The OrthoPets stifle devices are effective for: cruciate ligament injuries, fracture management, to prevent injury of a dog leg, torn ACL or other ACL injury, ligament injuries, CCL tear, knee injury, CCL injury, hind leg support, as an alternative to surgery, and other rear leg injuries in dogs of the knee joint.
Injury to the cranial cruciate ligament (CCL, also called the ACL) is the most common orthopedic injury in the dog. This injury is due to a partial or complete tear of a ligament inside the stifle (knee). The resulting instability leads to pain and arthritis.
Stabilization is recommended for best short and long-term function, quality of life, and comfort. Stabilization is traditionally done surgically either with a joint realignment surgery (TPLO or TTA) or with a pseudo-ligament surgically placed outside the joint (tight rope or lateral suture). These procedures are considered the standard of care, in general. In the past 7 years, the use of custom orthosis (brace) has become available as an alternative to surgery when surgery is not appropriate for any reason. These reasons may include other health issues, unacceptable surgical or anesthesia risk, advanced age, and financial constraints, among others.
Luxating patella is a common developmental pathology in large and small breed dogs. It is usually diagnosed at a young age. The patella can luxate medially or laterally in any size dog. Severity of luxation is graded on a scale from 1-4. The most severe grade, 4, means that the patella is permanently located outside of the trochlear groove of the femur. Grade 1 is the least severe and is characterized by a patella that easily slips in and out of luxation, but is properly aligned in the trochlear groove most of the time.
In humans, luxating patella occurs in various degrees of severity as well. Rehabilitation, bracing, and surgery are typical therapeutic options. Similar options are available for dogs with one important caveat. The human patella is fairly large and can be manipulated more easily with a brace system. This is very different from the dog.
The canine patella ranges in size from about 5mm (or a ½ of a pea) to 30mm (or a large lima bean). The former would be a toy breed and the latter a giant breed such as Great Dane. Even the large patella is not directly manageable with an orthosis. The patella cannot be held in place by straps or plastic shell. Rather the orientation of the tibia is manipulated to assist proper alignment and tracking of the patella within the trochlear groove. This is not possible with grade 3-4 luxating patellas and even some grade 2 luxating patellas cannot be helped with an orthosis. Generally speaking grade 2-4 are surgical candidates although some grade 2 luxations never become sufficiently clinical to require surgery.
Because an orthosis is not the correct therapy for all patients, before choosing an orthosis the following points are important to keep in mind:
1. The device MUST be put on every morning and removed every night. The device is to be used all day everyday, but must be removed at night. It is NOT like a human knee brace, worn only for sport. The orthosis stabilizes the stifle from the outside only when ON, while surgery does so from the inside permanently. Because of this it must be used whenever your dog will be standing and/or moving about. The device is not used at night and your dog must not be allowed to move about at night (jump on or off bed, wander the house, go outside through a dog door, etc.).
2. Adjustments are expected and are a normal part of the custom orthosis process. The device is custom-made for your dog. Every effort is made to accurately fit the device and 1 complimentary adjustment is included in order to meet the requirements for an appropriate fit; you or your veterinarian can coordinate these adjustments. Importantly, your dog is much more active at home than at the veterinary clinic. Increased activity and activity intensity can expose fit issues requiring further adjustment. Additional adjustments, if needed, are most commonly required in the first few months and as time goes on (see importance of follow-up #4). Please follow all instructions with regard to monitoring the leg and contact OrthoPets and/or your veterinarian promptly if you have concerns.
3. Follow-up is critical to success. An orthosis is considered a “durable medical device.” This means that proper use is necessary to meet therapeutic goals and to ensure its safe application over the lifetime of your dog. In the first few months of the fitting, your veterinary team with the help of your OrthoPets VOP Specialist will work with you in regard to device use and rehabilitation. Annual to twice annual appointments are advised depending on age and activity of your dog. At these appointments your doctor will thoroughly assess your dog’s orthopedic condition and evaluate the condition and fit of the device. Recommendations will be made for continued success in the device. If adjustments are required, it will be necessary to ship the device to OrthoPets with a turnaround time of 2-4 business days excluding shipping time.
4. Even with an orthosis, surgery may be required. When the cranial cruciate ligament is torn sometimes the meniscus is also torn. The meniscus is a comma shaped cushion on the inside of the stifle. There are 2, one on the middle and one on the outer side of the stifle. The middle or medial meniscus is most commonly injured and this may occur at the time of the initial cranial cruciate injury or any time later due to too much activity on an unstable joint. A torn meniscus is very painful and if not treated it will cause continued lameness despite stabilizing the joint with surgery or an orthosis. If this occurs, a surgical procedure called a partial medial meniscectomy is required. It can be done by itself or with a surgical stabilization (see first paragraph). A torn medial meniscus is diagnosed either at surgery, by MRI (rarely), ultrasound where available, or based on clinical judgment with or without use of an orthosis. If your veterinarian suspects a meniscus tear please see our handout on options available for your dog.
