Modified Platelet-Rich-Plasma on Cruciate Ligament Injuries in Dogs

Great Dane Dog with Papilloma Virus
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July 29, 2016

Modified Platelet-Rich-Plasma on Cruciate Ligament Injuries in Dogs

cruciate ligament injury in dogs
By: Meghan Reinders B.Sc (Hons) Candidate and Dr. Sasan Haghighat DVM, CVA

Platelet-Rich Plasma therapy has been applied to many different medical fields such as cosmetics, dentistry, sports medicine, pain management and now veterinary medicine. PRP is known as a portion of the blood that has been processed, usually by centrifuge, to contain a higher concentration of platelets than in whole blood. (McCally, 2015) An interesting new feature of the physiologic function of platelets is their role as vehicles for the local delivery of growth factors in wound healing. At sites of vascular injury, platelets adhere and aggregate and also generate thrombrin, which triggers tendon and ligament growth and repair. (Sánchez, 2007) In veterinary medicine, PRP has most often been reported for tendon/ligament injuries and osteoarthritis. Other than a higher concentration of platelets, PRP contains more than 1500 bioactive proteins, which include many growth factors and substances that are normally found in plasma. These additional growth factors play a key role in reducing the expression of inflammatory cytokines, and encourage proliferation and differentiation of resident cells. (McCally, 2015) This enhanced blood encourages the body’s natural healing process by directly targeting the site of injury.


Cruciate Ligament Injury in Dogs

One of the many common injuries found in dogs today are ruptured cruciate ligaments. Due to the highly active lifestyle and energy of many dogs, these hind leg tears can really hinder their daily mobility while also resulting in stress on the rest of the compensating body. Specifically, within the knee joint there are two cruciate ligaments that cross the knee joint – the cranial cruciate and the caudal cruciate. In relation to humans, this would be considered the anterior cruciate ligament and posterior cruciate ligament (more commonly know as ACL and PCL). It is important to note that Cranial Cruciate Ligament (CCL) injuries are less likely to occur in dogs whom have not yet been sterilized, which is why it is important to postpone spaying until your pets are 2 years of age and fully developed. (Haghighat, 2014) This allows for proper formation of collage and musculoskeletal structure, as you do not want to create any hormone imbalances that can harm their development. Through a good home-prepared diet, exercise program, specific bioregulatory medicine, which includes PRP, many patients will regain normal knee function within 6-8 weeks.


What is Bioregulatory Medicine?

The body is full of complex biological processes that need consistent attendance in order to stay in a healthy and homeostatic state. The main idea behind bioregulatory medicine is using therapeutics and natural healing processes to regulate these biological processes during imbalances, without having to use conventional pharmaceutical medicines.

The difference between conventional and bioregulatory medicine is that the conventional route to dealing with illness is to reduce the symptoms and minimize inflammation through anti-inflammatories. The issue with this is that inflammation is a key response of the immune system when it is trying to fix and treat the illness at hand. In contrast, bioregulatory medicine helps the body heal itself through re-establishing normal feedback systems and stimulating healing processes. (Demers, 2014) As integrative veterinary medicine is becoming more well known, it is important to understand that patients can live a long full life with quick recoveries through promoting immune response such as fever and inflammation rather than reducing such symptoms. (Demers, 2014) It is important when treating dogs with PRP that they are not on any anti-inflammatory medications as this suppresses the effects of PRP and the activation of that immune system response on the injury site.

The first step in treating a patient with PRP is to draw a small quantity of the patients own blood into a tube specified for the PRP procedure. The blood is then separated into a plasma portion and a red blood cell portion using one or two spins in the centrifuge. The plasma portion is then obtained with the use of a syringe and is what is then injected into the injury site. The high concentration of platelets then becomes activated upon contact with collagen and other substances located at injection sites and where there is a release of growth factors. (McCally, 2015)

Benefits of Platelet-Rich Plasma (PRP)

Through the support of many talented researchers, PRP has proven to be very successful in many different aspects of rehabilitation. Hyunchul et al. conducted a study using PRP for arthroscopic repair of large to massive rotator cuff tears and found that the retear rate of the PRP group versus the conventional method group was 35.6% lower (20% in the PRP group versus 55.6% in the conventional group). It was found to significantly improve structural outcomes for patients with large to massive rotator cuff tears. In addition to this, Gumina et al. reported to find that no retears occurred in patients treated with PRP (0% 0/39) while 3 retears occurred in control patients (8.1% 3/37). In another study, Sánchez et al. compared surgically repaired Achilles tendon tears with the use of Platelet-Rich Fibrin Matrices (PRGF). Researchers found that athletes that received PRGF recovered their range of motion 3 weeks earlier, showed no wound complications and took less time to take up gentle running (7 weeks less) than the conventional group. (Sánchez et al., 2007)

