Health

Dog knee injury? Get ready

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Ten years have passed since WDJ investigated “conservative management” – the non-surgical treatment – of knee ligament injuries (see “Saying No to Surgery,” February 2010). Since then, consumer demand for complementary therapies, including the use of custom knee braces, has increased, although surgery remains by far the most widely used treatment for knee injuries.

Almost all veterinarians have experience with dog ligament injuries because they are so common. Depending on the severity of the injury, a dog may have an indication of hind leg lameness, an obvious limp, or no weight on the leg at all. The injury can be a partial or total tear ligament.


“Most vets recommend surgery as soon as they diagnose a ligament injury,” says Jim Alaimo, a board-certified prosthodontist, “but that’s because surgery is their most popular option.”

Alaimo, who founded My Pet’s Brace in 2010, switched to veterinary braces after 25 years of designing human prostheses and orthotics. Prostheses are artificial replacement parts for body parts like arms, legs and joints, while orthotics are devices like splints or braces that support, immobilize or treat weak or injured muscles, bones or joints.

“Surgery is often the best treatment for cruciate ligament ruptures in dogs,” he explains. “However, in some cases the age, medical history, activity level, home environment, or cost of surgery is inappropriate for a dog.” A well-designed, bespoke knee brace can help a dog recover from a cruciate ligament tear by providing support for the joint while scar tissue provides stability. “

Knee supports can also be used for arthritis and postoperative cross support. Ligaments, like tendons, have a poor blood supply and therefore heal very slowly. According to Alaimo, it is the development of scar tissue that stabilizes the knee and helps an injured leg move normally.

An online search brings up dozen of knee brace designs. However, most veterinarians familiar with braces recommend custom braces that are made using modern technology for a particular dog’s injured leg. The key to success is the brace’s ability to keep the leg in a properly aligned stable position while allowing the dog to move naturally.

Canine Cruciate Ligament Disease

“Torn ACLs” and “bad knees” are familiar terms in the canine world. Understanding the meanings of these terms can be helpful if your dog has a knee injury that requires medical attention.

In this article, the term “cruciate ligament disease in dogs” describes various injuries that can affect the dog’s knee. In common parlance, the term “disease” is used precisely because the majority of ligament ruptures occur during normal activity, although it is often a traumatic injury that causes an acute rupture or rupture of the ligaments in a dog’s knee.

According to an article published in 2011 in the World Congress Proceedings of the World Small Animal Veterinary Association (“Review of Cranial Cruciate Ligament Disease in Dogs”), a number of studies suggest that the majority of knee ligament injuries are the result of chronic degenerative diseases Change is within the band.

DEFINITIONS OF RELEVANT TERMS

Ligaments are ligaments made of fibrous tissue that connect bone and cartilage while supporting and strengthening the joints.

The knee joint connects the femur (thigh bone) and the tibia (leg bone) with a patella (kneecap) in front and a fabella (a small bean-shaped bone) in the back. Cartilage (medial meniscus and lateral meniscus) cushions the bones and ligaments hold everything in place.

The cruciate ligaments of the skull (front) and the tail (rear) cross in the knee joint. The cruciate ligament of the skull prevents the tibia from sliding out of position under the femur. The term “anterior cruciate ligament” (ACL) is used in human medicine and “cranial cruciate ligament” (CCL) is a veterinary term, but both terms refer to the same ligament and both are used to describe knee injuries in dogs.

X-rays (X-rays) are commonly used to check for cruciate ligament disease, although they are devoid of soft tissue and cannot be used to diagnose a cross injury or to differentiate between a partial and a complete tear. However, you can rule out bone cancer or other conditions that can be a cause of leg pain. Advanced imaging tests such as MRI have torn ligaments, but they are expensive and require anesthesia, so they are not typically used on dogs.

The main diagnostic tool for CCL cracks is a procedure called a “drawer test,” in which a veterinarian holds the femur with one hand and manipulates the tibia with the other. If the tibia can be moved forward, similar to opening a drawer, the cruciate ligament is torn or torn. The drawer test may not be conclusive if a concerned dog’s tense muscles temporarily stabilize the knee, allowing anxious patients to be sedated before the test.

The tibia compression test, another way to check for ligament damage, involves holding the femur steady with one hand while the other hand flexes the dog’s ankle. A broken ligament allows the tibia to move forward abnormally.

An estimate recently quoted by several veterinary websites says that more than 600,000 dogs undergo cruciate ligament surgery each year in the United States.

