CCL tear and laser therapy?

My Mom just emailed me to tell me that their Airedale has a partial CCL tear and the vet recommended laser treatments and a month of crate rest. Everything that I'm seeing online says that surgery is better for larger dogs (he's probably 60 pounds or so) and that one month of rest will probably not be sufficient. I'm also not seeing laser therapy listed as a treatment anywhere.

Help? I don't want to be all "Your vet is doing it RONG" with only Google to back it up but...I kinda feel like they are doing it wrong. Max is only 3 and is super active so this will have a definite impact on his quality of life.

Oh and here's a picture of the lunatic as an advance thank you.

DogsBV-1485 by taqroy, on Flickr

DogsBV-1410 by taqroy, on Flickr

Megan (SpringerLover) works at a rehab clinic, I will direct her to this thread.

Also, I want Max. The End.

Where does your mom live? There's an online resource for rehab vets where you can search by location, http://www.rehabvets.org/Referrals.lasso.

Saying that, I don't know if I would attempt to "rehab" a CCL injury without the direction of a specialized vet. I know that our non-surgical dogs are on crate rest (with increasing leash walk time) for months. Not just a month. We definitely use cold laser to reduce inflammation in the joint.

But there's a lot of things that aren't broad/general that the vet should be looking for during recovery/rehab. The vet needs to take range of motion measurements, and muscle measurements to know if the therapy is working as it should.

So, yes, I think that non-surgical therapy can work (and we did it with Buzz successfully at 14 years old) but I wouldn't attempt it without a vet who knows what he/she's doing.

From what I know from my discussions with board-certified ortho specialists, it depends on the nature of the tear, how the dog responds, and the human's abilty to keep the dog on true crate rest.

All CCL tears are not created equal. Full tear, partial tear, microtears... In a big dog, in general significant tears = surgery but microtears can heal nonsurgically if the proper care is taken.

You're crazy!! I love Max and find him hilarious but mostly because he's not mine. Lol.

They live easily two hours away from any specialized vet - it looks like the ones listed on that link are mostly in Denver. Not out of the realm of possibility but I'm not sure they'd be willing to do that much traveling, especially with winter coming up. :|

Thank you for this! I'm going to pass it along and see what they think. I really hope they go get a second opinion. Their vet is great but definitely has more of a broad knowledge base and after talking to my Mom, I'm not overly convinced that they've rehabbed this injury before.

Can you define true crate rest for me? Their vet said that he'd be fine in his kennel (6' x 6' ish) during the day and needed to be out on leash at all other times - which isn't my definition of crate rest, let alone what I would call true crate rest.

How do they know if it's a microtear? I'm assuming you can tell a full or partial tear by manipulating the joint (I saw a cool but nauseating gif of it somewhere) but it seems like microtears could easily be missed or misdiagnosed.

I can tell you what our definition of crate rest was for Buzz.

He was in a normal sized crate for him all hours of the day he wasn't on a leash outside or on a leash next to me. I carried him up and down every stair. He very, very, rarely set foot on a potentially slippery surface.

In addition to that, I iced his knee twice daily and he took an NSAID daily. And we had routine cold laser appointments.

just a question? why nsaids if using ice? and why ice? I actually don't know why people use NSAIDS at all for ligament tissue injuries. Sure they help with pain because they analgesic properties to them, but they also result in weaker tissue. at least some studies i've seen and thinking thru the problem seems to tell me it does.

I don't remember the exact reference, but it was done on rats. They took them, dislocated their knee joints to sprain all the knee ligaments (nice I know) and then let them "heal". One group was left alone with nothing. The others were NSAIDS of different kinds.

I forget how long they did this and were deemed "healed", but lets say 4 weeks? At the end they killed them, then dissected them to pull out the major knee ligaments and put them under a load test to see at what point the ligaments would "fail"

The NSAID group failed under about 30% less load. They interfere with tendon and ligament repair.

I probably wouldn't use ice for too long either. Tendons especially need as much blood flow to an area to heal. Maybe ice at first, but not past the first couple days. It's probably not a big deal for deep structures, but more superficial ones, the ice will definitely affect the blood flow to that area.

