Does meniscal release confer similar clinical benefits to meniscal tear treatment when compared to meniscectomy?

Ben Garland

doi:10.18849/ve.v5i4.339

Abstract

PICO question In adult dogs with naturally occurring medial meniscal tears concurrent to cranial cruciate ligament disease does meniscal release confer the same benefits in lameness resolution as meniscectomy?  Clinical bottom line Category of research question Treatment The number and type of study designs reviewed A single prospective cross-sectional study was reviewed, that fulfilled the criteria Strength of evidence None Outcomes reported Meniscal release, meniscectomy (partial, hemi- or complete), or the two combined performed for concurrent medial meniscal pathology at time of surgery for naturally occurring cranial cruciate ligament (CCL) rupture resulted in an acceptable long-term outcome. Difference in outcome between the techniques was not reported Conclusion There is no evidence that meniscal release provides an equal or superior treatment option for medial meniscal injury treated at the time of surgery for CCL rupture when compared to meniscectomy. The study critically reviewed performed meniscal release via radial transection through the meniscotibial ligament, and therefore does not represent mid-body abaxial radial release. Neither is this summary appropriate for considering prophylactic meniscal release of the normal meniscus. In addition, the surgical treatments for cranial cruciate ligament rupture were either ‘Tightrope’ or tibial plateau levelling osteotomy (TPLO) procedures. Further studies are required to compare clinical outcome between meniscal release or meniscectomy for treatment of concurrent meniscal tears  How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care. 

Highlights

Summary of the evidencePopulation: Adult dogs with naturally occurring cranial cruciate ligament disease. Intervention details:
Of 223 cases, 160 (72%) had concurrent meniscal tear diagnosed at the time of inspection and stabilisation surgery
Given the commonality of cranial cruciate ligament disease in the canine population (Wilke et al, 2005) with reported rates of 10–77% concurrent meniscal tears (Cook & Pozzi, 2010), successful meniscal treatment via the least invasive method possible may prove beneficial for patients and surgical efficiency considering the similar biomechanics reported between techniques (Pozzi et al, 2008b, 2010a, and 2010b)

Summary

Summary of the evidence

Population: Adult dogs with naturally occurring cranial cruciate ligament disease. Intervention details:. Medium (6–12 months) and long-term (>1 year) functional outcome as assessed by owner questioning of:. These were grouped as successful (full and acceptable) or unsuccessful (unacceptable) outcome. Of 223 cases, 160 (72%) had concurrent meniscal tear diagnosed at the time of inspection and stabilisation surgery. Of these 159 were of the medial meniscus. At medium term follow-up (6–12 months): owners of 94/163 dogs contacted, 68 dogs had concurrent tears treated, of which 65 (96%) had successful outcome. At long-term follow-up (>1 year): owners of 87/160 dogs contacted, 62 dogs had concurrent tears treated of which 60 had a successful outcome (97%)

Limitations:

Findings

Methodology Section