According to the American College of Veterinary Surgeons (acvs.org), risk factors for cruciate ligament disease in dogs include ligament aging (degeneration), obesity, poor physical condition, genetics, conformation (skeletal shape and configuration), and breed. Most ligaments tear as a result of subtle, slow degeneration that has occurred over months or even years, rather than acute trauma to an otherwise healthy ligament. An estimated 40% to 60% of dogs with cruciate ligament damage in one knee eventually injure the other knee. The ACVS advises that if untreated, partial cruciate ligament rupture is likely to lead to a complete rupture over time.

The ACVS states that CCL injuries can affect dogs of all sizes, breeds, and ages, with Rottweilers, Newfoundlands, Staffordshire Terriers, Mastiffs, Akita, Saint Bernards, Chesapeake Bay Retrievers, and Labrador Retrievers commonly affected.

Castration before the age of 1 year has been statistically associated with torn cruciate ligaments. The magazine was published on July 7, 2020 Limits of Veterinary Science published “Support in Decision Making on the Age of Castration in 35 Breeds of Dogs: Associated Joint Diseases, Cancer and Urinary Incontinence” (Benjamin Hart et al.), which showed a significant increase in the risk of cruciate ligament in connection with the early castration of male Bernese mountain dogs, cocker spaniels and miniature poodles; male and female German Shepherds, Golden Retrievers, Labrador Retrievers, and Rottweilers; and female Saint Bernards and Australian cattle dogs.

The study concluded, “One likely mechanism by which early castration can lead to joint disease is related to the disruption of the long-bone growth plates’ obstruction by the secretion of gonadal hormone as the animal approaches maturity. We have suggested that neutering well before the growth plates close causes the long bones to grow slightly longer than normal and can disrupt joint alignment in some neutered dogs enough to result in clinically apparent joint disease. “

A related study, titled “Supporting Castration Age Decision Making for Mixed Breed Dogs with Five Weight Categories: Associated Joint Disease and Cancer” (Frontiers of Veterinary Science, Jul 31, 2020, Benjamin Hart, et al.), Showed similar results in mixed breeds, particularly for dogs weighing 44 pounds or more who were neutered a year ago.

Owners cannot change the status of dogs that have already been neutered, but there is much we can do to protect the knees of our vulnerable companions. The ACVS website states: “Poor physical condition and excessive body weight are risk factors for developing cruciate ligament disease in dogs. Both factors can be influenced by pet owners. Consistent physical condition with regular activity and close monitoring of food intake is advisable to maintain lean body mass. “

HOW KNEE BRACES ARE MADE

Different manufacturers use different materials and methods to create custom braces, which can be referred to as knee, knee joint, ACL, or CCL braces. Braces are also designed for canine teeth, ankles, ankles, and hips of dogs.

The first step in developing a custom brace is to review the patient’s size, breed, medical history, activity level, and environment to determine how strong the braces need to be to support the dog’s weight and activities, as well as any specific characteristics who may need braces.

Next, casts or detailed measurements will create a model of the dog’s knee. My Pet’s Brace’s Jim Alaimo uses fiberglass to create an impression of the dog’s affected leg.

Alaimo describes: “We fill the cast with plaster of paris and that gives us a positive model of the leg. Then we remove plaster of paris from some places and add it to others to increase or relieve pressure as needed. We add knee joints, foam and any necessary reinforcements. Then we take polypropoline (a thermoplastic polymer), heat it and vacuum form it over the modified model of the dog’s leg. After it’s cured we cut it off, take it to the engine room, smooth the edges, add joints and tapes and we have a finished bracket. We use closed cell foam and stainless steel fasteners to make the support completely waterproof. “

The final step is an appropriate appointment where all the necessary adjustments are made along with videos and photos of the dog walking and moving in the braces. “During the eight or nine months that the dog is wearing braces,” says Alaimo, “we schedule follow-up appointments to measure progress.”

After a run-in period, the dog wears its braces during the waking hours. “Most dogs put it on in the morning and take it off in the evening before bed,” he says.

Penny, a lively 83-pound Newfoundland woman who lives in Maine with Regina Helfer, injured her right hind leg just before her ninth birthday in September 2019. “She tore up her ACL,” says Helfer, “and the veterinarian on duty recommended an immediate operation.” Instead, Aide asked Penny’s breeder (as well as her other dog’s breeder) for advice. Both breeders recommended My Pet’s Brace.

“We received the braces in September,” says Helfer, “and Penny did it really well. She had no challenges at all. Penny is a Therapy Dog and a Reading Education Assistance Dog. She loves going to the library, working with kids, going for walks, and going swimming. We got her pink braces and whenever we put them on, she stretched out her leg to help.

