Duke is a 12-year-old mixed breed who presented to his primary veterinarian for right hind limb lameness in March of 2016. There, he was diagnosed with a right cranial cruciate ligament tear and chronic joint effusion, which is a common injury in dogs. An ACL, also known as a CCL or CrCL tear, is the same injury as seen in humans. When surgery isn't an option due to age, health, financial reasons, or any other reason, OrthoPets can offer an alternative solution via a custom made orthosis. In Duke's case, his owner chose an orthotic solution due to his age and opted to not put him under anesthesia for the corrective surgery most commonly known as TPLO (tibial plateau leveling osteotomy) or TTA (tibial tuberosity advancement). After we reviewed his case, it was decided that a standard stifle orthosis would be the best option for him at this time. Due to his age and therapeutic goals, a lower durometer (more flexible) hinge was installed on the lateral side along with a standard resistance hinge on the medial side to still provide stability and control but allow an easier range of motion. OrthoPets utilizes a number of different types of hinges and chooses the appropriate one for each patient based on a number of factors.[caption id="attachment_4429" align="aligncenter" width="600"]
Left: Duke's fiberglass impression. Right: Duke's stifle orthosis.[/caption]Once the device was fabricated, it was shipped to the clinic where the referring veterinarian was able to fit it properly and discuss with Duke's owners the recommended break-in schedule. Duke had been wearing the device for a few weeks and had been going on longer walks and even playing catch with a Frisbee, but unfortunately he reinjured his right stifle likely due to high levels of activity. Our stifle orthosis when properly donned will control tibial thrust, but patient activity in and out of the device as well as environmental factors may play a role in progressive tears. For partial tears, an orthosis is just a portion of the patient's overall treatment plan for achieving a "curative outcome." Most partial CCL tear patients are receiving accompanying therapies in addition to the use of an orthosis, including laser therapy, PRP injections, shock wave, and a few others. The patient's body requirements for healing are not changed with application of an orthosis.After reviewing additional media and discussing an adjustment plan with the owner, we decided it would be beneficial to Duke for us to switch out his lower resistance hinge on the lateral side for a standard resistance hinge. The owners were weary of Duke being without his device, so they decided to order a "back-up" device for him. Sometime after completing the adjustments for the original device and sending out the back-up device, we followed up with the owner and received a reply email with an amazing update as stated below:
"Thank you so much for checking in! Duke is doing great - he loves the brace and it enables him to do all the things he loves to do! Hiking, Frisbee, ball, and just enjoying life. I am so grateful for your company creating such a wonderful alternative for dogs so they don't have to go through surgery."
Duke, post-orthosis.[/caption]A year had passed after Duke had been using his device, and his mom reached out to us for a complete refurbishment of his devices, which is recommended every 1-2 years depending on environment and activity level in the device. We stripped the device down to the shell and added new foam, straps, and hardware to his device. After shipping them back out, his mom sent us another great email giving us kudos and letting us know how big of a difference we had made in Duke's life. Her response was as follows:
"We just received Duke's adjusted brace (actually yesterday) and it looks great!! Really wonderful - thanks so much!! I will be in the office on Tuesday and will send the other brace to you overnight (you will have it on Wed) for the refurb! Can't wait - it's really worn looking so it will be great to have it look nice again! We are so reliant on the brace for Duke - it's really made it so he can do all the things he loves! :-) Thanks again!"
We here at OrthoPets are so happy to be able to offer an alternative solution to help so many people and their pets. We wish you all the best and enjoy hearing of the success your pet has with their devices!