Additionally, once a dog has a CCL tear in one knee, there is a 25-50% chance that the other knee will tear in the next 12 to 16 months. help@toegrips.com Symptoms include shoulder pain and instability. Best of luck to you and your precious Jasmond. Conservative Maintenance worked for a while and interestingly enough, after the surgery, his lifestyle is pretty much according to those same guidelines. I was already doing some of the things mentioned (no activity, anti-inflammatory). If you can take her to the specialist and discuss your options, I think you will be much happier, and so will she. Our walks are down Dr. Buzbys ToeGripsinstant traction for senior and special needs dogs who struggle to walk on slippery floors. This increases stability in the knee joint, which is lacking the cruciate ligament. Daily uses: Pushing down car pedals; Example strengthening exercises: Tibialis posterior exercise with band. But anterior is used in humans and cranial refers to the same direction/position in animals. Hello Cindy, Im so sorry to hear that you and your dog have been through all of this! Having a clearer idea of recovery makes me feel a bit better. The cost of the TTA is comparable to the TPLO. HUGELY different healing times and prognosis. The tibial tubercle (the tuberosity of the tibia) is the protuberance along the anterior aspect of the tibia, just distal to the anterior surfaces of the medial and lateral tibial condyles. Rupture of the calcaneal (Achilles) tendon is common among people playing recreational sports. For health-related questions, always consult your veterinarian, as they have examined your pet, know the pet's health history, and can make the best recommendations for your pet. We live on the second floor so I carry his 50 pound body up and down the stairs. (The yoga mats you mentioned are great under the window.). If the lameness is not super obvious, I take my patients out to the parking lot and ask the owners to pretend like they are in the ring at Westminster, so I can watch the dog travel at a walk and a trot. Example strengthening exercises: Calf raises. Knees are very fixable. Its not the easiest, but hang in there, and best of luck to you and your dog! It is caused by repetitive strain of the muscle, resulting in cartilaginous and bony metaplasia. from one day to the other? The details of this method are slightly different from a TPLO, but the TTA still involves cutting the tibia and placement of metal implants. The funny thing is, I had another dog about 10 years ago who had cancer and had a leg amputated. The patellar apprehension test is performed supine with the knee in slight flexion (enough to engage the patella in the groove) and the quadriceps in a relaxed state. MSM from a good quality source Incredibly lousy vet. Injury to the patellar tendon generally requires a significant force such as falling directly on the knee or jumping from a height. Before I tried conservative management but it didnt do the trick. I have really appreciated reading about other peoples experiences to help guide me and my dog through such a discouraging and nerve-wracking time, so wanted to share what weve been doing. 28.6 ); also, medial and lateral cuts should be performed defining the proximal osteotomy limits. It sounds like he has a very nice life with his own room, mattress, toys, etc and lots of love! But, I have loved her above beyond crazy and have kept her near me and with me since then. I dont like the things I have been reading about TPLO, seems too costly and too risky, not to mention very invasive. Learn the signs, symptoms, surgery and treatment options in Dr. Buzby's ultimate guide. Did you stick with CM? He has one or two more sessions to go (he was considered cured after one but is still a little tender so we will do at least one more) and 3 prolo sessions cost about the same as a surgery, with the same result, and less risk. I freaked, cause I knew this was not good. The incision for anteromedialisation should be at the lateral aspect of the TT, 10 to 12 cm long. Both times he started to tip toe. Not all grades of HD do require surgery, lower grades do well with weight and exercise control and arthritis treatments. Any suggestions? Trauma may result in a fracture, bone bruise or cartilage injury. HHS Vulnerability Disclosure, Help My 2 year old chocolate lab had acl surgery 12 weeks ago. eCollection 2020. I hope she will get use to this, but even this scares me. Shes absolutely perfect now. Pain at the top of the shin (tibial tuberosity), just below the kneecap, is the main symptom that becomes swollen and inflamed. Unfortunately, no studies exist that compare this option to others, so it remains up for debate. It is now a complete tear, or a rupture. Most often this is 1 or 2 cm distal to the medial calcaneal tuberosity. In conjunction with the soleus muscle, it is a component of a composite, three-headed group of muscles referred to as triceps surae. After doing exams for many years, most vets get pretty good at being efficient and fast. Even taking him out on the leash to go potty is an adventure he likes to take the leash and walk himself, so he ends up doing a lot