To brace or not to brace?

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.

It matters.

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.