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New Emerging Treatment: Simitri Stable in Stride

An exciting new surgical option has been developed for treatment of canine cruciate injuries. It is called Simitri Stable in Stride®, invented by Dr. Neil Embleton and Dr. Veronica Barkowski in Alberta, Canada.

Dr. Embleton has almost 30 years of experience in treating canine cruciate injuries and has performed at least six thousand repairs, conservatively. He is certified in AO/ASIF techniques, spinal surgery, arthroscopy, TPLO, and total hip replacement. After performing close to 2,500 TPLO surgeries, Dr. Embleton started to question the goal of geometry-modifying procedures. “I began to think about what the role of the cranial cruciate ligament was and how we could reproduce its function and maintain joint biomechanics in as least an invasive method as possible. That process began 6 years ago. The result was the Simitri Stable in Stride® implant,” he said.

Simitri Stable in Stride® is a three-part, modular stifle (knee) stabilizing implant. It is designed to provide continuous translational and rotational stability while minimally affecting stifle kinematics and biomechanics. It is this symmetry between the two main objectives of cruciate repair techniques–stability and kinematics–from which the name Simitri is derived. Other surgical procedures would often result in one objective or the other, but never both. Simitri has changed that. No osteotomy (cutting bone) is performed and joint architecture is preserved. The implant is made with surgical grade stainless steel femoral and tibial plates and an ultra high molecular weight polyethylene (UHMWPE) sliding articulating insert. Dr. Embleton explains in detail how it works in this interview with Dawg Business:

emerging treatment

A=femoral plate, B=tibial plate, C=articular insert

“The femoral plate has a ball and stem which interconnects with the tibial plate via an 8 mm travel channel within the articulating insert. The implant is attached to the medial (inner) side of both the femur (thigh) and tibia (shin) using six cortical locking screws. The implant does not go into the joint and, no bones or muscles are cut during the procedure making it a less invasive option.

Joint biomechanics (function) are not significantly altered during the procedure. Once implanted it provides immediate and continuous translational and rotational stability while allowing the joint the freedom to flex, extend, compress, expand and move side to side in as normal a manner as possible.”

Dr. Embleton and Dr. Barkowski focused on evidence-based results as much as possible during the development process. “Implant design engineering was done using CT scans and CAD software, the implant design was tested and refined using 3D computer modelling and biomechanical testing. Finally, cadaver work was used to establish the surgical procedure before going anywhere near a live patient,” Dr. Embleton said.

Dr. Barkowski has been practicing veterinary medicine for nearly 30 years as well. While her main area of expertise now is soft tissue surgery, she was instrumental in the development of the Simitri implant and the surgical technique, said Dr. Embleton. She was especially involved with developing the method used to accurately position the implant during surgery based on measurements obtained from the preoperative radiographs.

While it is difficult to compare Simitri with other existing surgical procedures due to such stark differences in technique, results from Simitri clinical trials are promising. So far these trials have shown that after Simitri surgery, dogs regain normal range of motion, which has not been shown in studies of any of the current procedures.

emerging treatment

Postoperative lateral view

The initial study of the first 66 Simitri cases indicated very similar complication values compared to what is currently reported for TPLO and TTA surgeries; however, the types of complications encountered were significantly different and generally less serious than TPLO or TTA, Dr. Embleton said. Because Simitri is less invasive than other procedures, osteotomy-related complications (eg. higher rates of infection) are nonexistent. Minor complications such as incision site breakdown, swelling, and bleeding can be expected to occur at similar rates after any procedure.

