Paladin™ – information for veterinarians

About Paladin^TM

Paladin^TM is a prospective multi-centre study involving canine patients with cranial cruciate ligament tears.

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Fitting and Adjustments

The Paladin^TM brace is designed to be customized to each individual patient for the best fit. The neoprene liners (main and front) will need to be trimmed, and heat adjustments for pressure relief, brace height/length customization, etc. may be needed to achieve a comfortable and functional fit.

A heat gun can be used to heat the Woodcast material for adjustment, and cold spray can be used to cool the brace down once the adjustments have been made. A blow dryer and cold water can be used for adjustments as well, it just may take a little longer to heat up and cool down. Please refer to the videos under the Study documents & Instructional videos tab above for more information.

Why is this study needed?

Canine cranial cruciate ligament (CCL) injury is the most common orthopedic pathology for dogs. Its effects are detrimental to the pet’s quality of life.

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. There should be more evidence on optimal non-surgical management of CCL tears to help more pets recover their quality of life.  

Doesn’t the evidence show that surgery is the only effective option for CCL injuries?

We are not aware of high quality evidence proving the superiority of CCL surgery over conservative treatment, especially for all dogs.

The consensus that conservative treatment doesn’t work (including dogs under 15 kg) rests solely on two observational studies from 1972 and 1984. In these studies, dogs weighing less than 15 kgs achieved great outcomes with conservative treatment.

What’s the scientific background for this?

We are aware of only one RCT comparing surgery to conservative treatment for CCL rupture.  

One randomized trial from 2013 compared nonsurgical treatment (painkillers + weight loss + rehabilitation) to TPLO. The authors report that there was no significant difference between investigator-assigned lameness and pain scores at any time during the 12-month study (exact numbers not reported) ​(1)​. According to an arbitrary definition of “successful outcome”, more than two thirds of the dogs in both groups had a successful outcome at one year (64% vs 75%, in slight favor of surgical treatment).

How would 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.  

Contrary to common belief, the lateral suture technique is not designed to be a permanent cure. The suture will loosen or break with time, but as long as it stays in place for 8-12 weeks, periarticular fibrosis will have had time to develop around the knee, thereby stabilizing the joint.  

By applying the exact same principles, using an external device that provides temporary support until the periarticular fibrosis has developed could lead to similar outcomes. External devices are generally considered safer than surgery, as complications and failure rates are commonly lower.

What are the objectives of this study?

Can a combination of external support, rehabilitation therapy, and pain medication achieve good outcomes for non-surgically treated patients with CCL rupture?

The aim of this study is to get a baseline understanding for the clinical outcomes of conservatively managed cranial cruciate ligament injuries at 12 months.

The primary outcome of the study is the change in owner-assessed lameness score on a validated 5-point scale at 12 months. Secondary outcomes include quality of life, lameness at earlier timepoints, and re-injury rates.

Where are we now?

We are actively recruiting patients for the Paladin^TM brace study!

How to get involved

• Candidates for the Paladin^TM treatment will present with cranial cruciate ligament deficiency and should ideally not weigh more than 75 pounds.
• Joint health issues and comorbidities should be taken into account when deciding to enroll a patient, and should be included in the Baseline Survey, but these will not exclude your patient from participating in the study.
• Concurrent treatments are allowed during the Paladin^TM treatment.
• Any stage of CrCL diagnosis is eligible to participate in the study.
• There is no limit to the number of patients in a household that can participate in the study, and multiple patients from one household can participate simultaneously.
• You will not receive compensation for your participation in the study, but we encourage you to charge for all of your valuable time.
• We will email a baseline survey to the client’s email when the order is placed. This survey should be filled out by the owner and veterinarian at the time of the initial fitting.
• We will then reach out to the owner with surveys at two weeks after fitting and at the end of the two month treatment.  
  
• During the study, the brace is provided at a reduced cost*, contingent on responses for all three required surveys (baseline, two-week, and two-month follow-up)**.

‍         _*$200

         _{**Please be advised there will be an additional shipping cost of $60 if we are shipping the brace internationally, or $55 if we are shipping to Alaska or Hawaii} 

• If we do not receive responses to any one of these three surveys within 4 months of the ship date, the credit card provided will be billed for the remaining cost of the Paladin^TM brace ($300).  

       _{Total brace cost during the study: $500}

If you’d like to refer a patient or have any questions, please contact us or enroll directly using our Enroll Now form.

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​​1. Wucherer KL, Conzemius MG, Evans R, Wilke VL. Short-term and long-term outcomes for overweight dogs with cranial cruciate ligament rupture treated surgically or nonsurgically. JAVMA. 2013;242(10):1364–72.  

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