338 Medical Management of Cruciate Ligament Rupture
(McNamaraet al. 1997; Kelly 1998; Canappet al.
1999; Lippielloet al. 2000; Neilet al. 2005).
Notably, two studies evaluating the use of
glucosamine and chondroitin sulfate for the
amelioration of clinical signs associated with
OA yielded conflicting results. McCarthyet al.
(2007) demonstrated a positive effect on pain
score, weight-bearing, and severity of clinical
condition in dogs with hip and elbow OA, while
another study (Moreauet al. 2003) showed no
effect. Two small studies suggested positive
improvements when glucosamine and chon-
droitin sulfate are combined with glycosylated
undenatured type II collagen (D’Altilioet al.
2007; Guptaet al. 2012).
Avocado and soybean oil
unsaponifiables
Avocado and soybean oil unsaponifiables
(ASUs) are biologically active lipids believed to
have anti-inflammatory and anti-osteoarthritic
properties. ASUs decrease the expression of
inflammatory mediators and cartilage degrada-
tion (TNFα,IL-1β, COX-2, cytokine-inducible
nitric oxide synthase (iNOS), and MMPs)
and stimulate matrix synthesis by upregulat-
ing transforming growth factor beta (TGF-β)
expression by chondroblasts and osteoblasts
(Altinelet al. 2007; Auet al. 2007). A recent
experimental study reported the protective
effects of ASUs in a series of dogs with tran-
sected cranial cruciate ligaments (Boileauet al.
2009). Compared to the placebo group, dogs
treated with ASUs had smaller macroscopic
lesions on the tibial plateau. Histologically,
these dogs had decreased severity of tibial
and femoral cartilage lesions, synovitis, and
a decreased loss of subchondral bone and
calcified cartilage thickness compared with the
placebo group.
Conclusions
The goals of multimodal medical therapy are to
simultaneously maximize analgesia while min-
imizing the incidence and severity of adverse
effects and, if possible, to slow disease progres-
sion. This can be achieved by targeting multiple
sites along the nociceptive pathway, with the
inclusion of medications with varying mecha-
nisms of action. It is important when creating,
maintaining, and adjusting multimodal regi-
mens to remember that no individual responds
in the same manner, and no individual disease
progresses in the same way. It is imperative to
continually reassess the patient’s response and
adapt treatment as indicated.References
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