SUMMARY: To brace or not to brace? If your beloved dog has an ACL/CCL injury, a dog ACL brace may seem like the obvious answer. But is it? Integrative veterinarian Dr. Julie Buzby lays out definitive information about the dog ACL brace and whether it’s a preferable option over other treatment methods. If you want the facts, the pros/cons, and a vet’s point of view, this editorial is a must-read.
There are many veterinary-recommended treatment options for a torn ACL.
Is a dog ACL brace one of them?
I tell my clients if you get one hundred vets in a room and ask their advice, you’ll get 105 opinions. Medicine is, by very definition, something to be “practiced.” It’s an art form. Life experience, favorite skills, and different training programs contribute to each veterinarian having their own personal tricks, ideas, and strategies for treating their patients. Veterinarians’ practice protocols are kind of like snowflakes—no two are exactly alike.
Here’s a great example of this: the medical and surgical options for repairing a cranial cruciate ligament (CCL aka ACL) tear in dogs. There are at least four different surgical techniques, each with their own cult following, plus choices of medications and supplements. Not to mention rehabilitation, laser treatment, and complementary modalities (like acupuncture). The number of permutations for a dog’s treatment plan are through the roof.
But here’s where it gets interesting to me: whether or not a dog knee brace is appropriate for the treatment of a torn cruciate ligament is not murky. It’s not one of those areas where you have a huge diversity of opinion among veterinarians.
Spoiler alert: in general the consensus is a thumbs down for the concept of a dog ACL brace. That said, it may still be a valuable tool in a few cases. Plus, the “supply” for dog knee braces is strong (with a dozen options readily available), indicating high consumer “demand.”
To brace or not to brace, that is the question…
To get to the bottom of this debate, we’re going to look at the merit of the dog ACL brace from five perspectives.
1. Gaining the veterinarians’ collective perspective
When it comes to knee injuries, a dog ACL brace is not an “A list” solution for most veterinarians. Here’s why:
In my experience, the use of a brace is pretty much never suggested by a veterinarian as the first-choice course of action after diagnosing knee injuries in dogs. The issue is almost always raised by a client who has done internet research at home and is looking for an alternative to surgery.
I suspect it’s natural to envision treating your dog’s torn ACL with an ACL brace because we’ve all seen humans walking around with Frankenstein-esque contraptions on their knees for this type of condition.
But here’s where I need to reveal a deep truth: Dogs are not humans. Humans are bipeds, walking on two legs. Dogs are quadrupeds, walking on all 4 legs.
I still remember one of my favorite clients, Woody, balking at the use of the term quadruped—which means four-footed. I had referred to his dog Jenny as a quadruped while acupuncturing her hips. Woody patted Jenny on the head with concern and said to her, “Did you hear that, Jenny? She called you a quadruped.” I assure you this is a G-rated blog, and it’s important to note the quadruped/biped distinction, especially when it comes to understanding dog knee braces.
2. Considering a dog’s anatomy
While human anatomy lends itself to a knee brace, a dog’s anatomy does not.
Braces can work well for humans because they mimic the function of the ACL by preventing internal rotation and hyperextension. Dogs are not designed the same.
Also, humans mostly use our ACLs when flexing our knees into the “crouch” position, for example, while playing sports or doing the limbo. However, canine knees are in this position whenever the dog is standing or gaiting—meaning much of the dog’s day is spent putting stress on his cranial cruciate ligaments.
Non-athletic individuals with a torn ACL can often avoid surgery with conservative treatment. By virtue of their quadruped status, dogs aren’t as lucky.
3. Gathering a research-based perspective
Little research has been conducted on the dog ACL brace.
Besides the anatomical issue, there’s another reason veterinarians aren’t quick to recommend these types of leg braces. Vets love to see the scientific studies that support the anecdotal claims, and there aren’t many studies on dog ACL braces. There is one study evaluating the Orthopets stifle custom brace in a computer-generated model. The results looked promising, but more research is definitely needed. To read the study, click here.
4. Consensus views from veterinary specialists and general practitioners on the dog ACL brace
So how do veterinarians feel about knee braces for dogs? Allow me to present the unofficial party lines:
The Veterinary Surgeon:
A cranial cruciate ligament (CCL) rupture is a surgical problem. Period. Especially if the injury is associated with a meniscal tear, which 50-75% of them are. Meniscal tears are terribly painful and leg braces can’t help those one bit.
Conservative management (which would include dog knee braces) of a torn ACL in dogs is a bad idea, especially for large dogs. Using a brace and expecting the knee joint to heal and return to normal function is just wishful thinking. The fastest and most effective way to help these dogs get back on their feet is surgery.”
