Modern medicine moves forward at a rapid pace. There is limited published data directly comparing use of a stifle orthosis to surgical stabilization for Cranial Cruciate Ligament, or CrCL, injury in the dog. Recently however, new information has been published in the Journal of the American Veterinary Medical Association about the use of stifle orthotics, also known as knee braces, for conservative treatment of the ruptured CrCL in dogs. The study compared owner satisfaction between custom-made stifle joint orthoses and tibial plateau leveling osteotomy, TPLO, for medium- and large-breed dogs with cranial cruciate ligament disease, CCLD. A summary of their findings can be found in an excellent blog post by Dr. Nancy Kay.
Injury to the CrCL is the most common orthopedic injury in the dog. This injury is due to a partial or complete tear of a ligament inside the stifle, or knee. The resulting instability leads to pain and arthritis.
Stabilization of the injured knee is recommended for best short- and long-term function, quality of life, and comfort. Such stabilization is traditionally done surgically, either with a joint realignment surgery, called TPLO or TTA, or with a pseudo-ligament surgically placed outside the joint (tight rope or lateral suture). These procedures are considered the standard of care, in general. However, in the past 10 years, the use of custom knee braces has become available as an alternative to surgery when surgical stabilization is not appropriate for any reason. These reasons may include other health issues, unacceptable surgical or anesthesia risk, advanced age, and financial constraints, among others.
Dogs with cruciate ligament damage are often referred for surgery. However, there are many options for many patients who may also be good candidates for conservative medical management of their injured knee(s) using stabilizing knee braces, physical therapy, and other methods of arthritis prevention and pain control.
As a veterinarian certified in canine rehabilitation, I work very closely with an orthotics and prosthetics designer, OrthoPets Veterinary Orthotics and Prosthetics. Together, as a team, we select which dog would be a good candidate for a stifle orthosis, and we make very careful measurements to design a custom stifle orthotic specifically for each patient.
If the orthotic measurements and fittings are done by an experienced and trained rehabilitation professional, the outcome is usually better. Also, the level of skill and knowledge of orthotics manufacturers vary widely, so do your research, as this will greatly affect the outcome for both fit and function of the device.
If you are thinking about knee braces as an alternative to surgery for your dog, there are definitely some considerations to keep in mind to decide if that is the right solution for you and your dog. An orthosis is not the correct therapy for all patients, and so before choosing one, the dog owner should ponder fully and thoughtfully all aspects of using a knee brace on the injured dog.
First and foremost, the device must be put on every morning and removed every night. It is not like a human knee brace, worn only for sport. The orthosis stabilizes the stifle from the outside only—when it’s on your dog. Surgery does so from the inside, permanently. Because of this, the knee brace must be used whenever your dog will be standing and/or moving about.
Adjustments are expected and are a normal part of the custom orthosis process. The knee braces are custom-made for each dog. Every effort is made to accurately design and fit the device; however, dogs are more active at home than at the veterinary clinic, and increased activity can expose fit issues, requiring further adjustments.
Follow-up is critical to success. An orthosis is considered a “durable medical device.” This means that proper fit and function are necessary to meet therapeutic goals and to ensure safe use over the lifetime of your dog.
OrthoPets provides stifle orthoses for nearly 1,000 dogs per year. This level of experience allows for the careful selection of patients’ best suited for a stifle orthosis, and the company continues to work closely with university professionals at Colorado State University College of Veterinary Medicine to develop studies to prove and improve the use of orthotic devices in animals.
Whether your dog undergoes surgical or orthosis stabilization for a torn CrCL, and whether surgery is required for a torn medial meniscus, it will take time to recover to full, comfortable function. If an orthosis is part of therapy, most dogs adapt quickly to wearing an orthosis. Your dog will need to learn basic skills while wearing the device, including: transitions (sitting, lying down, and getting up), stairs, getting into vehicles safely, and managing on different types of surfaces (ground, carpet, hardwood floor, etc.).
The best way to ensure the highest level of success is to follow all recommended rehabilitation schedules and techniques. Each patient’s condition and abilities are unique, and, as such, an individualized rehabilitation program is needed. It is important to work with a certified canine rehabilitation therapist/practitioner, or CCRT/P, who will custom design your dog’s physical therapy program.
Ilana Strubel, D.V.M., heads up OrthoPets San Francisco, offering solutions for patients’ mobility problems in the San Francisco Bay Area where she currently owns and operates A Well Adjusted Pet – an Integrative Veterinary Physical Rehabilitation and Aquatic Fitness Center within the Rex Center in Pacifica. Find more info at AWellAdjustedPet.com.
Main article photo by: Courtesy of Ilana Strubel, D.V.M.