RE: Post Surgical CCL Casting

[Guest guest]

I haven't heard of this being done in many years. I think most surgeons

know better.

Hmmmm.....maybe your client needs a second surgical opinion.

Regards,

Carol Helfer, DVM

>

>Reply-To: VetRehab

>To: VetRehab

>Subject: Post Surgical CCL Casting

>Date: Mon, 11 Dec 2006 00:54:41 -0000

>

>An owner of a large 11 year old lab was told by the surgeon that her

>dog would be in a cast for 1 monthe s/p surgery. I've never heard of

>this. Is this an accepted approach? 20 years ago we put humans in a

>long leg cast for 4 months s/p ACL surgery! What a disaster!

>Judy Coates MS PT, CCRT

>

[Guest guest]

Hey guess what? I am one of those lucky ones that was put in the cast

(2 months) in 1977.

They removed the remainder of my ACL and removed my entire medial

meniscal cartilage

so you can imagine what my knee looks like now. I know of no boarded

surgeon that would do

what you have described, unless they are of the old school and still it

would surprise me. I finsihed my residency 17 years

ago and even then we only bandaged for a week to 2 weeks. Our motto

for joint surgeries was, "motion is lotion".

My advice (for what it is worth) for your client is to seek another

opinion. I do alot of knees, mostly

T.T.A., some facial strip with lateral suture stabilization. The TTA

cases have a bandage on for the first night,

then go home without a bandage. The FSG/LSS go a week to 10 days with

a soft wrap then start Rehab.

I typically go 4 weeks post-op on the TTA (or TPLO) before starting

rehab, but with some of the data that

I have seen from Rehab practices around the US, I am now likely going

to start them much sooner. Anyone else

have an opinion on that???

Mark B. Parchman, DVM, CVA, DACVS

Bend Veterinary Specialists,

Bend, OR

jcoates03 wrote:

An owner of a large 11 year old lab was told by the surgeon that

her

dog would be in a cast for 1 monthe s/p surgery. I've never heard of

this. Is this an accepted approach? 20 years ago we put humans in a

long leg cast for 4 months s/p ACL surgery! What a disaster!

Judy Coates MS PT, CCRT

[Guest guest]

Judy,

Unfortunately, some surgeons are still using coaptation

(splints/casts/bandages) post-op for their CCL repairs. Yes this

very old-school and disastrous for over all joint health, muscle

tone, etc. Studies have shown that by immobilizing a joint for a

short as 4 weeks causes significant negative effects on cartilage,

synovial fluid viscosity, etc. The reason for the post-op

coaptation……they are afraid their repairs will fail with too much

activity…ie will stretch the nylon or graft before periarticular

fibrosis has occurred, break the TPLO or TTA implants before the

osteotomy has healed……well, if their repair is adequate to begin

with, and if the owners follow an appropriate controlled activity

and rehabilitation protocol this will not be a factor. We actually

have surgeons (non-boarded) in the area that do not use post-op pain

medications because they are afraid the dog will be too comfortable

and actually use the leg…....this is very disheartening. If their

surgeon is adamant about this, find a new boarded surgeon. If there

are no other surgeons in their area you are in a tough spot. If you

take the cast of the patient he will probably stop referring you

cases……best option in this case would be to educate the surgeon.

Best of luck with this one and keep us posted on the client's /

surgeon's decision.

Best Regards,

Sherman

Sherman O. Canapp Jr., DVM, MS

Diplomate ACVS

Veterinary Orthopedic & Sports Medicine Group

10270 Baltimore National Pike

Ellicott City, MD 21042

PH:

FX:

www.vetsportsmedicine.com

>

> I haven't heard of this being done in many years. I think most

surgeons

> know better.

>

> Hmmmm.....maybe your client needs a second surgical opinion.

