Introduction
Anterior cruciate ligament (ACL) injuries are one of the most common orthopedic problems in dogs. The ACL is a band of fibrous tissue that connects the femur to the tibia in the knee joint and provides stabilization. When the ACL tears, it causes the knee joint to become unstable and leads to severe arthritis over time. Surgery is often recommended to treat ACL injuries in dogs, followed by a recovery period of crate rest and physical therapy.
After ACL surgery, physical therapy and rehabilitation are crucial parts of the recovery process. Physical therapy helps restore range of motion, rebuild muscle mass, improve balance and proprioception, and protect the new knee joint. This allows dogs to return to normal function and prevent re-injury. Proper rehabilitation can mean the difference between a smooth recovery and setbacks or complications after surgery.
In this article, we will explore why physical therapy is so important for dogs after ACL repair surgery and provide guidelines on when to start and how often sessions should occur. Information on the techniques used and associated costs will also be provided.
ACL Injuries in Dogs
The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments in dogs. ACL tears are the most common knee injury in canines (1).
The ACL is responsible for providing stability to the knee joint. When dogs tear this ligament, it causes the knee to become unstable and can be very painful (2). ACL tears often occur in larger, active dog breeds like Labrador Retrievers and Rottweilers (3).
There are several potential causes for ACL tears in dogs:
- Excess strain on the legs from exercise or obesity
- Inconsistent exercise routines
- Genetic factors that cause joint instability
- Trauma from falls or accidents
ACL tears can happen suddenly or develop slowly over time from wear and tear. Common symptoms include limping, swelling around the knee joint, stiffness, and trouble bearing weight on the affected leg (4).
Sources:
(1) https://www.brisbanepetsurgery.com.au/blog/the-most-common-causes-of-an-anterior-cruciate-ligament-tears-in-dogs
(2) https://topdoghealth.com/the-5-reasons-so-many-dogs-tear-their-cruciate-ligament/
(3) https://furdunkin.com/what-you-need-to-know-about-dog-acl-tears/
(4) https://www.brisbanepetsurgery.com.au/blog/the-most-common-causes-of-an-anterior-cruciate-ligament-tears-in-dogs
ACL Surgery
There are several surgical techniques used to repair torn ACLs in dogs, with the most common being TPLO (tibial plateau leveling osteotomy) surgery. As described on TopDogHealth.com, TPLO surgery involves “making a curved cut in the tibia bone near the knee joint and rotating the cut portion of the bone to change the angle of the tibial plateau.” This helps stabilize the knee joint and prevents excessive tibial thrust that can cause ACL tears.
Other surgical techniques include TTA (tibial tuberosity advancement), which involves moving the tibial tuberosity forward to reduce stress on the ACL. TTO (triple tibial osteotomy) is another option that makes multiple cuts in the tibia bone to alter its alignment. Less invasive techniques like ALL (arthroscopic-assisted ligament replacement) may also be used in some cases.
The specific technique chosen will depend on factors like the size of the dog, surgeon preference, and desired outcomes. But in general, ACL surgery aims to stabilize the knee joint by altering bone alignment and preventing excessive tibial thrust motion.
Recovery
The recovery process after ACL surgery in dogs is crucial for ensuring successful healing and regaining full function in the affected leg. According to PetMD, the overall recovery time can range from 4-6 weeks, but the leg must be slowly strengthened again through controlled activity 1. A more detailed timeline outlined by Licks Sleeve shows the initial 2 weeks after surgery involving strict rest, while weeks 3-8 gradually introduce short leash walks and other restricted activity. Around weeks 8-12, the dog can start more intensive physical therapy and exercise under veterinary guidance. But dogs must avoid running, jumping or rough play typically for at least 12 weeks post-surgery.
The initial period after surgery focuses on protecting the surgical site to allow proper healing of the ACL and surrounding tissues. Jumping, stairs or unstable surfaces that cause slipping are prohibited at first. Follow any instructions from your vet about brace use, pain medication, and caring for the incision site. Gradually normal function returns over the full recovery period as long as activity is closely controlled and increased slowly under veterinary supervision.
Complications
While recovery from ACL surgery in dogs is typically straightforward, some dogs may experience complications. Common issues include post-operative infections, implant failures, and chronic lameness or stiffness.
Infections can occur when dogs excessively lick their surgical wound. Signs include swelling, redness, pain, and discharge. Infections require antibiotic treatment and sometimes additional surgery. Implants like screws or plates may loosen or break over time. This can lead to instability and arthritis. Some dogs may continue to limp or have stiffness long after surgery, which can indicate arthritis or improper healing.