Simitri is designed to provide stability in the knees immediately after surgery and remain stable throughout the entire phase of stride (both weight bearing and non-weight bearing), unlike other surgeries. With TPLO and TTA, for example, the knee is purported to be “dynamically stable,” which means it is stable during only the weight bearing phase of stride. The full stability in Simitri knees may protect the joint from further damage, especially to the menisci (cartilages). “To date we have not seen any dogs develop clinical signs of meniscal tears after Simitri surgery,” Dr. Embleton said.

emerging treatment

Postoperative AP view

After 175 cases of Simitri surgery performed by Dr. Embleton, there has yet to be a documented case of postoperative infection. Rejection of the implant is also unlikely as both surgical grade stainless steel plates and the UHMWPE are both highly biocompatible.

Although dependent on age, breed, degree of preexisting disease or injury, and rehabilitation effort by the owners, most Simitri dogs return to their preoperative activity level within four months. Ideal rehabilitation includes controlled exercise, massage, and passive range of motion exercises, all of which are designed to strengthen the hind end and increase ROM of the ankle, knee, and hip. Because there is no cutting of bone or muscle during the procedure, postoperative restrictions are not as onerous, said Dr. Embleton.

Simitri is an option for any dog (without neoplasia or a known infection) that fits the currently available implants, which fit most dogs between 44 and 79 lbs (20-36 kg). A smaller design is also available that should allow dogs as small as 22 lbs (10 kg) to be treated. Implants for dogs larger than 80 lbs are currently in the design process and will hopefully be available by the end of this year. Simitri is an option for dogs of any age as well. In fact, “Simitri is ideal for older patients,” Dr. Embleton said. “Our oldest patient treated to date was 14 years old. He was walking within 24 hours of surgery.” The longest cases of Simitri knees have been out for over three years now.

As far as geographic availability is concerned, there are several vets in both Canada and the U.S. who are now performing Simitri surgery. Dr. Embleton and Dr. Barkowski hope that Simitri will become more widely available as awareness and knowledge of the procedure grows in the veterinary world. “We now have pre-surgical planning guides and a step-by-step surgical guide to assist surgeons in performing the procedure. We are also considering offering wet labs and I am willing to help any veterinarian at any time,” Dr. Embleton said. The implant itself is manufactured in the U.S. and is available worldwide.

Four weeks post-op

 
There is still a long way to go in the evolution of canine cruciate injury repair techniques, but Dr. Embleton is optimistic about the future. “This may sound strange coming from a surgeon, but my hope is that one day we can use nonsurgical means to treat, or better yet to prevent, cruciate ligament disease,” he said. While it will probably be many years before that option is available, he believes that immediate stability throughout the stride is the key to success in cruciate surgery. “I don’t know if the Simitri implant is the answer that we have been looking for, or just the direction we should be following. I do know this: we now have a new way to look at an old disease.”

Dr. Embleton would be happy to hear from dog owners and their veterinarians. For questions or more information, you may contact him directly at stifle.simitri@gmail.com. Veterinarians can also contact New Generation Devices for more information about the Simitri implant.

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37 Responses to New Emerging Treatment: Simitri Stable in Stride

  1. Melanie April 18, 2016 at 1:54 pm #

    Who/where are the vets in the US that are performing this?

  2. Neil Embleton April 23, 2016 at 8:09 am #

    Hi Melanie,
    We currently have veterinarians in Ohio, NY, California, and Texas performing the procedure. We would be more than happy to help any veterinarian learn the procedure.
    Please talk to your vet clinic. And they either contact me directly, or New Generation Devices. We having procedure learning tools that are available on line.
    Kind regards,
    Dr. Neil Embleton

    • Diane Huber December 30, 2016 at 2:47 pm #

      Hello Dr. Embleton, My name is Diane Huber, I live in Oregon and I am very interested in the stifle Simitri stable surgery. My dog is a 70lb. Labradoodle 6 year old female named Madison. My vet thinks she has a particle tear. She can walk and loves to run but if she does she pays that evening. As she than nobbles and finds it difficult to get up from laying position. She also sits with her leg to the side. We have been conservative with her but she cannot do much as it is. I am wondering if you are still practicing and if so where? Or if you could recommend someone in Oregon or Washington. I am near Portland area. But would prefer an experienced Dr. In this method.
      Thank you for taking your time and care.

