Join the cutting-edge research on nonsurgical treatment for CrCL injury
The Paladin™ project is a prospective multi-centre study involving canine patients with cranial cruciate ligament tears.
Study protocol
How the Paladin™ study works
How the Paladin™ brace works
Placing a tarsal brace to treat the most common orthopedic problem in dogs – the CrCL disease – may confuse many people but there is a significant clinical reasoning.
Does the research support conservative treatment?
Most veterinary surgeons will recommend surgical treatment as the primary treatment – but is this supported by evidence?
Q&A about the study
Why is this study needed?
Canine cranial cruciate ligament (CCL) injury is the most common orthopedic condition for dogs. Its effects are detrimental to the pet’s quality of life, often causing pain, limping, and lameness.
In the absence of quality evidence, the most common treatment decision is to perform surgery. Surgery, however, is not accessible for many pets or pet owners and carries substantial risks.
In the absence of quality evidence, the most common treatment decision is to perform surgery. Surgery, however, is not accessible for many pets or pet owners and carries substantial risks.
What’s the scientific background for this?
There are very few randomized controlled trials (which are considered the best evidence) comparing surgery to conservative treatment.
One randomized trial from 2013 compared nonsurgical treatment (painkillers + weight loss + rehabilitation) to the most common surgery for canine cruciate ligament (TPLO). There was no significant difference between investigator-assigned lameness and pain scores at any time during the 12-month study (exact numbers not reported).
One randomized trial from 2013 compared nonsurgical treatment (painkillers + weight loss + rehabilitation) to the most common surgery for canine cruciate ligament (TPLO). There was no significant difference between investigator-assigned lameness and pain scores at any time during the 12-month study (exact numbers not reported).
How can conservative treatment heal the ligament?
One of the most common surgical techniques to manage CCL tears is extracapsular lateral suture stabilization, where a fishing line-like suture is placed to stabilize the stifle joint. The suture will loosen or break with time, but as long as it stays in place for 8-12 weeks, the tissue will have had time to heal by developing scar tissue that stabilizes the joint enough to enable normal use of the limb.
Using the exact same principles, using an external device that provides temporary support until the periarticular fibrosis (scar tissue) has developed could lead to the same outcome. External devices are generally considered safer than surgery, and their failure rates are lower.
Using the exact same principles, using an external device that provides temporary support until the periarticular fibrosis (scar tissue) has developed could lead to the same outcome. External devices are generally considered safer than surgery, and their failure rates are lower.