Performing ACL Surgery on a Cat with Cancer

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 and faithfully doing physical therapy exercises. 

Tigress was doing very well at her two month progress exam, and she was released from confinement. That is the last time I expected to hear of Tigress, but I still remember how difficult our decision was and how happy we all were in the end. 

Imagine my surprise when I received this email, completely out of the blue:

"(…) You repaired her ACL in 2007.  It was not too long after she was diagnosed with lymphoma. We were uncertain if we should proceed with the surgery because of her cancer diagnosis, but we decided to go ahead and have the surgery done by you.

We are forever grateful to you for doing her surgery and we are glad that we decided to do it because we got another wonderful 6 years with her before she passed away.

She was such a joy in our lives and you gave us the greatest gift, which was more time with her."

Surviving 6 years is clearly much, much better than anybody expected for a cat with lymphoma. The morale of the story is that there is nothing wrong performing surgery on a pet with cancer — as long as owner and veterinarian are on the same page, and as long as we maintain our role as our pet’s best advocates.

If you have any questions or concerns, you should always visit or call your veterinarian -- they are your best resource to ensure the health and well-being of your pets.

Reviewed on: 
Friday, December 5, 2014