Re: Knee Braces for Cruciate Ligament rupture

Julian Earl — Tue, 28 Jan 2014 20:48:35 GMT

The ones that I saw advertised were taylor-made-to-measure in America and the cost was going to be about three times a lateral suture op, and almsot as much as a TPLO so I couldn't see the financial logic nor the bio-mechanical benefit compared to surgery. So they seemed like a good idea but too expensive for unproven benefit to me.

Re: Knee Braces for Cruciate Ligament rupture

Pete Andrew — Tue, 28 Jan 2014 17:42:10 GMT

Thanks for that info. My feeling was that you'd be better off doing a lateral suture and an orthopod friend did agree....

Re: Knee Braces for Cruciate Ligament rupture

John Flynn — Mon, 20 Jan 2014 19:04:39 GMT

I think the general consensus appears to be that most such devices are a waste of money that would better be reserved for NSAIDs / assistance with weight loss (if overweight) / surgery if fails to improve / a ramp to get into the car etc.

The problem would be that they don't maintain enough stability (because a flimsy brace fundamentally can't, especially in a large dog where there is much soft tissue between the bones and the outer skin) to allow decent periarticular fibrosis at a rate or success superior to no-brace. Some physios might moan that 'braces' are almost never part of the solution to any ligament problems as anything that encourages passive incomplete stability is not helpful in a rehabilitative sense as just reduces physiological stimulation of increased stability through use etc. - what you would want is rehabilitative exercises aimed at increasing muscle strength etc in a controlled way (of course doing that in a dog is another matter!) Just do a cranial tibial thrust exam on the joint and see how much force you need to prevent that movement - then try applying it by holding the femur and tibia tightly and repeating the tibial thrust tets (simulating the dog's foot load-bearing) - the mechanics of external restraints is quite different form an extra-articular fabello-tibial suture I suspect...)

If a client insisted that they wanted to try an orthotic brace that might work (perhaps a geriatric large-breed dog with other health issues and an inactive lifestyle - planning to wear the brace for the rest of it days), then I'd happily recommend http://www.orthopets.co.uk/products/stifle, but I rather suspect that surgery could be cheaper...!

I've pointed clients to www.dogleggs.com as a fairly reputable company in the past (eg for medial shoulder instability devices when they've wanted these), but I'm not sure they do a cruciate brace - if not then that's probably saying something.

Here's some links that may be of interest to you (or the client if you vet them first!):

http://veterinarycalendar.dvm360.com/avhc/article/articleDetail.jsp?id=729634

http://veterinarycalendar.dvm360.com/avhc/article/articleDetail.jsp?id=704202

[quote user="Pete Andrew"]I can't find any good evidence on the manufacturers websites about why these are good - do anyone have some anecdontal evidence?[/quote]

Hehe. To be fair, most manufacturers of various surgical implants are a bit short on decent objective evidence to point you towards for their favoured technique also, so I agree with your open-minded approach ;-)

Re: Knee Braces for Cruciate Ligament rupture

Michael Woodhouse — Mon, 20 Jan 2014 12:36:05 GMT

I know a little heavy according to some sources but I have done lateral sutures in some of these big dogs and they have done well - couple of hundred pounds and cured.

If you add in the costs of a brace, NSAIDS for a big dog, rechecks etc they will spend more (assuming the brace gives an equal outcome to Sx).