350 Medical Management of Cruciate Ligament Rupture
a rehabilitation environment as outpatients or
inpatients, based on the need for assistance. For
dogs recovering uneventfully, the bulk of man-
ual therapy and therapeutic exercises can occur
at home. For clients able to perform a home
exercise program, frequency may be every
2 weeks with a focus on re-assessment, progres-
sion of the home exercise program, and ther-
apeutic exercises in the clinic. With proactive
rehabilitation, recovery after CR stabilization is
complete after approximately 8 to 12 weeks.
Retroactive rehabilitation is performed to
address a problem or complication. It can be
referred to as targetedrehabilitation because
rehabilitation generally targets a specific prob-
lem, in addition to overseeing the dog’s over-
all recovery. The most common examples of tar-
geted rehabilitation focus on limb disuse, loss
of stifle joint extension, and eliminating abnor-
mal cranial weight shifts. Dogs are routinely
referred to rehabilitation because of their fail-
ure to progress. Limb disuse may result from
a mechanical problem, such as residual cra-
nial tibial instability, torsional instability (pivot
shift), failure of fixation, lack of joint stifle exten-
sion, or patellar luxation. Biological problems,
such as a torn medial meniscus, infection, patel-
lar tendonitis, or flare-up of chronic osteoarthri-
tis may also cause limb disuse. A rehabilita-
tion evaluation is critical to identify the cause
of limb disuse. The evaluation may include
gait assessment, assessment of functional activi-
ties, measurement of thigh muscle mass using a
tape measure, measurement of range of motion
of the tarsus, stifle, and hip in both pelvic
limbs using a goniometer, assessment of cran-
iocaudal and torsional stifle joint stability, pain
response to palpation, joint effusion, and crepi-
tus. While little is known about the benefits of
stifle braces in dogs recovering from CR sta-
bilization, stifle braces could potentially limit
the torsional instability that may occur during
weight-bearing in dogs with pivot shifts.
Loss of stifle joint extension leads to limb
disuse or to a crouched posture. Gains in
extension are achieved progressively through
a stretching program, with anticipated weekly
gains of 5–10◦ per week during the acute
or subacute recovery period, and 3–5◦ dur-
ing the chronic recovery period. Stretching can
start with manual stretching and transition to
stretching through exercises (Marcellin-Little &
Levine 2015). Stretching is more effective and
safer when tissues are heated (elevation in tis-
sue temperature of 3–4◦C) immediately before
and during stretching. While many exercises
promote stifle joint flexion, including clear-
ing low obstacles, walking over Cavaletti rails,
climbing steps, walking in water up to the sti-
fle or mid-femur, and stand-to-sit exercise (Fig-
ure 42.7), it is challenging to promote stifle
extension through exercise.(A) (B)Figure 42.7 This Australian Cattle dog is
recovering from surgical stabilization of his right
stifle joint. He has muscle atrophy of his right
pelvic limb and lacks stifle joint flexion. As part
of his exercise program, he is climbing
half-steps (A) and walking over Cavaletti rails
(B). The exercises promote limb use and flexion
of the stifle joint.