Treatment of canine cranial cruciate ligament disease

Summary

Objective: To describe veterinarians’ treatment recommendations and decision-making factors for dogs with cranial cruciate ligament disease (CCLD).

Methods: An online survey of American College of Veterinary Surgeons (ACVS)-Diplomates (surgeon group) and primary care veterinarians (practitioner group) was performed. The survey included questions on treatment recommendations for common case scenarios (small or large breed dog with complete or partial CCLD), treatment decision factors, non-surgical treatment options, and actual treatment, if any, provided for a client-owned dog as well as one owned by their family or close friend.

Results: The response rate was 42% for the surgeon group (n = 305/723) and four percent for the practitioner group (n = 1145/ 27,771). Extracapsular stabilization (ES) was the most common treatment recommendation for CCLD in small (9.1 kg) breed dogs amongst surgeons and practitioners. Tibial plateau levelling osteotomy (TPLO) was the most common treatment recommendation for CCLD in large (27.2 kg) breed dogs amongst both groups. The two most important treatment decision factors were dog size (78% of practitioners, 69% of surgeons) and activity level (63% of practitioners, 52% of surgeons). The most common treatment provided for a dog of their own or close relation in the surgeon group was TPLO (64%) followed by ES (15%), whereas in the practitioner group it was ES (38%) followed by TPLO (30%).

Clinical significance: Extracapsular stabilization and TPLO are the most commonly employed surgical procedures in the surveyed population; dog size and activity level (but not age) are the major factors influencing treatment decisions.

Keywords

Cranial cruciate disease - tibial plateau levelling osteotomy - TPLO - extracapsular stabilization - online survey

• References

• 1 Witsberger TH, Villamil JA, Schultz LG. et al. Prevalence of and risk factors for hip dysplasia and cranial cruciate ligament deficiency in dogs. J Am Vet Med Assoc 2008; 232: 1818-1824
• 2 Wilke VL, Robinson DA, Evans RB. et al. Estimate of the annual economic impact of treatment of cranial cruciate ligament injury in dogs in the United States. J Am Vet Med Assoc 2005; 227: 1604-1607
• 3 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22
• 4 de Medeiros M, Sanchez Bustinduy M, Radke H. et al. Early kinematic outcome after treatment of cranial cruciate ligament rupture by tibial plateau levelling osteotomy in the dog. Vet Comp Orthop Traumatol 2011; 24: 178-184
• 5 Chauvet AE, Johnson AL, Pijanowski GJ. et al. Evaluation of fibular head transposition, lateral fabellar suture, and conservative treatment of cranial cruciate ligament rupture in large dogs: a retrospective study. J Am Anim Hosp Assoc 1996; 32: 247-255
• 6 Vasseur PB. Clinical results following nonoperative management for rupture of the cranial cruciate ligament in dogs. Vet Surg 1984; 13: 243-246
• 7 Comerford E, Forster K, Gorton K. et al. Management of cranial cruciate ligament rupture in small dogs: A questionnaire study. Vet Comp Orthop Traumtol 2013; 26: 493-497
• 8 Wucherer KL, Conzemius MG, Evans R. et al. Short-term and long-term outcomes for overweight dogs with cranial cruciate ligament rupture treated surgically or nonsurgically. J Am Vet Med Assoc 2013; 242: 1364-1372
• 9 Nelson SA, Krotscheck U, Rawlinson J. et al. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. Vet Surg 2013; 42: 38-50
• 10 Gordon-Evans WJ, Griffon DJ, Bubb C. et al. Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. J Am Vet Med Assoc 2013; 243: 675-680
• 11 Christopher SA, Beetem J, Cook JL. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Vet Surg 2013; 42: 329-334
• 12 Kim SE, Pozzi A, Kowaleski MP. et al. Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. Vet Surg 2008; 37: 111-125
• 13 Monk ML, Preston CA, McGowan CM. Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament. Am J Vet Res 2006; 67: 529-536
• 14 Gatineau M, Dupuis J, Plante J. et al. Retrospective study of 476 tibial plateau levelling osteotomy procedures. Rate of subsequent ‘pivot shift', meniscal tear and other complications. Vet Comp Orthop Traumatol 2011; 24: 333-341
• 15 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39: 460-474
• 16 Hulse D, Beale B, Kerwin S. Second look arthroscopic findings after tibial plateau leveling osteotomy. Vet Surg 2010; 39: 350-354
• 17 Delincé P, Ghafil D. Anterior cruciate ligament tears: conservative or surgical treatment? A critical review of the literature. Knee Surg Sports Traumatol Arthrosc 2012; 20: 48-61
• 18 Pond MJ, Campbell JR. The canine stifle joint. I. Rupture of the anterior cruciate ligament. An assessment of conservative and surgical treatment. J Small Anim Pract 1972; 13: 1-10
• 19 Au KK, Gordon-Evans WJ, Dunning D. et al. Comparison of short- and long-term function and radiographic osteoarthrosis in dogs after postoperative physical rehabilitation and tibial plateau leveling osteotomy or lateral fabellar suture stabilization. Vet Surg 2010; 39: 173-180
• 20 Gordon-Evans WJ, Dunning D, Johnson AL. et al. Effect of the use of carprofen in dogs undergoing intense rehabilitation after lateral fabellar suture stabilization. J Am Vet Med Assoc 2011; 239: 75-80
• 21 Vandeweerd JM, Coisnon C, Clegg P. et al. Systematic review of efficacy of nutraceuticals to alleviate clinical signs of osteoarthritis. J Vet Intern Med 2012; 26: 448-456
• 22 Aragon CL, Hofmeister EH, Budsberg SC. Systematic review of clinical trials of treatments for osteoarthritis in dogs. J Am Vet Med Assoc 2007; 230: 514-521
• 23 Kim SE, Lewis DD, Pozzi A. Effect of tibial plateau leveling osteotomy on femorotibial subluxation: in vivo analysis during standing. Vet Surg 2012; 41: 465-470
• 24 Lampman TJ, Lund EM, Lipowitz AJ. Cranial cruciate disease: current status of diagnosis, surgery, and risk for disease. Vet Comp Orthop Traumatol 2003; 16: 122-126
• 25 American College of Veterinary Surgeons. ACVS Strategic Plan: Results from a Survey of the Diplomates on Topics of Importance to the College [document on internet]. ACVS: American College of Veterinary Surgeons; 2010 September [Cited on 2013 September 12]. Available from https://www.acvs.org/diplomates/members/topics-important-results
• 26 American College of Veterinary Surgeons. Diplomate Demographics [website]. ACVS: American College of Veterinary Surgeons; 2014 [Cited on 2013 September 12]. Available from https://www.acvs.org/diplomate-demographics
• 27 American Veterinary Medical Association. 2013 U.S. Veterinary Workforce Study: Modeling Capacity Utilization [document on internet]. AVMA: American Veterinary Medical Association; 2013 April 16 [Cited on 2013 September 12]. Available from https://www.avma.org/KB/Resources/Reports/Documents/Veterinarian-Workforce-Final-Report-LowRes.pdf