“Penny wore her braces every day for nine months. By this point she had fully recovered. It’s here in case she needs it, for example when she’s going on a long or challenging hike to keep the leg stable, but so far she’s been fine without it. “

Hero ribbons

When June was only 5 years old, she was diagnosed with arthritis and a cruciate ligament tear, with surgery recommended for the torn CCL. Her owners opted for a Hero Brace instead, and June recovered well. Their owners still use the braces when they go on long hikes in June.

Ben Blecha has both a personal and professional interest in leg supports. A survivor of an osteosarcoma whose leg amputation inspired him to help others at the age of 21, Blecha became a state-certified prosthetic orthopedist. Until 2005, when he was asked to help make braces for a dog, all of his patients were human. He then worked with Wayne Watkins, DVM, to develop hero braces for dogs.

Last June, a 5-year-old 100 pound German Shepherd owned by Ben Elsen of Dallas, Texas began to prefer her left hind leg. “June lives with her sister and littermate Shiner,” says Elsen, “and they played hard every day. Two years ago, my wife and I were warned that the knee was starting to show signs of wear and tear in June. “

Despite a reduced training schedule, June no longer jumped on the bed and the sofa. In October 2019, she was diagnosed with arthritis and a torn knee ligament. “Our vet recommended immediate surgery,” says Elsen, “but we had concerns, both about the cost and because June and her sister are always together, so weeks of rehabilitation would be stressful for both of them.” When we asked about braces, our vet said he didn’t recommend them. But when he referred us to a surgical center, we met a rehabilitation specialist who valued braces and recommended the Hero Brace. “

The specialist put a plaster cast on June’s leg and 10 days later she was fitted with her braces. “She agreed to it from the start,” says Elsen. “We kept it with her at home and on walks, and her knee reacted exactly as expected. We still use it while hiking, but otherwise June is fine without it. She jumps back on the bed and sofa, not preferring her left side at all. “

Pour or not pour

Australian cattle dog Howdy, seen here in his classy braces, was born with bifida spinalis and suffered a cruciate ligament injury shortly after his adoption at the age of 6 months.

Most custom braces are based on leg models cast in a veterinary clinic or at the customer’s home using materials provided by the brace manufacturer. The resulting cast is submitted with supporting dimensions so that the prop can be designed to fit. In some cases the cast will need to be repeated because the cast was damaged during shipping or the cast was made incorrectly. If done at a veterinary clinic, the appointment will add to the cost of the braces.

The Posh Dog Knee Brace was developed seven years ago after Pasha, an 11-year-old, 77-pound golden retriever, injured her left hind leg. Pasha’s vet diagnosed a cruciate ligament rupture and a ruptured meniscus for which he recommended immediate surgery. He warned that if left untreated, the strain would cause a similar injury to the right leg, lead to severe arthritis, and prevent Pasha from ever leading an active life.

Pasha’s owners, Florida-based Jim Morison and Beth Scanlon, were able to afford the $ 5,000 surgery but were concerned about Pasha’s age and medical history, which included a side effect of anesthesia. Instead of planning an operation, they ordered a custom knee brace and Pasha’s recovery began.

Although Morison was enthusiastic about Pasha’s advances, he felt that some features of the braces could be improved. He began designing customizations, in the process of creating his own knee support company, which he called Posh, one of Pasha’s nicknames. Within six months of wearing her improved braces, Pasha was running through tidal pools and swimming on the beach, and within nine months she had fully recovered.

“Posh started with the type of braces that required a mold, but we’re now using a different design,” says Nikki Bickmore, Posh’s senior veterinary technician answering customer questions, overseeing the service department and overseeing production.

“To avoid the casting process, Posh hired a team of orthopedic surgeons and veterinarians to develop a new system,” explains Bickmore. “The result is a semi-rigid brace instead of hard plastic with multiple layers of padding so that the brace works with the dog’s muscles as they move and contract. Ours is the only braces that use Tamarack brand double-reinforced hinges mounted on two layers of plastic to improve the braces’ strength at critical points of tension. The post fits without friction, irritation or slipping and is attached with quick-release micro-buckles that can be found in high-end snow sports and water sports equipment. “

Using measurements instead of casting to get a model of the dog’s leg speeds up and slows down the ordering process. Once accurate measurements are available, most braces arrive within a week. However, because customers have to study video instructions and take measurements with two people during a live video conference under the guidance of a veterinary technician, the order takes longer. Before Posh braces can be worn, they must be incorporated into another video conference, again under the supervision of a Posh veterinarian.

