In dogs weighing under 15 Kg with unilateral cranial cruciate ligament disease, does tibial tuberosity advancement lead to better long-term functional outcomes than lateral fabellar suture?

Tafara Mapuvire

doi:10.18849/ve.v5i2.297

Abstract

PICO question In dogs weighing under 15 kg with unilateral cranial cruciate ligament disease, does tibial tuberosity advancement lead to better long-term functional outcomes than lateral fabellar suture?  Clinical bottom line Category of research question Treatment The number and type of study designs reviewed There were no papers that answered the PICO question Strength of evidence Zero Outcomes reported Between TTA and LFS none of the techniques was shown to provide better long-term functional outcomes than the other in dogs weighing less than 15 kg Conclusion Given the absence of evidence answering the PICO question, choice and recommendation of procedure between TTA and LFS in dogs weighing under 15 kg should be guided by what the surgeon deems to be in the best interest of the patient  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

A study by Di Donna et al (2015) compared objective, validated long-term functional outcomes of TTA and LFS using force plate analysis
Data for the control group and TTA group in the 2016 study were reported and compared to data for the control group, tibial plateau levelling osteotomy (TPLO) group and extracapsular reconstruction (ECR) (LFS) group reported in the 2013 study
In the 2016 study, owners with dogs suffering from naturally occurring cranial cruciate ligament disease were offered three surgical interventions, that is, TPLO, ECR (LFS), and TTA

Summary

KNOWLEDGE SUMMARY

PICO question In dogs weighing under 15 kg with unilateral cranial cruciate ligament disease, does tibial tuberosity advancement lead to better long-term functional outcomes than lateral fabellar suture?. The results of the two studies suggest better long-term functional outcomes in the TTA group compared to the ECR (LFS) group, both studies excluded dogs weighing less than 15 kg, and the results may not be applicable to this PICO. Mölsa et al compared long-term surgical outcomes in dogs following surgery for cruciate ligament disease in a 2014 retrospective study They used force plate analysis, orthopaedic and radiographic examination, and physiotherapeutic examination as objective, validated methods to measure and compare long-term functional outcomes in dogs that had undergone intracapsular, extracapsular and osteotomy techniques. A 2013 study by Mölsa et al compared long-term surgical outcome and chronic pain in dogs that underwent intracapsular, extracapsular and osteotomy techniques for cranial cruciate ligament disease. Surgeons should be guided by the patient’s best interests in choosing between which of the two to perform in dogs weighing under 15 kg

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