This post has being written by Chelsea, one of our Hydrotherapy & Physiotherapy nurses. Chelsea has a Level 3 Certificate in Canine Hydrotherapy as well as a Degree in Veterinary Nursing. She talks us through Tilly's case from presentation, diagnosis, surgical treatment and rehabilitation.
Patient Details;
Breed - Patterdale Terrier
Age - 9 years & 2 months
Presentation - Tilly was first seen at the practice after falling and twisting her left stifle (knee). The vet examined Tilly and suspected she could have either pulled a muscle or it could be something more serious like a cruciate rupture. The vet also found that Tilly had a medial patella luxation (MLP) - this is where the knee cap slips out of place towards the inside of the leg. The MLP is not a consequence of the injury Tilly sustained but it certainly complicated her case. Initially Tilly was prescribed some non-steroidal anti-inflammatory (NSAID's) to go home and rest, if she had pulled a muscle she should quickly feel better however it was planned that if Tilly didn't improve within a few days we would book her in for a sedation and radiographs (x-rays) to investigate further.
Diagnosis - After a couple of days of rest and relaxation along side the NSAID's Tilly was still painful and so x-rays were taken of her left and right stifle and her hips to give the vet a full picture of Tilly's hindlimbs. When Tilly was sedated the vet also performed a full joint evaluation of all her joints in her hindlimbs - this is very painful and so can only be done fully when patients are under anaesthetic. The joint evaluation and radiographs confirmed Tilly's diagnosis. She had ruptured her cranial cruciate ligament and also had an MLP, both of which would require surgery.
The cranial cruciate ligament is inside the stifle joint and its job is to stabilise the stifle during weight bearing onto the joint. It prevents the tibia from moving forward relative to the femur.
Diagram showing ruptured cruciate ligament
An MLP occurs when the patella (knee cap) slips out of the groove it should sit in. This can be really painful and dogs will often lift their leg when walking until it slips back into place and they carry on as normal - despite being very painful dogs do seem to be able to ignore it enough to hide it from owners. Sometimes it dislocates and cannot go back in to the groove.
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Diagram showing MLP
Both of these conditions can be fixed during one surgery via a range of different techniques which reduces how often Tilly would need to have an anaesthetic.
Surgery - Tilly was booked in for surgery where the vet performed a procedure called a lateral suture which is where a very strong material is placed where the ligament should be to mimic the action of the criciate ligament and allow stability until the body produces long term scar tissue around the joint.
Simplified diagram of where the suture material is placed
To correct Tilly's MLP the vet performed two techniques, one was a sulcoplasty which is where th groove in the patella is moved out of the groove it sits in so that using an electric saw a wedge can be cut to remove the groove, the bottom of that wedge is then filed down, turned 180° then replaced. This results in the groove being much deeper than before meaning that when the patella is placed back in its correct place it can no longer dislocate from the groove.
The second technique was a retinacular imbrication which involves the soft tissue around outside aspect of the stifle joint is tightened - in a sense it gives the joint a 'tight hug' to keep everything where it should be.
Post operative care - After recovering from her surgery Tilly and her owners had a discharge appointment with Chelsea so that her tailored physiotherapy regime could be planned and everything her owners needed to do at home could be demonstrated. Her regime included thermotherapy, massage and passive range of movement techniques. Tilly needed to continue her NSAID's medications to help with post op pain and inflammation. 3 and 10 day post op appointments were arranged with the phyiotherapy team to ensure Tilly and her owners were doing well. Being a 24hour hospital really helps in these cases as owners can contact us any time of day if they have questions or concerns... caring for a patient like Tilly isn't easy and we're lucky to have 24hour contact available.
10 days post op - At this point TIlly's surgical wound was fully healed which meant that her rehabilitation could be pushed on to the next step which meant Tilly could start her hydrotherapy treatment.
Hydrotherapy - We have an underwater treadmill that offers partial weigh bearing exercise in a controlled environment. Patient's benefit from the support and buoyancy of the water and so can begin to use the affect limb/joints to their full potential without the pain associated with full weight bearing. Having the tank vs a pool also means that the hydrotherapy nurse can alter the depth of the water and which alters how patients move in the water... initially the water will be higher and as the patient improves the depth is dropped to increase weight bearing and range of movement required from the joint. The speed of the treadmill can also be adjusted as well as working flat, incline or decline.
Tilly's recovery - Tilly had hydrotherapy alongside her physiotherapy at home for six weeks and throughout showed vast improvement, with her owner really noticing the difference. Clinically Tilly started weight bearing on her leg and her range of movement improved throughout each session. Tilly's muscle mass was regularly measured - naturally this reduced in the lead up to surgery due to the long standing MLP meaning she naturally put more of her weight through her non-affected leg and more so after surgery when initially she hardly used the leg (this is normal post op which is why physiotherapy is so important to regain normal use). Tilly's muscle mass was rebuilt indicating fantastic recovery results and she now has regular rechecks with the physio team to ensure she continues to improve.
Tilly in our hydrotherapy treadmill
And again
Indications for hydrotherapy -
There are lots of different reasons that our patients use the hydrotherapy unit including;
- Reducing pain & inflammation
- Arthritis
- Hipy & elbow dysplasia
- Obesity
- Muscle wastage
- Cardiovascular fitness
- Neurological conditions
- Spinal conditions
- Pre & post operative rehabilitaion
Cases like Tilly's really show how much time and effort is involved in getting patients back on their feet and how each team member really plays a huge part in that process from a patients owner calling to book the initial appointment, a vet consult to determine the problem and its cause, surgeons to perform the surgery and work with the nursing team and owners to provide the important after care needed.
We would like to say a huge thank you to Tilly and her owner for letting us share her story.