“What people like most about our braces,” says Bickman, “is that they are easy to use and fit well. They like our system of straps and buckles, which eliminates the need for Velcro to get caught in a dog’s hair. The braces are comfortable because we use a soft rather than a hard shell. It allows more freedom of movement and is durable and super easy to clean. “

Howdy, a 3 year old Australian cattle dog, was born with spina bifida and posterior nerve damage and incontinence. “He’s a posh coworker favorite,” says Bickman. “Alicia McLaughlin adopted him when he was 6 months old and shortly afterwards he was injured at his CCL. He also had a luxating patella at the same time as the CCL tear. Many people thought he should be put to sleep, but with a lot of courage and patience he is now living a happy country life with Alicia in New York. “

KNEE BRACES AND REHAB

The author’s active and athletic Lab, Blue Sapphire (seen here) wore braces for a month to recover from a sprain in her right knee. The author says the braces not only helped her dog heal from the injury, but also supported the weakened soft tissues and prevented a luscious blue from making the injury worse.

All of the manufacturers listed here provide detailed instructions for owners and caregivers regarding exercise, recommended activities, do’s and don’s, and other guidelines.

“Success in a dog’s recovery depends on an educated owner,” says Jim Alaimo. “The owners have to be good observers and use the braces consistently. Our goal is to provide owners with conservative treatment so that their dogs can resume a full, active lifestyle as quickly and comfortably as possible. “

Paul Brumett, DVM, is a Colorado veterinarian and certified canine rehabilitation practitioner. Since 2018 he has been offering training seminars on braces as a representative and consultant for Hero Braces veterinarians. “Over the past 10 years,” he explains, “veterinarians have become more interested in learning about braces, also because so many of their clients ask about them. Braces are not a panacea, but not every dog ​​is a good candidate for surgery, and I help veterinarians like me understand the proper uses and benefits of custom braces. “

Dr. Brumett estimates that 25% of his canine patients have cruciate ligament disease, and he prescribes a custom knee brace for 5% to 10%.

“During the healing process,” he says, “dogs are supported by complementary therapies such as acupuncture, laser therapy, nutritional support, chiropractic adjustments, PEMF (pulsed electromagnetic field) therapy, massage, stretching, and rehabilitation exercises that improve core strength.” Balance. The braces are waterproof so dogs can exercise or swim on underwater treadmills while wearing their braces. You can walk in the rain and enjoy snow too. “

Dr. Brumett recommends a gradual break-in period during which the dog is introduced to their custom braces over a week to 10 days. The linen hikes are kept short, e.g. B. 15 to 20 minutes at the beginning, and the pet wears the braces longer each day.

“Many dogs take time for the muscles around the knee to become strong enough to support long walks,” he says. “This is why it is important to work with the prescribing veterinarian or physiotherapist. Wearing the brace will protect the knee from abnormal movements such as the dog suddenly standing because the doorbell rings. We want the custom braces in place so that it can do its job. Little by little, pets wear up to eight to 12 hours a day. “

“The biggest challenge for owners is to use the product consistently and plan appropriate activities for their dogs,” says Nikki Bickmore. “It breaks my heart when someone forgets and lets a dog that has been using braces for two months go outside without braces. That can lead to a major setback. I know it’s difficult, but dogs in a conservative one Maintaining a management program while your knees are strengthened and muscles come back is so important. “

MORE BRACING CONSIDERATIONS

If your dog prefers a hind leg, don’t assume the problem will go away on its own. It could, but it could be a symptom of cruciate ligament disease. Make an appointment with your veterinarian to be sure.

Surgery requires careful consideration, but so does the use of braces. The bespoke braces described here are not cheap and their successful use depends on the time and effort invested. Not every dog ​​is good for support, and not every owner either. The key to making informed decisions is gathering information and having a realistic understanding of what it is about.

Visit the websites of the companies listed here to explore custom knee braces. Think about how the braces are made, who makes them and what their qualifications are, what guarantees the company offers, how customer care works, what is the cost of replacement braces, what experience the company has had with dogs like yours, and what colors or decorative ones Designs the gear has chosen.

If available, read customer comments and watch videos demonstrating how to fit and use the braces. Custom braces last a lifetime. Some companies offer discounts if two braces are needed (one for each hind leg) or to convert one brace for later use on the opposite leg.

Some of the manufacturers listed in the table on page 17 make braces or prostheses for animals other than dogs, and braces for other parts of the body. This list only applies to bespoke dog knee supports. For best results, contact your veterinarian, certified canine rehabilitation specialist, or other expert for advice and recommendations.

CJ Puotinen, who lives in Montana, is a long-time employee of WDJ and author of The Encyclopedia of Natural Pet Care and other books.





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