Download Rehabilitation Following Cranial Cruciate Ligament

Rehabilitation Following Cranial Cruciate Ligament Surgery
By Dr. Ed Mapes
Surgical procedures treating ruptured cranial cruciate ligaments provide stabilization of
the joint and decrease the rate at which arthritic changes occur. Rehabilitation of the
limb is equally important in assisting the patient to a satisfactory recovery. No matter
which surgical procedure is used, controlled rehab prevents post-op damage and aids in
healing.
It is important to understand that whenever a joint is damaged, it will never be the same
again. There will be, at some time, other consequences that cause at least intermittent
discomfort. The most common is the development of arthritis. Tearing of the meniscal
cartilage can also occur after cruciate ligament rupture.
An important addition to our surgical protocols at Stonebridge Animal Hospital is
incorporation of scheduled laser therapeutic sessions in the early post-op period. This
has been a major factor in controlling pain and swelling, and hastens the return to
function in our patients.
We do the first session immediately after surgery to control post-op symptoms. A Robert
Jones bandage is then applied to prevent undue use of the leg in the first four important
days following the procedure. The second laser session is done on the following
morning, at which time patients are released from the hospital for home care.
We recheck patients at days 4 post-op to remove the dressings, monitor temperature
and attitude, and examine the limb carefully. At that time the third laser session is
performed. This is an important time for pet owners because patients often begin using
the leg to some degree after the protective dressings are removed – possibly causing
damage to the surgical repair. Owners at this time must control activity levels to leash
walks outdoors to urinate/defecate only.
During the first week, Range of Motion (ROM) exercises help prevent adhesion
formations and control swelling. As the patient lies on the floor with the operated leg up,
gently flex and extend the stifle joint 10 times. After the exercises, you can ice the limb
for 5 minutes – place a wet washrag on the limb first, and then apply the ice packing. Do
not perform ROM exercises if it seems painful.
At 10 to 14 days post-op we recheck the patients for examination, suture removal, and
the final laser therapy session. By this time (and often much sooner) they are placing
some weight on the leg; many are even using the leg better than before surgery. This
must be controlled, though, because swelling, damage to internal structures, or tearing
of surgical implants can occur.
During weeks 2 and 3, continue the ROM exercises, and now include gentle
flexion/extension of the hock and hip joints as well. It’s also time to apply slight pressure
in the flexed position, hold the limb there for 5 seconds, and then push with similar force
into the extended position. This helps to maintain joint fluidity. Controlled leash walks
can now be extended to 10-15 minutes per day. As always, discontinue exercises or
walking if they become painful.
At one month after surgery we can add the Sit/Stand Exercise to maintain thigh muscle
tone. While controlling any vigorous running, have the patient sit and then stand for 10
cycles two times per day.
Swimming is another beneficial activity; requiring muscular activity and joint motion
without pounding on hard surfaces. Swimming should only be allowed if the leg is
sufficiently healed to withstand the exercise, pain levels are well controlled, and the
patient is able to swim adequately. This must be strictly monitored in case any problem
arises. Begin with very short sessions as a trial period, and then monitor the patient and
limb afterward. Duration can increase gradually as the patient demonstrates ability to
handle it.
Massage of the leg muscles involves kneading of the thigh and shin muscles. This
should not elicit pain. Deep muscle massage can be done several times daily.
At the sixth week, begin short walks in taller grass to encourage muscular activity.
Again, prevent uncontrolled bursts of running or jumping. Slow stair climbing can now
be encouraged – 5 times up and down a flight of steps several times daily helps muscle
tone and joint flexibility. Recheck by the surgeon is recommended if problems such as
crying out, limping, drainage, or swelling are seen.
Excessive walking while the patient favors the operated leg places more weight and
stress on the opposite rear leg. Statistics show that 70% of patients with ruptured
cruciate will at some point damage the other. This is due in part to genetics and the
tendency for ligaments to lose elasticity; therefore excessive strain placed on the good
leg during healing can damage that ligament as well.
More vigorous motion such as light play and walking on an extended leash can usually
begin by the eighth week. Do not allow all-out running in activities such as chasing balls
or catching Frisbees due to the risk of fast turns and rapid start/stops. Healing is usually
complete by the end of the third month after surgery, and patients should then be able
to use the leg fairly normally. As stated previously though, intermittent discomfort is
common in any patient that has incurred a ruptured cruciate ligament.
The pace of rehab is governed in part by the patient’s response, but a desire for return
to normal activity doesn’t mean it’s medically wise to allow it. Setbacks can arise when
activity becomes too strenuous too soon, so even though the dog wishes to run after
squirrels after a few weeks of healing, it shouldn’t be allowed until at least three months
post-op.