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Postoperative Care Following
Rupture of the Anterior Cruciate Ligament
Extracapsular Technique

Surgery of the joint requires careful surgical technique by a trained professional; however, it is only the first step in the healing process. It is just as important to provide your pet with the proper environment and care after surgery as it is during the surgical procedure itself. Southeast Veterinary Specialists is extremely lucky to have a certified animal rehabilitation practitioner on staff. Robert Porter (Robby) is here to guide you through the process of physical rehabilitation after the surgeons have mechanically reconstructed your pet's knee.

Surgical Procedure

Cruciate ruptures in dogs are the result of a degenerative process that results in weakening of the ligament over time. There is no good way to primarily repair the torn ligament. For this reason, techniques to restore function to the joint without actually replacing or repairing the ligament have been developed. The extracapsular technique for stabilization of the stifle (knee) after rupture of the cranial cruciate ligament involves placing a suture that mimics the action of the intact ligament. This technique works well in dogs and has been considered the traditional technique of choice for surgical stabilization of cruciate ruptures. It is our opinion that large dogs and physically active dogs (working dogs and performance animals) will do better with a Tibial Plateau Leveling Osteotomy (TPLO), however the extracapsular technique is still a viable surgical option.

Activity and Physical Rehabilitation

Rest is very important following surgery. Your pet should not be allowed to run or jump for 6 weeks. CAGE REST (an airline carrier works well) during this time period is very important in order to give the knee time to heal properly. If too much stress is placed on the surgical repair, it will not be successful. Your pet should only be allowed out of the cage for short walks outside to urinate and defecate or for physical rehabilitation. After the first six weeks, controlled leash walks will help to improve the range of motion in the operated joint. You should begin leash walking slowly with only short walks for the first two weeks (around the yard) followed by a little longer walks lasting 10 minutes or less for the second two weeks. After this your pet can gradually return to his/her normal activity. Keep in mind that increased body weight will put added stress on the joint; therefore, your pet's diet may need to be adjusted for the decreased activity after surgery.
If a human member of your family received this type of surgery, the doctor would likely prescribe physical rehabilitation. Physical rehabilitation is also important for your pet. Physical rehabilitation appointments with Robby are strongly recommended after an extracapsular cruciate repair. We understand that both time and finances may be limited; however, it is our opinion that aggressive rehabilitation can greatly improve your pet's function after surgery. If you cannot make the rehabilitation sessions with Robby, you will have to take on the role of physical therapist. You should not begin therapy until 7 days after surgery. Begin by massaging your pet's limb and getting him/her used to the manipulation. After several minutes, begin to move the joint through its range of motion. Concentrate on reaching full extension and full flexion. If this is not possible or uncomfortable for your pet, do as much as you can and try to do a little more each day. This therapy should be performed for 10 to 15 minutes 2 to 4 times daily.

Medication

In most cases, a non-steroidal anti-inflammatory drug such as carprofen (Rimadyl®) or deracoxib (Deramaxx®) will be recommended. This class of drugs is often helpful in relieving postoperative inflammation, pain, and swelling. This will help your pet be more comfortable and return to normal function sooner. Do not give your pet any other medication without consulting your veterinarian. Many other non-steroidal anti-inflammatory drugs available for people are often toxic in dogs.
Antibiotics are usually used during surgery and may be considered postoperatively at home. Please do not give your pet any medication without discussing it with our office first. Antibiotics given inappropriately may result in the development of a resistant infection that can be difficult to treat.
Pain medication other than a non-steroidal anti-inflammatory drug may be needed in rare cases. If you feel that your pet is unusually uncomfortable, please notify us. Uncontrollable pain is not an acceptable complication of surgery, and methods are available to keep your pet comfortable without side effects.

Sutures and Bandages

External skin sutures, when present, should be removed in 7 to 10 days. In most cases the skin is closed with internal absorbable sutures which do not require removal. If you notice your pet licking and chewing the incision area, please notify us. Some swelling is normal after surgery; however, please call if you think the swelling is excessive or if you notice a discharge or foul smell from the incision.
A bandage is often applied following joint surgery to decrease swelling and provide pain relief. Bandages are applied for only a short time. If a bandage has been applied to your pet, make sure that the toes below the bandage are not swollen or cold to the touch. If this occurs or the bandage becomes wet, notify us immediately.