Thursday, March 3, 2016

The Pet PT Pit Stop: Full Ligament Tears (Part 3 of Cranial Cruciate Ligament Series)

by Susan E. Davis, PT “pull in for a helpful refuel!”  

It’s all about guiding and empowering you to help your dog avoid injury, provide practical solutions and achieve rapid restoration of health and function!   


Darn, your dog’s cruciate ligament has ruptured completely. “A full tear”, explains the vet, causing a bolt of hot lightning to shoot up your spine.


Is it time to panic? 

If finances are a problem, maybe (more on this a bit later). The best thing to do is face facts and adopt a ‘knowledge is power’ attitude.

For full tears of the cranial cruciate ligament, surgery is the best treatment, followed by post-op physical therapy and rehabilitation. 

Without treatment, the stifle joint remains unprotected and severe lameness, instability, corrosion of the joint and chronic pain will occur.

If there are reasons surgery is not possible, the next best option is physical therapy plus a custom stifle orthosis (brace). Physical Therapy alone will not be sufficient to treat a full tear.

Custom braces require that a cast be formed on the affected limb, hardened and cut off in 2 halves (called “bivalve”). This takes approximately 30 minutes and can be done by a vet or therapist. The bivalve cast is sent to a certified orthotist, who uses it to make a positive mold of your dog’s limb on which to build the custom brace. 

The braces are usually light weight and biomechanically sound, allowing the dog to walk, run and play while wearing it.

Studies show, however, that braces do not fully stop tibial translatory motion and degradation of the joint may still occur, though to a much lesser extent than without any treatment. 

This is why surgery followed by therapy remains the best option, and therapy plus bracing less optimal.

Soft, non-custom stifle supports are also available, but they are insufficient to protect a full tear and are more suited for partial tears. Animal stem cell transplants may also be an alternative to surgery, as advised by your veterinarian.

Various surgical options are available for repair of full cruciate tears and your vet can help you make a determination as to which is best suited for your dog.
(See explanations of each in my book Physical Therapy and Rehabilitation for Animals: A Guide for the Consumer, pp 109-112).

Whenever possible seek the services of a board-certified veterinary orthopedic surgeon to perform the procedure. You can save some money choosing a general vet surgeon, not orthopedic certified, but they will only perform the basic cruciate repairs (such as extra capsular, lateral suture technique), which are indicated for smaller to mid-size, lighter-weight dogs.

Before surgery, have a conversation with the vet about your dog’s meniscus (knee cartilage) as it is damaged about 50 percent of the time when the cruciate ruptures.  

If so, it can be removed or repaired and there are positives and negatives to both.

The controversy exists over the fact that the meniscus serves as a spacer and shock absorber for the stifle joint and if removed, can cause arthritis. 

However, repairs do not always hold. Some surgeons will opt to keep the meniscus in place but release the back portion of its attachment to the joint and capsule, to free it from strain and further damage. The surgeon may not know if the meniscus is damaged until the surgery is in progress, but having a pre-op plan and deciding your preference will be helpful.

Take a deep breath, gather the facts and make a timely decision on treatment, as it should not be delayed.


***

Susan E. Davis (Sue) is a licensed Physical Therapist with over 30 years of practice in the human field, who transitioned into the animal world after taking courses at the UT Canine Rehabilitation program.  She is located in Red Bank, New Jersey.

She has been providing PT services to dogs and other animals through her entity Joycare Onsite, LLC in pet’s homes and in vet clinics since 2008.

She also provides pro bono services at the Monmouth County SPCA in Eatontown, NJ.  Sue is the proud “dog mommy” to Penelope, a miniature Dachshund with “attitude”.  For more information see her website www.joycareonsite.com , or follow on Twitter @animalPTsue.


Sue is also the author of a fantastic book on physical therapy, Physical Therapy And Rehabilitation For Animals: A Guide For The Consumer.  

