Re: Cruciate Brace

April 24, 2012

For a large breed active dog I would use the Ortho pets hinged brace. It is expensive but good.Jan Huntingford DVM, CCRT, CVA, DLRSent from Jan's Iphone

Hi,

Does anyone have any suggestions on what brace to use for an 8 year old Lab with a complete cruciate tear. The surgeon is very suspicious of a meniscal tear and the owners know that surgery is the best option for their dog. However, they would like a brace to use until they get surgery done and to be used afterwards during recovery.

Thank you,

CCRA

April 25, 2012

Hi ,I sort of hate to stick my neck out here, but here goes:First let me say that I am a huge fan of the OrthoPets products (and have already seen the first response to your post).My concern is mostly regarding the suspicion of the meniscal damage, which will likely need to be addressed surgically regardless of other choices to manage the unstable stifle (that said, there are some specific tears that can actually be successfully managed conservatively, so it is a bit case-by-case). How long were they planning on delaying the surgery to stabilize? Plenty of cost/benefit things to consider. They might want to cut straight to the chase with surgery ASAP for multiple reasons, and maybe do some "pre-hab" in the mean time. Once the stifle has been successfully surgically stabilized, there

will be no need for bracing during rehab. Just my initial thoughts....Teri Subject: Cruciate BraceTo: VetRehab Date: Tuesday, April 24, 2012, 2:39 PM

Hi,

Does anyone have any suggestions on what brace to use for an 8 year old Lab with a complete cruciate tear. The surgeon is very suspicious of a meniscal tear and the owners know that surgery is the best option for their dog. However, they would like a brace to use until they get surgery done and to be used afterwards during recovery.

Thank you,

CCRA

April 25, 2012

I do feel that the Orthopets stifle brace is the best brace out there for

ligament injuries to the stifle. It is not a hinged brace, but uses Tamarack

joints, which are a special type of strong yet flexible plastic. Thus there is

no adjusting or limiting the amount of flexion and extension...they work well

and are less cumbersome than a hinged joint. I would assess the degree of

instability in the stifle. I have had VERY instable stifles (complete tear of

CCL and LCL or MCL as well) do very well with the Orthopets brace over time

(most cases had surgery that did not come out well). Surgery will stabilize

translation of the femur over the tibia, but will not fix the mediolateral

instability when this exists. However, with the Orthopets brace, there is

mediolateral stability provided as well, and the joint will eventually tighten

up (I have my owners plan on a year of wearing the brace). If the stifle is

really instable (more than just in the sagittal plane), I would get the brace

pre-op. Saving the ligaments and cartilage (further tear of the meniscus) will

prevent post-op arthrtitis. There are some variations on outcome based on

whether extracapsular repair, TTA, TPLO, but I have seen this brace help in very

case!

Liz Powers, MPT, CCRT

>

> Subject: Cruciate Brace

> To: VetRehab

> Date: Tuesday, April 24, 2012, 2:39 PM

>

> Â

>

> Hi,

>

> Does anyone have any suggestions on what brace to use for an 8 year old Lab

with a complete cruciate tear. The surgeon is very suspicious of a meniscal

tear and the owners know that surgery is the best option for their dog.

However, they would like a brace to use until they get surgery done and to be

used afterwards during recovery.

>

> Thank you,

>

> CCRA

>

April 25, 2012

Hi Liz, regarding this statement:

" Saving the ligaments and cartilage (further tear of the meniscus) will prevent

post-op arthrtitis "