of twisting and turning. He then tore the other not too long after and it healed with conservative management as well. I am beginning to feel very guilty for not pursuing a more intensive healing program. The axial view allows for the assessment of the alignment, tilt and subluxation and degree of PF arthritis. We are doing conservative maintenance now and he is slowly improving. Although medial contact pressure and tracking altered with progressive tibial tuberosity medialisation, the changes were smaller. The rest of the room is pretty much covered with an area rug but your idea is great!. Ive read about braces but there are many to choose from and all say theirs is the best. Innervation: Tibial nerve. It is challenging to assess cranial drawer in an awake dog who is painful. Conservative management and surgery do similar things but if your dog really does have a torn ligament, you are better off helping the arthritic changes be clean and effective with surgery, unless you have a small dog in which case, the results are generally the same whether youve done CM or surgery. The history should include characteristics of the patient's pain, mechanical symptoms (locking, popping, giving way), joint effusion (timing, amount, recurrence), and mechanism of injury. A force equal to almost three times the body's weight passes through the foot with each step. I can hardly breath.. My 5 year old 90lb goldendoodle has blown both knees, With X-rays weve learned he has arthritis in his spine, hips and hip displacia (sp) in both hips. Signs and symptoms of a high ankle sprain The difficulty with these types of injuries is that they are often associated with severe lateral or medial ankle sprains or fibular fractures. A retrospective review of operatively treated tibial tubercle fractures at our institution from 2003 to 2010 was performed. However, with a single 2-dimensional (2D) view, there may be a risk that the degree of injury can be underestimated. The history should include characteristics of the patient's pain, mechanical symptoms (locking, popping, giving way), joint effusion (timing, amount, recurrence), and mechanism of injury. Developed as an alternative to the TPLO and TTA, which cut and rearrange the dogs tibia, this technique uses an implant to create stability. I appreciate your story as I too would regret if CM didnt work and the problem became worse. In general I dont recommend knee braces because it seems like many of them dont work as well as we would like or expect due to the differences in how a dog stands and how a human stands. With that being said, as long as the x-rays are in your budget, I would proceed with the recommendation of your vet based on the exam findings. She was awarded the Robert S. Brodey Memorial Award for outstanding oncology research from the Veterinary Cancer Society. Actions: Hip extension. Privacy Policy | Return Policy | Shipping Terms He is starting hydro therapy next week. J Trauma Acute Care Surg. In a series of 22 knees with concomitant lateral retinacular release performed in 15, the average Lysholm score improved from 63.3 to 98, the patellar tilt angle improved from 9.4 degrees to 5.5 degrees and there were no redislocations. As with any orthopedic surgery, it is common for dogs to developarthritisin the future. A force equal to almost three times the body's weight passes through the foot with each step. 28.7 ; see Fig. PSS In case you need to know, Overstock has Regalo brand extra tall pet/baby gates that you lift a latch to open and walk through. The most common adolescent injury to this area is Osgood-Schlatters disease, which affects the distal pole of the patellar tendon and tibial tubercle. So in trying to decide to do surgery or CM, after reading about all of you guys that have taken that road I figured, what the hell. Proximally, the lateral and medial heads of gastrocnemius form the inferior boundaries of the popliteal fossa. Its a bit cheaper and can often help you avoid surgery altogether. In comparison, Baileys right knee looked normal. Good news on your guy, Ann! My 15 month old shepherd mix has a slight ACL tear. Dont give up on him, judge him with your gut, not your eyes. It gives attachment to the patellar ligament or patellar tendon. It is commonly the result of long distance running, basketball and tennis, where excessive friction caused by the movement of the tendon leads to inflammation. Jasmonds story began about 8 days ago. We didnt listen to her and we are glad we didnt. I never regretted buying her wheels. I have been researching like crazy since Sasha, 9 yo Australian/blue heeler mix, was diagnosed yesterday with an ACL tear at the emergency clinic. Ask the patient to point to the location of pain. He didnt get scar tissue because his knee was unstable; the vet didnt tie the line tight enough. To control the pain he took Tramadol and was later switched to Rimadyl. Outcomes and Complications of Tibial Tubercle Fractures in Pediatric Patients: A Systematic Review of the Literature. How is your dog doing? Long story short, she has blown her ACL and I am devastated. Randy, his pet parent, noticed that Bailey was favoring his left hind