After knee injury surgery, custom braces can benefit your dog and in certain cases, can take the place of surgery.
It has been ten years since WDJ investigated the nonsurgical treatment of knee ligament problems, or “conservative management” (see “Saying ‘No’ to Surgery,” February 2010). Since then, there has been an increase in consumer demand for alternative therapies, such as the usage of custom-designed knee braces, even though surgery is still by far the most common therapy for knee injuries.
Canine ligament injuries are so common that almost every veterinarian has seen one. A dog may be completely unable to bear weight on the limb, exhibit a noticeable limp, or show signs of hind-leg lameness, depending on the severity of the damage. A partial or complete tear of a ligament could be the injury.
The terms “torn ACLs” and “bad knees” are well-known in the canine community. Knowing what these terms represent will be helpful if your dog sustains a knee injury that needs to be treated by a veterinarian.
The phrase “canine cruciate ligament disease” refers to a number of injuries that can harm a dog’s knee in this article. In general, the phrase uses the word “disease” appropriately because most dog knee ligament ruptures occur during normal exercise, despite the fact that the majority are the result of catastrophic injuries.
Additionally, several studies indicate that the majority of knee ligament injuries are caused by chronic degenerative changes within the ligament, as stated in an article titled “Review of Cranial Cruciate Ligament Disease in Dogs” that was published in the World Small Animal Veterinary Association World Congress Proceedings in 2011.
Ligaments are bands of connective tissue that strengthen and support joints by joining bones to cartilage.
With the patella (kneecap) in front and the fabella (a tiny bean-shaped bone) behind, the stifle (knee) joins the tibia (leg bone) and femur (thigh bone). Ligaments hold everything in place while cartilage (the lateral and medial meniscus) cushions the bones.
Within the knee joint, the cranial (front) and caudal (back) cruciate ligaments cross. The tibia cannot move out of place beneath the femur because of the cranial cruciate ligament. While the words “cranial cruciate ligament” (CCL) and “anterior cruciate ligament” (ACL) are used in veterinary medicine and human medicine, respectively, they relate to the same ligament and are used to characterize knee injuries in dogs.
Despite the fact that radiographs, or x-rays, do not show soft tissue and cannot be utilized to distinguish between a partial and total tear or diagnose cruciate injuries, they are frequently used to screen for cruciate ligament illness. However, they can rule out other illnesses that might be the source of leg discomfort, such as bone cancer. Dogs rarely undergo advanced imaging tests like MRIs because they are costly and necessitate anesthesia, even though they can show tears in the ligaments.
The “drawer test,” which involves a veterinarian holding the femur in one hand while manipulating the tibia in the other, is the primary diagnostic method for CCL rips. Should the tibia be able to be pulled forward, as though opening a drawer, there has been a tear or rupture in the cruciate ligament. nervous patients may be anesthetized prior to the drawer test since it can be inconclusive if the stiff muscles of a nervous dog briefly stabilize the knee.
Another test for ligament damage is the tibial compression test, in which the dog’s ankle is flexed with one hand while the femur is kept steady with the other. The abnormal forward movement of the tibia is caused by a damaged ligament.
According to a recent estimate that has been cited by a number of veterinary websites, over 600,000 dogs in the US undergo cruciate ligament surgery annually.
Canine cruciate ligament disease risk factors include genetics, obesity, poor physical condition, conformation (skeletal shape and structure), age of the ligament (degeneration), and breed, according to the American College of Veterinary Surgeons (acvs.org). Rather than being ruptured due to an acute impact to an otherwise healthy ligament, most ligament ruptures occur as a result of slow, subtle degeneration that has occurred over months or even years. Between 40 and 60 percent of dogs with damage to one cruciate ligament later have damage to the other knee. According to the ACVS, if a partial cruciate ligament rupture is not treated, it is likely to eventually become a full tear.
According to the ACVS, CCL injuries can occur in dogs of all shapes, sizes, and ages, although they are most frequently seen in Rottweilers, Newfoundlands, Mastiffs, Akitas, Saint Bernards, Chesapeake Bay Retrievers, and Labrador Retrievers.
