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Performing ACL Surgery on a Cat with Cancer

Posted December 05, 2014 in A Vet's Life

Life and Death Decisions: Tigress’ Story

Dr. Phil Zeltzman is a traveling, board-certified surgeon in Allentown, PA. His website is He is the co-author of “Walk a Hound, Lose a Pound” (

Kelly Serfas, a Certified Veterinary Technician in Bethlehem, PA, contributed to this article.

Tigress was an 8 year old cat I met for an orthopedic consultation because she was limping on her right hind leg. An exam of her knee revealed that she had a torn ACL (Anterior Cruciate Ligament). Repairing it would be simple; ACL surgery is the number 1 procedure performed by most surgeons. It involves mimicking the ACL with two strands of heavy nylon suture. However, Tigress' situation made the decision more complicated.

You see, Tigress had a type of cancer called lymphoma; it affected all of her lymph nodes. In addition, she was undergoing chemotherapy. Her owner and I were facing several tough ethical dilemmas:

  1. Is it fair to perform a specialized orthopedic surgery in a cancer patient who may not live long?
  2. Chemotherapy drugs kill cells that divide rapidly. Since there is a lot of healing that needs to happen after ACL surgery, the chemo drugs may slow down the healing process. At worst, the surgery could fail.
  3. Tigress would need to be strictly confined for two months to heal properly after surgery.  Would it be ethical to isolate her from her family during what could be her final months?
  4. Is it fair to let an owner spend a significant amount of money for surgery, in addition to chemotherapy (also costly in this particular case), again, for a patient who may not live long?

In spite of these dilemmas we had to make a decision because Tigress’ quality of life was poor; her knee was causing a great deal of pain. 
Besides the pain, the consequences of not doing surgery on a torn ACL include arthritis and muscle atrophy (a.k.a. muscle loss). In addition, there is a risk of tearing the opposite ACL after shifting weight to the "good leg.”

After a long heart to heart, the owner and I agreed that it was reasonable to give Tigress a chance. We performed the ACL surgery and Tigress went home the next day. She was confined during the following two months. The owner spent as much quality time as she could with her, giving her lots of TLC

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Dr. Phil Zeltzman is a board-certified veterinary surgeon and author. His traveling practice takes him all over Eastern Pennsylvania and Western New Jersey. You can visit his website at, and follow him at

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