Regenerative Medicine

Britt Carr Benson, DVM

Regenerative medicine therapy has become increasingly common in both humans and animals and has been used to treat osteoarthritis and soft tissue injury. Osteoarthritis and soft tissue injuries are common causes of discomfort in the canine. According to a recent study, approximately 20% of middle-aged dogs and up to 90% of older aged dogs are affected by osteoarthritis. Multiple regenerative medicine therapies have become available recently to help manage OA and either compliment or replace traditional medical therapies. Soft tissue injuries also commonly afflict active dogs due to the repetitive forces placed on tendons and ligaments while partaking in these activities. A recent survey of agility dogs found that thirty-two percent of the population had orthopedic lameness during training, and that fifty-three percent of those evaluated by a veterinarian were due to soft tissue injury. Tendons and ligaments are especially susceptible to major stress during intense activity, and if injured, they typically heal slowly due to poor blood supply compared with other soft tissues. Many of these injuries are treated with regenerative medicine therapy to help optimize the healing response and minimize scar tissue formation.

Platelet-Rich Plasma

Platelet rich plasma (PRP) is an autogenous fluid concentrate composed primarily of platelets and growth factors. PRP is made by obtaining a small sample of the patient’s blood and either filtrating or centrifuging the sample to concentrate the platelets in the final sample. Platelets release growth factors, cytokines, chemokines, and other bioactive compounds which support healing. Multiple studies have shown PRP to be efficacious in managing both osteoarthritis and soft tissue injuries.

Stem Cell Therapy

Almost all veterinary research has focused on adult stem cells derived from bone marrow or adipose tissue. To date, no evidence supports superiority of one over the other in terms of viability or efficacy of the derived stem cells. Once the sample is obtained, it is either processing in hospital or shipped to a university or private company for processing, culturing, and banking for future use. Stem cell therapy is administered directly into the affected joint or soft tissue lesion under ultrasound guidance. Both stem cell collection and administration are performed under light anesthesia.

Stem Cell and PRP Combination Therapy

Stem cell and PRP therapy are often combined as when used together they have been shown to have a synergistic effect. PRP provides growth factors to enhance stem cell activation and survival and also provides a scaffold for the MSCs to attach to. Thus, stem cell and PRP therapy are commonly used together.

Rehabilitation Therapy following Regenerative Medicine Therapy

A rehabilitation therapy program is recommended for 12 weeks after regenerative medicine therapy. Rehabilitation therapy should be performed weekly in conjunction with a twice-daily home exercise program. Rehabilitation therapy helps to speed healing by decreasing inflammation and swelling, building muscle mass, increasing range of motion, and improving overall comfort. The weekly therapy sessions often include manual therapies, standard isometric exercises, and class IIIb laser therapy. A recent study has shown that class IIIb low-level laser therapy can stimulate stem cell differentiation, proliferation, and viability. On the other hand, certain therapies are contraindicated within the first 8 weeks of regenerative medicine therapy because their effects on stem cells and PRP have not been fully studied. Therapies that should be avoided for the first 8 weeks include class IV low-level laser therapy, underwater treadmill therapy, therapeutic ultrasound, shockwave therapy, neuromuscular electrical stimulation/transcutaneous electrical neurostimulation, and nonsteroidal anti-inflammatory drugs. Once the tissue has healed, the rehabilitation program then focuses on strengthening and conditioning. After appropriate muscle mass and condition has been achieved, dogs are cleared for retraining and return to sport. Depending on the type and severity of the initial injury, patients treated with regenerative medicine therapy typically return to competition or normal activity within 6 to 12 months of treatment.

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