Cranial Cruciate Ligament Disease Research Articles

Long-term outcome of an intra-articular allograft technique for treatment of spontaneous cranial cruciate ligament rupture in the dog.

To determine the 12-month outcome in dogs with spontaneous cranial cruciate ligament (CCL) rupture after repair with an intra-articular decellularized allograft. Prospective pilot case series. Ten client-owned dogs with unilateral CCL rupture. An intra-articular, decellularized, deep digital flexor tendon allograft was secured in the stifle with a femoral cross pin and tibial spiked washers and screws. An interference screw was placed in the tibial tunnel. Dogs were evaluated with an owner questionnaire, radiographs, and force platform gait analysis before and 2, 6, and 12 months after surgery. Owners reported improvement in level of pain and mobility throughout the study, especially over the first 6 months. Peak vertical force and vertical impulse improved across all time points. Ground reaction force asymmetry index for peak vertical force and vertical impulse at 12 months showed 3 dogs within a normal index (<6%), 4 dogs as nonvisibly lame (6-20%), and 3 dogs as visibly lame (≥20%). For most dogs, osteoarthritis scoring did not change over the 12-month period and some femoral-tibial translation was detected on standing horizontal beam radiographs. Intra-articular repair using a decellularized allograft can provide functional clinical outcomes in dogs with CCL disease. A better understanding of long-term engraftment after this procedure is needed.

Modified cranial closing wedge osteotomy for treatment of cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angles: Technique and complications in 19 cases

To describe short-term outcomes of a modified cranial closing wedge osteotomy (CCWO) for treatment of dogs with cranial cruciate ligament disease and excessive tibial plateau angle (eTPA). Retrospective clinical study. 18 client-owned dogs (19 stifles) with cranial cruciate ligament disease and eTPA (>34°). A modified CCWO was performed with Kirschner wires as osteotomy alignment aids. A juxta-articular neutral wedge osteotomy equal in angle to the preoperative TPA was performed. Fixation was achieved with a tibial plateau leveling osteotomy (TPLO) plate and tension band wire apparatus (89%) or a TPLO plate (11%). Preoperative and postoperative, and recheck TPA, cranial tibial long axis shift, and major and minor complications were recorded. The mean preoperative TPA (49.5° ± 6.7°) was reduced postoperatively (8.3° ± 4.8°). Four of 19 joints (21%) developed 2 major and 3 minor complications during the intraoperative and follow-up period (577 day mean in-hospital recheck). Two cases were diagnosed with surgical site infections requiring implant removal for resolution. Fixation failure or implant complications were not observed in any dog during the limited radiographic follow-up period. All dogs were sound or recovering as expected, with 15/19 dogs (79%) showing complete radiographic osteotomy healing at their final in-hospital follow-up examination. Modified CCWO should be considered for the treatment of cranial cruciate ligament disease in dogs with eTPA. In this case series, the described technique was associated with uneventful osteotomy healing without implant failures in all dogs, although radiographic follow-up was limited in some cases.

Surgical stabilization of concomitant canine medial patellar luxation and cranial cruciate ligament disease. Effect of fixation method on postoperative complication rate and clinical outcome.

To compare complication rates and outcomes between cases of concomitant cranial cruciate ligament (CrCL) disease and medial patellar luxation (MPL) treated using extracapsular stabilization and tibial tuberosity transposition (ECS+TTT) and tibial tuberosity transposition and advancement (TTTA). In a multicentre retrospective study, records from four referral hospitals were reviewed for dogs with concomitant CrCL pathology and MPL treated using ECS+TTT or TTTA. Data retrieved included signalment, partial/complete CrCL tear, MPL grade, treatment performed, occurrence of postoperative complications, and postoperative outcome grade. Associations between surgical procedure and risk of complication and surgical procedure and outcome were investigated using univariable logistic regression and proportional odds logistic regression respectively. Multiple logistic regression was used to explore confounding factors. A total of 72 stifles were evaluated in 66 dogs; 32 stifles were stabilized using ECS+TTT and 40 using TTTA. Overall complications were 2.7 times more frequent in the ECS+TTT group and major complications occurred only in this group. The TTTA group was less likely to suffer complications (17.5%) compared to the ECS+TTT group (46.9%) (p = 0.009) and TTTA cases had lower odds of a poorer clinical outcome (p = 0.047). Stifles stabilized using ECS+TTT are more likely to suffer from postoperative complications and a poorer clinical outcome when compared to TTTA.

