Do Knee Braces Really Work For Dogs?

Dog knee braces have become a go to for people and veterinarians when TPLO surgery is not the best option.  However should dog knee braces be the first line of treatment for a CCL tear rather than the last option when surgery is not optimal?  In the human medical industry all non-invasive treatments are exhausted prior to ever considering surgical intervention.  Things like rest, ice, heat, anti-inflammatories, orthotics, and physical therapy are all done prior to a surgical consult for humans.  In the animal industry veterinary medicine has yet to consider this a viable option with good reason, as many over the counter braces do very little to help in healing and custom braces can be ill fitting if not made properly.  This may be the reason veterinarians appear to be reluctant to implement non invasive methods into practice as a first line treatment.  Several studies have been done for humans regarding orthotics assisting in ligament and tendon repair.  A recent article in the British Journal Of Sports Medicine shows positive outcomes with the use of orthotics instead of surgery.  They reported “After management of acute ACL rupture with the CBP, 90% of patients had evidence of healing on 3-month MRI (continuity of the ACL). More ACL healing on 3-month MRI was associated with better outcomes.” 

https://bjsm.bmj.com/content/57/23/1490

Only a handful of studies have been done using orthosis for CCL tears in dogs and they also show positive results in favor of stifle braces. Two recent veterinary studies have found that bracing a dog with orthotics will help a CCL tear without the high expense or down time of a surgical intervention.  One study done and published by Veterinary Evidence assessed weight bearing on dogs with CCL tears treated with a custom canine stifle brace. The objective of the study was to assess weight bearing of dogs with CCL tear after using a custom brace.  Their findings were conclusive of CCL healing with the use of orthotics.  “Temporospatial gait analysis was performed using a pressure sensing walkway at baseline and 90 days or greater post orthotic placement to identify weight bearing with total pressure index % (TPI%). 

Results: TPI% improved significantly by 5.1% in the affected limb when compared to baseline ( p = 0.0020). At final gait analysis, TPI% significantly improved by 3% in the affected limb with the orthotic off when compared to the unaffected limb ( p = 0.0020). Conclusion: Custom canine stifle orthotics allow for improved weight bearing in the affected limb”.

https://veterinaryevidence.org/index.php/ve/article/view/10

The other study was done by the University of Louisville and they did a computerized experiment to test for improved biomechanics of dogs using a stifle brace for CCL tears.  Here are their findings: “Stifle joint biomechanics were improved following orthosis implementation, compared with biomechanics of the CrCL-deficient stifle joint. Orthosis hinge stiffness influenced stifle joint biomechanics. An orthosis may be a viable option to stabilize a CrCL-deficient canine stifle joint.”  https://avmajournals.avma.org/view/journals/ajvr/78/1/ajvr.78.1.27.xml

The key to these studies are well made custom fit orthotics.  Off the shelf soft braces often do nothing to help support and stabilize the knee joint.  Animal orthotics are new to the veterinarian industry and there are a lot of traditional human O&P companies jumping on board with little knowledge about animal anatomy, causing ill fitting products.  Hair loss, skin issues, and wounds are all symptoms of an ill fitting product and potentially the main reason for veterinarians not wanting to recommend this type of device.  However a recent study was done that asked one group of dog owners that had TPLO surgery and one group of dog owners that only used a stifle brace about their satisfaction.  American Veterinary Medical Association Journal published the article in which they asked people to rate their satisfaction with both modalities.  Their assessment concluded that pet owners that opted for surgery versus pet owners who opted for using only a stifle brace were both satisfied with their results. “85% of respondents in both groups reported that they would choose the selected treatment again.” Giving just as much relevance to Stifle braces as TPLO surgery.  https://avmajournals.avma.org/view/journals/javma/249/4/javma.249.4.391.xml

Furthermore TPLO surgery has been linked with an increased risk of Osteosarcoma.  A group of DVM’s from Flint Animal Cancer Center published an article in AVMA in 2018 they reported “Dogs with a history of TPLO were 40 times as likely to develop proximal tibial osteosarcoma as were dogs with no history of TPLO.”  Their official conclusion and clinical relevance states “Results suggested that dogs with a history of TPLO were at increased risk of developing osteosarcoma of the proximal region of the tibia relative to dogs with no such history.”  As a veteran animal O&P manufacturer Specialized Pet Solutions has also noted a lot more instances of a dropped hock joint after a dog has undergone TPLO surgery which requires a hock brace to help elevate and stabilize that area.  A side effect that has yet to be researched. https://avmajournals.avma.org/view/journals/javma/253/6/javma.253.6.752.xml#:~:text=CONCLUSIONS%20AND%20CLINICAL%20RELEVANCE%20Results,dogs%20with%20no%20such%20history.

Therefore we must ask the question why are we not using stifle braces as a first line treatment? The answer may be in the quality of braces as well as a full understanding of dog anatomy by the companies that are building these braces.  Perhaps Veterinarians believe bracing does not work as they are using sub par products.  Custom animal orthotics are much more effective than their softer off the shelf counterparts, and significantly more affordable than TPLO surgery as well as being safer.  The quality of materials sourced as well as a keen understanding of dog anatomy is crucial for the animal orthotic companies to get it right and help the veterinary industry get on board with non invasive healing methods.  It is also important for animal O&P companies to continue to grow and learn what can be done better, always learning, and always innovating. Making a high quality product that works is the goal and needs to be the focus of these companies. We need to help our veterinary colleagues embrace dog knee braces as a front line treatment for CCL tears. 

The truth about Animal O&P is that it works, if you can find a company that knows what they’re doing and cares about the outcome of the animal.  Specialized Pet Solutions formerly Extremity C-Fab has been building animal O&P for 17 years and developed a dog knee brace design like no other on the market.  Their dog knee brace is designed with two unique features.  First- they have a built in achilles relief channel that cushions the achilles tendon and keeps the strap on the front of the leg, reducing pressure on the achilles.  This will prevent breakdown of the achilles tendon and further injury.  Second-a patellar bar prevents the drawer motion which is the primary cause of a CCL tear.   It cages the knee and provides stability and prevents both medial and lateral movement.  They use the same materials in their dog knee braces that are used for making human orthotics.   Making Specialized Pet Solutions one of the best custom dog knee braces on the market today.  With good measurements and a good cast we can build a quality device to help your dog heal from a CCL tear without surgery.  Keeping in mind the fit must also be good and communication between the veterinarian, client and O&P company is crucial for success.