5. The Role of Rehabilitation. Whether your dog undergoes surgical or orthosis stabilization for a torn cranial cruciate ligament and whether or not surgery is required for a torn medial meniscus, it will take time to recover to full, comfortable function. If an orthosis is part of therapy most dogs adapt quickly to wearing an orthosis. Behavioral techniques can facilitate this. Also your dog will need to learn basic skills while wearing the device. These include: transitions (sitting, lying down, and getting up), stairs, getting into vehicles safely, managing on different types of surfaces (ground, carpet, hardwood floor, etc.). Finally, orthopedic injury leads to compensatory abnormal movement and associated muscle strain and weakness. The best way to ensure the highest level of success is to follow recommended rehabilitation schedules and techniques. Each patient’s condition and abilities are unique and as such an individualized rehabilitation program is needed. Your veterinarian can help find a certified rehabilitation professional (CCRT or CCRP) in your area.
6. A proactive approach to arthritis management is the second key to long-term success. Just as rehabilitation is important whether your dog undergoes surgical or orthosis stabilization, arthritis management is key as well. All dogs will develop arthritis after injury to the CCL regardless of the stabilization techniques chosen. The difference is the severity and speed of development of that arthritis. Steps taken early on and continued throughout your dog’s lifetime will make a difference in terms of regaining and maintaining comfort and an active lifestyle well into the senior years. Your family veterinarian or a pain and mobility specialist can create an individualized, integrative arthritis management plan for your animal.
7. Orthotics (braces) for dogs is a new solution to an old problem. Modern medicine moves forward at a rapid pace. It takes a lot of time and many tens of thousands of dollars to perform a controlled clinical trial to compare a new therapy to the standard therapies in common use. As such, there is no published study directly comparing use of a stifle orthosis to surgical stabilization for CCL injury in the dog. As the industry leader using our unique, anatomically aligned, and mechanically sound custom design, OrthoPets provides stifle orthoses for nearly 1,000 dogs per year. This level of experience allows us to carefully select the patients best suited for a stifle orthosis; design appropriate rehabilitation protocols for best success; and troubleshoot interesting individual patient challenges. This is not a substitute for clinical data, but is referred to as empirical (or experiential) data. This is the current state of orthotics for animals. OrthoPets continues to work closely with university professionals to develop studies to prove and improve the use of orthotic devices in animals.
What is a Tarsal Cuff?
A tarsal cuff is an articulating component that is added to the distal end of a modified stifle orthosis to gain additional suspension, purchase, or rotational support. The tarsal cuff can either be fabricated to present on the cranial or caudal aspects of the metatarsals. Considerations of design include patient confirmation, pathology, goals, lifestyle, donning & doffing, among other factors. The distal end of the tarsal cuff will terminate at the same level as the apex of the metatarsal heads. The most common indication of a tarsal cuff is to aid in suspension of the stifle orthosis in cases where the patient's anatomy or terminal stance phase angle of the tibiotarsal joint does not allow for traditional suspension techniques. In addition, a tarsal cuff will also provide additional control of the limb in cases where a rotational instability of the stifle or tarsus are present.
**All stifle devices will initially be fabricated with a tarsal cuff.**
When is it time to refurbish your device?
Since the goal of your custom made OrthoPets orthotic or prosthetic device is to return your pet to their active lifestyle, the device is going to experience quite a bit of wear and tear through day to day use. Depending on your pet’s injury or instability, he or she may need to be in the device long-term as determined by your prescribing veterinarian. Your OrthoPets orthosis or prosthesis is designed to last the lifetime of your pet. In order to keep the orthosis or prosthesis in top working condition, we recommend a full refurbishment as needed.
How often should I have a refurbishment done?
We generally recommend your device be refurbished every 12-24 months depending on how active your pet is. If you are unsure if it’s time, please contact your VOP Specialist. We may request pictures of the device to assess its current condition.
What does a refurbishment include?
A full refurbishment includes replacing the entire foam liner, replacing all straps and pads, replacing tread (if applicable), replacing all hardware, and buffing out any scratches or dings. Your device will return to looking brand new! Please be aware that since the foam is replaced, there will need to be an initial break-in period just like when you first received the device.
What if I only need straps, pads, or hardware?
If your device isn’t ready for a full refurbishment, you can order replacement straps and pads as needed. While you can order replacement hardware directly from OrthoPets, information of the type of hardware used is also located in your fitting brochure and can be purchased at a local hardware store.
OrthoPets devices are custom fabricated based off of an impression of your patient’s/pet’s leg. We fabricate each orthotic brace or prosthetic device to support the therapeutic mobility goals.
Manufacturing & Order Fulfillment Timeline:
Shipping & Costs: