Will a Leg Brace Heal Cruciate Ligament Injury?
Cruciate ligament injury is one of the most common causes of lameness in dogs. Anterior cruciate injury in people is often treated with a knee brace so is a brace the right option to treat your dog who has suffered a similar injury to their leg?
Question number two is about a dog who has got an anterior cruciate or cranial cruciate ligament injury and the owners wondering if a brace can help the repair and the healing process after cruciate damage.
What is a cruciate injury?
Cranial or anterior cruciate ligament rupture can be classed as partial or complete. A partial rupture is where the ligament has become damaged, a little bit frayed. Whereas a complete rupture is when it's completely given way and it's no longer intact.
Now, presumably, by this being described as a mild, this is a partial rupture. So it's still very painful, but the joint itself might still be pretty stable. When the ligament completely ruptures, the joint becomes very loose, it's very unstable, it causes a lot of pain and causes a huge amount of problems. Now, a partial rupture is still definitely painful, but it's one that can potentially settle down without more serious intervention, but we'll come onto that in a little bit.
Will a leg brace work?
Now, there are a number of braces that are available, but personally I'm not aware of any evidence that they actually improve healing, they improve comfort, they allow more exercise or have any other benefit. Now, if you go onto these websites, there's a lot of testimonials, there’s various videos, but testimonials, anecdotal evidence and a few videos doesn’t necessarily represent the full story of what's going on.
For example, a video of a before and after might also be that in the before video, the animal, the dog hadn't had any pain relief and then the after video they'd actually had some pain relief so that was why they were walking on their leg better. I'm not suggesting that everyone's going out of their way to deceive you, but certainly things like that we really need to bear in mind and there's just been no studies done that I'm aware of.
The other reason for improvement is that a lot of dogs with ACL rupture will improve with time so long as a dog is rested and given medication to control inflammation and pain. The dogs that have a brace applied may have been going to get better anyway, brace or not.
Now, that of course doesn't mean that they don't work just because there's been no studies done, but my concern would be that the dog anatomy is not the same as humans, in that their upper legs really are not a constant fixed diameter and they don't really readily allow a brace to be placed that in my mind would be firmly enough fixed in one spot to only allow the normal rotational movement to take place or the movement through one plane to take place and prevent other slipping forces acting on the knee.
Braces are something that are used a lot in human anterior cruciate ligament damage, but I don't know that that's necessarily easy to replicate in dogs.
Cruciate ligament damage treatment
So what can we do?
Well, rest is going to be crucial and, as I’ve said, if a dog rests and is given painkillers the problem may settle down.
In a lot of cases however, even with a partial rupture, unless it's very mild, surgical intervention generally represents the best chance of recovery for a dog with a partial or complete rupture of their ACL.
For dogs weighing less than 15 kg (or about 30lb) that are managed conservatively, then about 80 percent of those will recover to a satisfactory degree. They either won't be lame at all or they'll only have a mild lameness every now and then. Of course, that then leaves 20 percent or 1-in-5 as having more serious, more persistent lameness. Whether that's a good result or not, I'll leave that for you to decide.
Generally with surgery the outcome becomes much better. It goes up to 95% or so, maybe even higher.
Now, if we consider larger dogs (those over 15kg or 30 pounds), then they really don't do well without surgery. If we're resting these dogs straight away and for long enough the knee joint eventually stabilizes. The amount of arthritis present though will be so much worse than it would otherwise have been, and it will be crippling. There will be serious problems.
Just think too, that very often these are younger dogs as well, so they've got a long life in front of them to live with potentially an awful lot of pain.
Also, if we are then giving them painkillers for a long, long period of time then the cost of these can potentially be more than the surgical treatment. Definitely something to bear in mind when you’re deciding on which course of action to take.
For a full rundown of options, head over to my article all about conservative vs surgical treatment of a torn ACL in dogs
The best use of money
Now, going back to braces, it may be that a brace does help but, like I say, I have my doubts. Also, if you go online and you look for these braces then they can cost anywhere from several hundred dollars to a thousand dollars and we have to ask the question, is this money going to be better spent on treatment that we know benefits the individual rather than something which may or may not help at all?
So like I say, we don’t know the answer to this, or I certainly don't know the answer to this, and I'm not aware of any good studies that have been done. But that's really my concern, that we might be wasting money when it would be better used on another treatment modality.
Now, of course, I'd love a study to be done on knee braces because cruciate ligament rupture is really such a common problem, and if we have different ways to manage it, that may be a more affordable and more effective in certain conditions then that would be fantastic.
The above is a transcript taken from “The Dr Alex Answers Show”.
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