Veterinary medicine is a rapidly evolving field, and nowhere is it more apparent than in the practice of canine orthopedics. Not long ago, we diagnosed rupture of the cranial cruciate ligament only after gross palpable stifle joint instability (and often, advanced osteoarthritis) was present. Next, we would offer our clients surgical treatment options limited to ligament substitution that varied only in the pathway (intracapsular vs. extracapsular) and material (typically autologous tissues vs. prosthetic sutures) of the substituted ligament. Perhaps most remarkable was the paucity of our physical rehabilitation recommendations, essentially consisting only of restricted patient activity for some variable convalescent period.
Yes, much has changed in a few short years. In this symposium, I first discuss practical methods that foster an early diagnosis of cranial cruciate ligament pathology such that we can avail owners of all possible treatments for their pets, early in the course of the disorder (see the article "Diagnosing cranial cruciate ligament pathology"). Next, I describe the clinical application of the tibial plateau leveling osteotomy (TPLO) treatment for cranial cruciate ligament pathology (see the article "Understanding tibial plateau leveling osteotomies in dogs"). This discussion is aimed at helping veterinarians who have not scrubbed in on a TPLO procedure to be able to educate their clients regarding this treatment option so that referral is as seamless as possible.
Finally, Drs. Greg Arnold and Darryl Millis describe in their article on physical rehabilitation how modern postoperative care actually starts with preoperative pain-relieving medications and continues as a comprehensive care plan that may include superficial thermal modalities, range of motion and stretching movements, therapeutic exercise, and aquatic therapy (see the article "Physical rehabilitation: Improving the outcome in dogs with orthopedic problems"). I often tell my clients that while long bone fractures are dramatic, bone is an amazing tissue that often cooperates with our mutual desires to attain full return of limb function. Injured joints, on the other hand, while less dramatic initially, tend not to want to forgive and forget. To that end, Drs. Arnold and Millis conclude their article with a discussion of physical rehabilitation for osteoarthritic patients.
We hope that this symposium will facilitate your early diagnosis of cranial cruciate pathology and then your ability to knowledgeably and comfortably educate your clients regarding one of the newer surgical treatments, TPLO, which is currently favored by many surgeons. Regardless of the timing of your diagnosis and the treatment selected, we challenge you to maximize your patients' comfort and function by comprehensively rehabilitating them.1-3 It is our aim in this symposium to foster practical methods that will help you toward your goal of returning your canine orthopedic patients to lifestyles of normal comfort and function.
I dedicate this symposium to my co-workers (past and present) and to my friends and colleagues in general practice who have challenged me to be a better surgeon, educator, and patient advocate. I sincerely thank each of you.
1. Marsolais GS, Dvorak G, Conzemius MG. Effects of postoperative rehabilitation on limb function after cranial cruciate ligament repair in dogs. J Am Vet Med Assoc 2002;220:1325-1330.
2. Millis DL. Getting the dog moving after surgery. J Am Anim Hosp Assoc 2004;40:429-436.
3. Millis DL, Levine D, Taylor RA. Canine rehabilitation & physical therapy. St. Louis, Mo: WB Saunders, 2004.