There are numerous studies indicating the positive benefits of rehabilitation therapy following CCL surgery. In summary,
rehabilitation therapy has been shown to improve muscle mass and attenuate muscle atrophy that occurs in the post-operative
period, increase stifle joint ROM, especially extension, improve weight-bearing as measured by force plate analysis, and reduce
the progression of osteoarthritis.
Rehabilitation guidelines following stifle surgery are structured to direct the clinician in returning dogs to pre-injury
activity levels as quickly and safely as possible. Criterion-based protocols eliminate subjective progression through rehabilitation
by dictating the milestones that must be reached in order to progress to the next phase. The rate of progression can differ
between dogs and is dependent on the individual rate of healing and the demands of the dog's activity level. Also, clinicians
should prescribe therapeutic interventions within each phase that are tailored to the patient's needs. Prescribing therapeutic
interventions in a 'cookbook' fashion for each particular diagnosis is committing a disservice to the patient.
Three phases of rehabilitation are included for recovery in dogs: the acute phase, advanced phase, and return-to-play phase
Table 1. Three phases of rehabilitation
In the acute phase of rehabilitation, strategies are focused on controlling the effects of inflammation (pain, effusion, loss
of motion, and muscle atrophy). The goal of the acute phase is to revise full range of motion, reduce effusion, retard muscle
atrophy, and ambulate without assistance (Table 2). Cryotherapy, Laser therapy, NMES, TENS, passive range of motion, and compression
of the affected limb can assist in counteracting the effects of inflammation and edema. A combination of low-load sustained
stretching, joint mobilizations of the patella and tibiofemoral joints, and modalities to control pain and resultant muscle
spasm are commonly performed following CCL surgery.
Table 2. Rehabilitation days 14-30
Cryotherapy (Ice compresses) following CCL surgery provides an excellent method to help control pain and inflammation in the
immediate postoperative period. Not only is cryotherapy beneficial in the acute phase of tissue injury and inflammation,
it is also advantageous after exercise and throughout rehabilitation when inflammation occurs. The effects of cryotherapy
include vasoconstriction, decreased blood flow, reduced cellular metabolism and permeability, attention of traumatic or exercise-induced
edema, and decreased muscle spasm. Another primary effect of cryotherapy is analgesia, which is thought to be a result of
decreased sensory and motor nerve conduction velocity that occurs when nerve fibers are cooled.
Cryotherapy following CCL surgery can be accomplished with a variety of methods. The simplest way is by placing crushed ice
in a sealed plastic bag and than wrapping the bag in a thin towel. Alternatively, you can prepare a mixture consisting of
two parts water and one part alcohol in a double-sealed plastic bag and place it in a freezer. The resulting pack should
be frozen slush that conforms to any surface. Apply the cold pack to the stifle for 15 to 20 minutes immediately after surgery
while the patient is still recovering from anesthesia. Be careful when applying cold packs to patients that are already hypothermic
postoperatively. Following CCL surgery cryotherapy is used for the first three or four days to help minimize inflammation,
swelling, and pain from surgery. Apply the cold compress for 15 to 30 minutes three or four times a day. Monitor the patient
for discomfort, and assess the tissues periodically for signs of adverse effects such as white or pale areas. Do not use
cryotherapy in patients with poor or absent pain sensation. Cryotherapy will be a valuable part of the home rehabilitation
program once the patient is discharged (Tables 1-3).
Table 3. Rahabilitation days 30-60