As spring approaches, squirrel activity is increasing, which is driving your chunky Lab into a frenzy. One morning, you skip your normal routine of clearing the yard of these pesky intruders, fling open the door, and let your pooch run out to do her business. She spies a squirrel across the yard, and immediately lunges into a sprint, only to attempt to skid to a halt before the fence. The bushy tail disappears up your oak tree, and you see your dejected pup limping back to you, holding up her hind leg. Frantic with worry, you call our hospital to schedule an appointment, sure that your dog will need surgery to heal her leg. However, before we leap to surgical repair for healing, let’s understand the cranial cruciate ligament’s (CCL) purpose.
What is a cranial cruciate ligament tear in dogs?
The CCL is the dog’s main supporting ligament that provides stability to the hind leg by preventing the tibia from sliding forward under the femur. It allows for gliding motion of the knee, or stifle joint, while preventing hyperextension. The knees, and specifically the cranial, or anterior, cruciate ligaments and cartilage plates, called menisci, often develop degenerative disease, or arthritis, as a result of improper hip alignment and pelvic subluxations. Over time, changes in joint fluid viscosity, due to loss of chondrocytes (i.e., the cells which replenish healthy, viscous joint fluid), allow for injury to the ligament with minor joint stress. Chronic inflammation and joint disease further fray the ligament fibers, which can tear when your pet exerts herself, such as during a squirrel chase.
Typical signs of a cruciate ligament tear in dogs include acute three-legged lameness or toe-touching. Occasionally, a dog may intermittently limp on the injured leg, but the limp will worsen as joint disease progresses. To halt the inflammation and pain associated with joint disease, we use a variety of modalities, as most dogs respond well to alternative therapies and do not require surgical repair.
Prolotherapy for managing CCL tears
Prolotherapy, or proliferative therapy, is used in areas of joint instability and/or chronic pain to bring about proliferation of the surrounding joint support structures, thereby preventing hyperextension and stretching of the nerve-rich synovial membranes. Prolotherapy can be performed as a non-surgical option for CCL tears, because the proliferation in collagen, which forms around the knee joint, decreases hyper-extension and creates the same support that more extensive and invasive surgical procedures provide.
Patients who receive prolotherapy may also receive platelet-rich plasma (PRP) and/or ozone therapy, to help protect and heal joint cartilage. Prolotherapy involves injections into and around the collateral ligaments and tendons. Most pets will need between one and six treatments, at three-week intervals.
The vast majority (95%) of pets we treat with ACL tears have good to excellent response to this treatment, and do not require surgery.
Platelet-rich plasma therapy for non-surgical treatment of the injured joint
Platelet-rich plasma is derived from your pet’s own blood, by separating the red and white blood cells from the sample, and leaving behind the platelet-rich portion of the plasma. Platelets play an important role in injury healing and repair, as they release growth factors and bioactive proteins that assist with tissue regeneration, stimulating the healing process. The growth factors derived from platelets initiate connective tissue healing, and promote new blood vessel development. The ultra-concentrated plasma is injected directly into the affected area, to reduce inflammation, and speed tissue regeneration and repair. Since platelet-rich plasma is derived from your pet’s own blood, side effects or reactions are rare, while the advantages are many.
When a cruciate ligament is torn, PRP can be a viable option for avoiding surgery. We may choose this option alone, or use it with prolotherapy, depending on the degree of joint instability. In cases of partial CCL tears, PRP may actually help heal the ligament itself.
When an ACL tear is complete, PRP will not reattach the ligament, but rather, decreases joint capsule inflammation and helps heal the injured cartilage, thereby reducing pain, during response to other treatments, including prolotherapy.
Ozone therapy for meniscus and cartilage repair
While you may have heard of hyperbaric treatments, ozone therapy is another oxygen therapy that brings easily soluble oxygen to damaged tissues, to treat injury, inflammation, viruses, bacteria, and fungi. Ozone contains three oxygen atoms that break down in the body to ordinary oxygen, and a single oxygen molecule that easily combines with chemicals and other molecules. As cells break down in the body, whether caused by injury or disease, they release carbon dioxide, causing inflammation and pain. By adding medical-grade oxygen to affected areas, the carbon dioxide amount is reduced, lessening inflammation, pain, and swelling.
Ozone therapy has been shown to activate the immune system by stimulating the production of cytokines, which are messenger cells that stimulate the movement of healing cells toward inflammation, infection, and trauma sites. By injecting ozone in its gas form directly into the damaged joint, inflammation is reduced, and natural healing by the body is encouraged.
Physical therapy for healing cruciate ligament injuries
Rehabilitative and physical therapies aim to restore normal function to the musculoskeletal system, making them perfect modalities for managing a CCL injury. A wide variety of therapies are incorporated into rehabilitative treatment, including:
- Range of motion and stretching exercises
- Therapeutic ultrasound
- Laser therapy
- Sanawave therapy
- Electromagnetic field therapy
- Chiropractic adjustment
- Essential oil therapy
With CCL injuries in dogs, multimodal therapies are most effective for regaining full use of the affected limb. And, while not each modality works directly on the stifle joint, each treatment plays its part in treating the disease process, and returning your pet to normal health and well-being. For example, essential oil therapy will likely be used to keep your pet calm and relaxed while recovering from a ligament injury, whereas chiropractic care can realign the healthy rear leg that is bearing the brunt of the weight.
When incorporating rehabilitative therapies into your pet’s treatment plan for her injured cruciate ligament, keep in mind that each session builds on itself. You may not see a huge improvement after the first acupuncture, chiropractic, or laser therapy session, but you should notice a difference with each successive appointment.
At Cranberry Holistic Pet Care, we use many therapies to return your pet to health by battling the underlying disease process. For the best result, we form a multimodal treatment plan based on your furry pal’s needs, and then monitor her response to treatment. If conventional medicine is not providing the results you’d like for your pet’s CCL injury, contact us for an appointment with Dr. Maro.