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:

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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.

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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.

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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.

Simitri Stable in Stride® Four weeks post-op

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 Veterinarians can also contact New Generation Devices for more information about the Simitri implant.

53 thoughts on “New Emerging Treatment: Simitri Stable in Stride

  1. 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

    1. 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.

    2. Hi, Dr. Embleton.

      I’m so glad to hear that veterinarians in Ohio are performing this procedure. However, I’m having difficulty locating one. If you could provide me with a Veterinary Practice performing the procedure, I would be very grateful. My husky had TPLO surgery a year in a half ago on her right hind leg and ruptured her CrCL in her other hind leg about a year later. She is 7 1/2 and experienced some health issues when she contracted a very rare infection last November. I don’t want to put her through another invasive surgery that includes osteotomy. I thought your procedure may provide an option for her to have surgery and improve her quality of life. We feel helpless and want to help her in any way that we can. Thank you!

    3. Hi Dr. Neil

      I was wondering if you could send me the clinic in Ohio? Or if you know of someone in Wisconsin, IL, Iowa or MN?

  2. 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.

  3. 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

  4. 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..

  5. 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.

  6. 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.

  7. 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

  8. Hi,

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

    1. 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

  9. 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 and i will pass along his contact information.
    Kind regards,
    Dr. Neil Embleton

  10. 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!

    1. 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

  11. 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

  12. 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

  13. 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?

    1. 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.

      1. 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

  14. 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

  15. 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

    1. 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,

  16. 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.

  17. 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,

  18. 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

  19. 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,

    1. I’m also in Orange County. Did you ever find any local surgeons who can perform this procedure? And if so, was the price comparable to TPLO surgery if you know?

  20. 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.

  21. 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.


    Christopher Brisson

  22. Hi Dr Embleton,

    Anyone in Minnesota, Wisconsin or surrounding states doing this repair to your knowledge? Heck I’d even consider driving up to Canada possibly.


      1. Hey Dr. Neil

        I asked this same question in an email that was sent to your address.
        I haven’t heard back either. I know a few surgeons that would be interested.
        The UW Animal Clinic sounded interested when I talked to them. Also, if there is someone trained in Wisconsin or Minnesota, please let me know asap. My dog is scheduled for this Friday for TTA and don’t prefer it. I’d like to find someone so I can cancel it.

        Any help would be appreciated. Thank you!

  23. I live in Orange County, California. I was wondering if anybody has found a surgeon in the area? Also, how comparable is the cost to TPLO surgery?

  24. My 8 year old golden retriever has a torn ACL and is recommended TPLO surgery. We are in San Diego, CA. I’ve asked local surgeons at the best Veterinary hospitals about your surgery with no success. I have an appointment May 8th and will ask Dr. Pike at Veterinary Specialty Hospital if he would consider doing this surgery, however I prefer not to have my dog be a guinea pig.

    Do you have any doctors in Southern California (San Diego, Orange County, Los Angeles) that have performed this surgery? I much prefer this surgery to cutting the bone!

    Thank You
    Nancy Spiker

  25. Probably been asked but where in Canada can this be done
    We just adopted a hand me down beauty of a black lab pup and today we took him for a vet check after I had concerns about the way he was standing both his knees are shot at just a year old..
    We have gotten about 15 lbs off of him already so weight isn’t so much of an issue now

  26. Are implants now available for dogs >37.5 kg (82.5lbs)? Our dog is approx 100lbs. Also, are there any veterinarians in Michigan doing this procedure? I will be taking our dog to Michigan State Univ Veterinary School for an evaluation next week

    Thank you.

  27. I live in West Kelowna and I wondered if there were any vets in the Okanagan that do this surgery and what the cost is. Thanks

  28. My 84 pound dog, Maggie, is scheduled for CBLO surgery in two weeks… however, it seems that at a young age of less than 3 years old, she will wind up having arthritis and other problems in this knee years after surgery.
    There were x-rays, and a cat scan, showing the CCL (ACL) is “gone”… she was a foster that we adopted, and she had previous trauma on her thigh bone, which had NOT been set or fixed..when we fostered her, she was running on 3 legs, then had surgery on an old paw/broken/fused bones/ healed wrong injury on her “ring finger” digit. After fixing her paw thru surgery, she was “clicking” while walking (we thought it was the hip – our orthopedic vet found it was not the hip but the CCL). How does a CBLO procedure work on a 3 year old dog, for long term prognosis, versus this new Simitri Stable in Stride product for such a large dog? We live in Austin, Tx and are 3 hours from Houston ( Dr MIke McFadden). She is a Bloodhound/German Shepard mix. Thank you,
    Sue Stilwell

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