Bracing a CCL Tear. Does it work?

Frankly the biggest issues with bracing for a cruciate injury are:

1. Too many opinions based on limited exposure and
2. Non-custom braces.

Unfortunately, there is a lack of research into bracing a dog’s knee after a CCL tear. More general research into animal orthoses and prostheses does highlight:

• the need for custom products (i.e. molding or casting)
• the need for training of the owner for proper use to avoid negative consequences (e.g. wounds)
• improved outcomes with gait retraining and rehab therapies.

What’s the research on bracing for cruciate injuries?

To our knowledge, there are only 2 research articles specific to bracing the CCL-deficient stifle.

Bertocci, et al. (2017) looked at the biomechanics of the CCL-deficient stifle during the stance phase of gait using computer models on a simulated 33kg, healthy, 5-year old male, neutered Golden Retriever. They concluded that joint biomechanics were improved, but not normalized, with bracing and that “an orthosis may be a viable option to stabilize a CCL-D canine stifle joint.”

Hart et al. (2016) compared owner satisfaction between custom made stifle braces and TPLO surgery in large and medium dogs. While the clinical outcomes of a TPLO were better (lower rates of ongoing lameness) than the braced stifle, owner satisfaction was similar between both groups was similar (90% vs. 85%) with most owners stating they would choose the same treatment again.

Do ACL braces work for humans not having surgery?

There is more research into bracing for people with ACL injuries than dogs with similar injuries. However, common practice in humans is not necessarily backed by research. In other words, bracing in humans seems to be done more often than the research would suggested is beneficial.

Here’s what is known about bracing for human knees following ACL injury:

• Biomechanics are not normalized with bracing (i.e. the knee does not work the same without an ACL even with a brace)
• Braces do not protect repaired a repaired ACL
  • Some evidence that they reduced subsequent injuries in skiers with both repaired and non-repaired ACLs
• Braces do not improve long-term patient outcomes
• Bracing manages low loads better than higher, athletic-type loads

What else do I need to know when I’m considering a brace?

Amazon braces do not work. Full stop.

Braces that look like pants and suspenders that are sold as “custom” but are no more custom than knowing one needs a size 28 waist on a pair of pants, do not work.

If you are considering a brace for your dog, seek out a practitioner with experience who can make a cast mold of your dog’s leg to ensure intimate fit of the brace to the leg. This will ensure the brace does not cause pressure areas, rubbing or wounds. It will also increase the success rate of the brace. In your local community there may be a human orthotist who works with dogs. In Kingston, V2 Innovations does some canine bracing. Outside of Kingston, PawsAbility focuses on canine bracing. Alternatively, companies such as K9 Orthotics and Hero Braces offer shipped braces in Canada but do require a cast be made of the leg by either a vet or rehab practitioner (Pawsitively Fit does not offer this service at present). Posh Dog Knee Braces offers a semi-custom, adjustable brace that does not requires casting.

What dogs are braces not suited for?

• dogs who have a concurrent meniscal tear (these dogs require surgery)
• dogs who are not weight bearing on an injured leg
• dogs who have unmanaged pain

It is important to manage your expectations when considering a brace for your dog. Bracing is most successful when combined with rehab care to encourage use of the leg, regain muscle and safe resumption of activities. Bracing of an injured leg in hopes of quickly returning to high level of activity is not appropriate.

Kuma, a large male Akita, wearing a brace from Posh Dog.