There is a significant correlation between neutering before one year of age and ruptured cruciate ligaments. The study “Assisting Decision-Making on Age of Neutering for 35 Breeds of Dogs: Associated Joint Disorders, Cancers, and Urinary Incontinence” (Benjamin Hart, et al.) was published in the journal Frontiers of Veterinary Science on July 7, 2020. It revealed that early neutering of male Bernese Mountain Dogs, Cocker Spaniels, and Miniature Poodles; male and female German Shepherd Dogs, Golden Retrievers, Labrador Retrievers, and Rottweilers; as well as female Saint Bernards and Australian Cattle Dogs significantly increased risk of cruciate ligaments.
The study’s conclusion was, “A likely mechanism related to disruption of the closure of the long-bone growth plates by gonadal hormone secretion as the animal approaches maturity is related to early neutering may cause a joint disorder.” According to our theory, neutering a dog well before the growth plates close allows its long bones to grow slightly longer than average. In some cases, this can cause enough joint alignment problems to cause a clinically noticeable joint condition.
Similar findings were observed in mixed breeds, particularly for dogs weighing 44 pounds or more and neutered before one year of age, according to a related study, “Assisting Decision-Making on Age of Neutering for Mixed Breed Dogs of Five Weight Categories: Associated Joint Disorders and Cancers” (Frontiers of Veterinary Science, July 31, 2020, Benjamin Hart, et al.).
There is nothing owners can do to reverse a dog’s neuter status, but there are plenty of things we can do to save our vulnerable pets’ knees. Excessive body weight and poor physical condition are risk factors for the development of canine cruciate ligament illness, as stated on the ACVS website. Pet owners have the ability to alter each of these aspects. Maintaining a lean body mass requires careful meal control, regular exercise, and consistent physical conditioning.
Custom braces—which go by numerous names including knee, stifle, ACL, or CCL braces—are made by several manufacturers using various materials and techniques. Braces are also made to fit the hocks, hips, ankles, and wrists of dogs.
In order to assess how strong the brace needs to be in order to support the dog’s weight and activities, as well as any unique features the brace might need, the first step in designing a bespoke brace is to analyze the patient’s size, breed, medical history, activity level, and environment.
Next, casts or detailed measurements create a model of the dog’s knee. The last step is to schedule a fitting visit, where any necessary modifications are performed and images and videos of the dog exercising while wearing the brace are taken.
The dog wears the brace during the day after a break-in period. “Most dogs put it on in the morning and take it off in the evening before bed,” the owner says.
The majority of custom brace designs are based on leg models that were cast at the client’s house or in a veterinary clinic using supplies supplied by the brace maker. For the purpose of designing the brace to fit, the resultant cast is supplied together with supporting measurements. Castings that are damaged during shipment or that were made erroneously may require repeat castings. The visit raises the price of the brace if it is performed at a veterinary facility.
The 77-pound Golden Retriever Pasha, then 11 years old, suffered a left hind leg injury that led to the creation of the Posh Dog Knee Brace seven years ago. Pasha’s veterinarian determined that he had a torn meniscus and a ruptured cranial cruciate ligament. He advised surgery immediately once, stating that if the damage was not repaired, Pasha would suffer a similar lesion to his right leg, develop severe arthritis, and be unable to live an active life again.
Although Jim Morison and Beth Scanlon, who live in Florida, could afford the $5,000 surgery, they were concerned about Pasha’s age and past medical history, which included a bad anesthetic response. Pasha’s recuperation started when they ordered a custom-made knee brace rather than arranging surgery.
Although Morison was pleased with Pasha’s development, he felt that the brace might be made better in a few areas. He started creating modifications and, in the process, established his own knee brace business, which he called Posh after one of Pasha’s pet names. Pasha was swimming at the beach and running through tide pools six months after donning her upgraded brace, and she was fully recovered in nine months.
“We now use a different design, but we started with the type of brace that requires a casting mold,” says Nikki Bickmore, lead veterinary technician at Posh, who also manages the service department and production.
“Posh assembled a group of orthotists and veterinarians to create a new system that would do away with casting,” Bickmore adds. As a result, the brace has many padding layers and is semi-rigid rather than hard plastic, allowing it to adapt to the dog’s muscles as they contract and flex. The only brace that incorporates double-reinforced hinges from the Tamarack brand, positioned on two layers of plastic, to strengthen the brace at important stress locations is ours. The brace fastens with quick-release microbuckles, which are common in expensive snow and water sports gear, and fits without causing any rubbing, irritation, or slippage.