leg. It was originally 3500 which is still much less than 4000. Especially in dogs with a sudden acute injury, limping is the most common and easiest sign for owners to notice. Easiest to have 2 so one can be in there all the time. Is this a sign that maybe she isnt healing as well as we had hoped? The good new is, I am scheduling her surgery for two weeks from tomorrow I pray she recovers well and the surgeries are uneventful with successful results! World J Pediatr Surg. Because the patella joint surface and the anterosuperior aspect of the tibia are not always aligned in patients with PF instability and patellar subluxation, performing the measurement in the MRI may require selection and use of more than a single slice; also, the anterosuperior aspect of the tibia is less clear on the MRI. A standard radiographic series should be performed for all patients with suspected PF pathological conditions. In addition to obtaining a complete blood count with differential and an erythrocyte sedimentation rate (ESR), arthrocentesis should be performed. Some things are true about pit bulls-they are resilient. Based on your post, it sounds like you are thinking about having the TPLO done at a specialty hospital where I am guessing they would have an anesthesia department. Spinal cord injury or disease at the thoracic levels with neurological involvement of both the upper and lower limbs is rated within Chapter 19, Activities of Daily Living. It can look like a lump under the kneecap, on the tip of the shin bone. Even though anterior and cranial are basically synonyms, the term is different between humans and dogs. I had surgery. I definitely will try the information given on that site. We will give this crate time out 8 weeks to see how she is recovering. With an osteotome the proximal cut should be performed just proximal to the patellar tendon (perpendicular to the long axis of the tibia or oblique) ( Fig. Dimitrios Mytilinaios MD, PhD Hang in there- it will be worth it. Our preference, and that of most PF surgeons, is the CD index, because this measurement is not linked with the TT position and therefore will change with a TTO. 3 months later, she now has a partial ACL tear. My father is in the hospital just had colon cancer surgery and I havent been able to tell him about our dog yet. Hes also diabetic and his recent x-rays show evidence of arthritis on his left hip (good side). Right away, I took all the cushions off the couches and chairs so, if she actually did try to jump up, it would be very close to the ground and there would be no way to climb up to jump off the back. Like you, his walk back to the house it through the yard. Hope your dog is doing better now! Money is not the issue for the surgery, but he was born deaf and also has never been cratedthe idea of intense pain plus the isolation of the first two weeks is just something my wife and I are unwilling to do unless absolutely necessary. Symptoms may include pain, swelling, bruising, and an inability to walk on the injured leg. Thats all part of the conservative maintenance bit and I think in general has helped his success. Eventually it will be over , Thanks so much for the information and the words of encouagement. Just as Ann illustrated below, I worry that either through CM or through his recovery from surgery, his other knee could tear also due to taking up the slack. However, we recommend a more conservative approach, so that abnormality is set by mean + 1 standard deviation (SD; 22.8 mm) or + 2 SD (26.8 mm) from the control population, meaning 16% and 2.5% of the control population would be greater than that limit with a normal distribution, respectively. Are there varying degrees (movement) of positive drawer test? So not to worry. He or she may talk with you about some of these treatment options: Also, treatment options will vary depending on the size of dog and the type of tear (partial versus complete). Your veterinarian may discuss one or more of the following surgical treatment options with you: As a veterinary student, I was taught about the tibial plateau leveling osteotomy procedure, which is commonly called TPLO surgery for dogs. Help your senior dog enjoy more good days. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture.It is also used to correct a coxa vara, genu valgum, and genu varum.The operation is done under a general anaesthetic. We dont want the dog suffering, but if we have a chance to save him we want to, we just dont know what to do its so confusing. Please let us know. If the meniscus is loose enough to flip around the joint, there is usually something more serious at work. Does he want to eat? He goes straight out the back door to go potty. CM for him was confinement to two carpeted rooms, no running, no jumping to catch balls, no jumping up on furniture, etc. What does bed rest actually mean in this case? Take care. In July he started limping periodically so I gave him Rimadyl daily and took it easy again. CM refers to Conservative Management, essentially what you did with Bijou. found that trochlea dysplasia was the most important risk factor for focal cartilage lesions in the PF joint, followed by