Physical therapy choices are subjective
Q I am the owner of a Cane Corso. I know they have a horrible reputation, but this one is an absolute baby; loves her family, including our rabbit, and is afraid of everyone else. The problem is that she is a health disaster. She has horrible skin and eye issues, chronic colitis, and now she has ruptured her anterior cruciate ligament.
We were told that she would need surgery, and that extensive physical therapy would be a requirement. One big concern for us is that she will be very stressed out by the surgery itself, not to mention having to stay or be brought in for physical therapy. When she is stressed, it's a literal colonic blowout. What would you suggest?
A: Given her breed, she is a large dog, and these dogs definitely benefit from surgical stabilization following an injury to the anterior cruciate ligament (ACL). I (Dr. Henri Bianucci) could not agree more with this recommendation.
As we have discussed in this column previously, newer procedures have come into popularity over the past 15 years that have allowed for a faster recovery, less pain and better overall function and durability.
These newer procedures are described as "dynamic" because they actually result in a change in the way forces are distributed in the joint as weight is applied under dynamic conditions. The weight is shifted away from the damaged ligament.
These procedures are completely different than what is offered in the realm of human surgery for the same injury. The reason is that, although the anatomy of the canine stifle is essentially the same as that of a human, the conformation and biomechanics are completely different. To start with, we are bipedal. When we stand, our legs are straight; dogs stand with their knees bent, which places almost continuous strain upon the ligament.
Furthermore, the reason that the canine ligament tears is most likely due to the way the dog's knee is shaped. Subtle variations in the anatomy can result in significantly increased strain on the ligament. This results in accelerated wear, until the ligament spontaneously tears.
Due to individual variation, a dog that tears one ligament is at increased risk of tearing the other one. This is not because he or she favors the first injured leg, but because both knees were built the same.
In humans, the cause of a cruciate ligament tear is most commonly traumatic, such as skiing, football, etc.
The benefits of physical therapy after knee surgery in people has been comprehensively researched, using the scientific method. Simply put, people do better, both in the long and short term, with physical therapy than without it following knee surgery. This is what we call an evidence-based application of a treatment modality.
The same cannot be said in dogs.
Many aspects of human and veterinary health care share features in common. So much so that most medications, diagnostic techniques, surgical materials, etc., are virtually the same in both human and veterinary medicine.
But there are differences, just as there are differences in how the knee bears stresses and how the injuries occur, there are differences in how dogs recover compared to humans. One big difference is the far greater tendency of humans to form fibrous adhesions after surgery. These can limit motion in a joint and impeded recovery. Not so in dogs. Humans are at risk for DVT, or deep vein thrombosis; this is why they try to get us up and moving as soon as possible. Again, this is rare to nonexistent in canines.
PT, such as passive range of motion and sit-stand exercises, hot and cold packs, etc, are easily performed at home. In the short run, these procedures have demonstrated some benefit in terms of earlier weight bearing, reduced swelling, increased range of motion and muscle redevelopment.
More involved PT, such as underwater treadmills, swimming, etc., has also been shown, in the short run, to provide the same benefits.
The difference between the two approaches has not, to my knowledge, been proven in either the short or long term. Long-term studies (greater than 6 months after surgery) are lacking altogether.
In short, no studies have objectively established that a dog that has knee surgery will perform better in the long term (greater than 6 months) with PT than dogs who do not. Don't get me wrong, PT is fine, and may provide some short-term benefits, but to say it is required for a good long-term recovery is simply not a supportable point.
My advice would be to have the knee repaired, utilizing one of the newer techniques, and do the PT at home where she is comfortable.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to firstname.lastname@example.org or veterinaryspecialtycare.com.