Clean Run Magazine - July 2007 - 57

Figure 4: Cranial (forward) displacement of the tibia due to a CCL rupture Figure 5: The osteotomy and the plate that is applied to hold the tibia in this position and allow for the bone to heal COURTESY OF SHERMAN CANAPP Figure 6: A post-operative X-ray of the TPLO procedure which alters mechanical forces acting on the stifle, rendering the CCL unnecessary. Two of the most common surgical options for correction of the CCL injury include the TPLO or an extracapsular stabilization. The extracapsular stabilization stabilizes the joint with a prosthetic ligament. This technique relies on scar tissue to ultimately stabilize the joint. The reported recovery time for the extracapsular stabilization is approximately 3 to 5 months. The reported recovery time for the TPLO procedure is approximately 2 to 3 months. Following surgery, patients use the limb much sooner with the TPLO than with an extracapsular stabilization. Additionally, studies show that there is far less arthritic development long term following a TPLO verses the extracapsular stabilization (Lazar T, Vet Surg, 2005). For these reasons, at VOSM the TPLO is considered to be the “gold standard” for correcting this injury, especially in the canine athlete. What can I expect after TPLO surgery? After surgery, dogs are typically non-weightbearing to toe-touching lame for the first few days. Shortly thereafter, dogs begin to bear weight with an obvious lameness. When walking, they will use the limb but they will often hold the leg up when standing. Within two to three weeks, however, they are using the limb consistently, although a lameness will still be obvious. Patients are typically quite comfortable within two or three days following surgery. Most owners report that the greatest challenge they face while caring for their recovering dog is preventing him from being too active! By the four-week recheck and radiographs, the dog is typically fully weight bearing. By the eight-week recheck and radiographs, most pets are healed and may begin a gradual return to normal activity. A few pets require an additional month to complete healing. At-home care and rehabilitation therapy are the most important aspects of a successful recovery. A soft padded bandage is applied to the leg post-operatively to help reduce swelling. This bandage will be removed one to two days after surgery. An Elizabethan collar or Bite Not collar is needed following surgery until the incision has healed and the staples are removed (10 to 14 days). The dog will need to be confined to either a crate or a small area of the house where he does not have access to stairs or furniture. A crate is only recommended for dogs that are normally confined in that manner. The dog should not run, jump, or play for at least two months following surgery. Stairs should be limited to only those necessary. A sling and leash should be used when performing stairs, crossing slippery surfaces, and on uneven ground. You will be given rehabilitation exercises to perform at home. Your dog is limited to short leash walks for elimination only for the first two weeks. Thereafter, your dog is allowed gradually increasing leash walks as part of rehabilitation. Radiographs will be needed at 4 and 8 weeks, and possibly, 12 weeks post-operatively. At those appointments, based on the amount of healing noted and orthopedic evaluation, changes to the at-home therapy program are provided. All at-home care and rehabilitation exercises will be reviewed with you in detail. Like in humans, rehabilitation therapy will help to speed your dog’s recovery and return to full function. In the next part of the article, we will discuss the structure of rehabilitation, rehabilitation at home, and the dog’s progression during the process. D What is a TPLO? The TPLO procedure stabilizes the knee by leveling the tibial plateau. In the earlier example of a car parked on a hill, the TPLO levels the hill, eliminating the need for the brake. Radiographs of the knee are taken before surgery. Using specific landmarks, your dog’s tibial plateau angle (slope) is observed to precisely determine the amount of rotation that is needed to reduce the angle. During the TPLO procedure, a circular cut (osteotomy) will be made in the top of the tibia and rotation of the segment will occur so that the load-bearing surface of the tibia is between 5° to 8°. Figure 5 shows the osteotomy and the plate that is applied to hold the tibia in this position and allow for the bone to heal. A post-operative Xray of the TPLO procedure is seen in Figure 6. Restricted activity is required while the bone heals. The menisci are the “shock absorbers” of the knee and are located between the bottom of the femur and top of the tibia. There is a meniscus located on the inside (medial) and outside (lateral) aspects of the knee. When the knee is unstable due to a CCL rupture, either complete or partial, these structures are at risk for injury. Before the TPLO procedure, I perform a stifle arthroscopy or a mini arthrotomy to evaluate these structures, and if either menisci has sustained an injury, the damaged portion will be treated. Dr. Canapp, a Diplomate of the American College of Veterinary Surgeons, completed a combined D.V.M./M.S. at Kansas State University, an internship in small animal medicine and surgery at the the University of Missouri, a three-year residency in small animal surgery at the University of Florida, and training in canine rehabilitation by the Canine Rehabilitation Institute. Dr. Canapp currently practices orthopedic surgery and sports medicine at the Veterinary Orthopedic & Sports Medicine Group (VOSM) in Ellicott City, Maryland, and acts as a consultant to local zoos, police K-9 units, agility, flyball, and disc competition dogs. See additional information about Dr. Canapp at www.vetsportsmedicine.com. July 07 | Clean Run 57

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Clean Run Magazine - July 2007

Table of Contents for the Digital Edition of Clean Run Magazine - July 2007