patella alta (CD > 1.2 was present in 25% of patients). For PF pain or arthritis, 83.3% of patients have been shown to return to one or more sporting activities at an average of 7.8 months after surgery. In the lower leg, the muscle fibers of gastrocnemius gradually form a broad aponeurosis. We walk around in the yard on leash so he can sniff. Daniel first, you should be so proud that your dog is over 17 years old. Daily uses: Bending the knee to step over something. The gait cycles consists of a stance phase and a swing phase. Like the pet parents on the other posts I read, I was heartbroken, especially since Jaspers favorite stimulation is going for walks. Julie. As this ligament weakens, it wears down and becomes more fragile. If good muscle tone doesnt help, sometimes a surgery to deepen a groove in the bone to keep the knee cap in place can help. I have a medium sized dog border collie/australian shepherd mix (13-1/2) with a torn acl on the right. He is extremely large. Two years later my dog is back to being 100% functional: chasing frisbees, balls, playing with other dogs, running full out, etc. This new vet gave him an antiinflammatory (1st vet refused to) in addition to his tramadol for pain and that seems to have helped a lot in making him more comfortable until we can get him in for surgery. A ruptured cruciate is a painful and immobilizing injury. I feel between her age and health issues, it is really not something that is even good for her. Jenna has also written for DMV 360 and DogTime. In patients with intra-articular involvement, consistent 3D fracture patterns were seen on CT including anterior fragments (sagittal plane), lateral fragments (coronal plane), and anterolateral fragments (axial plane). Did your vet tell you to give that much? I just got home from the vet this morning. Hi Jennifer. The rest of the time should be spent resting in a crate (ideally) or resting on a comfy bed right beside them with no chances to jump up or down off furniture, roughhouse with other pets, run through the house, etc. Since then, it has been updated with the most current information and recommendations. , Regarding TTO as an associated procedure, when TTO was performed selectively to correct maltracking, various authors found no differences in clinical outcomes between patients with and without TTO in association with autologous chondrocyte implantation (ACI), scaffolds and particulated juvenile articular cartilage (PJAC). , Afterwards a thigh tourniquet should be used to improve visualisation and decrease blood loss during anteromedialisation. Increased pain at the tibial tuberosity with sports activity. I would reccommed it to everyone. Both have worked wonders. It really does help to know others are going through this gives me hope. Jasmine was going to bathroom outside the whole time. You may be wondering what happened to my veterinary patient Bailey. It was absolutely worth it, and typically, it is one of the cheaper surgeries. I bought a back on track wrist band for people, it is supposed to increase circulation and reduce swelling. And her leg was so so so swollen all the way down to her paw. WebTibial tuberosity advancement (TTA) is one of the surgical repairs that alter knee anatomy to achieve stabilization. If they have a partial tear, it often becomes a complete tear. I remember caring for him post-op and all that went along with it, but for some reason I could not remember that part. There is no consensus on the parameters or measurements (e.g., TT-TG distance, CD index, etc.) Hi. The TTA may have a faster recovery than TPLO, as well, though some surgeons see little difference. Occasionally, the patella will slide out of place. Calcaneal bursitis involves inflammation of the bursa that separates the calcaneal tendon from a process of the calcaneus called the calcaneal tuberosity. Jasmine had undiagnosed knee problems also (until finally diagnosed and corrected) and she did develop arthritis in her shoulders as a result of the long term compensation. Its been 6 months since you posted. My 3 year old VERY active aussie/pit mix was just diagnosed with a CCL tear in his right rear leg. FOIA PRP is another injectable option. The Canine Camper looks great! Great that hes trying to get around and eliminate (full bladder would have been a whole another problem). Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. If she was a younger healthier dog I would. Daily uses: Bending the knee to step over something. The patellar tendon arises from the inferior pole of the patella, a sesamoid bone within the quadriceps tendon. Baileys surgeon elected to repair his cruciate rupture with TPLO surgery, which was a huge success! After two years, I would imagine that some scar tissue has probably formed around the knees. Last week was a bad week, was a little overwhelmed with everything going on, my dad was in hospital recovering from major surgery and Jake got injured the night he had his surgery. The tibial tubercle is entirely cartilaginous. Just worried that she may not actually have a tear! I am hoping Hamlet has a partial tear and that with conservative management we can correct the issue. Prior