Systematic review of postoperative rehabilitation interventions after cranial cruciate ligament surgery in dogs

Assessment of a continuous passive motion assistive device in dogs following stifle surgery

Canine rehabilitation optimizes recovery and the quality of life in dogs with musculoskeletal conditions or after surgery. Achieving proper range of motion (ROM) is vital post-stifle surgery, often accomplished through manual therapy and active exercises. We investigated the mechanical performance of a continuous passive motion (CPM) device for dogs and its potential use in canine rehabilitation therapy. In the ethical review process, our research was accepted to be evaluated in a sample of four dogs that had undergone left stifle surgery. Each dog underwent four sessions with the device at three different speeds. Results showed the device replicated extension angles close to goniometer measurements used in manual therapy. Flexion was also achieved, but not to the same extent. A force threshold stopped the device, avoiding discomfort in dogs with restricted ROM. Dog-specific factors like body position, opposition to movement, limb size, stage of recovery, haircoat, and discomfort, appeared to influence device operation. Mechanical improvements to allow for enhanced flexion are recommended in future CPM device designs, including a resistance threshold that could be adjusted for individual dogs and stages of healing. This study serves as a foundation for future advancements in canine rehabilitation systems. A canine CPM device may provide an affordable option to improve ROM. This could be beneficial for dog owners, who may not be comfortable with manual therapy, to assist with home rehabilitation exercises.

Effect of intra-articular platelet-rich plasma or hyaluronic acid on limb function recovery in dogs with TPLO for cranial cruciate ligament rupture: a randomised controlled trial

OBJECTIVES

This study aimed to investigate the recovery of limb function following a single intra-articular injection of platelet-rich plasma or hyaluronic acid in dogs with cranial cruciate ligament rupture treated with tibial plateau levelling osteotomy compared to dogs receiving no injection intraoperatively.

MATERIALS AND METHODS

Sixty-two dogs with cranial cruciate ligament rupture, body weights of 20 to 40 kg, and no other orthopaedic conditions were enrolled in this prospective, randomised, double-blind, controlled study at the small animal clinic at LMU Munich. All dogs underwent tibial plateau levelling osteotomy. Based on random allocation, they received either a single intra-articular injection of platelet-rich plasma, hyaluronic acid or no injection intraoperatively. Gait analysis, clinical examinations, radiography of the stifle joint for osteoarthritis progression and two validated owner questionnaires were compared among groups at three timepoints postoperatively (6 weeks, 3 and 6 months). Limb function was primarily assessed by measuring the ground reaction forces.

RESULTS

At all times postoperatively, no differences were observed among groups regarding clinical examinations, osteoarthritis score values, ground reaction forces or owner questionnaires. All dogs showed significant improvement in limb function clinically, in all ground reaction forces and in the validated questionnaires. Osteoarthritis progressed minimally during rechecks in all dogs regardless of the additional injection or not.

CLINICAL SIGNIFICANCE

All dogs treated with tibial plateau levelling osteotomy for cranial cruciate ligament rupture showed improvements in limb function. No additive effect on faster recovery was demonstrated with the additional intra-articular injection of platelet-rich plasma or hyaluronic acid. Addition of platelet-rich plasma/hyaluronic acid injections during tibial plateau levelling osteotomy is unnecessary considering the lack of benefit observed up to 6 months postoperatively.

Comparative analysis of post-operative rehabilitation approaches for medial patellar luxation in small-breed dogs

Background and Aim

Electrical stimulation (ES) and light amplification by stimulated emission of radiation (LASER) therapy are frequently used in post-operative rehabilitation; however, there is currently insufficient research comparing their effectiveness. This study aimed to assess the effectiveness of post-operative rehabilitation following medial patellar luxation (MPL) surgical correction by comparing ES and LASER therapy when combined with exercise. This was compared with a control group that consisted solely of post-operative home exercise implemented by the owner.

Materials and Methods

We conducted a prospective clinical trial on dogs that had undergone surgical treatment for MPL. The dogs were categorized into the following three groups: The control group, which did not participate in any post-operative rehabilitation program; the ES group, which received post-operative rehabilitation involving ES therapy; and the LASER group, which underwent post-operative rehabilitation featuring LASER therapy.

