Clean Run - December 2015 - 51

Regenerative Medicine
for Partial Cranial Cruciate
Ligament Injuries in

Agility Dogs

By Sherman O. Canapp, DVM, MS, CCRT, DACVS, DACVSMR and Brittany Jean Carr, DVM, CCRT
Photos courtesy of VOSM except where noted

Cool is a 5-year-old Border Collie from
Washington. Cool presented for evaluation of left hind limb lameness/oﬄoading. About a month prior to presentation, Cool was noted to be oﬄoading
the left hind limb after playing outside.
He was taken to his primary care veterinarian where radiographs were performed and appeared unremarkable.
The lameness resolved with strict rest
but reappeared a few days later. Cool
was referred to both a surgeon and a
neurologist. Cool had an MRI of his stifles and lumbar spine, which revealed
a mild partial disruption of the cranial
cruciate ligament of the left stifle joint
with mild intracapsular soft tissue swelling and bone edema. Cool was taken to
multiple specialists, all of whom recommended surgical intervention (TPLO).
Owners declined aggressive surgical
intervention for the mild cranial cruciate
ligament (CCL) injury, and instead contacted VOSM regarding the use of stem
cell therapy for this injury. Cool was continued on strict crate rest and flown to
VOSM for further evaluation.

Physical Examination and Diagnostic Findings
At initial presentation, Cool had a mild
left hind limb lameness and shortened
stride at a trot. He would slightly oﬄoad
the left hind limb at a stance. On physical exam, Cool had mild effusion in the
left stifle. Very mild instability was noted
in the left stifle, consistent with an early
partial tear.
December 15 | Clean Run

Initial Gait4Dog objective gait analysis revealed a decreased pressure on the left pelvic limb as compared to the right pelvic limb. On radiographs there was mild effusion
confirmed in the left stifle.
Cool's left hind limb oﬄoading/lameness was attributed to an early partial CCL rupture. A left stifle arthroscopy was recommended to confirm the CCL injury and further
evaluate the left stifle joint.
A left stifle arthroscopy was performed and showed mild disruption of the craniomedial band of the CCL (~10% tear). Mild synovitis (joint inflammation) was noted. The
remainder of the cranial cruciate and caudal cruciate ligaments were within normal
limits as was the meniscus.

CCL Injury in the Agility Dog
CCL injury is the most common stifle (knee) injury in dogs. A rupture of this ligament
causes pain, lameness, and arthritis formation. Instability may lead to injury of other
structures in the knee (the meniscus). Diagnosis can often be accomplished through
physical examination and minimally invasive diagnostic modalities. VOSM's specialists commonly recommend an objective gait analysis (such as Gait4Dog System) to
identify and quantitate lameness and various gait parameters. Gait analysis is repeated at every recheck to allow for an objective measure of response to treatment. Minimally invasive diagnostic modalities such as stifle arthroscopy and MRI are used not
only to confirm a diagnosis, but also grade the level of injury. Depending on the grade
of injury, conservative management with regenerative medicine and rehabilitation
therapy may be an option. In Cool's case, a left stifle arthroscopy was used to confirm
the partial cranial cruciate ligament tear and grade the injury. Since Cool had changes
consistent with an early tear (~10%), regenerative medicine was offered.

Stem Cell Collection and Treatment
Under fluoroscopic guidance bone marrow was collected from Cool's femur. The stem
cells were isolated from the bone marrow sample (BMAC) in VOSM's regenerative medicine laboratory using the validated CRT machine. Blood was also collected from Cool
for processing of platelet rich plasma (PRP) using the validated CRT machine. The stem
cells and PRP were combined and injected into Cool's stifle using fluoroscopic guidance.

Regenerative Medicine Therapy for the Agility Dog
Regenerative medicine therapy has become increasingly popular in both human and
veterinary medicine for multiple disease processes. Recent studies have shown regenerative medicine to be efficacious in managing numerous orthopedic conditions,
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Clean Run - December 2015

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