Page 196 - Veterinary Laser Therapy in Small Animal Practice

182 Veterinary Laser Therapy in Small Animal Practice

several species: in a rabbit model where the Achilles
tendon was damaged and treated with either therapy
alone or in combination, both modalities by themselves
led to a better repair when compared to no treatment
(with no significant differences between them), but the
combined treatment with PRP and LT was even more
efficient. [143] The same was found in tenotomized rats,
in which adding the two modalities enhanced type
I collagen in the repaired tendon. [481] Similar results
were seen in rat injured muscle: the combination of
both therapies produced better histological scores than
with either of them separately. [482] The same research
group had previously found this combination also
reduced the oxidative stress resulting from stretch-
ing injuries and modulated collagen production even
better than the therapies did individually. [483] Although
not all experiments conclude there is an additive
effect, [484] at least there is no contraindication to trying
this combination.
In fact, all three modalities can be combined. A clini-
cal study (mentioned previously) reported good results
with stem cells in combination with PRP to treat unilat-
eral partial tears (≤ 50% as confirmed by arthroscopy)
of cruciate ligaments. Those cases underwent a reha-
Figure 11.16 Applying LT over the hip area after stem cell bilitation program after the intra-articular injection,
infiltration of the joint in a case of severe hip OA. which included LT and manual therapy once a week
and a home exercise program for the first 8 weeks.
guess is that the answers to most or all of them will be Three months after treatment, a significant change
positive, but (again!) research has to demonstrate the was observed in functionality, pain, and arthroscopic
optimal parameters, and clinical studies will take many parameters, including formation of new blood vessels
years. Meanwhile, I suggest you treat those areas with and changes in fiber arrangement. [298]
moderate dose and power, according to the depth of Like any new modality, we will continue to learn
the location and the state of the local tissue. That means which treatments synergize with laser to best help our
for a wound/burn/superficial lesion you would use 1–4 patients. And I’m sorry, but if you wait to see double-
J/cm , but about double for deeper-seated locations blinded studies with each possible permutation of treat-
2
(Fig. 11.16). ments (control, laser + stem cells, stem cells + PRP, PRP
The use of platelet-rich plasma (PRP) is also becom- + acupuncture, etc.), pull up a chair because it will be
ing more and more popular, as it is relatively easy to a while, especially with all the corporate interest (and
obtain and more affordable than stem cell therapy. conflicts of interest) out there between companies.
Although experimental studies show positive results, But whether or not you expect to see a benefit from
not all clinical studies do. For instance, PRP did laser boils down to the question of whether whichever
improve functionality and pain scores in dogs with treatment you intend to enhance will benefit from
OA, [479] but did not enhance osteotomy healing in dogs better local circulation, tissue oxygenation, and cellular
undergoing surgery for cruciate ligament rupture. [480] metabolism in the treatment area. If yes, then yes, laser
The combination of PRP and LT has been studied in will help.

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