Conformation of the proximal tibia and cranial cruciate ligament disease in small breed dogs.

To investigate the conformation of the proximal tibia in small breed dogs with and without cranial cruciate ligament disease (CCLD) and to identify morphologic abnormalities that may predispose to development of CCLD. Mediolateral radiographs of the entire tibia of dogs <15 kg with surgically confirmed CCLD were retrospectively evaluated. Proximal tibial width (PTW), tibial plateau length (TPL), tibial plateau angle as described by Slocum and Slocum (sTPA), proximal tibial tuberosity angle (PTTA), tibial plateau angle as described by Inauen and colleagues (nTPA), and diaphyseal tibial width (DTW) were measured. The same variables were obtained from mediolateral radiographs of the entire tibia of dogs <15 kg without CCLD. In addition, a quotient nTPA/PTW, relative tibial tuberosity width (rTTW), and relative body weight (rBW) were calculated for each dog. Independent two-sample t-test (p = 0.05) was used to compare mean ± SD of all measured variables between the two groups. Gender, age, and weight mean ± SD were not significantly different between the two groups of dogs (p <0.05). Dogs with CCLD had significantly greater sTPA (p = 0.015) and rBW (p = 0.016). In dogs of small breeds, a combination of an excessively steep tibial plateau and an increased relative body weight may predispose to early CCLD development. The slope of the tibial plateau was found to be caused by an abnormal caudal angulation of the proximal tibia, a phenomenon previously associated with CCLD development in small breed dogs in individual cases.

Distal femoral lateral closing wedge osteotomy as a component of comprehensive treatment of medial patellar luxation and distal femoral varus in dogs.

To describe a cohort of dogs with medial patellar luxation managed with a distal femoral lateral closing wedge ostectomy (DFO) as a component of comprehensive treatment, and to report radiographic and long-term clinical outcome of this technique. Medical records of dogs that had a lateral closing wedge DFO as part of management of medial patellar luxation at three veterinary teaching hospitals were reviewed. Surgical reports as well as the preoperative, postoperative, and follow-up radiographs were reviewed. The anatomical lateral distal femoral angle (aLDFA) was determined. Long-term clinical outcome was assessed by telephone interview with the owner. A lateral closing wedge DFO was performed on 66 limbs. The mean pre- and postoperative aLDFA was 107.6° ± 5.8° and 94.1° ± 4.2°, respectively. Cranial cruciate ligament disease was identified in 28/66 affected limbs. Tibial angular deformity, torsional deformity, or both was identified in nine of the 66 limbs. Ostectomy healing was confirmed radiographically in 51/66 limbs. The mean time to union was 73 ± 37 days. All patellae were in the normal position and stable. Complications included infection (2/51), fixation failure (1/51), delayed healing (2/51), and persistent lameness (1/51). In this cohort of cases, DFO was a highly successful and repeatable component of surgical treatment for dogs with medial patellar luxation associated with femoral varus. This study also provides more evidence of the high rate of concurrent cranial cruciate ligament disease in cases of medial patellar luxation complicated by femoral varus, and supports an association between stifle instability and medial patellar luxation.

Tibial plateau angle: methods of measurement, value, applicability

The tibial plateau angle measurement and its applicability have been reviewed based on the literature. The measurement was made on radiographs of the stifle joint with superimposition of the femoral condyles (with maximum tolerance of 2.0-4.0mm). Due to great variation among dog populations (size, breed), mean tibial plateau angles were found to be between 16.9° and 34°, but an excessive angle was described as &gt;35°. An appropriate measurement of the tibial plateau angle can be made at about 108 days of age. The influence on the magnitude of the measured tibial plateau angle were the limb position during radiographic examination, the measurement technique (with modifications) and the experience level of the observer. Differences in magnitudes of the tibial plateau angles in dogs with and without cranial cruciate ligament rupture were not observed. The tibial plateau angle is commonly used in osteotomy of the tibia and its magnitude in order to select the proper surgical technique. The significance of the tibial plateau angle on the aetiopathogenesis of cranial cruciate ligament disease is questionable. Other measurements of the proximal tibia were attained to determine the risk factor of cranial cruciate ligament insufficiency. Knowledge of the tibial plateau angle and factors influencing measurement errors have great clinical importance.