The Rehab Practitioner:
Rehab can help a dog with a torn ACL more effectively than a brace can. And even if an owner elects for a brace, the dog should still have rehab.”
The General Practioner who is “pro brace”:
It’s a lot to ask of a client to cough up $5000 for a stifle (knee joint) surgery. I recommend this type of leg brace for clients who can’t afford surgery because some stability has to be better than nothing. I also recommend braces as an alternative to surgery for dogs who just aren’t good anesthesia/surgical candidates for whatever reason. I see decent results with dog knee braces in my practice. I think they improve quality of life for my patients.”
The General Practitioner who is “anti brace”:
In my experience, dog knee braces cost a lot and don’t produce results. I certainly wouldn’t waste time or money on anything less than a custom brace if the client insisted on getting one, but I’m not a fan.”
5. Sharing my own perspective on the dog ACL brace
Apparently, as veterinarians we’re not supposed to say, “This is what I would do if it were my own dog…” but I find myself saying this to my clients all the time. Here’s what I would do if my own dog ruptured his cruciate ligament:
As a veterinarian certified in both acupuncture and animal chiropractic, I don’t commonly send dogs off to surgery. I consider myself a very conservative practitioner. I am a huge believer in tincture of time and the body’s ability to heal itself. However, after two decades of caring for lame dogs, I am in the pro-surgery camp for cruciate tears.
Also, I wholeheartedly agree with the rehab practioners’ stance on rehabilitation as a more effective solution than a brace. Physical therapy is a valuable adjunct for treating ACL tears in dogs. In fact, there are several studies supporting the value of rehab for CCL treatment across the board—pre-op, post-op, and even no-op.
A dog’s unstable knee joint is arthritis waiting to happen.
It’s important to set expectations. Without surgery (even with bracing), dogs will never again be “good as new.” Knee braces are a “band-aid” solution. They are to be worn during periods of activity. But dogs can be active in the house spontaneously and whimsically. When the brace is off, the knee joint is unstable enough to develop arthritis, which is the serious long term complication from a torn ACL that we seek to minimize or even prevent. With surgery, dogs often return to full, unrestricted activity, and arthritic changes are expected to progress more slowly.
Related: Signs of Arthritis in Dogs
The case of Pete, a middle-aged Irish Setter
In 22 years of practice, I’ve only had one dog ever get a custom brace, at his owner’s insistence. His name was Pete, and he was a middle-aged Irish Setter. After I diagnosed his torn ACL, his mom brought me five pages stapled together of instructions for measuring for a good fit. We measured Pete and he received his brace shortly thereafter. It looked solid and well constructed. It had not been cheap and, holding it in my hands, I understood why. I continued to care for Pete for many years after he joined the knee brace club, and I have to confess, although my “n” was only one, I was not impressed.
He had the right kind of owner to make the leg brace a success; she was meticulous. And because his mom was very conscientious about using it properly, I don’t think it caused him any harm, but my observation was that it did not improve his lameness.
Arthritis set in and became progressive and painful in that knee over the subsequent years.
My secret weapon for treating dog ACL tears
I do, however, have a secret weapon for treating cranial cruciate ligament (CCL) tears that functions as a different type of stifle (knee joint) brace for dogs. Let me explain how:
Did you know that ligament-related stifle problems occur in horses too? How do we stabilize the stifle in horses? One of the things we do is apply horseshoes.
We can apply “horseshoes” to dogs too. They aren’t called “dogshoes”, they are called ToeGrips® dog nail grips. Whether or not the dog has a surgical repair, ToeGrips® provide improved traction and stability to the hind legs.
Alison says it better than I could:
Our Yellow Lab, Cali is 13 and thriving. In her lifetime she has had 2 ACL surgeries on both of her back legs and arthritis has tried to slow her down just a bit… but these ToeGrips have given Cali a newfound confidence on slippery surfaces around the house and have helped maintain her footing in the company of our 1-year-old playful Golden Retriever puppy, Zoey.
Before ToeGrips we were trying everything to help build up her confidence —laying rugs samples all over the kitchen and hardwood floors, trying under the belly harnesses etc. ToeGrips were a game-changer for us. Immediately after putting them on, it was like seeing a different dog. She doesn’t even know they are on and she looks fabulous wearing them!
We can’t thank you enough for making a product that has brought so much joy to my dog in her golden years!”~Allison
6. Sharing my colleagues’ experiences fitting dogs with ACL braces
Dr. Tanis Walker, DVM—my friend and colleague—has fit three dogs with custom stifle braces with varying success. She has graciously allowed me to share her point of view and her photos with you.