  3. Carly May 7, 2016 at 9:12 pm #

    I believe my dog may be getting this surgery soon at WCVM however now that I read this article it states there isn’t a implant big enough for him (he’s 117lbs). Is there a large implant already on the market…as now I’m worried! He’s been through so much already.

  4. Dr. Neil May 9, 2016 at 1:31 pm #

    Hi Carly,
    It might be best for you or better yet, your veterinarian to contact me directly. The currently available implant is designed for patients with a maximum of 37.5 kg (82.5 lb).
    Dr. Neil
    Stifle.simitri@gmail.com

  5. Cinda B June 13, 2016 at 11:19 am #

    Where in NY ? I am in Ct and sadly it appears no vets are familiar with this procedure

  6. Clyde Stratman August 30, 2016 at 9:23 am #

    Hello..My dog Buddy, by xray showed acl/tplo injury. The veterinarian missed reading the xrays right so after almost a year of pills etc. I am now faced with the knee injury to repair by tplo or just rehab. I have contacted the CSU Ft. Collins vet hospital and scheduled with them for surgery but remain skeptical. It is scheduled for Sept. 8, 2016, but I think I will re-schedule for up to a month to provide myself with more time for research..I do so hope you can be of assistance. I am poor so I have been selling everything to fund the problem and cure. I am faced with home rehab or procedure.. I recently was told about orthopedic lateral post technique that was said to be good.?? other choices would be a large and deep animal stock tank with heater for daily swimming, massages, walking, etc. I know I would need some training for this so I did things right, not causing more problems. I can not afford to do both, procedure vs. rehab. Buddy is 8 yrs old and weighs 95 lbs. so I am sure I could get him to the correct weight with proper diet, swimming, supplements etc. Please help me with advice if You will. I would be willing to call you if that is an option..Also I have looked into braces and know I would want Buddy properly measured and fitted and seem to feel that a “double knee brace ” seems best to me for equal support. I didn’t mention that it was Buddys left knee. Thank you so very much in advance for helping me..

  7. Linda Meyer October 31, 2016 at 7:14 pm #

    I have a 100 lb. Dobe with a torn curvature. We are on our 4th opinion. To operate or not….arguments for various operations and reader shares of success of out come not to…just rest. My choices for both is not encouraging. We have a long time vet (both large and small animals). He also raises race horses. He has a procedure that would create scar tissue in the joint (both). I would appreciate your opinion.

  8. Cheryl Stitzer January 5, 2017 at 10:55 pm #

    I am interested in knowing if this has been developed yet for large breed dogs. Just had my Great Dane diagnosed and I don’t feel comfortable with the other options as I research the low rate of recovery long term and no guarantee of a positive outcome.

  9. Dr. Neil Embleton January 6, 2017 at 12:59 pm #

    Hi Cheryl, I believe the larger sized implants are in development. The process is much slower than i would have liked. The best thing you can do to push this process along more quickly is to contact your veterinarian and ask them to contact the company (New Generation Devices) and ask questions. I hope that helps. Neil

    • Cheryl Stitzer January 6, 2017 at 7:02 pm #

      Thank you!

  10. Meridith Bush January 7, 2017 at 2:18 pm #

    Hi,

    Could you give me the name of the closest veterinary surgeon to Atlanta who is currently performing this surgery?

    • Dr. Neil Embleton January 9, 2017 at 4:03 pm #

      Hi Meredith,
      I have sent an email, on your behalf, to a Dr. Lockwood in Atlanta. i’ll let you know what she says.
      Dr. Neil Embleton

  11. Meridith Bush January 9, 2017 at 4:07 pm #

    Thank you!

