Rehabilitation Principles in CCL Surgery Recovery

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Questions and Answers

What type of collagen is primarily present in early granulation tissue during the proliferative phase of wound healing?

Type II collagen

Type I collagen

Type III collagen (correct)

Type IV collagen

Which statement is true regarding the gain of wound strength after a cranial cruciate ligament injury?

The fastest rate of strength gain occurs between 7 and 14 days post-injury. (correct)

Most of the strength is regained by 7 days post-injury.

Wound strength does not improve after 14 days.

Final strength regain occurs within the first month.

What is a key characteristic of provisional extracellular matrix in the early phases of healing?

It is composed solely of Type I collagen.

It is typically replaced by Type I collagen as healing progresses. (correct)

It provides significant strength to the wound.

It is replaced by Type III collagen each week.

Which of the following factors affects the healing of tissues during craniocerebral ligament surgeries?

Rate of healing varies with tissue type Signup and view all the answers

Delayed Onset Muscle Soreness (DOMS) primarily occurs due to which of the following physiological changes?

Acute inflammatory response Signup and view all the answers

What is the expected timeline for complete epithelization of well-apposed incised wounds?

24 to 48 hours Signup and view all the answers

Which statement is true regarding muscle healing?

Muscle can take between 6 weeks to 6 months to regain normal strength. Signup and view all the answers

What is a significant factor affecting collagen remodeling?

Stresses placed on the collagen tissue Signup and view all the answers

What consequence can reliance on scar tissue have during the healing process?

It can predispose to repeated injury. Signup and view all the answers

How long does it typically take for skin sutures to be removed after achieving adequate strength?

10 to 14 days Signup and view all the answers

How does scar tissue influence the healing progress of muscle?

It can lead to varying ultimate strength and flexibility. Signup and view all the answers

What role does periarticular fibrosis play in surgical techniques?

It provides passive stabilization. Signup and view all the answers

What is a key difference between the proliferative phase and chronic (maturation/remodeling) phase of healing?

The chronic phase shows a contraction of scar tissue. Signup and view all the answers

What role does delayed onset muscle soreness (DOMS) play in the remodeling stage of healing?

It may be an indication of reinjury to healing tissue. Signup and view all the answers

Which therapeutic intervention is typically included during the inflammatory stage of tendon-fascia healing?

Cryotherapy with compression Signup and view all the answers

What is the primary characteristic of collagen during the fibroblastic stage of healing?

Collagen fibers are randomly organized. Signup and view all the answers

What aspect of muscle healing does extracorporeal shockwave therapy (ESWT) primarily influence?

Pain resolution Signup and view all the answers

During which healing stage does the synthesis of collagen lead to tendon scar formation?

Fibroblastic stage Signup and view all the answers

What is the main focus of therapeutic exercise during the remodeling stage?

Increasing active range of motion and muscle strength Signup and view all the answers

Which of the following describes a characteristic of the remodeling stage?

Pain may arise from various sources. Signup and view all the answers

What is an expected outcome during the remodeling stage after tissue healing?

Improvement in organization of scar tissue Signup and view all the answers

Which role does the extracellular matrix (ECM) play during the fibroblastic stage of healing?

It provides a scaffold for cellular activity. Signup and view all the answers

What is the significance of scar mobilization during the remodeling stage?

To improve the flexibility and function of healing tissue. Signup and view all the answers

Which factor does NOT characterize the inflammatory stage?

Substantial collagen synthesis Signup and view all the answers

What is an important therapeutic approach during the cicatrization phase?

Manual therapy and strengthening exercises Signup and view all the answers

What type of cells are primarily involved in the fibroblastic stage of healing?

Fibroblasts Signup and view all the answers

What is the primary goal of therapeutic interventions during the fibroblastic stage?

Facilitate scar tissue remodeling and function Signup and view all the answers

Study Notes

Fundamental Principles of Rehabilitation and Musculoskeletal Tissue Healing

This review examines fundamental principles of tissue healing and physical rehabilitation in dogs recovering from cranial cruciate ligament (CCL) surgery.
A multidisciplinary group of specialists reviewed current evidence for rehabilitation after CCL surgery.
Guidelines were proposed based on fundamental principles of tissue healing and patient-centric therapy.
Four fundamental principles of small animal physical rehabilitation are proposed based on tissue healing and patient-centric therapy.
Postoperative rehabilitation programs should be tailored to individual patient needs, considering tissue healing, strength, and functional goals.
Therapists must understand tissue healing phases, frequently reassess patients, and use clinical reasoning for treatment.

Principle 1: Tissue Healing Follows a Predictable Pattern

Tissues heal in predictable phases, overlapping in duration.
The acute phase involves inflammation (heat, erythema, pain, swelling) and lasts ~72 hours post-injury.
The subacute phase (proliferative/reparative) includes angiogenesis, fibroplasia, and collagen production – tissue gains strength but still not fully healed (within 7-14 days).
The chronic phase (maturation/remodeling) involves continued collagen deposition, reorganization, and scar tissue maturation, lasting months or years.
The rate of tissue healing depends on the tissue type and injury severity.

Principle 2: Individualized Treatment Plans

Treatment plans should be tailored to individual patient needs.
Functional assessment of the patient is crucial, including assessment of tissue healing, functional abilities, and limitations.
Treatment should consider comorbidities like hip/elbow dysplasia, obesity, or bilateral disease—these influence treatment, goals, and timelines..
Passive assessments include muscle mass (symmetry and girth), and range of motion (ROM), assessed using goniometry.
Active assessments include gait, static weight bearing with bathroom scales or pressure mats, which assess strength asymmetry, and functional tests.

Principle 3: Specific, Measurable, and Attainable Goals

Goals for rehabilitation should fully consider the whole body, not just the injured limb, and should be individualized.
Post-operative goals may need modifications throughout the healing phases depending on injury chronicity, comorbidities, and surgical techniques employed.
Goals should be specific, measurable, attainable, and relevant.

Principle 4: Pain Management, Therapeutic Exercise, Manual Therapy, and Guided Return to Activity

Pain management is essential for optimal healing and progression through rehabilitation. Multimodal approach including pharmaceutical and non-pharmaceutical methods are suggested.
Therapeutic exercises must be prescribed according to goals; strength training is beneficial, along with ROM and neuromuscular patterning.
Manual therapy, including joint mobilization, should be used to reduce pain, swelling, improve arthrokinematics and osteokinematics.
Therapeutic modalities are beneficial for pain and swelling, but are not the sole method.
The duration of rehabilitation may range from 2-6 months to return to a normal activity level. This is influenced by the type and severity of injury.

Osteotomy vs Extracapsular Surgical Techniques

Osteotomy procedures aim for complete stabilization during stance phase, but do not eliminate all cranial tibial subluxation.
Extracapsular techniques aim to provide static stabilization during recovery.
Expected timeframes for healing and ultimate strength vary considerably between procedures.

Rehabilitation for Partial CCL Tears

Nonsurgical techniques (orthotics and intra-articular therapies) may be used instead of surgery for partial tears.
Nonsurgical rehabilitation periods are often prolonged and less predictable.

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Description

This quiz covers the fundamental principles of tissue healing and rehabilitation for dogs post-cranial cruciate ligament surgery. Learn about the predictable phases of tissue healing and how to tailor rehabilitation programs based on individual needs. Gain insights from a multidisciplinary review of evidence-based practices in veterinary rehabilitation.