Variation in the Quantity of Elastic Fibres with Degeneration in Canine Cranial Cruciate Ligaments from Labrador Retrievers.

Objectives This study aims to quantify numbers of elastic fibres in cranial cruciate ligaments from a dog breed at high risk of cranial cruciate ligament disease. Methods Macroscopically normal cranial cruciate ligaments were harvested from six Labrador retrievers. Sequential histological sections were assessed for extracellular matrix degeneration (haematoxylin and eosin stain) and elastic fibre staining (Miller's stain). Elastic fibres were semi-quantified using previously published scoring systems. Each section was scored twice by two observers. Results Increased numbers of elastic fibres were seen with increasing cranial cruciate ligament degeneration (p = 0.001). Labrador retriever cranial cruciate ligaments had lower elastic fibre staining when compared with previous published findings in the racing greyhound. Clinical Significance The cranial cruciate ligaments from a dog breed at high risk of cranial cruciate ligament disease vary in the quantity of elastic fibres in association with ligament degeneration. Breed variation in the quantity of elastic fibres may reflect differing risk of cranial cruciate ligament disease.

Prospective Randomized Clinical and Radiographic Evaluation of a Novel Bioabsorbable Biocomposite Tibial Tuberosity Advancement Cage Implant.

To evaluate the suitability of a novel bioabsorbable biocomposite cage (BC) implant for use in tibial tuberosity advancement (TTA) surgery in dogs with cranial cruciate ligament (CrCL) disease and to compare radiographic osteotomy healing scores and complications between groups that received either a BC or stainless steel cage (SSC). Prospective randomized clinical study. Dogs with unilateral CrCL rupture (n=56). TTA was performed in 60 consecutive dogs using either a BC (30 dogs) or SSC (30 dogs). Patient parameters, 6 week and 6 month postoperative radiographic osteotomy healing scores, time elapsed to postoperative rechecks, and complications were compared between groups. Osteotomy healing was graded using a 5-point (0-4) scale. Data were analyzed using Wilcoxon Rank Sum tests and χ(2) tests with significance set at P<.05. Fifty-six dogs (30 BC, 26 SSC) had complete medical and radiographic records at 6 months for inclusion in data analysis. Three complications occurred in the BC group (1 major, 2 minor) and 2 occurred in the SSC group (2 minor). There was no statistical difference in patient parameters, 6 week healing scores, or complications between BC and SSC groups. Healing scores at 6 months were significantly higher in the BC group (3.3 ± 0.52) compared to the SSC group (2.9 ± 0.69; P=.04). Based on improved BC osteotomy healing scores 6 months after surgery with no significant differences in complications compared to SSC, BC TTA cages are a viable alternative to SSC.

Incidence of complications associated with tibial tuberosity advancement in Boxer dogs.

To retrospectively review and describe the incidence of complications associated with tibial tuberosity advancement (TTA) surgical procedures in a group of Boxer dogs (n = 36 stifles) and compare the data with a non-Boxer control population (n = 271 stifles). Retrospective analysis of medical records to identify all dogs that underwent TTA surgery due to cranial cruciate ligament disease. These records were categorized into two groups: Boxer dogs and non-Boxer dogs (controls - all other breeds). Of the 307 stifles included, 69 complications were reported in 58 joints. The complication rate differed significantly for Boxer dogs (16/36 stifles) and non-Boxer dogs (42/271 stifles), corresponding to an odds ratio of 5.8 (confidence interval: 1.96-17.02; p-value <0.001). Boxer dogs were more likely to undergo revision surgery and to develop multiple complications. The incidence of tibial tuberosity fractures requiring surgical repair (2/36 versus 1/271) and incisional infections requiring antibiotic treatment (three in each group) was significantly higher in the Boxer group. Boxer dogs had more major and multiple complications after TTA surgery than the control non-Boxer group; these complications included higher rates of revision surgery, tibial tuberosity fractures requiring stabilization, and infection related complications. The pertinence and value of breed-specific recommendations for cranial cruciate ligament disease appears to be a subject worthy of further investigation.

