Laurie's Blogs.

 

11
Jan 2015

Patellar Tendinopathy Post TPLO

Hi Laurie 

I have a topic suggestion for you:

Patellar Tendonitis - seen most often with dogs with TPLO - have you seen it with other CCL repair techniques?

I have seen post-op x-rays where the patellar tendon is 2-3x the size of what it should be.  I see a lot of dogs with enlarged tendons that don't seem to have pain and other dogs that are more lame than they should be at 4-8 wks out etc, and I’m wondering if the tendon is painful 

I went on the internet and watched videos of what they do manually for patellar tendontitis in people – It’ pretty vigorous therapeutic exercise by the therapist in some of the videos.

Is this the same for dogs?

What is the best way to evaluate for it, & to palpate?

Do you see dogs with painful response to palpation? I can't say that I have consistently seen this. 

Our Veterinary Surgeons typically recommend rest and NSAIDs and tell them to stop rehab for 2-4 wks.

 I have lasered some of them and I’m not sure if I see a favorable response or if they get better on their own. 

I guess, Is there some manual techniques that we can do to get them to respond quicker? 

A surgeon once commented to me that by the nature of TPLO technique, that you will always have patellar  tendon thickening

I would like some clarification on this and a review of why that is. 

Thanks

-A

 -- -- -- -- -- 

Hi A!

Great Ideas and I have jotted down notes for creating a training video... but to answer your questions:

I've only seen the patellar tendonitis issues with TPLOs. Apparently, it can happen with TTA's as well - both change angles of the joint.  (Nobody in Calgary is doing TTA's so I've not had the chance to see any of them.)

Why?  My thoughts are that it's due to the biomechanical changes and now forcing the patellar tendon to act (in part) like the CCL and there only being muscles left to resist cranial drawer (especially in a flexed or semi-flexed position).

I would imagine that there are plenty of patellar tendonitis issues that are undiagnosed in part because they may not be painful with typical palpation.  However in years of treating people with 'resolving' tendons (achilles or patellar) I have found that the area of the tendon that is painful on palpation seems to 'shrink' and/or move inwards.  So I think that in THIS case the area of irritation / problem could be on the medial or lateral side of the tendon or behind the tendon or in the deeper inner-most fibres... and as such may not be easily palpable.  So when I am checking I push REALLY hard and from as many angles as I can... especially if I find a thicker tendon... and an unresolving / slow to resolve / new lameness.

Rx.  NSAIDS delay healing, and so does rest.  It's a “bury your head in the sand approach.“ (But we know that!)  So in people the talk is about 'controlled loading'.  Eccentric exercise has been heavily touted, but any targeted loading is okay.  Some experts say that modalities may help (and if nothing more they bring the patient into the clinic so that you can be monitoring the tendon).  If pain management is needed - Ibuprofen and acetaminophen do not affect tendon healing... so advise / prescribe one of those if need be.

Dog thoughts:  Reduce the time or speed within the UWT - but no need to stop cold turkey.

Add eccentrics:  sit-stands, backing up, slow hill walking

I'd use modalities.

It is important to note and let the owners know that a slight increase in soreness / stiffness is normal, okay, expected, AND a good sign.

The dog just shouldn't be 'dead lame' or crying in pain.

And then slow gradual return to activities and previous level of exercises.

(PS I have found that long periods of walking and/or pushing faster exercises is more problematic than controlled strengthening)

The videos on Tendinopathies outlines these thoughts / the research quite nicely.

Thanks for the ideas.  I hope this helps!

Cheers,

Laurie

 



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