Client Education

	Bonnie has undergone an intracapsular reconstruction with the addition of an autograph, and a partial meniscectomy may also have been performed.    
A cold compress should be applied to the surgical area for twenty minutes three times a day for the first two to three days after surgery to control swelling and to provide analgesia.  Beginning the first week following therapy, heat therapy is applied. This decreases pain, and improves circulation to the joint.   It also relaxes the muscles for passive physical manipulation. A moist hot towel can be applied to the stifle joint being careful not to burn the skin!  Bonnie should begin to stand on the leg within the first post-operative week.   Raising the uninjured leg will force Bonnie to stand on the injured leg.  This should only be done for one to two minutes, and then gradually increase the duration until she is weight bearing on her own.  Passive physiotherapy involves controlled stretching of the muscles, tendons and ligaments, and gently flexing and extending the joint.  This is done gradually to increase the range of motion.  This exercise does not increase muscle tone or strength, and therefore needs to be combined with physical therapy.  Swimming is excellent therapy for it combines both joint movement, and strengthens muscles without impact loading. However, caution must be taken when entering or leaving water so as not to slip and re-injure the leg.  Leash walking should be done slowly gradually increasing the duration of the walks, and level of activity. Leash walking and no use of stairs is recommended as the autogenous tissue graft that was used to replace the cranial cruciate ligament is biomechanically weaker than the original ligament, and during the first three months of surgery the graft will undergone re-vascularization, and needs protection from stress.  By twelve weeks full activity can be resumed.  Bonnie should also be put on some sort of weight management diet to encourage loss of weight, and to reduce stress of the affected limbs.  
	Bonnies weight needs to be regulated to minimize the stress to her joints.  Her body weight should be assessed weekly.  Bonnie also needs to be put on a weight reducing/high fiber diet.
	Bonnie will also need rest and physical therapy as treatment of the degenerative joint disease in her stifle joint to decrease inflammation and strengthen the supporting structures of the joint.  Controlled exercise, such as those mentioned above, should be practiced to maintain muscle tone and prevent fibrosis of periarticular tissues.  All stressful activity, such as vigorous walks and stair climbing, should be kept to a minimum.    In addition to physical therapy Bonnie will need to take Rimadyl twice daily to control the pain associated with osteoarthritis.  We must inform you that possible side effects include damage to the liver and gastrointestinal system.  Aspirin can be given as an alternative if cost is an issue although the gastrointestinal side effects are more severe.  These are only symptomatic treatments as the changes seen as a result of osteoarthritis are irreversible.