Spectrum of care: Students get hands-on with alternative treatment for canine knee injuries

Students clustered around Flori Bliss, listening intently to the chief of small animal physical rehabilitation as she narrated her way through fitting a cast on a golden retriever.  

"How far up do we want it to go? What's the main thing we want to include in our cast?" Bliss called out. She pointed to the cast’s position on the dog 

"The stifle!" the students responded.  

Soon, it was the students' turn to practice casting. 

This lab is part of an elective on small animal physical rehabilitation at the Virginia-Maryland College of Veterinary Medicine. The purpose of the class is to introduce the students to a variety of therapeutic modalities, techniques, and alternative treatment methods to support patients with orthopedic and musculoskeletal diseases, and thanks to this education, veterinary students can offer a better spectrum of care for their future patients.  

The lab focused on stifle orthosis/braces, a treatment for canine cruciate ligament (CCL) injuries. A CCL injury is similar to an ACL injury in humans, and it’s the most common knee injury in dogs. A brace can’t repair a cruciate tear, but it can help reduce pain, build muscle, and offer a better quality of life. 

"Today, we’re learning about the importance of bracing and orthotics in veterinary medicine,” said Amanda Gabriel, a Class of 2025 veterinary student on the small animal track, after she practiced fitting a cast on a dog named Annie. “It's a new area that's been up-and-coming in the past 20 years and will change so much in the coming years, but it's amazing what they can do with animals in rehab and limiting their range of motion to improve their function,” 

CCL injuries are usually repaired through surgery, but for some dogs, the operating room isn’t an option. 

"If a patient isn't a good candidate for surgery, or if the owners can't afford surgery, this is an alternative method for treating a problem while reducing pain and discomfort in our patients,” explained Rebecca Persons, a clinical instructor at the Veterinary Teaching Hospital’s Small Animal Community Practice.  

There are many reasons why a dog may not be a good candidate for surgery—for example, if the dog had a heart condition that could make anesthesia dangerous. Recovery can also place a burden on owners, since dogs can take weeks to safely recover movement. 

For many owners, the cost alone is a massive barrier: they may have to pay $3,000 to $6,000 for their dog to regain full mobility and function in that limb. A custom-made orthosis can cost $200 to $1,000 dollars. 

The students practiced wrapping the cast material around dogs’ legs, a motion similar to wrapping a bandage. After the cast hardened, students removed it. The cast could then be used to create a custom brace for the dog, allowing the dog to move around without further damage to the ligaments. 

Why is it necessary to use a cast? When it comes to creating braces for dogs, getting the right fit is key. A one-size-fits-all approach to braces doesn’t work for dogs because they vary widely in size and conformation — it’s hard to imagine a brace that could fit a tiny Chihuahua, a tall Great Dane, a chunky pit bull, and a lanky greyhound. 

"If you don't get the casting correct and perfectly aligned, they can develop contact sores. If it's not fitting properly, the animal can reject it and just not walk on that leg, or have other complications,” said Persons.  

The spectrum of care is the concept that the “gold standard” of treatment doesn’t suit every case, and sometimes a different solution is needed. When these veterinary students graduate and enter practice, they will need flexibility and a variety of options to provide the best treatment for each pet and pet owner—and thanks to this lab, stifle braces are now part of their arsenal. 

The lab was conducted with the support of Hero Braces and began with an online lecture by Hero Braces veterinarian Paul Brummett the week before. All casting supplies for the lab were donated by the company.

Written by Sarah Boudreau M.F.A. '21, a writer with the Virginia-Maryland College of Veterinary Medicine