This is a frequent request that I receive in person, mail, phone, and e-mail. I would like to address how one assesses the patient and develops a protocol that matches the need of the patient and client with the capabilities of the rehabilitation provider.
Step 1: Statistics
Develop a sense for your “statistics of repair.” If you operate on 10 cruciate patients, what is the outcome of these patients in your hands, not what has been published? Where are they at one week, six weeks, twelve weeks, and one year?
Step 2: Outcome goals
Based on the injury, diagnosis, and technique of repair establish outcome goals. For example, I want my TPLO patients to be ready for all activity and competition by 12 weeks post-op.
Step 3: Capabilities and resources
Look at your capabilities/resources. Who will provide the rehabilitation therapy? What resources can I commit? (Purchase U.S., E-stim, therapy pool?) How do I achieve patient/client compliance? How can we be paid?
Step 4: Patient assessment
Patient assessment. The post-operative status of patients undergoing the same procedure is always different. One needs to have a good working knowledge of the repair used and the temporal aspects of wound healing.
A. Extra capsular vs. BTB allograft
C. Limb circumference (muscle mass)
D. Scar assessment
G. Published recovery details for given procedure
H. Demeanor of patient
I. Willingness of owner to be part of the solution
Step 5: Patient/procedure specific protocol.
Patient: 7 year “hunting” female Labrador
Acute CCL tear < 2 weeks old
Goal complete return of function
Trying to achieve Master Hunter Title
Anticipated surgical results—osteotomy healing 6-9 weeks
Return to competition 12-16 weeks.
“Job dedicated” vet tech.
Post-op patient assessment—first week
Left rear leg (repair)
Mild synovial effusion
i. PROM Q.I.D.
Ice packs Q.I.D.
E-stim second week
Start leash walks—begin sit/stands/wall sits
ii. 2-3 weeks
iii. Reassessment—Phase II P.T. 3–6 weeks
Re-education of muscle—E-stim
Proprioception help—unbalance while walks
Decline walking 30-45 min. B.I.D.
mid frequency electrical stimulation?
iv. Reassessment Phase II 6-12 weeks
T.E. –muscle specific
Figure of 8’s
With this stepwise format, one can design and implement a treatment protocol designed specifically for your patient, your clinic and PT capabilities.