Case study: laser therapy and stance analysis for post-TPLO recovery

History

This case is of a seven-year-old female spayed Labrador Retriever named Jaffa who had suffered from a partial CCL rupture in the left pelvic limb. Treatment was approached conservatively for three years with physiotherapy including photobiomodulation (PBM), hydrotherapy and pharmaceutical pain management (tramadol). A complete CCL rupture was then diagnosed and TPLO surgery was performed. Tramadol was used pro re nata post-operatively. Due to reduced renal function NSAIDs were avoided.

Pre-surgical diagnostics

Initial stance readings were taken pre- and post-PBM therapy. Those results were 33/34/3/30 (LF/RF/LH/RH). Normal weight distribution is 30/30/20/20 (LF/RF/LH/RH).

Post-operative treatments and exam

PBM therapy was delivered once a week for two weeks before physiotherapy assessment was able to take place.

In the 10-day post-operative physical exam overall good range of motion was noted through the left stifle with some mild swelling and slight pain response in full extension. Discomfort on palpation and minor spasms were noted in the spinal segments L5 to L7.

Photobiomodulation therapy

PBM therapy was offered using the Companion CTX-15. The patient was treated with 2100 total joules (7J/cm²) delivered to the left stifle and 2300 total joules (8J/cm²) to the lumbar spine in contact with the large contact treatment head.

After physiotherapy assessment, the patient was treated twice weekly, reducing to once weekly at four weeks post-operatively and then once every two to three weeks over the next eight-week period.

Progress

Over the next 21 days post-operatively, the patient became more weight bearing on the LH limb. Mild spasms continued in the thoracic and lumbar spine, and PBM therapy and tramadol were continued. Stance readings improved to 31/35/14/20 (LF/RF/LH/RH).

Eight weeks post-operatively the patient had good range of motion through the left stifle. There was very slight hesitation in full extension but no other discomfort noted. General posture and spinal discomfort were much improved. Stance readings improved to 36/29/16/18 (LF/RF/LH/RH) and PBM therapy session frequency decreased to every two weeks.

Conclusions

PBM therapy was a key part of Jaffa’s pain control and rehabilitation allowing for a quicker return to weight bearing and activity after surgery. The Companion stance analyzer was crucial in obtaining objective data post-operatively. The frequency of treatment sessions was reduced at a pace that was suited to the patient and obtaining these objective measures permitted progress through the rehabilitation programme at an adequate level, introducing strength exercises only when an appropriate level of weight bearing was achieved.