>

> Regards,

> Carol Helfer, DVM

>

>

> >

> >Reply-To: VetRehab

> >To: VetRehab

> >Subject: Post Surgical CCL Casting

> >Date: Mon, 11 Dec 2006 00:54:41 -0000

> >

> >An owner of a large 11 year old lab was told by the surgeon that

her

> >dog would be in a cast for 1 monthe s/p surgery. I've never heard

of

> >this. Is this an accepted approach? 20 years ago we put humans in

a

> >long leg cast for 4 months s/p ACL surgery! What a disaster!

> >Judy Coates MS PT, CCRT

> >

>

[Guest guest]

My experience with canine patients casted after CCL surgery has been minimal (thank goodness) but usually the intracapsular or fascial graft (without lateral suture) techniques.  I've even seen a few patellar stabilization surgeries casted for 2-4 weeks.  These were not done by boarded surgeons but veterinarians with "an interest in" surgery.Our suggestion is to start rehab immediately after ECS (extracapsular stabilization) CCL/TPLO surgery with ice, PROM, laser (if seen in-house), and short controlled leash walks-- this is usually a home program.  Our "full" rehab program starts anywhere from 7-14 days post-op regardless of the type of procedure used.  I recall my human patients starting rehab the day after surgery-- regardless-- and the surgeon giving us (PTs) hell if we couldn't get the patient in rehab that day!!!Amie Amie Lamoreaux Hesbach, MSPT, CCRPPresident, Animal Physical Therapy Special Interest Group, Orthopaedic Section, American Physical Therapy Associationwww.orthopt.orgInstructor, The Canine Rehabilitation InstituteWellington, Florida USAwww.caninerehabinstitute.comCEO, For Paws Rehabilitation, LLCPort Republic, land USAwww.forpawsrehabilitation.comManager, Physical Rehabilitation, The Mid-Atlantic Animal Specialty Hospital, LLCHuntingtown, land USAwww.vetmash.com Hey guess what?  I am one of those lucky ones that was put in the cast (2 months) in 1977. They removed the remainder of my ACL and removed my entire medial meniscal cartilageso you can imagine what my knee looks like now.  I know of no boarded surgeon that would dowhat you have described, unless they are of the old school and still it would surprise me.  I finsihed my residency 17 years ago and even then we only bandaged for a week to 2 weeks.  Our motto for joint surgeries was, "motion is lotion".My advice (for what it is worth) for your client is to seek another opinion.  I do alot of knees, mostlyT.T.A., some facial strip with lateral suture stabilization. The TTA cases have a bandage on for the first night,then go home without a bandage.  The FSG/LSS go a week to 10 days with a soft wrap then start Rehab. I typically go 4 weeks post-op on the TTA (or TPLO) before starting rehab, but with some of the data thatI have seen from Rehab practices around the US, I am now likely going to start them much sooner. Anyone elsehave an opinion on that???Mark B. Parchman, DVM, CVA, DACVSBend Veterinary Specialists,Bend, ORjcoates03 wrote:An owner of a large 11 year old lab was told by the surgeon that her dog would be in a cast for 1 monthe s/p surgery. I've never heard of this. Is this an accepted approach? 20 years ago we put humans in a long leg cast for 4 months s/p ACL surgery! What a disaster!Judy Coates MS PT, CCRT

[Guest guest]

The boarded surgeon I work with puts a bandage on the animal for about 14 days,

no matter

what the proceedure. I always start rehab the day of bandage removal. I am still

working on

him to stop bandgaing so much but he is from the " old school " . Oh well, I think

that owner

should get another opinion, or did they mistake a bandage for a cast?

Take care,

Combs RVT, CCRP

>

> An owner of a large 11 year old lab was told by the surgeon that her

> dog would be in a cast for 1 monthe s/p surgery. I've never heard of

> this. Is this an accepted approach? 20 years ago we put humans in a

> long leg cast for 4 months s/p ACL surgery! What a disaster!

> Judy Coates MS PT, CCRT

>