his leg.

Adapting the Plan: A Tailored Approach

Just like every dog has their own personality, their rehab plan needs to be unique too:

Will the rehabilitation program be adjusted if a pivot shift is identified? How will the exercises differ from a standard post-TPLO rehab protocol?

Definitely. If we find a pivot shift, your dog’s rehab program will be specifically designed to tackle it. While we’ll still do many of the standard post-TPLO exercises, we’ll put extra emphasis on:

• Increased focus on rotational control exercises: We’ll incorporate exercises that specifically challenge and strengthen the muscles that control rotation in the knee.
• More emphasis on strengthening specific muscle groups: We might focus more intensely on the muscles on the outer side of the leg that help prevent that sideways movement, like the ones that were weak in Haka.
• Potentially slower progression of certain exercises: We want to make sure your dog is truly stable and comfortable before moving on to more challenging activities.
• Careful monitoring of the knee’s response to different activities: We’ll keep a close eye on how the knee reacts to various exercises and adjust things as needed.

Looking Ahead: What’s the Prognosis?

It’s natural to wonder what the future holds for your furry friend:

What is the prognosis for a dog who develops a pivot shift after TPLO and undergoes appropriate rehabilitation?

Generally, the outlook for dogs with post-TPLO pivot shift who get consistent and targeted rehab is really good. While some dogs might still have a tiny bit of subtle instability, many can get back to enjoying comfortable activity levels and have a fantastic quality of life. It takes patience, sticking with the home exercises, and keeping in touch with your rehab team. Haka is a perfect example – with dedicated rehab, he regained so much stability and lived a happy, active life for many more years.

Home Management: What to Avoid

Your role at home is so important in protecting that recovering knee:

Are there any exercises or activities I should absolutely avoid at home if a pivot shift is suspected or confirmed?

Yes, to keep your dog’s knee safe, it’s best to avoid:

• Sudden twisting or turning movements: These can put a lot of stress on that already somewhat unstable joint.
• High-impact activities (jumping, hard running) without proper strength and control: These can make the instability worse and potentially lead to other injuries.
• Uneven terrain or slippery surfaces initially: These can challenge their balance and increase the risk of the knee giving way.
• Activities that consistently seem to make that sideways movement more noticeable: Pay attention to what makes your dog seem less stable and try to avoid those specific movements.

Tracking Progress: How We’ll Monitor

We’ll be keeping a close eye on how things are going during our sessions:

How will we monitor the progress of the pivot shift (if present) during our therapy sessions? What are the indicators of improvement or lack thereof?

We’ll regularly check your dog’s knee stability with our hands and watch how they move. Signs that things are getting better include:

• The knee feeling more stable when we palpate it.
• Your dog walking more evenly and putting weight on the leg more confidently.
• Their muscles getting stronger and their balance improving.
• Your dog seeming more comfortable and willing to do more activities.

If we’re not seeing the pivot shift improve, or if your dog is still limping or seems unstable, that’s a sign we need to re-evaluate our approach.

When to Re-Engage the Surgeon

Knowing when to seek further medical advice is key:

At what point should we consider further intervention (e.g., consulting the surgeon again) if the pivot shift is not improving with therapy?

We would definitely talk to your dog’s surgeon again if:

• We’re not seeing any real improvement in the pivot shift despite consistent rehab efforts.
• The instability or limping gets worse.
• New or concerning symptoms pop up.
• We suspect there might be a structural issue that rehab alone can’t fix.

Long-Term Strategies: Minimizing Future Impact

Thinking long-term is always a good idea:

Are there any long-term management strategies for a dog who has experienced a pivot shift post-TPLO to prevent recurrence or minimize its impact?

Yes, for long-term management, we’ll focus on:

• Keeping up with a consistent home exercise program to maintain muscle strength and stability.
• Avoiding high-risk activities without proper warm-up and conditioning.
• Regular check-ups with your vet and maybe occasional “tune-up” sessions with your rehab therapist.
• Keeping your dog at a healthy weight to reduce stress on all their joints.

Open Communication is Key

We’re all on the same team, working towards the best for your dog:

How will you communicate your findings regarding pivot shift (if any) to my dog’s surgeon? A collaborative approach between the rehab therapist and surgeon is ideal.

I will always keep your dog’s surgeon in the loop about my findings regarding pivot shift. Clear communication between us is essential for making the best decisions for your furry family member.

What is the best way for me to communicate any concerns I have about potential pivot shift symptoms I observe at home?

Please, please reach out if you have any concerns! The best way is usually to give me a call or send me an email. Be as detailed as you can about what you’re seeing, when it happens, and what activities seem to bring it on. Your insights are invaluable.

Working Together for a Stable Future

My journey with Haka taught me so much about the nuances of post-TPLO recovery, especially this tricky thing called pivot shift. By being observant, asking the right questions, and working closely with your rehabilitation team and surgeon, you’re taking such important steps to ensure your senior dog has the most stable and comfortable future possible. Remember, we’re in this together, and open communication is key.

Please don’t hesitate to schedule your dog’s rehabilitation appointment and bring all your questions with you. We’re here to help your wonderful senior dog navigate any twists and turns and get back to enjoying all the joys of their golden years!