Adding alternative modalities — such as acupuncture, laser therapy and stem cell therapy — to the treatment plan for a dog with CCLD increases the chances of recovery.

Cranial cruciate ligament disease (CCLD) in dogs is a common and debilitating problem, and surgery alone may not be the answer. This article explores how an integrative approach that includes alternative therapies, ranging from acupuncture to stem cell therapy, can help dogs with CCLD regain their mobility.

UNDERSTANDING CCLD

The cranial cruciate ligament is a fibrous band of tissue that restricts excessive movement between the femur and tibia, the two main bones of the knee. This ligament’s primary job is to stabilize the joint. Cranial cruciate ligament (CCL) injury is one of the most common causes of pelvic limb lameness in dogs.

Even though research has greatly progressed over the past years, the local and systemic mechanisms leading to ligament degeneration and structural failure remain largely unknown.¹ The initial view of traumatic ligament rupture, fostered by “wear and tear”, has been replaced by a new concept of systemic processes linked to progressive degenerative joint disease and ligament failure; thus the term “cranial cruciate ligament disease” was coined and is generally accepted.¹ In cranial cruciate ligament disease (CCLD), primary osteoarthritis (OA) is a key feature.

MULTIMODAL APPROACH TO CCLD

The progression of secondary OA can be slowed by joint-stabilizing surgery; however, the primary underlying osteoarthritic disease process continues and, in most cases, prevents a full return to integrity.¹ Many nonsurgical options can be implemented to help the patient with CCLD. These include, but are not limited to, physical therapy, acupuncture, chiropractic care, low level laser therapy, and stem cell therapy, among others.

Managing pain and inflammation in these patients should be the first step. A multimodal approach works best. Many of the modalities mentioned above can be combined and a patient-specific plan developed. Most traditional pain relief drugs (i.e. NSAIDS, steroids, gabapentin, etc.) have numerous side effects; combining them with alternative therapies may mean the patient needs fewer of these drugs to address pain and inflammation.

ACUPUNCTURE AND CHIROPRACTIC CARE

Both acupuncture and chiropractic help restore balance in the body.

• Acupuncture stimulates the nerves and muscles, helping to boost the body’s response to pain and improve blood circulation.
• Chiropractic can also increases nerve and blood flow to the joints. Regular chiropractic adjustments help reduce pain, restore alignment of the pelvis, and maintain symmetrical loading in the hind end. When dogs injure one knee, they tend to shift their weight to the opposite side, which can lead to rotation of the lumbar spine and pelvis. This can cause back pain and asymmetrical loading of the knees. By improving alignment, we can ease discomfort and reduce the extra wear and tear on an already unhealthy arthritic knee.

PHYSICAL THERAPY AND LOW LEVEL LASER THERAPY

• Photobiomodulation (PBM) induced by laser therapy involves the application of electromagnetic radiation in the near infrared spectrum, and is aimed at stimulating healing or analgesia within the target tissue. Currently, laser therapy is being advocated for a variety of conditions, including musculoskeletal pain, osteoarthritis, joint pain and inflammation, neuropathic pain, otitis, dermatitis, chronic or non-healing wounds and ulcers.⁴
• Physical therapy can be a tremendous help to the patient with CCLD. Some of the objectives of physical therapy protocols are pain management, periarticular and core muscle strengthening, and correction of proprioceptive deficits. The goal is to limit prolonged disuse of the limb in order to avoid negative effects such as muscle and cartilage atrophy, reduced joint motility, and loss of strength in tendons and ligaments.

STEM CELL THERAPY

Intra-articular injection of mesenchymal stem cells for the treatment of CCLD in dogs has demonstrated great clinical benefits. This therapy offers systemic and anti-inflammatory potential by decreasing CD8 lymphocytes c-reactive protein (CRP) and inflammatory cytokines in serum and synovial fluid.³

DIET AND WEIGHT MANAGEMENT

A significant number of patients that experience CCLD are at an unhealthy weight and in a state of inflammation. Managing the patient’s weight by offering a species-appropriate diet will help decrease inflammation overall. A raw or gently cooked diet is ideal. These diets can either be home prepared with the guidance of a veterinarian, or store bought. Not all store bought raw foods are recommended, so it is important that clients seek the guidance of a veterinarian who is well educated in raw feeding.

• Bone broth can also be added to the diet on a daily basis. Bone broth contains natural collagen that aids in bone and cartilage support. It can be easily made at home.
• Golden paste is another great super food made by mixing turmeric, coconut oil and black pepper. It offers nutritional support for bone health, joint strength, and flexibility.

Many multiple alternative modalities and natural treatments are available for the CCLD patient. Helping these dogs heal and regain quality of life can be achieved by implementing a multimodal approach.

AUTHOR PROFILE

Miraida Rivera-Viera, DVM