Step 6: Recovery Process
For the first 6 to 8 weeks, before the bone is healed your pet should be confined to a kennel until his or her x-rays are performed showing the bone is healed or healing appropriately. Running, jumping or playing, whether it is inside or outside, could lead to severe complications such as a fracture of the bone or breakage or loosening of the metal. At 10 to 14 days, your pet will be evaluated in person or remotely (picture of the incision and a video of them walking) regarding the healing of the incision. Skin sutures or staples, if placed, will be removed at this time.
In general, your pet should be improving from day one until they plateau at a good level of function. At any point during the process if they seem to be worsening, seem swollen, or less willing to use the limb, they may need to be evaluated in person, and with x-rays, earlier than originally designed.
Professional rehabilitation is available, it can be beneficial in recovery however in many cases it is not required. It is important to remember that in general a pet should always be improving otherwise they should be seen by a veterinarian.
Weeks 1 and 2
Controlled leash walks
- Strict crate rest, no off leash activity
- Short leash walks only to the bathroom. A sling or folded bath towel under the belly should be used for support especially on slick surfaces and will allow you to slow your pets pace if they are attempting to get away. They must still be on a leash even if a sling is used.
Passive Range of Motion (PROM)
- Passive range of motion should be performed by laying your pet on the side with the surgical limb up. Gently flex and extend the knee to the point of resistance while supporting it to prevent twisting. It should be repeated 2 to 3 times a day approximately 10 to 15 repetitions unless pain or discomfort is shown.
Ice and Heat therapy
- Ice packs should be used for 20 minutes at a time, four times daily for the first five days. Drugstore ice packs, frozen peas or crushed ice in a Ziploc covered by a very thin towel can be used. Ice as much of the circumference of the knee as you can.
- After five days we switch from ice packing to heat packing. Please test this on your wrist first; if it is too hot for your skin and it’s too hot for your dog. The compress can be applied for 10 minutes four times daily.
- Please consult your veterinarian if your pet is not using his or her leg during the first two weeks.
- A two week incision recheck is performed
Weeks 3 and 4
- If your pet appears to benefit from it or enjoy it, use warm packing before a walk and ice packing afterwards.
- Strict crate rest. Leash walks should still be just to the bathroom (5 mins). A sling should no longer be needed.
- You should notice an improvement in how your pet feels and how well they use the leg
- To build strength walk in a large figure 8, step slowly up and down onto a curb and use very gentle inclines.
- On a non slip surface you may stand your pet four-legged and gently nudge them from side to side at the hips
- Instruct your pet to repeatedly sit down and stand up and perform three legged standing exercises where you pick up the good leg for 10 to 15 seconds at a time to encourage weight-bearing through the surgical leg.
Weeks 5 through 10
- X-rays and progress re-evaluation is scheduled at 6 and 10 weeks and specific recommendations may be given.
- Leash walks can increase 10 minutes up to four times daily and from this, 5 minutes can be added to the length of the walk per week, as long as your pet is still improving.
- After confirmation of bone healing
- When given the all clear from our surgeons, generally leash walks should be gradually extended to 40 mins up to four times daily. At this point slowly reintroducing off leash exercise starting with 5 minutes of gentle off leash twice daily and add 5 mins to this per week until you have reached ‘normal exercise’.
- Ups and downs can happen as your pet stretches scar tissue and occasionally may have a flare up of inflammation which could require rest and medications
- After confirmation of bone healing
My pet is still limping after surgery.
There are a few reasons why patients may struggle to recover. If they are not bearing weight on the leg within two weeks or seem to be in any way worsening during any point of the recovery, please contact your veterinarian. The most common reasons for limping after surgery are listed below.
- Your pet overdid it during the recovery. Similar to humans, if we do significantly more than usual, this can lead to a short amount of lameness, swelling and discomfort. High intensity exercise is much more likely to cause flare ups of discomfort.
- Implant infection. About 3% to 5% of patients will develop a surgical site infection. The source of the bacteria is usually the pet’s skin. Infection is usually much less obvious than one would expect. Rather than a swollen, red incision with pus coming out, more frequently an infection just exhibits lameness, pain, swelling or redness of the surgery site and a small amount of discharge. In these cases we may need to grow the bacteria (perform a culture), place your pet on antibiotics until the bone is healed (often 6 weeks or more) and when the bone is healed, if infection persists, the metal implant may need to be removed. This happens in approximately 2% to 3% of cases.
- Implant associated pain. Excessive activity prior to bone healing can result in excessive forces on the plate and screws. Bending or breaking is rare but will require further surgery. Occasionally heat or cold can be transmitted through the plate leading to discomfort and irritation and extreme weather.
- Meniscal tear. Up to 70% of dogs undergoing surgery for a CCL tear will have a tear of the meniscus, a shock absorbing disc in the knee. In those cases, we will remove the torn portion of the meniscus. If we elect to leave the meniscus intact to optimize athleticism and reduce the progression of arthritis there is a chance that the meniscus may tear at a later point. If this causes acute lameness, additional surgery might be required to remove the torn portion of the meniscus. We may elect to release the meniscus at surgery to prevent further trauma.