Can regenerative therapy treat canine partial cruciate injuries?
When I have an option to chose between surgery or regenerative therapy, I am always willing to consider regenerative therapy first.
Platelet-rich plasma treatment is what we decided to try to treat Cookie’s partial CCL tears.
Our experience
A long time has passed since Cookie’s treatment. It is time to review how we feel it worked for her.
Cookie has been doing really well.
Her physical therapist is thrilled with how far she’s come. Cookies muscles are getting bigger and stronger, remaining flexible and relaxed. You can see the muscles rippling on her legs again.
Technically, she’s been cleared for normal activity.
I’ve been increasing the amount of running and walking in challenging terrain we’ve been doing together. We could start letting her off the leash.
Return to normal activity?
This has been a source of a dilemma for me, and here is why.
Her knees seem to be doing well and should be able to take whatever she might throw at them. And if we’re lucky, they will never give her a problem again. But what if we’re not lucky? It could well happen that her first chase after a bunny could cause another injury. The chances are always 50/50, right?
This could, of course, happen with perfectly good knees too.
This could happen if there was never anything wrong with them. When we were discussing the PRP option with Jasmine’s vet, he brought up an important point, “Say that the treatment works and restores the ligament(s) to their original healthy state. We need to keep in mind that what caused the cruciate(s) damage the first time might do that again.”
Aware of that we are supporting the ligament health the best we can with nutrition, supplements, acupuncture … But it could still happen.
Normally, that’s a kind of risk one needs to live with having a dog.
Risk versus reward
It’s a risk we’ve been taking the whole time. But …
We don’t like TPLO. We really don’t like TPLO. The traditional suture repair worked for Jasmine but with Cookie, the risk of failure during post-op is higher. Cookie is VERY enthusiastic.
Now we know there is an option out there which we do like – the hinge technique, Simitri Stable in Stride. We feel that if we had to do a surgery on Cookie’s knee(s), that’s the one we’d choose.
Here is the catch.
Cookie is too large for their present implants size range. They have done large dogs with the existing implant but the failure rate was higher. They are working on developing a larger, stronger implant, for larger dogs.
Initially, it looked like it should be ready by summer but now the timeline has been pushed to the end of the year.
The option we like is out there but not available for Cookie at this time.
Should she bust her knee now, we would have several options. We could do nothing. That is not a good idea at all, though. We could do the TPLO. But we would really rather not to. We could see whether Dr. Neil would implant the available, smaller hinge for her. But that increases the risk it might not hold up.
Or, we can try keeping Cookie’s knees safe until the larger implant is ready.
Finding a solution
After a lot of discussion and deliberation that’s what we decided to do. Cookie is happy enough with her walks and outings the way they are, on the leash. I try really hard to make sure she can go where she wants and do what she wants within reasonable limits.
If Cookie was miserable about this, we’d look at things differently. But since this is working well enough, we feel that this is the best decision for her.
Her knees might never give her trouble ever again. But if they do, and if we manage to safely bridge the time until the new surgery could be done for her, we believe that would be the best scenario.
The other thing is that it’s too hot, at least for now to let her run free anyway.
Last summer we kept her on the leash during the heat because if she was tracking a bunny she would not stop. Not until her body collapsed under her.
What do you think? What would you do?
Three months post-treatment update
It’s been about three months since Cookie got her platelet-rich plasma (PRP) treatment for her partial cruciate tear(s). We knew that it wasn’t a sure-fire option and the success depended on the degree and type of tear, the stability of the knee(s) and other factors.
We knew that it might not work going in. However, it made sense to us to give this a try.
The odds were reasonable and, more importantly, there is no downside to the treatment. The entire time we were very careful about what we allow Cookie do, making sure that she rebuilds her strength and stamina gradually. Cookie has gone through intensive physical therapy to give the treatment the best chance.
Three times through that period we thought that the ligament might have failed.
Cookie would suddenly start favoring the hind left leg and might heart would sink. Each time, though, everything looked fine the next day and neither of those times a problem with the knee was found.
This confirms the reports from her physical therapist.
Veterinary progress evaluation
Cookie went to see Jasmine’s vet, who did the treatment for her, for evaluation. He was asking about how Cookie was doing and how much credit we though the PRP should get. I figured that the best way to find out where were are at with those knees would be him getting his hands on her once again.
The news was good!
The vet examined Cookie thoroughly and said there wasn’t much she was telling him. He found no myofascial trigger points and he found both stifles stable with no thickening or joint fluid effusion.
In closing
It’s been a couple of years now and Cookie’s knees are still doing well.
Related articles:
PRP for CCL Injuries: Cookie’s PRP Treatment for Partial Cruciate (CCL/ACL) Tear Update and Considering the Future
Further reading:
Biologic Approaches for the Treatment of Partial Tears of the Anterior Cruciate Ligament