Rehabilitation of the postoperative CCL patient

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Rehabilitation of the post-operative CCL patient

• Kim Knap BS, CVT, CCRP

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Presentation

• Jordan, 6yo, FS, rott mix
• Weight 83 pounds and was a 7/9 BCS.
• Was grade 3/5 lame at a walk and 4/5 lame at a
  trot on the left hind limb.

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Orthopedic findings on presentation

• Decreased ROM, effusion, painful hyperextension
  and flexion, and crepitus of bilateral tarsi
• Bilateral effusion, and pain on extension of
  stifles, and thigh muscle atrophy LgtR
• Diagnosis bilateral CCL ruptures and bilateral
  tarsal DJD

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Evaluation
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Evaluation reveals
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Surgery

• Jordan had an extra capsular repair of the l
  stifle on 8/25/04.
• Was managed with cage rest for 2 weeks
• At 3 weeks, returned for a week of intensive
  rehab.

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3 week Pre-rehab evaluation reveals
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Plan

• Instituted BID for 5 days
• PROM of all joints of hind limbs 10 reps each
• 10 minutes of fast walking on the land treadmill
  40 at 15 degree incline
• 15 minutes of UWTM at 1.7 MPH and water filled
  just past the hock (26 cm)

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3 week post rehab evaluation reveals
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Week 4 at home

• Jordan was released to owner for one week of
  rest.
• They were instructed to take Jordan on a 30
  minute leash walk twice a day.
• No other activity or NSAIDS were allowed.

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5 week pre-rehab evaluation reveals
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Plan

• Instituted BID for 5 days
• PROM of all joints of hind limbs 10 reps each
• 10 minutes of fast walking on the land treadmill
  50 at 20 degree incline
• 15 minutes of UWTM at 2.3 MPH and water filled
  just past the hock (26 cm)

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5 week post-rehab evaluation reveals
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Week 6 at home

• Jordan was released to owner for one week of
  rest.
• They were instructed to take Jordan on a 30
  minute leash walk twice a day.
• No other activity or NSAIDS were allowed.

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7 week pre-rehab evaluation reveals
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Plan

• Instituted BID for 5 days
• PROM of all joints of hind limbs 10 reps each
• 10 minutes of fast walking on the land treadmill
  65 at 20 degree incline
• 15 minutes of UWTM at 3 MPH and water filled
  just past the hock (26 cm)

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7 week post-rehab evaluation reveals
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Overall improvements
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Release from rehab

• By the end of week 7 there was no clinical
  evidence of lameness, no obvious muscle atrophy,
  and no exercise intolerance.
• She weighs 68.9 pounds and is a 4/9 BCS.
• Jordan had improved ROM of both her tarsi and her
  stifles.
• Jordan was sent home with home exercises and
  permanent lifestyle changes that include regular
  controlled exercise and diet restrictions.

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Home Exercises

• BID
• Controlled leash walks for 35 minutes/walk.
  During these walks
• Vary the surfaces on which she is walking. Such
  as through tall grass, in sand, short grass,
  gravel, and mulch. The different surfaces help
  will make her think about her gait.
• Have her walk over obstacles such as landscape
  timbers or through the rungs of a ladder
• Add circles and figure eights on the walks to
  encourage weight shifting in another way.
• You may also walk up and down small hills or
  ditches during your walks.
• After or during these walks have her perform
  several repetitive sit to stand exercises. Work
  up to 15 in a row.

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Final success

• Jordan was able to return to all of her normal
  activities.
• She is pain free and comfortable
• Her owners are thrilled to have their healthy
  young girl back.