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Rotura do ligamento cruzado cranial - técnicas de fisioterapia e reabilitação pós-operatória
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Abstract(s)
A rotura do ligamento cruzado cranial (RLCC) é uma causa frequente de claudicação do membro pélvico nos cães. Esta situação pode ter origem traumática, degenerativa, genética, conformacional, ambiental, imunomediada ou inflamatória. Têm sido descritas várias técnicas cirurgicas para estabilizar o ligamento cruzado cranial, apesar de nenhuma delas conseguir impedir a progressão da osteoartrite ou uma recuperação eficaz do membro afetado.
As técnicas cirurgicas mais utilizadas para a estabilização são a intra e extracapsular, assim como as técnicas modificadoras da biomecânica do joelho. Estas últimas, denominadas osteotomias corretivas, têm como objetivo a estabilidade dinâmica assim como a alteração da geometria da tíbia proximal.
O objetivo de qualquer técnica cirúrgica é restaurar a estabilidade, simular a função e manter a biomecânica normal do joelho para prevenir a deterioração, especialmente o dano dos meniscos e a progressão da doença degenerativa articular.
Do ponto de vista clínico, o controlo do programa de reabilitação do ligamento cruzado cranial está em constante mudança, devido a fatores influenciados pelo retorno funcional do membro após a cirurgia. A reabilitação pode permitir diminuir o tempo de recuperação de alguns pacientes e pode ser uma mais valia ao processo cirúrgico.
Os objetivos do pós-operatório são analgesia, promover a cicatrização, manter a massa muscular, aumentar a estabilidade do joelho, flexibilidade, propriocepção, equilíbrio e coordenação, facilitar o retorno à função, prevenir doença degenerativa articular e restabelecer a condição cardiovascular.
Neste artigo irei realizar uma pequena aproximação ao tema da rotura do ligamento cruzado cranial, com foco na descrição das técnicas de físioterapia na reabilitação pós cirúrgica da resolução da RLCC, enumerando as vantagens, benefícios e indicações de cada técnica.
The rupture of cranial cruciate ligament is the most common cause of hindlimb lameness in the dog. Trauma accounts for a minority of cranial cruciate ligament (CCL) ruptures in dogs, whereas progressive degeneration of the ligament has been attributed to a variety of factors that may be broadly classified as genetic, conformational, environmental, immune-mediated, and inflammatory. Several surgical techniques have been described to stabilize the cranial cruciate ligament deficient stifle with no single technique has been shown to consistently arrest development or progression of osteoarthritis, or consistently return operated limb to normal function. The most used surgical techniques are the intra- and extraarticular stabilization, as well as the modifier biomechanics of joint. The last, called corrective osteotomies, aim to achieve a dynamic stability through the alteration of bone geometry. The purpose of surgical management is to restore stability, mimic normal kinematics, and maintain normal biology of the joint in order to prevent further deterioration of the joint, especially the medial meniscus damage and progression of degenerative joint disease. From a clinical standpoint, the design of a rehabilitation program after CCL surgery is challenging because many factors influence limb use and return to function after surgery. Rehabilitation can allow the salvaging and acceleration of recovery time of some patients and it can make either the best or worst surgical procedure better. The goals for any post-operative case are to: reduce pain; promote healing; maintain muscle mass and promote muscular development and joint stability; maintain joint flexibility; retrain proprioception, balance and coordination; facilitate early return to function; prevent degenerative joint disease and rebuild cardiovascular endurance. In this revision article I will make a small approach to the theme of the rupture of the cranial cruciate ligament, focusing on the post-surgical in what concerns physical therapy and rehabilitation of patients with this pathology. I will also describe the rehabilitation techniques in order to compare the potential benefits of each one, and in what situations they should be used.
The rupture of cranial cruciate ligament is the most common cause of hindlimb lameness in the dog. Trauma accounts for a minority of cranial cruciate ligament (CCL) ruptures in dogs, whereas progressive degeneration of the ligament has been attributed to a variety of factors that may be broadly classified as genetic, conformational, environmental, immune-mediated, and inflammatory. Several surgical techniques have been described to stabilize the cranial cruciate ligament deficient stifle with no single technique has been shown to consistently arrest development or progression of osteoarthritis, or consistently return operated limb to normal function. The most used surgical techniques are the intra- and extraarticular stabilization, as well as the modifier biomechanics of joint. The last, called corrective osteotomies, aim to achieve a dynamic stability through the alteration of bone geometry. The purpose of surgical management is to restore stability, mimic normal kinematics, and maintain normal biology of the joint in order to prevent further deterioration of the joint, especially the medial meniscus damage and progression of degenerative joint disease. From a clinical standpoint, the design of a rehabilitation program after CCL surgery is challenging because many factors influence limb use and return to function after surgery. Rehabilitation can allow the salvaging and acceleration of recovery time of some patients and it can make either the best or worst surgical procedure better. The goals for any post-operative case are to: reduce pain; promote healing; maintain muscle mass and promote muscular development and joint stability; maintain joint flexibility; retrain proprioception, balance and coordination; facilitate early return to function; prevent degenerative joint disease and rebuild cardiovascular endurance. In this revision article I will make a small approach to the theme of the rupture of the cranial cruciate ligament, focusing on the post-surgical in what concerns physical therapy and rehabilitation of patients with this pathology. I will also describe the rehabilitation techniques in order to compare the potential benefits of each one, and in what situations they should be used.
Description
Keywords
Cruzado Terapia Cães Cirurgia Reabilitação Joelho Cruciate Therapy Dogs Surgery Rehabilitation Knee