Treatment of cranial cruciate ligament (CCL) rupture is conservative or surgical; surgical techniques use intracapsular or extracapsular stabilization. All surgical techniques eliminate cranial tibial thrust when the affected limb is weight bearing. The importance of physiotherapy and rehabilitation after CCL repair has been increasingly recognized. This prospective study examined an extraarticular surgical stabilizing technique and postoperative rehabilitation on 39 dogs with CCL rupture. The dogs were operated on by the same surgeon using the same technique for each dog. The dogs were then randomly assigned to group A (n = 20) or group B (n = 19). Owners of both groups of dogs were given the same written instructions for leash walking after surgery. Owners of group A dogs also received additional instructions—the dogs underwent further physiotherapy (swimming and transcutaneous electrical nerve stimulation). Dogs were monitored and owners given questionnaires to fill out on weeks 4, 12, and 24 after surgery. Thirty of the 39 dogs were followed for the 24-week period. Before surgery, all dogs demonstrated grade 2 or 3 (out of 4) lameness and grade 2 to 4 (out of 4) draw movement. At the 24-week examination, 28 of the 30 dogs showed the same level of stability in the knee joint as in the contralateral healthy limb. Twenty showed no lameness and 10 were slightly lame or stiff. Group A and group B dogs did not differ. The authors concluded that the extracapsular suture technique yields good results in dogs weighing 25 to 50 kg if the dogs are actively leash-walked after surgery. Further studies are necessary to determine the value of postoperative rehabilitation in these patients.
COMMENTARY: CCL rupture is one of the most common orthopedic problems in dogs. All the dogs in this study weighed at least 25 kg and less than 50 kg. Leash walking was recommended for all dogs. One group also had additional physiotherapy. Dogs were given training in swimming twice a week for 4 weeks and once a week for 8 weeks. The owners were also loaned a transcutaneous electrical nerve stimulation apparatus but the article does not mention how often the owners used this device. A physiotherapist provided precise instructions for leash walking, as well as muscle massage and stretching. Although no difference was seen between the dogs whose owners had no additional instruction on rehabilitation methods and those that did, it is unclear what further rehabilitation techniques the owners actually used. The authors also mention that they prefer underwater treadmill therapy over swimming because it provides proprioceptive training, which is more suitable for cruciate rehabilitation.—Patricia Thomblison, DVM, MS
Rehabilitation after extra-articular stabilization of cranial cruciate ligament rupture in dogs. Jerre S. VET COMP ORTHOP TRAUMATOL 22:148-152, 2009.