According to the Back Mountain Veterinary Hospital, stiffening of the knee joint is the most common complication after cruciate surgery, occurring in 10-15% of cases. This is caused by excessive scar tissue formation during healing. Physical therapy can help improve range of motion if stiffness occurs.
Overall, while most dogs recover fully, owners should monitor their dog closely after surgery and alert their vet to any concerns. Proper at-home care and physical therapy can minimize complications.
Benefits of Physical Therapy
Physical therapy after ACL surgery can provide several important benefits for your dog’s recovery process. The main goals of post-operative physical therapy are to improve range of motion, rebuild muscle strength, and prevent complications.
Performing gentle exercises under the guidance of a physical therapist helps restore normal range of motion in the affected leg. Things like passive range of motion exercises and stretching help maintain joint mobility and prevent the leg from stiffening up (https://www.ellicottvets.com/physical-therapy-after-cruciate-ligament-repair/). The earlier these exercises are implemented after surgery, the better.
Physical therapy also focuses on slowly rebuilding muscle mass and strength. The leg muscles will atrophy after surgery due to disuse. Exercises to strengthen the thigh, hip, and core muscles are important to help support the joint and prevent re-injury (https://healingpawsfl.com/rehabilitation-after-canine-knee-surgery/). This muscle-strengthening should be gradual.
In addition to improving mobility and strength, physical therapy helps prevent complications like scar tissue build up and arthritis. It also aids recovery of normal gait patterns. Your therapist can monitor progress and make adjustments to optimize your dog’s healing.
Physical Therapy Techniques
Physical therapy after ACL surgery focuses on controlled stretching and range of motion exercises to restore mobility and strengthen the leg. Some common techniques include:
Stretching the leg – Gentle stretching helps restore range of motion. The therapist may apply gentle pressure to flex and extend the knee joint through the natural range of motion. Stretches should be held for 10-30 seconds and repeated several times during each session (Ellicott Vets).
Massage – Massage improves blood flow and helps reduce swelling and scar tissue. The therapist may gently massage the surgical area and along the limb (The Balanced Dog).
Range of motion exercises – The therapist will guide the dog through controlled exercises like sitting, standing, and controlled leash walks to improve strength and mobility. Caution is taken to avoid overexertion. The owner can perform similar exercises at home.
Strengthening exercises – Low-impact exercises like controlled sits/stands, stairs, and ramp walking help rebuild muscle tone over time without stressing the joint.
Balance and proprioception exercises – Exercises like sitting on an exercise ball and standing on unstable surfaces help improve coordination and balance.
Assisted swimming – Gentle swimming allows for range of motion with minimal weight-bearing. This can be introduced gradually under supervision.
When to Start and How Often
It’s recommended to start physical therapy as soon as possible after ACL surgery. According to Ellicottvets.com, physical therapy should begin on the first day after surgery. The initial focus is on cold therapy and passive range of motion exercises. As the dog progresses in recovery over the first 2 weeks, the physical therapy shifts to include more active exercises, massage, stretching, and hydrotherapy.
Most veterinarians recommend continuing physical therapy 1-2 times per week for 6-8 weeks after surgery. The frequency helps the dog regain strength and range of motion in the affected leg. Consistency is key – attending regular physical therapy sessions maximizes the benefits and aids the overall recovery process after ACL repair.
Cost
The cost of ACL surgery typically ranges from $1,500 to $4,000 per knee, according to Forbes. However, there are additional costs associated with recovery, including the expense of physical therapy. Physical therapy for dogs after ACL surgery generally costs $50-100 per session. Most dogs will require 8-16 sessions over the course of their recovery, so owners should budget an additional $400-1600 for physical therapy.
Some factors that influence the cost of physical therapy include the provider, geographic location, and the specific techniques used. Underwater treadmill therapy tends to be more expensive than traditional land-based exercises. Despite the extra expense, physical therapy is highly recommended to ensure a successful recovery from ACL surgery.
Conclusion
ACL surgery is a major procedure for dogs to undergo. While many dogs go on to live happy, active lives after surgery, the recovery process is long and difficult. Most veterinarians recommend starting physical therapy shortly after surgery to help facilitate the healing process. During physical therapy, techniques like passive range of motion, massage, cold compression therapy, therapeutic exercises, and hydrotherapy can help reduce pain, increase mobility, strengthen muscles, and prevent scar tissue formation. Physical therapy gives dogs the best chance at making a full recovery from ACL surgery. Though it requires an investment of time and money, physical therapy is highly recommended for any dog recovering from this surgery. With the help of a trained veterinary physical therapist, dogs can overcome this injury and get back to playing, running, and jumping.