Discussion related to the musculoskeletal system - injuries, post-op, lameness, extremity issues (joint, muscle, tenon, fascia...), axial skeleton issues, etc., as it relates to canine rehabilitation.
We have 2 cases at our veterinary clinic where the clients are interested in braces but 2 vets have differing opinions on it being a good idea or not. I told them I would get your wise advice to help them decide
1st case - owner had opted for MMP procedure at out clinic (we are not specialists and offer this type of repair as mid range - better than a lateral fabella but not as good as TTA at a specialist which is more costly as well as involving travel. The client had been researching and wants a cast moulding made so they can have a brace fabricated and shipped to NZ. The brace is to support the contralateral limb during recovery. So my first question was - if they can afford the brace, why not just get a TTA as in my opinion the recovery is much faster and thus less strain on the contralateral limb. Apparently they think the dog may have an immune disorder that caused degeneration of the CCL and possibility (isnt there always) of rupturing.
I know the companies market the braces for the use of supporting the contralateral limb, do you ever do this? Beneficial during rehab process while mm is restored?
2nd case - dog 3 years ago had CCL rupture repaired at a different veterinary clinic using lateral fabella method. Now NWBL and instability of the stifle confirmed. Owner is not wanting to do surgery again and is requesting brace. However, how successful is this likely to be now with old scar tissue? I questioned meniscus being already removed in the last surgery or not but the vet will have to try and find this out from the other clinic.
Both dogs are large breeds
Any thoughts would be appreciated
Thank you
Okay... so case 1:
I wouldn't brace the opposite leg. MUSCLE is the best protectant against a cruciate tear. A brace, while it does hold some value in this scenario can't be used all the time, and the time the dog would rupture the other side could simply be in the house when the doorbell rang or he jumps off the couch or chases a bird in the back yard. A brace on a 'good' leg, (I believe) will only serve to reduce it's use and hinder muscle development - as compared to putting it on a dysfunctional leg where it can provide a support for a leg that 'feels' unstable to the dog. So I'd say build the other leg with controlled exercise. Ironically, the rehab for the post-op leg will build the other. AND even after saying all of that... there is still a potential for rupture that can't be stopped, simply because of angles and/or internal degenerative processes! IF they simply demand that they want something. Get a sleeve or tube of neoprene that can go around the dogs leg, poke holes in the top and fasten it to the dog with straps or theraband going around his middle. It may aid in proprioception.
case 2:
You do have to test for a meniscal tear just the same. When a 'meniscus is removed', it is just the 'offending bit' that's removed. Not the whole thing. So there can be a subsequent meniscal tear of a different part of the remaining meniscus.
Now if the meniscus does not seem to be a factor (which I'm betting it is), then be aggressive with pain management - all forms (pharmaceutical, nutraceutical, modalities, manual therapies, etc...). And slowly start to build muscle. Scar tissue in this case is GREAT! That's what was holding the joint before now anyways - not the nylon line... the nylon line tends to rupture somewhere along the way with the lateral suture technique anyways (that's what surgeons told me 20+ years ago when it was the only technique around.) Which takes me back around to... I bet it's meniscal. So do a search of FourLeg for my 'Meniscal technique' video. (search the little white bar up and to the right.) Give it a whirl. IF there is meniscus, then either YOU need to fix it (in humans we have a 58% success rate with conservative - physio treatment for them. I find a similar success in dogs - maybe a we bit less). If the meniscus is clear, then Pain Management, Rehab, and a Brace could be fabulous!!!
