Systematic review of postoperative rehabilitation interventions after cranial cruciate ligament surgery in dogs

Abstract

Objective To critically evaluate the evidence for rehabilitation interventions following surgery for cranial cruciate ligament disease (CCLD) in dogs. Study design Systematic review. Methods Google Scholar and Pubmed databases were searched for studies evaluating postoperative CCLD rehabilitation interventions from 1990 until March 2020 per the international Prospective Register of Systematic Reviews (PROSPERO). Each study was assigned a level of evidence score from I to IV and a risk of bias (RoB) score by 2 reviewers, and by a third reviewer, when consensus was not reached. Results Nineteen studies met the inclusion criteria. Twelve comprised randomized, controlled trials (Level II), 6 were nonrandomized or nonblinded (Level III), and one was retrospective (Level IV). Nine studies had high RoB scores. Sixteen studies yielded positive results. Therapeutic exercise had the most studies with positive results but all had high RoB. Cold compression therapy had 3 supporting studies (2 Level II, low RoB). Extracorporeal shockwave yielded 2 positive Level II studies (low‐moderate and high‐moderate RoB) and photobiomodulation had 1 positive study (Level II, low RoB) with objective outcomes. A negative outcome was noted in 1 photobiomodulation study. There was 1 supporting study on electrical stimulation and there was none on low‐intensity pulsed ultrasound. Conclusion This systematic review supports the use of rehabilitation interventions in recovery of postoperative CCLD in dogs; however, many studies had a high risk of bias. Clinical significance There is a lack of class I level evidence in veterinary rehabilitation. This study supports therapeutic exercise and cold compression therapy for postoperative CCLD rehabilitation. Existing studies on other modalities are limited and demonstrate conflicting results.

Effect of Nail Grips on Weight Bearing and Limb Function in 30 Dogs 2 Weeks Post Tibial Plateau Leveling Osteotomy

“…It is possible that the standardized rehabilitation protocol accelerated recovery in both groups. The degree to which these post-operative therapies improved recovery is unknown as there is inconsistency in the literature reporting the benefits of modalities such as therapeutic lasers, TENS, and PEMF therapy [ 35 ]. However, as therapies were distributed equally among the groups, this should not have been a confounding factor.…”

Effect of intra‐articular platelet‐rich plasma or hyaluronic acid on limb function recovery in dogs withTPLOfor cranial cruciate ligament rupture: a randomised controlled trial

“…Slocum and Slocum (1993) proposed a recovery period of 3 to 4 months for dogs to regain normal limb function after TPLO. To support dogs limb rehabilitation after TPLO, different protocols were proposed; however, some results were conflicting per the systematic review of Alvarez et al (2022).…”

“…To support dogs limb rehabilitation after TPLO, different protocols were proposed; however, some results were conflicting per the systematic review of Alvarez et al . (2022).…”

Long‐term outcome in dogs with cranial cruciate ligament disease evaluated using the canine orthopaedic index

“…Treatment outcome in dogs with CCLD has been evaluated in several ways, for example, by using force plate gait analysis, visual gait observation, orthopaedic and physiotherapeutic examination, radiography for evaluation of OA progression and owner questionnaires 8,17,22–29 . Owner questionnaires based on behaviour are considered one of the most reliable tools for assessment of chronic pain in dogs 30–32 .…”

“…11,12,[19][20][21] Treatment outcome in dogs with CCLD has been evaluated in several ways, for example, by using force plate gait analysis, visual gait observation, orthopaedic and physiotherapeutic examination, radiography for evaluation of OA progression and owner questionnaires. 8,17,[22][23][24][25][26][27][28][29] Owner questionnaires based on behaviour are considered one of the most reliable tools for assessment of chronic pain in dogs. [30][31][32] There are several questionnaires available, such as the canine orthopaedic index (COI), the Helsinki chronic pain index (HCPI), the Liverpool osteoarthritis in dogs, the canine brief pain inventory (CBPI) and the Bologna healing stifle injury index (BHSII).…”