Rehabilitation Following Cranial Cruciate Ligament Surgery

By Dr. Ed Mapes
Stonebridge Animal Hospital
McKinney, Tx

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.

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