This has been a statement that has been shown to be untrue going back to the

pond-nuki dog model. With the very first injury to the ACL, even minor, the

osteoarthritis process begins, and no matter whether surgery is done, and if it

is, no matter what procedure is done, they will develop OA and/or it will

progress. As far as humans, I believe this is also true. but I am not an MD or

PT. The surgeon that just recently did a hamstring graft on my daughter's knee

also said that she would in the future develop OA. In dogs, we cannot take an

joint with an injured ACL or an ACL deficient knee and return it to normal

biomechanics and normal function. The unfortunate truth is that no technique

and no brace at this time is able to accomplish this feat. Further evidence of

early OA formation is seen time and time again when dogs present for early

subtle lameness and radiographs of the knee reveal enthesiophyte formation on

the distal patella, mild remodeling of the ventral asp

ect of the fabellae and a very mild effusion. Those are the earliest

radiographic signs of osteoarthritis seen in the ACL affected joint and are the

result of the biomechanical change seen with even a tear as minimal as few %

(which can be seen well with an arthroscope and even arthrotomy). The reason we

do surgery is to flush and debride the joint, assess damage to the mensci and

treat appropriately, grade any cartilage lesions, to stabilize an ACL deficient

joint, and in cases of very minor tears, to unload the remaining ACL with one of

the procedures that eliminates cranial tibial thrust. Extracap stabilization

does accomplish this latter procedure also, but results in a biomechanically

more abnormal knee than the osteotomies. There has been recent studies in VCOT

that showed that TTA results in the closest to normal condyle to plateau contact

through the functional joint ROM when compared to TPLO. I also believe compared

to extracapsular it does also, but I would ha

ve to check that latter thought. Intuitively I would think it does as

compressing the lateral aspect of the joint does not seem like it would yield

anywhere near normal contact during tibial thrust or rotation. Anyway, just

some thoughts. Thanks for your posts of your experiences, as they are helpful

to my thought processes and cases.

Mark Parchman, DVM, DACVS, CCRT, CVA

Bend Veterinary Specialists

Cruciate Brace

> > To: VetRehab

> > Date: Tuesday, April 24, 2012, 2:39 PM

> >

> > Â

> >

> > Hi,

> >

> > Does anyone have any suggestions on what brace to use for an 8

> year old Lab with a complete cruciate tear. The surgeon is very

> suspicious of a meniscal tear and the owners know that surgery is

> the best option for their dog. However, they would like a brace to

> use until they get surgery done and to be used afterwards during

> recovery.>

> >

> > Thank you,

> >

> > CCRA

> >

>

April 26, 2012

Putting in some 2 cents along with some experience we have had with ACL’s (partial, full and misdiagnosed), braces, meniscus tears, surgeries and arthritis. We have had the joy of treating many ACL injured dogs and our findings have been that regardless of partial or full, 90% of our cases (100’s) have full recoveries without surgery. We find the main reason that a small % of cases do not recover fully with rehab alone is usually due to the pain they have caused by the meniscus tear (we see this in humans as well), not because of a laxity in the joint due to ACL deficiency. I myself had my ACL removed (due to a complete tear) along with meniscectomy (of the torn portion) and proceeded to be extremely functional (racquetball, skiing etc). In the human world they actually replace the cruciate ligament (makes sense right? Just as they did with the HS graft on Mark’s daughter). None of the stabilization procedures available in veterinary medicine actually replace the cruciate ligament. All options, surgery and without tend to develop arthritis. As far as braces go, we tend to use braces only in cases where surgery is not an option and the patient has enough instability that is not responding to rehab alone. When we choose a brace it is a custom made brace from Ace Ortho Solutions. We have engaged in a prospective study with patients who have suspected co-morbidity of CCL rupture plus meniscal tear. This involves arthroscopic evaluation of the subjects and partial meniscectomy and debridement of cruciate ligamentous remnants. (similar to what they do in humans). We follow this up with 8 weeks of post-op rehab and have very positive results thus far with regard to clinical outcome and client satisfaction. Along with the fact that the arthroscopic surgery has fewer risks such as no risk of implant failure, reduced risk of infection, less invasive, faster recovery. The objective of the study is to determine whether affected pets with cranial cruciate ligament rupture and suspected meniscal damage who undergo only meniscectomy with subsequent physical rehabilitation will recover strength and functionality with equal or better results than affected pets that undergo any traditional knee stabilization procedures with meniscectomy. We look forward to publishing our results and are confident that this will change the way we all approach CCL disease. Oxford, DVM, MPH, CCRT, CVA Waldman, VMD, CCRT, CVAAmy Kramer, PT, DPT, CCRT California Animal Rehabilitationwww.CalAnimalRehab.com From: VetRehab [mailto:VetRehab ] On Behalf Of mbparchman@...Sent: Wednesday, April 25, 2012 2:14 PMTo: VetRehab Subject: Re: Re: Cruciate Brace Hi Liz, regarding this statement: " Saving the ligaments and cartilage (further tear of the meniscus) will prevent post-op arthrtitis " This has been a statement that has been shown to be untrue going back to the pond-nuki dog model. With the very first injury to the ACL, even minor, the osteoarthritis process begins, and no matter whether surgery is done, and if it is, no matter what procedure is done, they will develop OA and/or it will progress. As far as humans, I believe this is also true. but I am not an MD or PT. The surgeon that just recently did a hamstring graft on my daughter's knee also said that she would in the future develop OA. In dogs, we cannot take an joint with an injured ACL or an ACL deficient knee and return it to normal biomechanics and normal function. The unfortunate truth is that no technique and no brace at this time is able to accomplish this feat. Further evidence of early OA formation is seen time and time again when dogs present for early subtle lameness and radiographs of the knee reveal enthesiophyte formation on the distal patella, mild remodeling of the ventral aspect of the fabellae and a very mild effusion. Those are the earliest radiographic signs of osteoarthritis seen in the ACL affected joint and are the result of the biomechanical change seen with even a tear as minimal as few % (which can be seen well with an arthroscope and even arthrotomy). The reason we do surgery is to flush and debride the joint, assess damage to the mensci and treat appropriately, grade any cartilage lesions, to stabilize an ACL deficient joint, and in cases of very minor tears, to unload the remaining ACL with one of the procedures that eliminates cranial tibial thrust. Extracap stabilization does accomplish this latter procedure also, but results in a biomechanically more abnormal knee than the osteotomies. There has been recent studies in VCOT that showed that TTA results in the closest to normal condyle to plateau contact through the functional joint ROM when compared to TPLO. I also believe compared to extracapsular it does also, but I would have to check that latter thought. Intuitively I would think it does as compressing the lateral aspect of the joint does not seem like it would yield anywhere near normal contact during tibial thrust or rotation. Anyway, just some thoughts. Thanks for your posts of your experiences, as they are helpful to my thought processes and cases.Mark Parchman, DVM, DACVS, CCRT, CVABend Veterinary Specialists Cruciate Brace> > To: VetRehab > > Date: Tuesday, April 24, 2012, 2:39 PM> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Â > > > > > > > > > > > > > > > > > > > > Hi,> > > > > > > > Does anyone have any suggestions on what brace to use for an 8 > year old Lab with a complete cruciate tear. The surgeon is very > suspicious of a meniscal tear and the owners know that surgery is > the best option for their dog. However, they would like a brace to > use until they get surgery done and to be used afterwards during > recovery.> > > > > > > Thank you,> > > > CCRA> >> > >