  12. Dr. Neil Embleton January 11, 2017 at 3:20 pm #

    Hi Meredith,
    A Dr. Sam Franklin from the Veterinary Medical Centre at the University of Georgia has asked that you contact him directly. Please send me an email at stifle.simitri @gmail.com and i will pass along his contact information.
    Kind regards,
    Dr. Neil Embleton

  13. Adi Dimov January 11, 2017 at 5:18 pm #

    Hello Dr. Embleton,
    I am living in Alabama but am willing to drive to have this surgery for my dog. I have family in Colorado and Kansas but can drive elsewhere as well. Please let me know if there are any veterinarians in the states performing this procedure. Thank you so much!

    • Dr. Neil Embleton January 13, 2017 at 4:15 pm #

      Hi Adi,
      A Dr. Todd Yeagely, in Tulsa, Oklahoma is performing Simitri procedures and I am sure he would be happy to help. A Dr Gary Old in Texarkana, Texas would be willing to help and there is a Dr. Sam Franklin in Geogia that would also be willing to help. Send me an email about your dog, (ie, age, breed, body weight, etc…) we will see if you pet is a candidate.
      Kind regards,
      Dr. Neil Embleton
      stifle.simitri@gmail.com

  14. shaun skinner January 12, 2017 at 3:52 pm #

    dr embleton,

    my dog shadow had a tightrope procedure about 5 months ago and so far we have had good results. she has torn her opposite ccl and we have been doing a nonsurgical approach because when she tore this one we didn’t feel like her surgical leg was ready so to support her the way it would have to. my questions are if CM fails later on, where are the vets in texas that perform this procedure? and what is the average cost of this procedure? i really like that in this procedure the bone and muscle are not cut, and the meniscus is protected. now this implant seems to be rather large, so what, if any, are the long term affects that people should look for if they choose this surgery option

  15. Dr. Neil Embleton January 13, 2017 at 4:07 pm #

    Hi Shaun,
    Sorry to hear of your dogs cruciate issues. In Texas, a Dr. Gary Old in Texarkana and a Dr. Mike McFadden in Houston are both willing to perform the Simitri procedure. Cost is similar to TPLO. The size of the implant hasn’t seemed to cause any concerns, short or long term to this point. The implant has been well tolerated by all patients and successfully used in Canada (no effect on cold temperatures), the USA and Australia.
    Hope that helps.
    Kind regards,
    Dr. Neil Embleton

  16. James January 13, 2017 at 8:27 pm #

    Who in New York does this procedure, and how can they be contacted?

  17. Mandy January 14, 2017 at 2:25 am #

    Hello Dr. Neil Embleton, I have a Newfoundland with a suspected ACL tear, we have a Orthopet leg brace but he is struggle to adjust to this. Is the larger implant available yet and do you have an surgeons in the UK that can perform this surgery?

    • Cheryl Stitzer January 15, 2017 at 10:38 am #

      Hi Mandy,
      I asked the same question. If you scroll up to Jan. 6th there is a reply. I also contacted the developer of the product and they said they hoped they would have had it on the market by now, but have run into delays. It is slated for the end of this year. We had been considering the brace as well, but our Dane actually has both legs with torn ligament and we’re afraid she would reject it. Would love to hold out until the implant comes along, but I’m afraid it will be too long. Hope things work out for you and your pet.

      • Mandy January 16, 2017 at 10:34 am #

        Hi Cheryl, thanks for the message. The brace is brilliant, but my newfie is taking ages settling into it and I want him to have a lease of live now. I will keep on with the brace and hope this product comes out soon. Wishing you all the best with your dane xx

  18. Pam Heiney January 15, 2017 at 4:52 pm #

    Hello Dr. Embleton.

    We have a 6.5 YO flat-coat (mix?) with a suspected ACL injury. We read the article in Bark on your Simitri Stable in Stride procedure and are very interested. Can you tell us if anyone in Las Vegas is doing this procedure?

