Rehabilitation for Dogs with Cruciate Ligament Rupture 349sling under the pelvis. Harnesses and slings can
provide safety and facilitate limb use. Under-
water treadmill therapy may be emphasized in
patients with limited mobility recovering from
CR or surgery.
Scientific evidence for rehabilitation
Rehabilitation offers clear benefits to dogs
recovering from CR surgery. Rehabilitation pro-
grams after surgical stabilization have been
shown to facilitate gains in thigh circumfer-
ence, passive mobility, and improved limb use.
In one study involving dogs with extracapsu-
lar stifle stabilization, peak vertical force and
vertical impulse six months after surgery were
improved (Marsolaiset al. 2002). In another
study, thigh circumference was larger six weeks
after a tibial plateau leveling osteotomy proce-
dure in a group receiving rehabilitation, com-
pared to a home exercise-only group (Monk
et al. 2006).
Overall in the long-term, scientific evidence
for the use of physical rehabilitation after sur-
gical stabilization does not show that dogs that
undergo rehabilitation function or feel unequiv-
ocally better than dogs that do not undergo
rehabilitation. The absence of documented
long-term benefits of short-term rehabilitation
programs after CR stabilization surgery is due
to the fact that CR is a multifactorial problem
with varying chronicity, osteoarthritis, menis-
cal health, loss of muscle mass or joint motion,
articular fibrosis, shape of the tibia and femur,
patient demeanor, mobility, living environment,
oversight during recovery, and owner expecta-
tions. Also, current long-term medical and func-
tional assessment of dogs after CR stabiliza-
tion is generally subjective (Jandiet al. 2007;
Molsa ̈ et al. 2013). For example, in veterinary
orthopaedics, a validated functional score that
would allow objective assessment of overall
limb function during activities of daily living
after CR stabilization is lacking. The use of such
validated scores are the foundation of evidence-
based rehabilitation after anterior cruciate liga-
ment repair in humans (Collinset al. 2016; Monk
et al. 2016).
Clearly, physical rehabilitation clinicians
provide valuable assistance throughout the
recovery process, particularly in dogs at risk
of complications after surgery. Rehabilitation
offers clear and unequivocal benefits at all
stages of recovery. Rehabilitation alleviates
pain throughout recovery, prevents limb
edema, protects or restores joint motion,
decreases the loss of muscle mass, and restores
functional strength and mobility. Rehabilitation
programs also include medical oversight and
client education. These programs offer short-
term and long-term benefits to dog owners.Management protocols
Rehabilitation after CR stabilization can be
either proactive or retroactive. Proactive reha-
bilitation occurs before complications occur;
retroactive rehabilitation occurs when recovery
is complicated, most often when limb use is
less than anticipated. Proactive and retroactive
rehabilitation require an initial evaluation and
are tailored to the situation. Key goals during
the acute postoperative period are to manage
pain, eliminate edema, improve passive and
active mobility, prevent falls, and initiate pro-
tected use of the operated limb. Key goals dur-
ing the subacute recovery period are to manage
pain, restore joint motion, support increased
use of the operated limb, and minimize loss of
strength. Key goals during the chronic recov-
ery period include restoring strength, mobility,
motor control, and fitness to return to perfor-
mance and achievement of owner goals. The
intensity of proactive rehabilitation is tailored
to the patient. Patients with chronic osteoarthri-
tis of the stifle joint need pain relief for a
longer period of time than patients with little
stifle osteoarthritis. Larger dogs, dog with a fat-
ter body condition, and dogs with orthopaedic
comorbidities need ambulation assistance and
may benefit from exercise in water rather than
on land.
Clinician oversight during all phases of reha-
bilitation is critical to the success of proac-
tive rehabilitation. Patients with good limb use
and mobility can be seen periodically. The fre-
quency and duration of rehabilitation sessions
should be based on the patients’ clinical func-
tion, healing time frames, owners’ means, goals,
and expectations. The selection of therapeu-
tic modalities also influences the frequency of
rehabilitation sessions. For patients with poor
limb use or poor mobility, the bulk of therapy
and exercise may occur more successfully in