fourleg.com

I have a 8 YO MN German Shepherd mix that has been receiving rehab at my facility post R TPLO. He was doing very well 2 weeks post-op...and then slipped and splayed at the rDVM's and started to regress in his weight bearing. I identified a mild iliopsoas strain (almost got bit there!), and we treated accordingly with laser therapy and careful heat packing and stretching.

However, in the past week (he is 5 weeks post-op) he has regressed again. On palpation, he is not reactive when iliopsoas is put on strain; minimal to no effusion at the stifle; no meniscal click (surgeon said removed all meniscus). A recheck with the surgeon involved X-rays - x-rays taken revealed no loosening of implant,etc. However, X-rays did demonstrated indication for patellar desmitis.
Additionally, was suspicion of a very mild infection (one irritated area along the ventral portion of the incision site) - he was started on antibiotics and a culture is pending.

The surgeon would like him to rest for 2 weeks. This is a very challenging case to rehab for many reasons - including the owner is not committed with performing his rehab exercises at home correctly. His muscle mass on the leg continues to atrophy (very very marked atrophy at this point in time), and I would like to provide him additional pain relief and treatment if I can. Unfortunately, I do not have shockwave and neither does the surgeon.

What are some protocols for treating patellar desmitis?

thank you!
Dr. Jessie

Hi Jessie,

So frustrating when you don’t have an owner that will do what needs to be done at home.

Okay… so I recommend a reduction in generalized activity (reduce walk time, or UWT time & speed, or off-leash, etc.). Basically reduce the time and speed of repetitive tasks (walk, trot, run).
BUT, I would add some targeted exercises for the quads & patellar tendon. Specifically adding some step ups, or sit to stands facing up hill, or stair / hill walking.
The key is reducing the ‘repetitive tasks’, but adding in some specific tasks.
Some kind of pain management would be okay, but not necessarily an NSAID, as anti-inflammatories can delay the healing process.
Laser is great, that should help as well.

I hope this helps!

Cheers,

Laurie