    Thank you,
    Pam, Mike & Daisy

  19. Dr. Neil Embleton January 17, 2017 at 2:03 pm #

    Hi Pam,
    I’ve sent an email to a surgeon in LV. I’m currently out of the country with limited internet.
    I’ll advise as soon as I hear anything.
    Kind regards,
    Neil Embleton

    • Pam Heiney January 23, 2017 at 3:04 pm #

      Hello Dr. Embleton.

      Hope you are enjoying your travels.
      Thought I’d check in to see if there was any word from the LV surgeon yet.

      Thank you so much,
      Pam

  20. Dr. Neil Embleton January 25, 2017 at 4:04 am #

    Hi Pam,
    Unfortunately the specialists don’t want to help. Their concern is that the patients aren’t out far enough and they are concerned the implant won’t last. I did try to explain to them that extensive biomechanical testing was done but that didn’t seem to help. Changing their mindset has been a slow process. As owners, you have to be advocates for your pets. If Simitri Stable in Stride is the procedure you would like you need to insist on it. If you can find a clinic willing to do the procedure, I would be more than willing to help the surgeon in any way. Let me know what I can do to help.
    Neil

  21. Pam Heiney January 25, 2017 at 6:10 am #

    Thank you very much, Dr. Embleton. We truly appreciate the effort and will work to find local vets interested in utilizing your procedure. We will speak with our regular vet and encourage him to be an advocate, as well.

    Thank you again,
    Pam

  22. Dr. Neil Embleton January 25, 2017 at 4:08 pm #

    Hi Pam,
    I would be willing to come to LV and help any vet that needs help performing the procedure. All I ask is that my expenses be covered.
    Dr. Neil Embleton

  23. Pam Heiney January 26, 2017 at 3:52 pm #

    Wow. Thank you, Dr. Embleton.

    How can my vet contact you directly? Is e-mail best?

    Pam

    • Dr. Neil Embleton January 28, 2017 at 6:18 am #

      Yes, but to be clear I am willing to work with a vet that is willing to learn and perform the procedure. your task is to find that vet.
      Email : stifle.simitri@gmail.com
      Neil

  24. Lov Gotao January 26, 2017 at 7:12 pm #

    Hi Dr Embleton,

    I had contacted you a while back for my 2 year old golden doodle, 57 pounds, Do you now have any surgeons doing this method in Orange County, California? I had emailed the maker and have received no reply from them.

    Thank you,
    Lov

  25. Dr. Neil Embleton January 28, 2017 at 6:15 am #

    Hi Lov,
    That’s odd that they didn’t respond. I’m currently on vacation but I’ve sent an email to a surgeon in CA. I’ll advise once I’ve heard a response. In the meanwhile feel free to start asking vets if they will do the procedure (helps get the word out). I would be happy to help any vet wanting to learn the procedure.
    Neil

  26. christopher brisson February 20, 2017 at 4:21 pm #

    Hi Dr. Embleton–

    I live in Los Angeles. Which practices in this area have experience with the device? I have a 13 year old mixed breed (45 lb) who was diagnosed yesterday with an ACL tear and the Simitri Stable in Stride appeals to me as an option because there is no cutting of the bone required.

    Thanks–

    Christopher Brisson

  27. Neil February 23, 2017 at 5:10 am #

    Hi Chris,
    I’ve sent an email request for you. Give me a couple of days.
    Neil

  28. Neil emlbeton February 24, 2017 at 8:32 am #

    Hi Christopher
    Please send an email at stifle.simitri@gmail.com
    I have surgeon for you to contact
    Kind regards,
    Dr. Neil Embleton

Trackbacks/Pingbacks

  1. Simitri Success - Harley and Rudy - Dog Knee Surgery and Ligament Injuries - March 1, 2017

    […] with knee surgeries from past experiences with Crosby, and he told us about this new surgery, Simitri Stable in Stride surgery, by Dr. Neil Embleton.  Because our dog Harley was an extremely active dog, our vet knew […]

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