CLC Members' Seminar 5 march 2015 - Member Case Study - Ann Pidgeon & Sue Jones, Kibble -
Case Report, Bindi Sue L.
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Transcript of Case Report, Bindi Sue L.
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8/11/2019 Case Report, Bindi Sue L.
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Case Report
Signalment: Bindi Sue, 2yr, 9mo old, spayed female, Labrador Retriever, weighing 39kgs
Clinical History: Bindi Sue has had a history of grade III/V lameness of her left hind limb for
the past several months, which had been monitored by her primary care veterinarian. According
to her owners, on August 30-31, 2014 her lameness became more apparent after a trip to thebeach, where Bindi Sue was playing in the surf. Owners administered aspirin as means of pain
control. In the past week, she has received antibiotics and a steroid injection for the control of a
hot spot on her left rear limb.
Presenting Signs: Bindi Sue presented to the surgical department on September 4, 2014 with
obvious lameness in her left hind limb. Her vital signs on presentation were all within normal
limits and her mentation bright, alert, and responsive.
Physical Examination: Physical examination of the left rear limb revealed mild atrophy of the
thigh muscle and palpable medial buttress. Stifle effusion, cranial drawer instability, and a
positive cranial tibial thrust was evident. Palpation and manipulation of the right stifle revealedmild joint effusion. Manipulation of the coxofemoral joints revealed reasonable range of motion
with no signs of obvious discomfort.
Laboratory Tests: Radiographs of the left stifle demonstrate stifle effusion with cranial
displacement of the infrapatellar fat pad, degeneration changes with osteophyte formation and
minimal sclerosis, and cranial displacement of the tibial eminences relative to the femoral
condyles. A measure of the tibial plateau angle equaled 28 degrees and is suspicious of a
complete cranial cruciate ligament tear with mild secondary arthritis.
Diagnoses: Left cranial cruciate ligament rupture; moderate osteoarthritis; left medial meniscus
release
Treatment: Metoclopramide 19.5mg was administered subcutaneously at 10:57AM. An 18
gauge, 2 IV catheter was placed in the left cephalic vein to allow for the administration of pre-
operative hydromorphone 3.9mg at 11:18 AM. Intravenous Midazolam 7.8mg was administered
at 11:2AM to begin inducing anesthesia. Propofol 117mg was administered to effect at
11:43AM. The patient was intubated with a 51 French endotracheal tube and placed on
Isoflurane. An epidural at the lumbo-sacral junction was administered using Bupivicane 3.9mg
and Duramorph 3.9mg. LRS at 390mL/hr was started. A left medial parapatella arthrotomy was
performed, revealing a completely ruptured cranial cruciate ligament; the ligament fragments
were excised and the medial meniscus released after inspection. A tibial plateau leveling
osteotomy was performed to stabilize the stifle. The tibia was cut with a 27mm circular sawblade and a six hole, 3.5 TPLO plate was placed to correct 28 degrees of tibial plateau slope. All
screw holes were filled with 3.5mm screws and tightened well. Cefazolin 858mg IV was
administered intraoperatively at 12:10PM and 2:00PM and Atropine 0.7mL IV at 1:05PM as the
patient was bradycardic at 45-55 BPM from 12PM-1PM. Closure of the surgical site using 3-0
PDS was performed without incident. Post-operative radiographs were performed and
demonstrated good implant placement and tibial alignment. Recovery from anesthesia was
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uneventful. Post-operative hydromorphone 1.95mg IV was administered at 3:22PM. Post-
operative temperature was 96.3F and heat support was applied until temperature stabilized at
1:30AM. Post-operative treatments included: cold compressing of the surgical site every six
hours, cefazolin 858mg IV every eight hours, tramadol 100mg PO every six hours, and laser
therapy of the left knee every six hours. A hydromorphone 0.01mL/kg/hr at 105mL/hr was
started at 3:30PM and decreased to 50mL/hr on September 5, 2014 at 9:00AM. NSAIDs couldnot be given due to recent steroid administration.
Prognosis: Good with proper restriction of activity, weight-control management, physical
therapy, and chrondoprotective supplementation. There is likely to be some arthritic progression
in this knee over time, and Bindi Sue may become symptomatic long-term.
Outcome: Bindi Sue was discharged at on Sept. 5 at 3:00PM after 12 hours of post-operative
care.
Discharge Instructions: Confinement phase (first eight weeks following surgery): A strict
confinement regiment must be followed for the first eight weeks following surgery. Do not allow
unsupervised activity such as running, jumping, fetch, etc. Bindi Sue can be inside on carpeted
surfaces under direct supervision. Slick surfaced such as hardwood, tile, or linoleum should be
avoided if possible. When not under supervision, confinement in a kennel or crate is strongly
recommended. She can be taken outside on a short leash for bowel movements, urination, etc 3-4
times a day for 3-5 minutes. Total exercise time should be no more than 10 minutes for the first
two weeks and no more than 15 minutes from 2-8 weeks. Towel/sling walking is recommended
on slick floors, uneven ground, or stairs. There is always some risk of premature failure with
implants, especially with overactivity, so exercise restriction is important to reduce the risk of
this happening. Playing with other animals is not allowed during confinement. If there are other
pets in the household, they will need to be kept separated. Bindi Sue should start to use the leg
within the next 3-5 days; if she is not using the leg within 5 days, please contact us. Begin gentlephysical therapy exercises starting 5 days after surgery.
Physical Therapy Instructions: Bindi Sue needs to have passive range of motion performed on
the operated knee during the confinement phase, especially if she is not started to toe-touch on
the leg by 5 days post-op. Administer anti-inflammatory medication as prescribed to reduce
inflammation and discomfort and apply a warm compress to the knee for 3-5 minutes prior to
physical therapy sessions. Perform range of motion exercises three times daily as follows: slowly
flew the knee to where Bindi Sue first feels discomfort, then slowly extend the knee until Bindi
Sue shows signs of discomfort. Repeat this process 20 times at each session for the first three
weeks, then 10-15 times per session thereafter. Do not cause pain by moving the join too far;
rather, gradually build up range of motion by stretching rather than tearing scar tissue. Ice the
knee for 3-5 minutes at the end of each therapy session, if Bindi Sue will tolerate it. Range of
motion should gradually improve over time. We have a rehabilitator on staff who can work
closely with you and Bindi Sue during the post-operative period.
Bruising and swelling adjacent to the incision should subside over the next week; some of the
fluid may accumulate around the hock joint during this time, producing a soft-tissue swelling,
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but should subside. Keep the incision clean and dry and check it daily to ensure that there is no
abnormal discharge; if necessary, use an Elizabethan collar to prevent Bindi Sue from licking,
biting, irritating, or otherwise bothering the incision. Monitor attitude and appetitethese should
return to normal over the next 2-3 days. Reduction of feedings by 20-30% is advised to reduce
weight-gain during the recovery period and is important to reduce stress on the rear legs.
Medication:
1. Tramadol 50mg tablets: give one and a half tablets by mouth ever 8 to 12 hours as needed
to control signs of post-operative discomfort
2. Fish oil or Omega-3 fatty acids: give 1200mg liquid cap orally every day. Additional
supplementation with Chondroitin sulfate and glucosamine HCl supplementation can be
used.