April 26, 2012

May I ask what our outcome measures are? The difficulty being that studies with

solely subjective outcome measures tend to be a bit more difficult to evaluate

because of observer bias. What are you terming full recovery and what groups

are you evaluating?

, VMD, CCRP

Veterinary Orthopedic Sports Medicine Group

https://www.VOSM.com

________________________________________

From: VetRehab [VetRehab ] On Behalf Of Amy

Kramer [AKramer@...]

Sent: Wednesday, April 25, 2012 7:03 PM

To: VetRehab

Subject: RE: Re: Cruciate Brace

Putting in some 2 cents along with some experience we have had with ACL’s

(partial, full and misdiagnosed), braces, meniscus tears, surgeries and

arthritis.

We have had the joy of treating many ACL injured dogs and our findings have been

that regardless of partial or full, 90% of our cases (100’s) have full

recoveries without surgery. We find the main reason that a small % of cases do

not recover fully with rehab alone is usually due to the pain they have caused

by the meniscus tear (we see this in humans as well), not because of a laxity in

the joint due to ACL deficiency. I myself had my ACL removed (due to a complete

tear) along with meniscectomy (of the torn portion) and proceeded to be

extremely functional (racquetball, skiing etc). In the human world they

actually replace the cruciate ligament (makes sense right? Just as they did with

the HS graft on Mark’s daughter). None of the stabilization procedures

available in veterinary medicine actually replace the cruciate ligament. All

options, surgery and without tend to develop arthritis.

As far as braces go, we tend to use braces only in cases where surgery is not an

option and the patient has enough instability that is not responding to rehab

alone. When we choose a brace it is a custom made brace from Ace Ortho

Solutions.

We have engaged in a prospective study with patients who have suspected

co-morbidity of CCL rupture plus meniscal tear. This involves arthroscopic

evaluation of the subjects and partial meniscectomy and debridement of cruciate

ligamentous remnants. (similar to what they do in humans). We follow this up

with 8 weeks of post-op rehab and have very positive results thus far with

regard to clinical outcome and client satisfaction. Along with the fact that

the arthroscopic surgery has fewer risks such as no risk of implant failure,

reduced risk of infection, less invasive, faster recovery.

The objective of the study is to determine whether affected pets with cranial

cruciate ligament rupture and suspected meniscal damage who undergo only

meniscectomy with subsequent physical rehabilitation will recover strength and

functionality with equal or better results than affected pets that undergo any

traditional knee stabilization procedures with meniscectomy. We look forward to

publishing our results and are confident that this will change the way we all

approach CCL disease.

Oxford, DVM, MPH, CCRT, CVA

Waldman, VMD, CCRT, CVA

Amy Kramer, PT, DPT, CCRT

California Animal Rehabilitation

www.CalAnimalRehab.com<http://www.CalAnimalRehab.com>

From: VetRehab [mailto:VetRehab ] On Behalf Of

mbparchman@...

Sent: Wednesday, April 25, 2012 2:14 PM

To: VetRehab

Subject: Re: Re: Cruciate Brace