The importance of improving muscle mass after orthopaedic surgery

Muscle wastage is very common after orthopaedic surgery and neurological conditions, such as:

· Cruciate ligament repair surgery – suture repair, TTA, TPLO

· Total hip replacement

· Femoral head and neck osteotomy - FHNO

· Fracture repair

· Arthroscopy

· IVDD

· FCE

Muscle wastage or 'atrophy' occurs when the muscle is not functioning optimally or not being used from reduced weight bearing. After surgery, it is greatly important maintain the existing muscle through gentle non weight bearing mobilisation techniques provided by your vet or vet physio. Once your animal has reached the correct stage of healing; indicated by your vet, it is essential to gradually strengthen the muscle mass on the injured leg.

Muscle is important to be able to mobilise and stabilise the joints. Joints that are less supported by muscle are prone to additional forces travelling up the limb which places extra strain through the tendons and ligaments. When joints are exposed to greater forces or torque through instability, this has a direct impact on the joints integrity and therefor possibilities of development of osteoarthritis.

What the research says for TPLO surgery:

In numerous studies, post-operative stifle joint range of motion (ROM) is improved. However, these studies show the ROM decreases with time and link this with onset of osteoarthritis (Jeram et al., 2005; Au et al., 2010; Gordon-Evans et al., 2013). ROM enables mobility, to facilitate; increased muscle mass, remodelling and alignment of tissues to promote successful rehabilitation. Decreased joint ROM was reported by Au et al. (2010) who compared joint angle values pre and post-operation 24 months following TPLO. Mölsä et al. (2014) study, although a small sample, also found significant differences in stifle ROM, pre and post TPLO at 7% and 5% of extension and flexion, respectively, when compared to the contralateral limb; with a greater range 1-5 years after TPLO. Although these studies make links between degenerative joint diseases with post-surgery and aging, it could suggest that rehabilitation should be continuous for optimal effects, utilising physiotherapy as maintenance to increase and maintain joint ROM.

Similarly, Monk et al. (2006) found post-operative physiotherapy greatly beneficial after TPLO at 3 and 6 weeks post-operation, significant differences were found during proliferation and remodelling healing stages. Interestingly, after 6 weeks no significant differences were found between groups. These studies may indicate initial physiotherapy alone is inadequate; gentle stretching and controlled exercise are important as an active and passive mobilisation technique and utilised in veterinary physiotherapy for fibre realignment. Millis and Ciuperca (2015) states that stretching also strengthens fibres through increasing collagen fibril size, and assists the conversion of collagen III to` collagen I, which are less susceptible to re-injury. Therefor exercise programmes under professional advice can also increase the longevity of your animals athleticism and musculoskeletal health.

Thesaurus:

Collagen type 1: strongest type of tissue

Collagen type 3: weakest type of tissue – scar tissue

Proliferation: production of new cells and collagen

Extension: straightening a joint

Flexion: bending a joint

Musculoskeletal: muscles, tendons, ligaments, skeleton, joints

Torque: twisting movement on a joint

References

Au, K, Gordon-Evans, W, Dunning, D, O’Dell-Anderson, K, Knap, K, Griffon, D, Johnson, A. (2010). Comparison of short- and long-term function and radiographic osteoarthrosis in dogs after postoperative physical rehabilitation and tibial plateau levelling osteotomy or lateral fabellar suture stabilization. Journal of Veterinary Surgery. 39 (1), 173-180.

Gordon-Evans, W, Griffon, D, Bubb, C, Knap, K, Sullivan, M, Evans, R. (2013). Comparison of lateral fabellar suture and tibial plateau levelling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. Journal of American Veterinary Medical Association. 243 (5), 675-680

Jerram, R, Walker, A, Warman, C. (2005). Proximal tibial intra-articular osteotomy for treatment of canine cranial cruciate ligament injury. Veterinary Surgery Journal. 34 (2), 196-205.

Millis, D, Ciuperca, I. (2015). Evidence for canine Rehabilitation and Physical Therapy. Veterinary Clinic of Small Animal Practise. 45 (1), 1-27.

Mölsä, S, Hyytiäinen, H, Hielm-Björkman, A, Laitinen-Vapaavuori, O. (2014). Long-term functional outcome after surgical repair of cranial cruciate ligament disease in dogs. Biomed Central Veterinary Research. 266 (10), 1-11.

Monk, M, Preston, C, McGowan, C. (2006). Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament. American Journal of Veterinary Research. 67 (3), 529-536.

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