Very Mild CCL Tear

[lehughes]

Hello Laurie,

I saw you posted an article on cryotherapy! Super cool! Thank you for reviewing that!

I wanted to ask you because I am starting to see this a lot -- what is your protocol for rehabilitation for dogs who have intermittent HL lameness, barely any evidence (even the surgeon states it might be a tiny bit of CCL tear but no instability noted) of CCL instability, and only very mild stifle effusion (even on X-rays!)?

In essence, these dogs are in the "grey" area (aka before potential CCL surgery but not significant (or even present at presentation) lameness).

For some reason, I keep seeing these dogs this week! The surgeon offers them a "watch and wait" option for surgery given the intermittent lameness and boring PE -- which the owners are not thrilled with.

Hence, they are here in my clinic.
My goals would be to strengthen the gastrocnemius (pull tibia back), as well as gluteals and hamstrings. BUT I don't want to over do it in these dogs!

Warmly,
J.D.

[lehughes]

Hi J!

Great question!

I have a protocol that I use for the dogs with Grade 1 CCL strains. I think ‘Wait and See’ is just code for ‘Let’s do surgery 3 months from now’. Whereas is you treat the partial (Grade 1) tear, you can prevent that!
Here’s the link: https://www.fourleg.com/media/Protocol%2 ... gement.pdf
It’s in the FourLeg members articles section under protocols. (Formatted so you can print it on your own letterhead if you choose.) I’ve used it TONS successfully on mild CCL injured dogs.

But as an overall:
Modalities for healing and to reduce swelling.
Strengthening for joint protection. (Don't get too hung up on exacting which muscles... just strengthen the entire leg. Research shows that quads become the most atrophied with CCL injury... I focus on quads and glutes.)
Manual techniques for joint health and proprioception.
Do the drawer test as a way to put low loads of normal force through the affected tendon in order to stimulate healing.
Limit potentially hazardous activity (2-3 months without exception).

Oh, and treat whatever other compensations there might be… (and check out the SIJ… vey common co-injury with a CCL).

Best of luck! Be the hero for this dog!!!



Cheers,

Laurie

[David Lane]

Just as am academic point of order, the origin of the gastrocnemius muscle is the medial and lateral supracondylar tuberosities of femur via the fabellae... it is a muscle that contributes to tibial thrust rather than prevent it. The hamstrings are the primary muscles that put caudal traction on the proximal tibia.

David Lane DVM
ACVSMR