Physical therapy can do so many great things for your dog. Understanding all the possibilities physical therapy can offer will change your dog's life. This book definitely belongs on the shelf of every dog lover.



Articles by Susan E. Davis:
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core
Canine Massage: Every Dog ‘Kneads’ It”
Photon Power: Can Laser Therapy Help Your Dog?  
Physical Therapy in the Veterinary World  
Reiki: Is it real? 
Dog Lessons: Cooper  
The Essentials Of Canine Injury Prevention: 7 Tips For Keeping Your Dog Safer 
It's Not Just Walking, It's Therapy! 
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part I)
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part II Physical Therapy)
Range Of Motion: It’s A Matter Of Degree…
The Weight Of Water And How It Helps Dogs 
By Land or By Sea? A Comparison of Canine Treadmills 
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part I)
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part II) 
Scar Tissue: Is it Too Much of a Good Thing? 
Physical Therapy Tip Of The Month: Ramps! 
Physical Therapy Tip Of The Month: Indoor Duo Dog Exercises!
Physical Therapy Tip Of The Month: Best Practices After Your Dog’s Surgery 
Physical Therapy Tip Of The Month: Ideas to Chew on - Can Physical Therapy Help with my Dog’s Digestive Problems?
Wrap It Up: Using Soft Supports For Your Dog
When Do I Use Heat versus Cold? : A Tale (or Tail) Of Two Temps! (Part I) 
When Do I Use Heat versus Cold? : A Tale (or Tail) Of Two Temps! (Part II) 
Physical Therapy Tip Of The Month: Safe Summer Boating Tips for your Dog 
Physical Therapy Tip Of The Month: Hip Dysplasia - What’s a Dawg Mama to Do?
PT Pit Stop: Wheeled Carts Keep Them Doggies Rollin' (Part I)
PT Pit Stop: Wheeled Carts Keep Them Doggies Rollin' (Part II)
Staying in the Loop with Targeted Pulsed Electromagnetic Field Therapy
Addressing Frailty Syndrome in Geriatric Dogs 
The Pet PT Pit Stop: "Where's The Evidence?"
Physical Therapy is Great, Except When It Isn’t 
Top Dogs and their Toplines at the Westminster Kennel Club Dog Show (Part I)
Top Dogs and their Toplines at the Westminster Kennel Club Dog Show (Part II) 
What's in a Dog's Gait? 
A Practical Method to manage your Dog’s Care Plan 
Wound Care 101 (Part I The Basics) 
Wound Care 101 (Part II Wound Management)
Prevention and Management of Hip Dysplasia in Puppies: Attention all Breeders!
Support and Braces
Vaccinosis - A Vexing Conundrum 
The Pet PT Pit Stop: Blame it on the Weather, Really!
Relief for Laryngeal Paralysis using Physical Therapy 
Is the Treatment Necessary? Is It Working? 
Preventing CCL (ACL) Tears (Part 1 of series on Cruciate Ligament Tears) 
“All or None, or Partial?” (Part 2 of  series on Cruciate Ligament Tears)

Related articles:
How The Oddysey Started: Jasmine's ACL Injury 
Talk To Me About ACL Injuries
ACL Injuries in Dogs: Non-Surgical Alternatives?
ACL Injuries in Dogs and Stem Cell Regenerative Therapy
Newest Surgery For Ruptured ACL In Dogs
Preventing ACL Injuries In Dogs
ACL Injuries In Dogs: Xena's Story 
ACL Injury Conservative Management: Sandy's Story
Surviving The Post-Op: After Your Dog's ACL Surgery
Talk to Me About Arthritis
Don't Forget the Physical Therapy 
My Love Is Sleeping At My Feet: ACL Surgery Complications 
Coco's TPLO Post-Op Diary 
Small Breeds Can Hurt Their ACL Too: Star's Naughty Knee 
One Thing Leads To Another: Why The Second ACL Often Goes Too 
Dog Knee Injuries: Should You Say Yes To Pain Management?

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