Home Newsletter - Cruciate Ligament Tears, Repairs, and Rehabilitation

Greetings!

A torn cruciate ligament is one of the most common orthopedic disorders amongst dogs. The cranial cruciate ligament (CCL) or anterior cruciate ligament (ACL) is one of several ligaments that stabilizes the knee. However, it tends to be the one most commonly injured. The injury can be acute, usually due to some sort of trauma like being hit by a car or a sporting injury. However, most often it is a slow degeneration of the ligament. All breeds and sizes of dogs are at risk for traumatic injury of the CCL, but medium to large breeds and spayed females are most prone to the degenerative process. Dogs with systemic diseases, like Cushing's disease or hypothyroidism, are also at risk because these diseases can weaken ligaments over time. Cats are not immune from this type of injury, but it is most often related to a traumatic event. Please read on to find out more about how CCL tears are diagnosed, treated and rehabilitated here at VHRC.

Diagnosis

ACL tears are diagnosed by taking your pet's history, physical exam, orthopedic exam, gait analysis, and x-rays. An injury may be acute-with a sudden non-weight bearing lameness chronic-with a sudden lameness, that got better over time but not quite normal partial ligament tear-with a mild lameness that is present during or following exercise

Exam Findings Include:
• lameness
• an abnormal sit position-with leg out to the side
• muscle loss
• knee pain and swelling
• knee instability (cranial drawer and tibial thrust)

On x-rays, we look for joint swelling and signs of arthritis. Arthritis may not be present if the injury just occurred. Older injuries generally show signs of arthritis on x-rays.

If your pet is lame and you think he/she may have a torn cruciate ligament...we, at VHRC, can assist you with diagnosing this condition. It is helpful to have x- rays taken prior to your appointment at VHRC, as we do not take x-rays here.

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Medical Management

Medical management alone is not the ideal way of treating a torn cruciate ligament. Without surgery, the knee will remain unstable, pain will persist, and arthritis will continue to worsen over time. Your pet's mobility will be affected in the long term. Surgery with post-operative rehabilitation is the treatment of choice and ensures optimal function of your pet, and will help to slow the progression of arthritis. If your pet is a poor surgical candidate or you choose not to perform surgery for personal reasons, then rehabilitation (with conservative exericise), pain management, and possibly a knee brace would be the best treatment plan. At VHRC, we have a human orthotist (a person that makes braces) come to our office on an as needed basis for this purpose.

At VHRC we will develop a treatment plan that will meet you and your pet's specific needs. Low impact exercise such as walking through shallow water or walking in our underwater treadmill would help to keep your pet in shape, maintain or improve muscle strength and muscle mass, and relieve the stress on your pet's joints while exercising. This ultimately helps to alleviate the pain associated with exercise and helps to manage some of the secondary complications associated with torn cruciate ligaments (such as decreased flexibility in the knee and muscle atrophy).

We will also develop a pain management plan that fits with your pet's level of pain and your specific needs as well. Some of our clients prefer to avoid non-steroidal anti-inflammatory medications due to the potential gastrointestinal, liver and kidney side effects. We are more than happy to develop an alternative plan that may include supplements, herbs, homeopathics, acupuncture, and pulsed signal therapy that help to reduce pain and inflammation, and are also are very safe. These options could be helpful to control pain, build muscle strength to support the joint, and encourage the formation of scar tissue in and around the ligament to provide support to the knee.

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Rehabilitation

Pre-operatively:
• During this period we focus on keeping your pet pain free prior to surgery, by reducing pain and inflammation.
• Icing the knee helps with analgesia and reduces inflammation.
• Very restricted exercise.
• Use of anti-inflammatories and Adequan injections to manage pain.
• Acupuncture is also effective for pain management leading up to surgery.
• Dr. Danoff can customize a pre-operative program for your pet, and also teach you the techniques that will need to be done immediately after surgery.

Post-Operatively:
• Initially the emphasis is on reducing pain and inflammation through analgesics, hot/cold therapy, and natural and/or traditional anti-inflammatory medications.
• Passive range of motion (PROM) helps to return the knee joint to its normal range of motion (flexibility).
• Massaging the leg helps to reduce swelling.
• We slowly initiate exercise and over time work up to your pet's prior exercise regimen.
• The underwater treadmill is a large part of the rehab program. Initially it is better than deep water swimming, as it is less stressful on the joints, facilitates weight bearing, and optimizes range of motion.
• In the underwater treadmill, we are able to adjust the water level based upon the patient's size, level of pain, and stage of the rehab process.
• We tend to keep the water level higher for more painful animals to make them more bouyant and thus reduce the stress on their joints.
• Over time, we increase the challenge of our rehab program.
• We may do this by using the incline in our underwater treadmill; lowering the water level; or turning on our jets to provide for more resistance.
• We may also switch them to our land treadmill.

