Regenerative Laser is a relatively new tool to an equine veterinarian’s therapeutic arsenal. But then again, so is most of what is now called Regenerative Medicine. Being new, this technology is (and should be) subject to some extra scrutiny, especially as it is trying to permeate in this unregulated, wild-west that is the veterinary world. Good news is that Sound is dedicated to not only being on the forefront of technology, but also doing so responsibly, with evidence to support its decisions. In this article you’ll get a glimpse of three levels of evidence, all of which are necessary, but none of which should be presented without the other.
- Anecdotal Testimonials
- Documented Case Reports
- Double-blinded Study Results
We are always skeptical of word-of-mouth reports of success; they are usually only convincing if you know and/or trust the source. But even that is a little arrogant, to put your opinion above someone else’s. Still, with the number of positive testimonials from reputable colleagues, at least the beginnings of credibility can be built, enough at least to peak your interest.
Fortunately SOUND® has been in the equine technology business for a very long time, and within its client base are some of the best practitioners in your profession. And even more fortunately, some of these have been forward-thinking (or adventurous) enough to be on the ground floor of this new technology. Here is what a few of them had to say of their experience with SOUND’s Regenerative Therapy Lasers (RLT):
“The Smart RLTlaser has been one of the greatest things in sporthorse medicine for veterinarians. The technology absolutely, 100% works. Best choice ever! ”
-Hope Batchelor, DVM, Pickering Equine
“The Smart RLT™ laser is hands down the best treatment option for acute suspensory ligament desmitis.
You will see a difference even ultrasonographically within 7-10 days.”
-Keith Merritt, DVM, Merritt and Associates
“Equine Medical Associates has been providing RLT laser treatments to a minimum of 3 to 10 horses weekly since November 2012. At this point we are still evaluating the progress made in these cases and have multiple individuals back in early training at the track or working towards their next performance goal. ”
-James P. Morehead, DVM, Equine Medical Associates
“This is the greatest thing in equine medicine since ultrasound… and I’ve been doing this for 40 years!”
-Norman Rantanen, DVM, MS, Dip. ACVR
“We have been very impressed with the results we have seen with the Smart RLT, and it is quickly revolutionizing our treatment protocols for sports medicine conditions in show horses and sport horses. From pre-performance conditioning, to treatment of acute conditions, to use as a stand-alone or adjunct regenerative therapy for injuries, and for management of chronic conditions such as suspensory ligament desmitis, we find this treatment modality to be highly beneficial. The portable design, ease of use in the software, and variety of treatment protocols makes it an invaluable tool for our practice to help our equine athletes perform at the highest level possible.”
–Ty Wallis, DVM, MS, Dipl. ACVS and Brad Hill, DVM, Equine Athlete Veterinary Services
But you’re no sucker; this is only the first level of evidence you’d need to really get interested. So what about real cases with real horses?
Documented Case Reports
One step beyond “hey I think it’s great” is evidence that a horse with an injury you’ve seen before got demonstrably better or in a shorter recovery period than what you’re used to seeing. Even still, these reports often lack the proper documentation to be convincing. Again Sound comes to the rescue. We are an imaging company and so the pioneers in RLT were first pioneers in imaging. With that in mind, below are just a couple of the scores of case reports submitted by your colleagues, all with ultrasonographic evidence before and after treatment. You can decide for yourself how the quality and/or timeline of recovery compares with other traditional therapeutic interventions…
But there are always extenuating circumstances that may lead you to be less convinced by an single case report. There could have been some un-reported adjunctive therapy or diet change or whatever. So the final level of evidence for you needs to standardize all of these unknowns.
Double-Blinded Study Results
If you’re still not convinced about SOUND’s dedication to diligence in it’s products, the final tipping point might be to learn that Sound funded the first ever double-blinded study of Regenerative Lasers on equine tendons. This study was led by Michael Schramme DrMedVet CertEO PhD HDR DECVS DACVS AECVDI at the University of Lyon in France. The preliminary results of this study were presented at AAEP 2017 by Roy Pool DVM PhD DACVP (honorary), Norm Rantanen DVM DACVR, Bryan Stephens PhD, and Mark Martinelli DVM PhD, and was submitted for formal review by AAEP earlier this year.
In case the number of letters after those names wasn’t impressive enough, let’s explain the guts of the study.
Standardized core lesions were surgically created in the SDFT of both forelimbs of 8 horses based on a previously used and reviewed surgical model. A randomly assigned forelimb of each horse was treated with RLT from 1 week after lesion induction for 8 weeks. Lesions were serially evaluated ultrasonographically and with MRI for 13 weeks after injury. The horses were then sacrificed and histology performed post-mortem.
This is by far the most robust and clinically relevant laser study performed to date. And while we can not share the full text until publication, we can share a subset of preliminary results.
To briefly summarize what we expected, the recovery from this type of injury is broken into two phases inflammatory and remodeling. These typically manifest themselves with initially the lesion getting bigger until about 5 weeks, then it turns a corner and starts gradually decreasing in size. Dr. Schramme’s surgical model has shown this in previous publications as well. In the study, for the control group, this exact behavior was confirmed. Notice the tipping point of transition from inflammatory to remodeling at week 5. For the laser group, there are several interesting points:
- The initial slope was significantly greater in the laser group. This means that the inflammatory process was enhanced (almost by a factor of 2).
- In fact the tipping point was achieved on average about 2 weeks early in the laser group than the control (again statistically significant).
- Once the remodeling phase began (2 weeks earlier) rate of healing was significantly better in laser than the control.
- After that tipping point, the laser group average was lower than the control group AT EVERY measurement point EVEN THOUGH the average size of the lesion was higher in the laser group at the tipping point.
This represents a supra-natural response rate within the natural structure of tendon healing, which falls very nicely in line with the fundamental mechanisms of laser. Also worth noting is that this model is a condensed time-table for the real-world analog (and purposefully so, with almost full healing in 13 weeks). In the real-world, we are not seeing virtually any ultrasonographic evidence of repair in the time frames of this study. So any changes in time length of recovery in the study (by the data of lesion size or crimp size/structure) should be significantly exaggerated in the real-world scenario where these naturally-occurring lesions take several months to heal.
Take Home Message
Again, not any one of these level of evidence should be enough to convince you of the legitimacy of this technology in the practical equine clinic. But the length and breadth of the combination of these reports really does build a strong fundamental case for Regenerative Laser Therapy.