Ordering is sped up and slowed down by using measurements rather than casting to create a replica of the dog’s leg. Most braces come within a week after precise measures are given, but buying takes longer since clients need to watch instructional videos and take measurements with two individuals during a live video conference while a veterinary technician watches over them. A Posh vet tech must supervise the fitting of a brace during a second video chat before it can be worn.
The fact that our braces fit well and are simple to use is what most people appreciate about them, according to Bickman. They appreciate that our solution uses buckles and straps instead of Velcro, which can tangle in a dog’s hair. Because we use a soft shell instead of a hard one, the brace is more pleasant to wear, has greater range of motion, is long-lasting, and is very simple to clean.
Three-year-old Howdy, an Australian Cattle dog, was born with incontinence, spina bifida, and nerve damage in his hind end. Bickman states, “He’s a favorite of the Posh staff.” He was adopted by Alicia McLaughlin at the age of six months. Shortly after, he had a tear to his CCL and also had a luxating patella. Many believed that he ought to be put to death, but thanks to bracing, Alicia, and a lot of love and patience, he is now happily living in the country in New York.
Don’t think that just because your dog starts favoring one leg over the other, the issue will go away. That could be, but it could also be a sign of cruciate ligament damage. To be sure, make an appointment with your veterinarian.
Both surgery and brace use need to be carefully considered. The proper usage of the custom-fitted braces discussed here requires time and attention commitments, and they are not cheap. Not every owner or dog is a suitable candidate for bracing. Information collection and a realistic grasp of the issues at hand are essential for making wise judgments.
For more information about our Posh Dog Knee Brace contact us via our contact page or visit our Facebook Page.
Dog knee injuries may have some correlation with poor conformation, but a dog’s weight, health, and activities all have a significant impact.
A patellar luxation or a cruciate ligament damage is the most common knee injury in dogs. An abnormal patellar conformation, also known as a patellar luxation, or dislocation, is typically caused by congenital abnormalities. Despite the possibility of a conformational component, trauma is typically the cause of cruciate ligament injuries. Both are painful and need medical attention from a veterinarian.
Your dog’s patella is its kneecap. The femoral trochlear groove, which is naturally present at the femur’s end, is where the patella ordinarily slides up and down in the middle of the knee. Unfortunately, the dog’s knee might develop genetic flaws that cause the kneecap to slide to one side or the other. A lateral luxation occurs when it slips to the outside. It is a medial luxation if it slides inward.
The majority of medial luxations affect tiny breeds like Boston Terriers, Chihuahuas, Miniature Poodles, and Pomeranians, Akitas, Great Pyrenees, Flat-Coated Retrievers, Chinese Shar Peis, and other large dogs frequently exhibit lateral luxations.
Only 7% of puppies have patellar issues, and the majority of them exhibit signs of luxation in both back legs.
You might notice your dog “skipping” occasionally when he moves, holding up a leg, or pausing and extending out his back limb before moving again if his kneecap is misaligned. Puppies with severe luxations may modify their stance, giving them a knock-kneed or bowlegged appearance (medial luxation) (lateral luxation).
Physical examinations are typically used to identify kneecap issues. Due to the possibility of an association between the two issues, your veterinarian will also examine your pet’s cranial cruciate. X-rays are frequently advised to check for further orthopedic issues that can affect treatment, like hip dysplasia.
Treatment is dependent on how severe the luxation is. Especially in smaller dogs, grade 1 and many grade 2 instances are frequently left alone while being kept an eye out for emerging issues. Grade 3 and grade 4 instances typically require surgery to keep the dog comfortable and lessen the likelihood of future orthopedic issues.
In order to keep the patella in place during dog knee surgery for a dislocation, the soft tissues on the side opposite the luxation are typically tightened. To assist in keeping the kneecap on its optimal course, the femoral groove may be deepened. To realign important muscles and give the leg a more typical anatomy, the tibial crest may be repositioned. Osteoarthritis is a common later-life ailment in dogs with kneecap issues.
Bracing can be used to stabilize the knee, with a LP, to give shock absorption, and to help prevent a CCL tear. Most dogs with a luxating patella will also get a concurrent Cruciate ligament tear, so it is important to do something to prevent this. Physical therapy is also something that is recommended, to help strengthen the surrounding muscles, and help with a grade 2 or less.
