Front Matter

Chapter 14 Disorders of the Pelvic Limb: Diagnosis and Treatment 379

require alternative anchoring such as screws
or bone tunnels. A 6% recurrence rate requir­
ing a second surgery has been reported
(Bernard, 1977; Mauterer et al., 1993; Reinke &
Mughannam, 1993; Hoscheit, 1994). Chronic
tendonitis and bursitis can decrease the likeli­
hood of a good surgical outcome (Raes et al.,
2011). Nonsurgical management can yield
adequate function, especially in less active
patients.

Postoperative care

Immobilization of the tarsus was traditionally rec­

ommended for 2–4 weeks after surgery (Piermattei

et al., 2006). Rehabilitation therapy in these patients

focuses on maintenance of range of motion as well

as static and dynamic weight‐bearing exercises to

regain strength in the postsurgical limb. Treatment

modalities in  addition to manual and exercise

therapy include ultrasound and laser therapy.

Case Study 14.2 Traumatic Achilles tendon rupture at the level of the mid‐tendon

Signalment: 1.5‐y.o. M/N, Labrador Retriever, high‐

activity companion that chases balls, plays Frisbee.

Presenting complaint: Acute grade IV/V right pelvic

limb lameness with a dropped tarsus after getting foot

stuck in a fireplace vent

Physical examination: Plantigrade stance in the right

pelvic limb. Palpation reveals moderate soft tissue

swelling at the level of the gastrocnemius with a pal­

pable void of tendon at the level of the mid‐tibia.

Remainder of orthopedic exam unremarkable (Figure

14.30).

Diagnostics: Radiographs: orthogonal views of right

and left tarsi reveal mild soft tissue swelling in the

distal 3–4 cm of the right common calcaneal tendon

(1 cm thickness right vs. 8 mm thickness left). No

osseous changes at calcaneus (Figure 14.31).

Surgical treatment: Superficial digital flexor and

gastrocnemius tendons severed 3 cm proximal to

the tuber calcaneus. Tendons individually apposed

using 0 Prolene® in a three loop‐pulley pattern.

Tendon sheath closed with 3‐0 PDS® and infused

with platelet‐rich plasma (PRP‐Angel System® set

at 7% hematocrit, 1.5 mL). Transarticular external

fixator with hinge applied following repair to

immobilize tarsus at 160 degrees of extension

(Figure 14.32).

Postoperative care: Patient discharged 1 day postop

with fixator in locked out position. Clients instructed

to provide brief leash walks for first 14 days (Figure

14.33).

Rehabilitation therapy: Weekly therapy recom­

mended for 12 weeks minimum.

Week 2‐4: Manual therapies including PROM of

affected limb joints, excluding tarsus, joint compres­

sions, cross frictional massage over length of Achilles,

and passive limb stretching. Pulsed ultrasound over

repair site, and laser therapy of affected region and

compensatory regions.

Therapeutic exercise goal: Early limb use to

encourage proper healing. Initial exercises include

weight shifting, cookie stretches, and low front

feet up, ensuring weight bearing on the surgical

limb. On‐leash deliberate walking exercise begins

with 5–10‐minute walks up to 2–3 times a day if

well tolerated, with 3–5‐minute intervals added

weekly.

Week 4‐8: Resistance damper is applied to fixator to

allow for controlled, increasingly dynamic motion at

tarsus. Continuation of rehabilitation therapies, with

partial tarsus ROM, and advanced therapeutic exer­

cise plan to progress tendon loading.

Exercise: Diagonal thoracic limb lifts eventually

progresses to the opposite pelvic limb lifts.

Backwards walking and pivoting a radius initiated,

Figure 14.30 Plantigrade stance in the right pelvic limb. (Continued)