nonoperative treatment, injections and physical therapy (PT) should be noted. A third surgical method is the tibial tuberosity advancement (TTA). I understand your concern and the complex issues you will face should you decide to pursue surgery for your Mastiff. Knee pain accounts for approximately one third of musculoskeletal problems seen in primary care settings. Check out our 3D muscle anatomy videos! As he progressed, one thing we did for fun was play with a soccer ball. Your dog will be doing much much better in 2-3 months, dont get me wrong, but there will be permanent damage done to that knee in that time AND, youre right, major stress placed on the opposite knee. TTO may be performed in isolation or concurrent with soft tissue patellar stabilisation and a variety of treatment modalities for cartilage lesions. The tibial tubercle is entirely cartilaginous. To be quite frank, my back is not in the best shape to continue to do this for an indefinite amount of time. If he has gone to the bathroom on his own by the time you read this post you can focus on his knees, but if he hasnt you really need to help him. Part II, Differential Diagnosis, appears on page 917 in this issue. I would strongly recommend the rest approach and no surgery. Better price than the stores in my area. The dog's anatomy and lifestyle are also deciding factors. If you decide on surgery, the best procedures in experienced hands will give you an approximate 95% chance of a good to excellent long term outcome. Currently we are doing CM and after 3 weeks of doubling up on her normal joint supplement and using Rimadyl as needed, each day brings slight improvement. Thanks for sharing your story! So heres mine: IF we are sure there is an ACL tear (which I would diagnose more from manual manipulation than xrays), then 100% I recommend surgery as the treatment of choice. I think pain meds give false security. Not until later at the house that night did I notice the extent of her injury. Once I read some of the things on the web site I felt a lot better. My dog had surgery for a torn acl. Plantar fasciitis is the result of collagen degeneration of the plantar fascia at the origin, the calcaneal tuberosity of the heel as well as the surrounding perifascial structures.. 2) How to Relieve Arthritis Pain in Dogs: The Ultimate Guide The lateral condyle is above the head of the fibula and the medial condyle is opposite. The musculature should be symmetric bilaterally. Should I stop hydrotherapy? eCollection 2021 Apr-Jun. Had surgery on left elbow. Best of luck to you! Also, you may expect to limit your dogs activity to short leash walks outside to use the bathroom. Ive been carrying my 55lber up and down 3x a day. My advice to you.dont try to do too much for Jasmond. Daily uses: Pushing down car pedals; Example strengthening exercises: Tibialis posterior exercise with band. There are plenty of joint supplements and cold laser/hydrotherapy to get your pup back on his feet but I will refrain from saying more in the event that youve already made a decision to let him go if you havent, I can offer some pointers on having a happy, mobile boy. In human medicine, it is assumed that rehab or physical therapy will be a part of the recovery process following surgery. After getting a thorough history of your dog, the physical exam is next. I think he might appreciate it better too. The TPLO is significantly more expensive than traditional surgery. He would eventually be able to use the leg again, though it would always be his Achilles heel, prone to reinjury. If not Probably cant avoid a surgical consultation. 2011 Dec;42(12):1416-25. doi: 10.1016/j.injury.2011.03.025. 3 months later he started limping again, walked very slowly on walks, and had no interest in playing outside. The posterior tibial tendon courses posterior to the medial malleolus with the major tendon inserting on the tuberosity of the navicular and plantar aspect of the medial cuneiform. That being said, a recent article in JAVMA (Journal of the American Veterinary Medical Association) discussed the probability of a 50-60% chance of an ACL rupture healing without surgical intervention. Mate is a neat name! Z Orthop Unfall. Last night she kept licking her private area. Osteoporosis, a weakening of the bones that commonly occurs in the elderly, can increase a He had the traditional surgery on both knees separately following a year of CM/Conservative Maintenance. While we opted for less invasive extracapsular repair, I think that TPLO, TTA or TTO would enable better use of the hind legs faster. Have a pleasant day. Origin: Lower posterior surface of the femur above the medial condyle. Example strengthening exercises: Knee curl with a resistance band. Much to my horror, she also has hip dysplasia in both hips with arthritis and arthritis in both legs also. I have read your blog about dog braces and I was wondering if you feel like that would be a better option? Hi Janice, This site needs JavaScript to work properly. Fractures of the greater tuberosity are often caused by direct trauma to the shoulder. Additionally, veterinarians often try to position both knees on at least one