The majority of cruciate ligament issues are caused by trauma, however, they can also be degenerative. It can be an acute injury brought on by the dog turning too tightly while moving quickly, for instance, or it might be a low-grade, ongoing issue that has gotten worse over time (cruciate disease). Tears might be either partial or full, but this can’t be diagnosed without an MRI. Your veterinarian may tell you it is a Full tear, but without sound imaging, that is impossible to fully diagnose.
Your dog has two cruciate ligaments: the caudal, which is in charge of the joint’s forward stability, and the cranial (rear stability). These ligaments “cruciate” or cross over the knee joint between the top of the tibia and the bottom of the femur. They allow for extension and flexion while also giving the knee joint stability. Movement from side to side is restricted.
When dogs are active—running, making sudden turns, stepping in holes while running, and other such activities—they frequently damage their ligaments. However, something as easy as an obese Beagle leaping from the couch and landing awkwardly might tear a ligament. Environmental elements like lifestyle choices and weight are risk factors for cruciate issues, as well as spaying and neutering too soon (see our blog on spaying and neutering too early on the Posh website)
The ligament fibers are stretched and torn with sudden, intense pressure. The majority of dogs will become suddenly three-legged lame and hold up the injured leg. The joint could become painful, swollen, and inflamed. Less obvious symptoms of a chronic partial tear may resemble arthritis. After a period of inactivity, your dog can become particularly stiff and/or have intermittent lameness.
Large, muscular breeds of dogs, such as Labrador Retrievers, Golden Retrievers, German Shepherd Dogs, Rottweilers, and Pit Bulls, are most susceptible to cruciate ligament tears.
Due of the prevalence of this injury in laboratories, Research Laboratory offers a genetic test to check for cruciate issue susceptibility. Though not definite, a dog with a positive result on this genetic test is thought to be at a higher risk of cruciate rupture: roughly 62% genetics plus 38% environment. Owners should exercise frequent physical therapy and be more watchful to avoid their dogs from gaining weight.
The knee injury in your dog will probably be identified by your veterinarian after a physical examination. An obvious sign of a tear is a lax (loose) joint, or drawer test. Additional diagnostic procedures may include radiographs, to check for arthritic changes and/or arthroscopy, a surgical procedure that enables the veterinarian to examine the menisci, two cartilage discs that cushion the knee joint, in the joint.
Small dogs may benefit from wearing a brace that is specially made for them, as they tend to recover well with conservative management. Sometimes they may require extracapsular repair surgery, which involves placing a suture to stabilize the joint until scar tissue takes over. This procedure should never be done on dogs over 40lbs.
Some veterinarians may recommend very invasive surgery, that involves relocating and cutting bones in the joint. This is currently the only surgical option for large breed dogs, and should be researched with caution. The tibial plateau leveling osteotomy (TPLO) and the advancement of the tibial tuberosity are two of these treatments (TTA). (We recommend to try others means before doing surgery, but this is an option if you choose it.)
If you decide on conservative therapy combined with a Posh Dog Knee Brace, consider having our custom brace created, to give your dog the best chance of recovering. Regardless of size, a brace could be the best solution for dogs who are not suitable candidates for surgery, or if you prefer a conservative approach.
Regardless of the course of action you and your veterinarian determine is best for your dog, aftercare is crucial. Careful guidelines must be adhered to exactly as prescribed by your veterinarian. We include such a program with our custom Posh Brace.
A program of walks that gradually increase in distance and difficulty will be part of the rehabilitation, as will other workouts like an underwater treadmill. It might be suggested to use laser and pulsed electro-magnetic field (PEMF) therapy. It may be advised to use joint supplements to maintain his joints and delay the onset of arthritis. Unfortunately, 40–60% of dogs that rupture one cruciate will also eventually damage the other if nothing is done. This % will go up after surgery, by a significant amount, and decrease with custom bracing.
The likelihood of an injury and a full recovery might be influenced by your dog’s general health. Maintain your dog’s ideal weight. Look into an exercise plan to help him build his core muscles, as well as balances drills like wobble board or peanut work. Regarding your dog’s conformation is reasonable. To further reduce the chance of damage, you can think about conducting scent work or rally with your dog instead of agility or fly ball. If you dog already has 1 injured knee, or a knee that has had surgery, consider also bracing the good leg, in order to prevent overcompensation on the other side.
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