Laurie's Blogs.

Do you use a testing model or check list for return to off-leash activity after a cruciate surgery?  It’s quite likely important… and a ‘time line’ of ’10-, 12-, 16-weeks’ after surgery isn’t objective.  So, what can we do?

I found a ‘human’ blog about Return to Running following Cranial Cruciate Ligament (CCL) that was a synopsis of a huge systematic review on the topic.

https://www.physio-network.com/blog/acl-rehab-when-can-i-run-again/  

The review was of 201 studies.  What they found was that the median time from which return to running (RTR) was permitted was 12 post-operative weeks. Apart from “time after surgery”, only 18% of the studies used additional criteria to allow patients to RTR.

The studies that DID look at return to running with objective outcome measures used some the following indicators: 

• The most common clinical criteria were full knee AROM and pain <2/10 in the visual analog scale (VAS)
• For strength, the most common objective criteria were isometric quadriceps limb symmetry index (LSI) >80% and isokinetic quadriceps and hamstrings LSI >70%
• For performance-based criteria, the most common objective tests were: proprioception LSI of 100%, composite score on Y-Balance Test >90%, hop test LSI >85%, 10x consecutive single leg squats to 45 degrees knee flexion and 30 step up and holds
  (I'm not going to explain or dive into these tests in any detail... because that's not the point of this blog...)

Clinical Implications:

• The decision to allow someone to start a running program should be made on passing clinical/strength/functional criteria, rather than being based on an arbitrary time-point
• It should be individualized and for many patients it might be reasonable to commence running between weeks 8-16 post-op provided that there has been adequate progressively loaded rehab
• The patient should have <2/10 pain, full to near full AROM, and little to no effusion
• The clinician may also choose to use a battery of strength and performance-based tests

Going to the Dogs

Okay… so if you are a human, and you have a knee, and that knee has had an ACL reconstruction… you have some idea of what’s important.  What should we do for dogs? 

Well, I actually created a testing protocol for a previous client of mine.  I incorporated some basic evaluations (i.e. goniometry, palpation, stance analyzer), and I added in a series of functional tests.  These included skills such as jumping up, jumping over, coordination, balance, stamina, sit to stands, lateral stepping, plank, etc.!  All of them were pretty interesting, but the ones that seemed to tell me the most (i.e. they were the last ones to improve completely) were:

1.  Stance analyzer

2.  Timed diagonal leg stands

3.  The 1 rear-leg slide test (pelvic drop test)

These were the things we worked on improving and getting to a state of near normal / comparable to the unaffected side.  So, they are the ones I care about most with return to ‘off leash’ activity.  Now, this is not to say that testing the other things aren’t important (i.e. jumping, coordination walking over poles, sit to stands, etc.), they certainly are!  However, this list above likely doesn’t hit the top 3 of the ‘typical’ return to off-leash considerations as often as they should.  Do you have a list of favourite functional objective measures that you use?  Give me a shout, I’d love to hear what you have come up with!

Want to learn more?  Check out Members side of FourLeg.com to view Training Video 211 to see the testing on the dog I mention above, and in the Articles section, the Return to Sport Checklist.