X-ray image. Accessibility Also, eventually signs of canine arthritis would set in, causing chronic pain and lessening his quality of life. Dear Eilen, so sorry about Jasmond! The small saphenous vein and accompanying sural nerve run along the superficial surface of the muscle, separated from it by the deep fascia. One thing I found out last weekend my dog likes that I have been doing with him each day for about a week is going for walks in which I push him in a stroller I got for him. Not true. A dislocated shoulder is a condition in which the head of the humerus is detached from the shoulder joint. All the things you would do to introduce a puppy to a crate help with adult dogs. Hi Ala. My 7 year old Australian Shepherd is starting his 6th week of recovery after having the traditional surgery. He also examined him to make sure he wasnt dehydrated and checked his bowels and bladder and he seems to be ok so far. If she seems well enough by weeks end, will introduce hydrotherapy to regain muscle tone. Pretell-Mazzini J, Kelly DM, Sawyer JR, Esteban EM, Spence DD, Warner WC Jr, Beaty JH. For the posterior drawer test, the patient assumes a supine position with knees flexed to 90 degrees. The female that had to have both ACLs repaired also ended up having mast cell cancer and having to have surgery and radiation, etc. Keep at it, I know its hard but just be patient. A history of knee injury or surgery is important. Im wondering how your pup is doing now? doi: 10.2106/JBJS.ST.19.00062. Fractures of the greater tuberosity are often caused by direct trauma to the shoulder. Reviewer: The non-slip grips fit on a dogs toenails to reduce slip-and-fall injuries by improving traction on hardwood floors. I walked and dribbled the ball with my feet and he followed along. They may recommend TPLO based on the size of your dog, but keep in mind that TPLO (which requires shaving portions of the bone to change the angle of the leg and installing metal hardware) has a high affiliation with bone cancer at the surgery site not many years after the fact. said to give her 2000mg. Child age, weight, mechanism of injury, Ogden classification (x-ray), advanced imaging results [computed tomography (CT)/magnetic resonance imaging (MRI)] including intra-articular fracture patterns, surgical techniques, intraoperative articular findings, and postoperative complications were collected. It is frequently responsible for anterior knee pain, typically presenting at the tibial tuberosity insertion site of the patellar tendon. Fortunately, Jasmines angle was favorable. He does use stairs, I just dont let him run up and down all the time. Depending on the issue though, having done both, for major issues stem cell therapy does come out cheaper at the end. We had some decisions to make. Im slowly adding rooms for my Aussie to be in. Casey is a 15 yrs. ), which should work in her favor. J Pediatr Orthop. Radiographs should be closely inspected for signs of fracture, particularly involving the patella, tibial plateau, tibial spines, proximal fibula, and femoral condyles. He has an appointment in two days at the pet surgeons office my vet recommended. There is a lot of useful information here to help with conservative management or surgery if the day comes when that is necessary. Hooch is 6yrs old and has been waddling with torn CCLs, for almost 2yrs.. My question is, how long after injury is too late to perform surgery and we Ill braces work as an option to surgery. My 5 year old Catahoula/Pit mix has a partially torn CCL in his left hind. In summary, the lateral quadriceps vector is best evaluated by TT-TG distance, TT-TG angle and the TT-PCL distance, , , , although none of these measurements is absolute and they must be interpreted in the context of dynamic factors, connective tissue laxity, trochlea dysplasia and rotational malalignment. Is this normal or something we should be concerned about? Sudden lameness in a rear leg is often the first sign of injury. Observe for evidence of medial patellar subluxation in any patient who has had previous surgery, more specifically lateral retinaculum release, by performing a medial glide test. They only mean as much as the dog allows them to 5 years old is fairly young, and my girl has had back surgery and knee surgery and has done well with both. Today hes favoring his back right leg. Jana thanks so much for your post! So sorry to hear about your poor puppy. While early results are promising, wide use of this procedure is not common. Anyway, has anyone here tried prolotherapy? A dislocated shoulder is a condition in which the head of the humerus is detached from the shoulder joint. Why is there no cast for this so she could distribute the weight better and not wreck the other leg? Oh Julie, I am walking in your shoes.. Since I moved she wont walk past the driveway whereas a year wed walk about 1 1/2 miles this has nothing to do with her knee for when I visit my old house she again walks that mile. The patient should be asked about previous attempts to treat knee pain, including the use of medications, supporting devices, and physical therapy. 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