Front Matter

322 Canine Sports Medicine and Rehabilitation

disruption, or in chronic cases where there is
evidence of core lesions and reorientation of the
fiber pattern to suggest fibrous tissue, biologi­
cal therapies may be used. The authors prefer to
use a combination of mesenchymal stem cells
(either bone marrow or adipose tissue) com­
bined with PRP. The stem cells and PRP combi­
nation is injected directly into the lesion using
ultrasound guidance. A more in‐depth discus­
sion on biological therapies can be found else­
where in this textbook (see Chapter  16).
Following treatment with biological therapies,
the carpus is immobilized in a custom, hinged,
controlled ROM orthosis for 12–16 weeks.
Initially, the orthosis is locked‐out to prevent
any range of motion, then every 4–6 weeks
there is gradual dynamization of the orthosis to
allow the ligament to heal. Formal rehabilita­
tion therapy is begun 2 weeks following bio­
logical therapies and continued until the patient
can return to normal function. Recheck ultra­
sound is recommended at 4, 8, and 12 weeks

post biological therapies to evaluate tissue

healing.

Severe sprains (grade 3 or those unrespon­

sive to conservative management) or luxations

resulting in instability usually require surgical

intervention. Surgical correction can be aug­

mented with biological therapies. If the liga­

ment cannot be primarily repaired, a prosthetic

ligament can be used via placement of bone

tunnels or bone screws at the origin and inser­

tion of the collateral ligaments. The long‐term

outcome with these techniques is not known

(Kapatkin et al., 2012), but one author (DD) has

had good success with prosthetic ligamentous

fixation. Following ligamentous reconstruction

or prosthetic ligament repair, external coapta­

tion with a lateral or palmar splint is recom­

mended for 6–8 weeks to protect the fixation

and allow healing and fibrous tissue develop­

ment. Severe ruptures or avulsions of the

FCU require surgical treatment consisting of

tenorrhaphy or reattachment with or without

Figure 12.29 Carpal support wrap for a dog with a
grade I flexor carpi ulnaris tendinopathy.

Figure 12.30 Custom carpal orthosis for a dog with a

grade 2 carpal hyperextension injury following biological

therapy.