Post Cranial Cruciate Surgery Rehabilitation.
Your pet has sustained an injury to one of the major ligaments stabilizing the knee joint. The result of this type of injury is an unstable knee joint. This instability is the reason for the lameness which you have observed and will result in degenerative arthritis. Many dogs that sustain this injury are overweight. If this is the case, weight loss is imperative. Additionally, 30-40% of patients that injure their cruciate ligament, will suffer the same injury in the opposite limb.
The surgery performed used extra-articular nylon sutures (outside the joint) placed to stabilize the joint in a normal alignment. The dog should not be bathed or allowed to swim until the skin sutures are removed at 10 – 14 days post surgery. The incision should appear clean and dry, with skin edges well apposed and no redness or discharge from the site evident. If the patient wants to lick or chew at the surgical site an Elizabethan may need to user Page 1 06/08/2015
Dogs should be on a leash at all times when outside for the first 2 weeks following surgery. If excessive activity is allowed too soon following surgery, stabilization of the knee can be lost requiring additional surgery.
Intermittent ice therapy of the surgical site during the initial 24-48 hours following surgery may help to reduce swelling and discomfort.
After the initial 48 hours you should begin gentle flexion and extension (bending and straightening) of your pets knee for 5-10 minute sessions three times daily. Continue this therapy until the dog starts to use the affected limb well.
It is not uncommon for your pet to carry the limb for two weeks following surgery. By 2-4 weeks they will usually start to touch the foot on the ground and by 6-8 weeks they usually start to bear considerable weight on the limb.
Swimming, if possible, is excellent therapy during recovery from 2 weeks.
By 12-16 weeks your pet should have returned to normal activity. Any significant deviation from this timetable should prompt you to contact your veterinarian for a reevaluation of your pet’s knee. Also, a very small proportion of dogs do have a reaction to the stabilizing suture that requires a second surgery for removal of this material.With a gradual return to normal activity good function can be expected on the limb.
PHYSICAL THERAPY REGIMEN
Week 1
-Apply an ice pack to the knee 10-15 minutes four times a day for the first 24-36 hours following surgery. Use a towel between the skin and ice pack for comfort.
-When swelling and redness have resolved (3 days postop), begin application of a warm compress (a damp towel warmed in water) to the knee for 10 minutes three times a day before performing 10 slow repetitions of range of motion exercises. (lying on their side grip the front of the thigh with one hand and hold the foot with the other. Slowly push the foot up into flexion of knee and then slowly pull the foot and push the thigh down and back into extension of the knee. Do not go to the point of creating pain or resentment. Following exercise apply ice packs to the surgical site for 10 minutes
-After the third day, begin slow leash walks of 3-5 minutes duration three times daily. Use a short leash during the walks outside when your dog must urinate or defecate.
Weeks 2 and 3
–Stitches out during follow-up consultation,
– Apply the warm compress and continue flexion and extension of the knee as described above
-Slow leash walks for 10 minutes 1 to 2 times a day is acceptable and Underwater Rehabilitation commences if necessary.
Weeks 4 and 5
-Sit/stand Exercise (for dogs)—Have your pet repeatedly sit and stand for 10 repetitions twice daily. Do not push down on his/her rump.
-Massage—your pet may stand or lie down.
-Increase the slow leash walks to 20 minutes 1 to 2 times a day.
Weeks 6 and 7
-Active exercise-Place your pet on a short leash and have him/her walk at your side on an incline. Continue 4 weeks, gradually increasing time and distance.
Weeks 8 – 10
-At the end of week 8, the dog should be re-examined by your veterinarian for evaluation of limb usage.
-Increase the slow leash walks to 30-40 minutes once or twice daily. The pace should be slow enough to ensure full weight-bearing on the affected limb.
-Have your dog slowly climb a flight of stairs 5-10 times twice daily.
-Swimming is wonderful rehabilitation exercise. You may allow controlled swimming after week 8.
Week 11 and 12
-Light play exercise
-On a long leash; encourage playing and romping with your dog for 15 minutes twice daily. Continue 2 weeks.
-Healing should be complete and your dog can return to full activity by the 12th-16th week.
LONG TERM LIFESTYLE Following the 12 week recovery period, there are no recommended limitations to their lifestyle. If stiffness and lameness develop over time, intermittent use of anti-inflammatory medications can help improve limb function. Occasionally the implants that were placed in your dog’s knee will cause irritation and lameness. If necessary, these are easily removed once complete healing has occurred.