Results

There were no significant differences among the groups regarding the evaluation parameters, including lameness score, pain score, thigh muscle circumference, and range of motion. Although there may have been a difference in pain score in some groups, it could be attributed to the pre-operative condition of patients. These results aligned with the owner questionnaires' canine brief pain inventory assessments, showing no significant differences between treatment groups.

Conclusion

Post-operative rehabilitation for MPL correction may enhance limb usage, joint function, muscle mass, and pain relief. However, the duration and level of post-operative pain may influence the necessity for rehabilitation. In addition, ES and LASER therapy offer similar pain-relieving effects after MPL surgery; therefore, the choice between these methods depends on the availability of equipment and veterinarian preferences.

The Effect of Therapeutic Exercise on Body Weight Distribution, Balance, and Stifle Function in Dogs following Stifle Injury

Stifle injury is common in the companion dog population, affecting weight bearing, neuromuscular control, and balance. Therapeutic exercises after stifle injury seem to be effective, but high-quality research evaluating the effects is lacking. This randomized controlled trial evaluated the effects of a 12-week progressive therapeutic home exercise protocol on three-legged standing, targeting balance and postural- and neuromuscular control and disability in dogs with stifle injury. Thirty-three dogs with stifle injury were randomly allocated to intervention (n = 18) and control groups (n = 15), both receiving a standard rehabilitation protocol. Additionally, the intervention group received a progressive therapeutic exercise protocol. The outcome measures were static body weight distribution between hindlimbs, balance control, the canine brief pain inventory, and the Finnish canine stifle index. Both groups improved after the intervention period, but the group using the progressive therapeutic exercise protocol improved to a greater extent regarding static body weight distribution between the hindlimbs (I: median = 2.5%, IQR = 1.0-4.5; C: median = 5.5%, IQR = 3.0-8.8), pain-related functional disability (I: median = 0.0, IQR = 0.0-0.2; C: median = 0.9, IQR = 0.1-1.8), and stifle function (I: median = 25.0, IQR = 9.4-40.6; C: median = 75.0, IQR = 31.3-87.5), with intermediate to strong effects. These clinically relevant results indicate that this home exercise program can improve hindlimb function and restore neuromuscular control.

Long-term outcome in dogs with cranial cruciate ligament disease evaluated using the canine orthopaedic index

BACKGROUND

Cranial cruciate ligament disease (CCLD) is common in dogs, but studies on the long-term treatment outcome are scarce.

METHODS

The long-term outcome in a cohort of 71 dogs with CCLD treated with tibial plateau levelling osteotomy (TPLO, n = 18), tibial tuberosity advancement (TTA, n = 23) or lateral fabellotibial suture (LFS, n = 30) was evaluated using the canine orthopaedic index.

RESULTS

The risk of stiffness and lameness was increased in dogs treated with TPLO (stiffness: incidence rate ratio [IRR] 1.33, p = 0.015; lameness: IRR 1.34, p = 0.020) or TTA (stiffness: IRR 1.26, p = 0.035; lameness: IRR 1.31, p = 0.026) when compared to LFS at a median follow-up time of 4.6 years.

LIMITATIONS

No follow-up veterinary examination was performed. Data were collected from only two university animal hospitals, and thus, a referral bias towards more complicated cases is possible, which may limit the generalisability of the results.

CONCLUSION

Clinicians can use the results to inform dog owners about the expected long-term outcome in dogs with CCLD.

The Single Intra-Articular Injection of Platelet-Rich Plasma vs. Non-Steroidal Anti-Inflammatory Drugs as Treatment Options for Canine Cruciate Ligament Rupture and Patellar Luxation