Toward the end of our rehab program, we focus on more functional exercises-essentially exercises that will get your pet back to his/her normal routine at home. This will, obviously, vary depending upon whether or not the dog was very athletic or a couch potato previously.

We start to include stairs, controlled play time, and jogging. For the typical ACL rehab, our patients are back to normal in 12 weeks.

Every 4 weeks, Dr. Danoff reevaluates your pet's progress, and at the end of 12 weeks, our goal is to have your pet discharged from rehab.

At The Veterinary Holistic & Rehabilitation Center, we provide excellent quality care. The majority of our rehab treatments are performed by either Dr. Danoff or our licensed physical therapist, Renee Packard.

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Clinic Updates

In August, Dr. Danoff attended a veterinary practice management conference (Module 1-Human Resources). The program is through the Veterinary Management Institute at Purdue University. She will be attending Module 2 in February which will be on Financial management. She also attended an herbal conference at the Chi Institute which discussed gastrointestinal problems and how to treat them using acupuncture, herbs, and Chinese food therapy. She recently completed her Reiki Level 3 (Reiki Master) training, and will also be attending a Sports Medicine conference at the Animal Rehab Institute in March in Loxahatchee, FL.

We are currently in desperate need of permanent or foster homes for 7 bunnies and a cat. The bunnies are Katrina bunnies-5 of which are currently spayed and neutered. The other 2 are still too young to be spayed or neutered. They are all young adults, we suspect less than 1 year of age, and have a clean bill of health. Our cat, is a dark grey, gorgeous domestic long hair, approx. 7 months old, that was trapped by Dr. Danoff's mother. He is very sweet, but still nervous in new situations. He has had full bloodwork and is in great health. If you are interested, please give us a call. They have all been here for several months, as we are having difficulty finding them homes. We want to get them into loving homes asap.



 

Charles celebrated his 7th birthday in October. He had a party at his grandparent's house on October 23. It was attended by many doggie friends including "Darwin", "Holden", "Bailey", and "Maxi".

 

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In Memoriam



Unfortunately, some of our friends have lost their Beloved animal companions. In memory of "Jasmine"Ashmore, "Brittany" Asner, "Mija" Baker, "Darlin" Butler, "Buddy" Call, "Amber" Carter, "Darby" Cubbage, "Sassy" Davis, "Zelda" Derrico, "Sushi" Eisenach, "Ceilidh" Fair, "Keeper" Fellinger, " Thomas" Fritz, "Chloe" Ginn, "Kayla" Gegg, "Pepper" Grocholski, "Winston" Hickling, "Flaps" Hinkle, "Byte" Knepley, "Jess" Littleton, "Henson" Lubcher, "Chat" Meyer, "Jackson" Peterson, "Nanette" Prescott, "Albert" Stern, "Bella" Titus, "Tango"and "Tasha" Wasserzug, "Molly" Wood, "Obie" Zinzi, "Duncan" Barbaro, "Daisy" Bernstein, "Samantha" Burger, "Cisco" Cake, "Piglet" Carlson, "Scarlet" Gordon, "Crusoe" Louppe, "Missy" Parkin, "Snowtoes" Pica, "Window" Walker, "Miss T." Wall, "Bubba" Corr. They will all be missed.

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New Staff Introductions

Leanna Van Osten is one of our veterinary assistants. She received a B.A. in psychology from Randolph Macon College in May 2004, and has also studied in Italy and Australia. She is pursuing a career in one of the following areas: veterinary medicine, animal behavior or animal assisted therapy. She is planning on returning to school in the spring of 2006 to begin working toward this goal. She enjoys going to the beach with her family, spending time with her boyfriend and friends, camping, concerts and playing soccer. She has a dog named Oscar that she rescued from an animal shelter.

Terri Le Bel is also a veterinary assistant at VHRC. She graduated from art school, and also was a chef. She left all that behind for her love of animals and became a professional pet sitter, including sitting for Dr. Danoff's menagerie. She shares her home with a rescued Doberman, 3 Cardigan Corgis and a recently released squirrel.

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