I educated the owners on the downsides of stifle braces versus having stifle surgery performed (which is like having a 24/7 internal brace), but the owners were concerned their dogs would not do well for either the surgery or prolonged rehab period, so we moved forward with fitting the dogs for the braces. The first stifle brace we did was GREAT (dog pictured in photo below). The second two dogs had a lot of fit issues despite multiple casts and remeasures for adjustments. They only work when the dogs wear them (obviously) and you aren’t supposed to leave them on an unattended dog, so how much do they really help? I don’t know. They were fun to do but also stressful—they are $1200-1500 and if you get the measurements wrong…ugh.”
~Dr. Tanis Walker, DVM
Veterinarian and rehab practitioner, Dr. Mandi Blackwelder, graciously shared this perspective:
As a rehab practitioner, I agree that it is a surgical disease. 99% of the time that is my preference. However, there are many dogs that surgery is just plain not a good idea — for example dogs >14 or dogs with heart disease. Here are some points about stifle braces — and my N is somewhere around 100.
1. It HAS to be a custom brace with the cast done by a PROFESSIONAL. Many companies will send owners the casting material. I, too, am a vet of 22 years and I can tell you that it took me MANY years to feel proficient with casts in general AND another 2 or 3 of casting for braces to have the skill to make a consistent cast that reflects the pet’s anatomy enough for a proper fitting brace.
2. It has to have data that it minimizes cranial tibial thrust. No data = No dice. If it is not helping CTT, then it is a painful weight on the dog’s leg.
3. The owner needs to be prepared for it to potential require many adjustments and appointments — even with good casting, how the dogs bears weight will determine if areas will rub or not. A proper practitioner or company will work through these with the owner with a grace period after obtaining the brace.
4. It has to have proper suspension to hold it on the leg in the right place. For example, a pit bull has a leg that is narrow at the bottom and big at the top. This dog MUST have a component on the metatarsal region in order to have it not slide down the leg — if it slides it is a big painful weight.
5. It is NEVER, EVER a “cheap” alternative to surgery. In my practice a stifle brace starts with a consultation to make sure the patient and the owner are a proper fit for a brace ($250), casting ($300), the brace is $1200-$1600, plus rehabilitation ($600). So yes, you are within $1000 of TPLO when all is said and done. So in general, surgery is indeed the way.
Fear of anesthesia is not a good reason to not consider TPLO and proper education about screening and monitoring often help with that, plus in cities, there is often a traveling anesthesiologist who can be called in. BUT in those cases that surgery is a bad idea, it is a good option with the proper practitioner, proper device, and proper expectations.”~ Dr. Mandi Blackwelder, DVM
Making an informed decision in partnership with your vet
Ultimately, our job as veterinarians is to provide you information so that you can make an informed choice. With that in mind, I close with the Dog ACL Brace Pros-Cons List as a springboard discussion with your veterinarian:
Dog ACL brace cons:
- Cumbersome to put on and keep on
- Potential to slip and rub the skin
- Predisposes to skin disease (One study reported almost half of dogs who wear braces suffer from skin problems related to the brace)
- The dog will still limp while wearing the brace (for some period of time)
- Relatively expensive ($1000+)
- Doesn’t relieve pain, especially if a meniscal tear is involved
- Needs to be worn long term (possibly for life)
- Possibility of incurring an additional cost for a replacement brace if worn long term
- May put more stress on the opposite hind leg, increasing the chance of injuring that leg
Dog ACL brace pros:
- Cheaper than surgery
- A DIY option for helping your dog
- Provides joint support for dogs whose owner declines surgery
If you choose “to brace…”
If you’ve read this litany and choose to pursue the knee brace option, I do not judge! Especially if you have an older, less active dog or a smaller dog. I understand that surgery is expensive, and physically and emotionally demanding.
But I draw the line here: if you elect to go with a dog ACL brace, please choose the custom brace—one that is measured and fit for your dog.
Here’s a list of reputable companies that manufacture and sell custom braces:
If you choose “not to brace…”
I encourage you to read the flip side of this blog post and learn how I WOULD script a torn ACL in the happy-ending story of Bailey the Labrador: Torn ACL in Dogs: From Diagnosis to Recovery.
Finally, wherever you land on the “to brace or not to brace” issue, please work closely with your veterinarian on the decision. By building a trusting relationship with your vet and sharing your questions and concerns, you’ll be a team that champions the common goal—giving your beloved dog the healthiest, happiest life possible.
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