After conducting a study on PRP versus Autologous Whole Blood for the treatment of chronic lateral elbow epicondylitis, Thanasas et al. demonstrated that through the action of PRP it may be possible to initially inhibit excess inflammation while stimulating proliferation and maturation. This is especially important in preventing the fibrous scar tissue healing that occurs with macrophage-mediated tendon-to-bone healing. (Thanasas at al., 2011) Many positive effects have been found when using PRP as a treatment for tendon and ligament healing. It has also been found successful in pain reduction for patellar tendon donors. In a randomized controlled trial, De Almeida et al. concluded that the use of PRP in the patellar tendon harvest site reduced donor site morbidity after ACL reconstruction. More importantly, results found that the patellar tendon harvest site non-regenerated area (gap area) in the PRP group patients was 4.9mm and 9.4mm in the control group patients, showing a significant difference; it indicates that PRP enhanced tendon healing. (De Almeida et al., 2012)


Why PRP over Prolotherapy (Proliferation Injection therapy)?

PRP has been found to support the bodies healing processes in many effective ways. Some include:

  • Better long-term outcomes
  • Reduction in pain
  • Enhances the quality of tendon repair and the time of healing
  • Less scar tissue after healing process
  • Platelets store specific proteins important in infection prevention as well as disease transmission

PRP is an all-natural process that stimulates the repair of soft tissues and joints without the use of harmful pesticides and chemicals. Although proliferation injection therapy is another route in triggering the healing processes, it is a more invasive technique. Prolotherapy injects an anesthetic and an irritant into joints, ligaments or tendons that are weakened or torn. Many of these irritants include mild chemical irritants and chemotactic agents. The chemical irritants cause an irritation/inflammation that stimulates the body to produce collagen and start the healing process, where as, chemotactic agents attract immune cells directly to the injected area. (APM, 2017) Thus, one can see how using PRP is one step closer to stem cell therapy and uses the bodies own programming for self-healing on an amplified scale.


References

APM. (2017) Proliferative Therapy (Prolotherapy). Spine and Sports Physicians. Retrieved from https://apmspineandsports.com/diagnosis/prolotherapy/

De Almeida, A. M., Demange, M. K., Sobrado, M. F., Rodrigues, M. B., Pedrinelli, A., & Hernandez, A. J. (2012). Patellar tendon healing with platelet-rich plasma: a prospective randomized controlled trial. The American journal of sports medicine, 40(6), 1282-1288.

Demers, J. (2014) Bioregulatory Medicine and Homotoxicology. Integrative Veterinary Care. (V4I3), 28-31.

Gumina, S., Campagna, V., Ferrazza, G., Giannicola, G., Fratalocchi, F., Milani, A., & Postacchini, F. (2012). Use of platelet-leukocyte membrane in arthroscopic repair of large rotator cuff tears: a prospective randomized study. JBJS, 94(15), 1345-1352.

Haghighat, S (2014) Cranial Cruciate Injury in Dogs ~ A Second Option. Vitality. Retrieved from http://vitalitymagazine.com/article/cranial-cruciate-injury-in-dogs-a-second-option/

Hall, T. (2017) Platelet Rich Plasma Therapy Certification. Retrieved from http://www.tericowellness.ca/courses/Platelet-Rich-Plasma-Therapy-Certification/

Jo, C. H., Shin, J. S., Lee, Y. G., Shin, W. H., Kim, H., Lee, S. Y., ... & Shin, S. (2013). Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial. The American journal of sports medicine, 41(10), 2240-2248.

McCally, R. E. (2015) Platelet Rich Plasma (PRP) in Canine Orthopedics. Veterinary Health Center. Retrieved from http://vhc.missouri.edu/platelet-rich-plasma-prp-in-canine-orthopedics/

Sánchez, M., Anitua, E., Azofra, J., Andía, I., Padilla, S., & Mujika, I. (2007). Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. The American journal of sports medicine, 35(2), 245-251.

Thanasas, C., Papadimitriou, G., Charalambidis, C., Paraskevopoulos, I., & Papanikolaou, A. (2011). Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. The American journal of sports medicine, 39(10), 2130-2134.

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