POSTSURGICAL CARE AND REHABILITATION OF THE DOG
FOLLOWING CRUCIATE LIGAMENT SURGERY
Donald. L. McLain DVM
Diplomate, American College of Veterinary Surgeons

    Your dog has had reconstructive surgery following rupture of the anterior cruciate ligament in the stifle (knee) joint. Just as with people who have had similar surgery, the post-surgical care and rehabilitation is very important if the dog is to regain good function in the injured joint.

Incision and stitches:
The skin incision has been closed with nylon stitches which your veterinarian will remove in about two weeks.

Bandage or splint:
Usually we will apply a bandage or splint to the leg. This will be removed by your veterinarian after a week or two. You should bring your dog back to the pet hospital at least every week while the bandage is on so the bandage can be checked by the veterinarian. Because of the tapered shape of the dog’s leg, bandages usually tend to slide down and loosen up at the top.  This usually is not a problem unless the bandage gets very loose and floppy, in which case you should return the dog to the animal hospital to have the bandage repaired or removed. Keep the bandage dry, if it gets too wet it will need to be replaced. During rainy weather you should put one or two heavy plastic bags around the bottom of the bandage before the dog goes outside to urinate.  Some people put a heavy sock over the plastic bags to help hold the bags on and to prevent a hole from being worn in the bags as the dog walks around. Remove the plastic bags as soon as the dog comes back indoors. Leaving the bandage covered with plastic will cause the bandage to become wet from trapped body moisture.

PREVENT EXCESSIVE ACTIVITY FOR THE FIRST FEW WEEKS AFTER SURGERY.

Do not let the dog run or jump or play roughly with other dogs during the first 6 weeks following surgery. Excessive early activity can damage the surgical reconstruction and may result in the need for additional surgery to repair the damage.
If you have stairs in your house you should not permit the dog to run up and down the stairs by itself. If the dog is small enough for you to carry it is best if you carry it up and down the stairs during the first month or so. If the dog is too large to carry you should put the dog on a very short leash and make it walk slowly beside you as you guide it up or down the stairs.
If your dog tends to become too active in the house you may need to confine it to a small room or a pen. If this still isn't enough to prevent excessive running, jumping, and twisting, your veterinarian will prescribe tranquilizers to calm the dog enough to prevent it from re-injuring itself. If the dog is quiet, it is permissible to let it walk by itself in the yard enough to urinate and defecate. If the dog tends to get too active during these "bathroom breaks," you will need to keep it on a leash while it is outside.

REHABILITATION:
Thus far we have discussed only how to prevent excessive activity during the first few weeks following surgery. Now we need to discuss what types of activities are acceptable to rehabilitate the injured leg. Just as excessive activity can be harmful, so too can inadequate activity prevent a return to normal function. Muscle weakness, atrophy, and loss of the normal range of motion in the joint can result from inadequate rehabilitative activity.
    The most practical method of rehabilitation after knee surgery is to simply take the dog for short walks on a leash. You should begin these walks as soon as the bandage has been removed. It is important to keep the dog on a leash to prevent it from running too fast on the other three legs. Go slowly so that the dog will begin to use the injured leg. If possible, try to walk on a grassy surface. Dogs do better if they can dig their toes into the grass. Don't go too far at first, probably about 50 yards is enough to start with. You can gradually increase the distance as the dog begins to use the leg better. You may be able to work up to a distance of 3 or 4 city blocks by the fourth post-surgical week. If the dog stops using the leg and begins to hold it up you have gone far enough for that day. Try it again the next day with a little less distance. After the dog has started to use the leg fairly well on a level grassy surface you might try walking uphill on grass. This improves the range of motion of the knee and helps to strengthen the leg.
    It is very important to let your veterinarian closely monitor the dog’s progress for the first six or eight weeks following surgery. Your veterinarian has followed many dogs with this problem and knows when a dog is "on schedule" and when it is not. Some dogs are timid and need more aggressive physical therapy. Others are too active and require more restriction. Your veterinarian will help you tailor the amount of exercise and the type of exercise to your individual dog according to its progress. Be sure to make an appointment for your first follow-up examination before you leave the hospital after your dog’s surgery. The veterinarian will want to see your dog at intervals during the first several weeks post-surgically. Be sure to keep these appointments as the post-surgical rehabilitation is a critically important part of the recovery from the cruciate ligament injury.

    Drugs:
Rupture of a cruciate ligament is a very serious injury to the knee joint and some arthritis usually develops in that knee as a result. Your veterinarian may prescribe one of several available drugs that are intended to reduce the severity of the arthritis.  Sometimes it is necessary to try more than one drug over a period of weeks to see which one is the most effective for a particular dog. Be sure to give the medication according to the directions and don't fail to report back to your veterinarian your observations as to the effectiveness of the drug.

    Weight control:
Keeping the dog from becoming too fat as it gets older is perhaps the most effective single thing you can do to keep the dog comfortable and active after a cruciate ligament injury. Talk to your veterinarian about low fat diets and lifelong nutritional management.  Also try to keep the dog "in shape" through frequent moderate physical activity such as daily walks.

Donald L. McLain, DVM
Diplomate, ACVS