Laurie,
My name is Erin. I am a CVT, and I watched your video on the conservative management of the torn meniscus in a post op TPLO case. I feel like we see so many meniscal tears after a TPLO and we almost always are recommending our patients go back to sx. Of course, not everyone is able to afford this after a TPLO and a lot of people are just hesitant to do sx again. In this case, we Rx Gabapentin for pain management and continue rehab, but focus heavily on pain and swelling control. Exercises in this case are limited as we do not want to further damage meniscus and cause pain.
We have a human PT here working with us and she said a similar technique for conservative management of meniscus was used in her practice. I have been picking her brain for more info as well. I was curious to see what you recommend to clients after the distraction technique is used for pain management, and what particular exercises you use while conservatively managing the torn meniscus. Also, what is a good supplement to use in conjunction with the conservative management of the torn meniscus? We have starting selling the Hyalogic products here; I am curious to see if you recommend Hyaluronic Acid particularly in this case. I assume glucosamine and chondrotion, and fish oil would be good to recommend as well during the healing process.
A few other questions I have are: How long on average do you feel you expect the healing process to take if everything goes as planned? Finally, is this an option you try 1st before going to sx if you feel confident you are dealing with a bucket handle tear or folded caudal pole tear? I feel like in this practice most of our DVMs would still be more on board with sx 1st, but I would like to have this technique available to those clients that just cannot afford or are not willing to go forth with another sx.
Thanks! I look forward to any information you have!
E
Conservative Treatment of Meniscal Tears
Conservative Treatment of Meniscal Tears
LAURIE EDGE-HUGHES
Re: Conservative Treatment of Meniscal Tears
Hi E,
This is a bit of a trial and error kind of a condition.
Essentially the stats are that 20% of post-op TPLO’s will go on to develop a meniscal tear. There is argument amongst surgeons over whether or not doing a meniscal release actually reduces that percentage.
Okay, now as far as the technique and success goes, you may only have about a 55% of success (according to human literature - but that’s better than none)!
So the meniscal technique requires a strong traction / pull. When I do it on people, I literally hang off their leg while flexing, extending it and twisting … (it’s quite acrobatic!)
In conjunct with the techniques, I’d do laser, PEMF, shockwave, recommend joint supplements, and likely discuss anti-inflammatory medications.
If you have enough traction and the meniscal tear isn’t ‘free floating’, I’ve found that less than 3 treatment attempts will do it. From a pain perspective, you could also think about alpha stim.
Unfortunately, if it’s painful and the dog is still toe touching after all of this, then surgery likely is what’s needed. It’s sort of like having a rock in a shoe otherwise.
Now that being said, there is research out there on healing meniscal tears, and it is months… but our issue is knowing what kind of tear you have or if it’s a free floating piece of meniscus.
So, if the owners are really unwilling to do surgery, I’d offer 1 month of rehab as a trial - once or twice a week, for the traction technique and modalities.
That way, if there is likely to be success, you should see it in that time, and if not, then the owners may be more willing to consider surgery.
I've not tried / heard of / recommended hyaluronic acid for these cases either. Perhaps someone else will pipe up with feed back there.
I hope this helps a little anyways!
Sincerely,
Laurie
This is a bit of a trial and error kind of a condition.
Essentially the stats are that 20% of post-op TPLO’s will go on to develop a meniscal tear. There is argument amongst surgeons over whether or not doing a meniscal release actually reduces that percentage.
Okay, now as far as the technique and success goes, you may only have about a 55% of success (according to human literature - but that’s better than none)!
So the meniscal technique requires a strong traction / pull. When I do it on people, I literally hang off their leg while flexing, extending it and twisting … (it’s quite acrobatic!)
In conjunct with the techniques, I’d do laser, PEMF, shockwave, recommend joint supplements, and likely discuss anti-inflammatory medications.
If you have enough traction and the meniscal tear isn’t ‘free floating’, I’ve found that less than 3 treatment attempts will do it. From a pain perspective, you could also think about alpha stim.
Unfortunately, if it’s painful and the dog is still toe touching after all of this, then surgery likely is what’s needed. It’s sort of like having a rock in a shoe otherwise.
Now that being said, there is research out there on healing meniscal tears, and it is months… but our issue is knowing what kind of tear you have or if it’s a free floating piece of meniscus.
So, if the owners are really unwilling to do surgery, I’d offer 1 month of rehab as a trial - once or twice a week, for the traction technique and modalities.
That way, if there is likely to be success, you should see it in that time, and if not, then the owners may be more willing to consider surgery.
I've not tried / heard of / recommended hyaluronic acid for these cases either. Perhaps someone else will pipe up with feed back there.
I hope this helps a little anyways!
Sincerely,
Laurie
LAURIE EDGE-HUGHES
-
David Lane
- Posts: 164
- Joined: Mon Oct 24, 2016 10:51 pm
Re: Conservative Treatment of Meniscal Tears
I don't have any data to offer on HA for meniscal tears, just opinion... First off, I'm assuming you mean IA HA, and not oral. I don't see the benefit in oral. I am also skeptical that IA HA will do anything more than a palliative transient befefit, if that.
In general, all non-surgical meniscal issues will do better over time (that's the advantage of being profoundly lame - there's nowhere to go but up). The problem is, we do know from serial arthroscopy that by the time the dog grinds the meniscus down to nothing, enough to not be as dramatically lame, there is no cartilage left in that region and OA will progress rapidly. I mention that as a caution; that we don't atribute the "grinding down" of menicus and cartilage, and the clinical change that comes with it, to the effect of therapy a/o improvement in the joint environment.
If repeat surgery is not an option, then all we can do is all we can do, but I offer the above thought as a caution that if the owner is on the fence, the idea of non-surgical treatment may have tempting appeal but they need to know that delaying surgery may well result in permanent cartilage loss.
David Lane
DVM, ACVSMR
In general, all non-surgical meniscal issues will do better over time (that's the advantage of being profoundly lame - there's nowhere to go but up). The problem is, we do know from serial arthroscopy that by the time the dog grinds the meniscus down to nothing, enough to not be as dramatically lame, there is no cartilage left in that region and OA will progress rapidly. I mention that as a caution; that we don't atribute the "grinding down" of menicus and cartilage, and the clinical change that comes with it, to the effect of therapy a/o improvement in the joint environment.
If repeat surgery is not an option, then all we can do is all we can do, but I offer the above thought as a caution that if the owner is on the fence, the idea of non-surgical treatment may have tempting appeal but they need to know that delaying surgery may well result in permanent cartilage loss.
David Lane
DVM, ACVSMR
David Lane DVM
ACVSMR, CVA, CVSMT, CCRP
ACVSMR, CVA, CVSMT, CCRP