Q: Our 3-year-old Lab, Dixie, is scheduled for surgery for a torn anterior cruciate ligament. They have recommended that we perform laser therapy on the surgical site to improve healing of the bone and the incision to get the best possible outcome.
It was a stretch to do the surgery in the first place, and now this will be an added expense and time commitment. If this is necessary, I will make it happen. Do you think this is a necessary additional step?
A: The frequency with which I am asked this type of question has increased dramatically in recent years, because there has been an explosion in the availability of, and interest in, alternative and auxiliary treatments. Ten years ago, it was generally accepted that veterinary medicine lagged behind human medicine by about 10 years. Now, I would say its more like five years or less.
Medical advancement in the human field is taking place at an unprecedented rate. It truly gives the impression that almost anything is possible. Meanwhile, the rate of pet ownership has exploded in the past 10 years, and this is true in all age categories from millennials to baby boomers. Dog ownership has increased by 29 percent overall in the past decade. Beyond the increase in the rate of pet ownership is the elevation in the status of our dogs and cats from pets to members of the family. The convergence of these forces has brought about a golden age of veterinary medicine.
The application of some medical treatments, once considered extravagant when applied to pets, has become commonplace, such as radiation therapy, total hip replacements and root canals. These are procedures that are just as effective on animals as they are on people, and are now widely accepted and available for pets. More importantly, their effectiveness is based upon real scientific evidence that they make a positive difference.
In medicine, we all live by the mantra of "Do no harm." Laser therapy certainly fits into that philosophy, but the actual results in both humans and animals has been mixed with regard to wound healing. There were a couple of studies that indicated improved wound healing in rats and cattle. Subsequent studies in rats and horses were equivocal. In dogs, there have been case reports in which the laser was credited with positive results, but in controlled studies, no differences were seen. So, from a strictly evidence-based standpoint, the laser may offer little to accelerate or enhance wound healing.
On the other hand, laser therapy has been extensively evaluated in animal and human models in regards to inflammation. The findings indicate that they produce an anti-inflammatory effect that is roughly equivalent to administering a nonsteroidal anti-inflammatory drug (NSAID), like aspirin. There are various NSAID drugs available for dogs and cats, but these are not always well tolerated by the patients and can cause gastrointestinal issues as well as injury to the liver and kidneys, any of which can be life threatening,
Inflammation is painful, and it is the first step in wound healing. So, controlling inflammation is an important part of controlling pain after a surgical wound is created. NSAID administration is an effective, but not always safe, means of achieving this. So laser therapy provides a safe and effective alternative. Inflammation is also largely responsible for the pain we, and our pets, feel in arthritic joints. Again, laser therapy presents a safe and effective means of treating arthritic pain and inflammation.
Now, to answer your question. Currently, the evidence is mixed that wound or bone healing will be enhanced with laser therapy. But, in the early post-operative period, the laser will likely reduce inflammation and, therefore, pain. This could also be achieved with NSAID drugs. However, if your dog has a known intolerance of NSAIDS, or has underlying liver or kidney issues, or you simply don’t want to risk using them, a laser is a great alternative to NSAIDS for pain control.
As for the best possible outcome, this will be mostly determined by the skill and technique of the surgeon. No additional therapy has been proven to influence long-term outcomes more than that.