I'd think modalities like US or Laser would be much more appropriate, and assisted pain free ROM exercises and light walking and things.

I think it really depends on the dog, how bad the tear is, etc.

I tried the "wait and see" approach with Piper when she was diagnosed with a partial tear. We have a great rehab place here (I actually work there now) so I took her there. Did a lot of laser, and different exercises to strengthen her. While it did help (she came to them 3 legged lame, ended up walking fairly normal after 6wks.), it didn't "cure" her.

She just had TTA surgery 7wks. ago. She wasn't terrible, but her gait was getting worse and after talking with the surgeon, felt surgery was the best route.

Best decision ever. I really wish I had done it from the beginning.. but oh well! Now that I work at the above mentioned rehab place, it's been great because I just bring her to work and do all of her treatments there.

I know a few of these answers and I don't know the others because I can't ever remember enough. I do what I'm told and it works. I do what I'm told because her PhD is in NSAIDs and pain management.

NSAIDs are important to reduce inflammation. Icing is to further reduce inflammation after stretching or exercising the leg.

I know lots of people do what they're told. I see it with people, I see it with animals. Everyone does what they think is best. I'm not questioning the person that you listen to has an education, but I am asking you to question the advice

It makes me come off as an asshole a lot of times, but things I have said on this board concerning all sorts of things has been said to get people to dig a little deeper and try to find answers. I guess I'm not very good at it, because i'm usually met with resistance rather than inquiry. I'm not singling you or your response out, so don't take it personally (unless you want to ) But I posed a couple questions and rather than, hmmm, I should check into that, I got, i do what i'm told by the doctor and it works.

But does it?

If sprained ligaments heal as quickly and are 30% stronger with NO intervention over NSAID treatment, is it working?

From here:

http://archinte.jamanetwork.com/article.aspx?articleid=616696
From here:
(Kulick, M. Oral ibuprofen: evaluation of its effect on peritendinous adhesions and the breaking strength of a tenorrhaphy. The Journal of Hand Surgery. 1986; 11A:100-119.)

This one showed a very dramatic decrease in strength. 12 newtons of force to cause failure of the tendon after 4-6 weeks on the control groups and only 2.5 or 3.5 Newtons of force (depending on NSAID used) to cause failure in the NSAID groups.

Here's another rat study similar to the one I referenced above another one
http://ajs.sagepub.com/content/29/6/801.short

another on knees

http://ajs.sagepub.com/content/34/7/1094.short

Beyond 4 and 12 weeks differences were not noted.

another Rat study

http://ajs.sagepub.com/content/34/3/362.short


Some more get into a lot of detail on fibroblasts, macrophages or the lack of them in NSAID treated humans and animals and prostaglandin production and how NSAID's affect all this and there subsequent effect on healing tissues.

Almost all of the NSAID literature that is "positive" deals with cost and the amount of time to get back to activity due to decreased pain. NSAIDs do show pretty positive results in those 2 areas. They are relatively cheap. Much cheaper than going to see a therapist with US or laser and some hands on modalities. And they do take pain away rather quickly, making people feel like they are "better". One big study used to "prove" the use of NSAIDS showed those two things, it also showed that ligament laxity and such was also present, but ignored that part.

But most of the literature in the past 10-15 years hasn't been all that positive in terms of how they impact the actual healing of ligaments and tendons. I would think healing is priority number 1 and anything that interferes with that can it really be beneficial?

Anyway, i don't expect everyone to have the same conclusions I do. (Highly intelligent beings will of course arrive at the same conclusions ), but mostly I would like people to dig a bit further sometimes, take a more active role in what they're told, etc.

We were specifically told not to use NSAIDs for the ligiment microtear issue we had. Said there would be no benefit and it would just mask pain and make reinjury more likely. Crate rest (down and carried out and back for pottying then up to a no-stairsteps walk straight out and back) followed by structured PT w/ swimming and cold laser was the recipe given and followed.

All I can say for certain is it worked.