Cranial cruciate ligament rupture (CCLR) and patellar luxation (PL) are common pathologies affecting canines. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used as a non-surgical treatment plan in these cases. Clinical usage of platelet-rich plasma (PRP) is an emerging area of interest in veterinary medicine. There is a lack of studies comparing those two different treatment methods in veterinary medicine. The main purpose of this study was to evaluate and compare the use of oral NSAIDs and single intra-articular injection of PRP on treatment outcomes in cases of canine CCLR and PL. Dogs diagnosed with CCRL (n = 12) and PL (n = 10) were subgrouped by the severity of pathologies and administered treatment: half of the CCRL and PL groups were orally administered NSAIDs and supplements for 14 days, and the other half received a single intra-articular PRP injection into affected stifle joint. We measured serum TNF-α levels and clinical outcomes (lameness scores, painfulness to manipulations, goniometry of stifle joint in flexion and extension, and muscle strength) before treatment, at day 14 and day 28 of treatment. The results of TNF-α concentration indicates a significant difference between groups of differently treated partial CCLR groups on d14 (p = 0.006). Results of group CCLR-P1 on d14 were decreased, while results of group CCLR-P2 on d14 were increased. When comparing TNF-α concentration between all CCLR cases treated with NSAIDs and treated with PRP, there was a significant difference between those groups on d14 (p = 0.001). The results of TNF-α concentration indicates a significant difference between groups of differently treated PL-III on d28 (p = 0.036). Results of group PL-III1 indicate growth of TNF-α concentration, while at the same d28, results of group PL-III2 indicate decreased levels of cytokine, comparing results between the subgroups at the same time point and within subgroups from baseline. Results indicate a significant difference in muscle strength between group CCLR-P1 and group CCLR-P2 on d28 (p = 0.007), indicating an increment in muscle strength in group CCLR-P1 up to d14 and its reduction up to d28, and muscle strength of group CCLR-P2 increasing up to d28. When comparing the muscle strength between all CCLR cases treated with NSAIDs and treated with PRP, there was a significant difference between those groups on d28 (p = 0.007). In conclusion, a single intra-articular injection of PRP has a superior effect on management of inflammatory processes, has better clinical outcomes, and longer duration of action than oral NSAIDs, in the treatment of canine CCRL or PL.

Photobiomodulation (Therapeutic Lasers): An Update and Review of Current Literature

Photobiomodulation therapy, also commonly known as laser therapy, continues to grow in popularity in veterinary medicine. It is the use of red and near-infrared light to simulate healing, relieve pain, and reduce inflammation. The potential variety of conditions for which it can be used as an adjunctive, non-invasive modality has propelled its use in both veterinary rehabilitation, sports medicine, and general practice. In the last decade, clinical research has grown with increasing evidence for efficacy for some conditions but mixed to limited in others and many conditions not represented.

Therapy Exercises Following Cranial Cruciate Ligament Repair in Dogs

Therapy exercises can help to optimize the outcome for dogs following cranial cruciate ligament repair surgery. This article focuses on land exercises that can be done with minimal equipment in home or in clinic. The first 8 weeks of recovery are covered including therapy and basic exercises for each phase.

Effect of Nail Grips on Weight Bearing and Limb Function in 30 Dogs 2 Weeks Post Tibial Plateau Leveling Osteotomy

Simple Summary

Devices made to improve mobility are becoming increasingly popular among owners of dogs with orthopedic conditions, but there are few studies investigating their efficacy. Nail grips are commonly used by veterinary rehabilitation practitioners to improve the security of foot placement by increasing nail traction. This study aimed to assess if nail grips would improve mobility outcomes in dogs recovering from knee surgery. The results did not show a significant effect on outcomes during the initial 2-week post-operative period; however, further research is needed to determine if they are useful for other applications.

Abstract

The objective of this study was to assess the functional outcomes of dogs wearing nail grips in the first 2 weeks following tibial plateau leveling osteotomy (TPLO). Thirty dogs were included (n = 13 nail grips and n = 17 sham grips). Visual lameness scores (VLS), total pressure index (TPI), and client-specific outcome measures (CSOMs) were obtained by blinded observers on day 1 and day 14 +/− 3 post TPLO. CSOMs were also obtained on day 7. There were no differences in VLS and TPI between the treatment and sham group on day 14 (p = 0.44 and p = 0.59, respectively) or at any time point. CSOMs assessing walking on slippery flooring, ability to rise, and consistent use of surgical limb on a 5 min walk were also not different between groups (p = 0.78, p = 0.80, and p = 0.63) at any time point. Nail grips were well tolerated in dogs after orthopedic surgery. This study did not demonstrate a benefit for dogs wearing nail grips during the first two weeks after TPLO; however, further studies are warranted.

Physical Rehabilitation for Small Animals

Physical rehabilitation incorporates several elements, including but not limited to therapeutic exercises, manual therapy, and physical modalities. Understanding of the effects, indications, contraindications, and precautions is essential for proper use, while understanding of the diagnosis, assessment of the stage of tissue healing and repair, and accurate clinical assessment of the functional limitations are essential when establishing a physical rehabilitation plan.