Peak Vertical Force and Vertical Impulse in Dogs With Cranial Cruciate Ligament Rupture and Meniscal Injury.

To compare the peak vertical force (PVF) and vertical impulse (VI) in dogs with naturally occurring cranial cruciate ligament (CCL) disease with or without concurrent meniscal injury. Prospective case series. Client-owned dogs with naturally occurring CCL disease. Dogs with hind limb lameness because of CCL disease that required surgery underwent force plate gait analysis. Force plate analysis was performed at a walking gait (speed 1-1.3 m/s; acceleration ± 0.5 m/s(2)) and data were analyzed using commercial proprietary software. Meniscal injury was diagnosed either by mini-arthrotomy or arthroscopy. The primary outcome was PVF and the secondary outcome was VI. Comparisons were made between dogs with or without meniscal injury, and dogs with partial or complete CCL rupture. Forty dogs were included. Meniscal injury was present in 18/40 dogs (45%). PVF (P = .003) and VI (P = .01) were significantly lower in dogs with meniscal injury than in dogs without meniscal injury. Dogs with CCL disease and medial meniscal injury had significantly reduced PVF and VI.

Epidemiology of Cranial Cruciate Ligament Disease Diagnosis in Dogs Attending Primary-Care Veterinary Practices in England.

To estimate the prevalence and risk factors for a diagnosis of cranial cruciate ligament (CCL) disease in dogs and to describe the management of such cases attending primary-care veterinary practices. Historical cohort with a nested case-control study. Nine hundred and fifty-three dogs diagnosed with CCL disease from 171,522 dogs attending 97 primary-care practices in England. Medical records of dogs attending practices participating in the VetCompass project that met selection criteria were assessed. Univariate and multivariate logistic regression methods were used to evaluate association of possible risk factors with diagnosis of CCL disease. The prevalence of CCL disease diagnosis was estimated at 0.56% (95% confidence interval 0.52-0.59). Compared with crossbred dogs, Rottweilers, West Highland White Terriers, Golden Retrievers, Yorkshire Terriers, and Staffordshire Bull Terriers showed increased odds of CCL disease diagnosis while Cocker Spaniels showed reduced odds. Increasing bodyweight within breeds was associated with increased odds of diagnosis. Dogs aged over 3 years had increased odds of diagnosis compared with dogs aged less than 3 years. Neutered females had 2.1 times the odds of diagnosis compared with entire females. Insured dogs had 4 times the odds of diagnosis compared with uninsured dogs. Two-thirds of cases were managed surgically, with insured and heavier dogs more frequently undergoing surgery. Overall, 21% of cases were referred, with referral more frequent in heavier and insured dogs. Referred dogs more frequently had surgery and an osteotomy procedure. Breed predispositions and demographic factors associated with diagnosis and case management of CCL disease in dogs identified in this study can be used to help direct future research and management strategies.

Comparison of the tibia plateau angle between small and large dogs with cranial cruciate ligament disease.

To compare the conformation of the proximal tibia evaluated on a medio-lateral radiograph between small and large dogs with cranial cruciate ligament disease (CCLD). Retrospective clinical study with dogs having radiographic evaluation and CCLD confirmed at surgery. The first group (n = 52) was comprised of dogs weighing less than 15 kg and the second group (n = 52) of dogs weighing more than 15 kg. The tibial plateau angle (TPA), the relative tibial tuberosity width (rTTW), and the Z angle were measured on preoperative radiographs with imaging measurement software. Linear mixed models were used to assess the effect of weight, age, sex, and neutered status on radiographic measurements and to estimate interobserver variabilities. The small dog group had a greater TPA (30.1° ± 5.3; p <0.001 with a mean difference of 4.9° [95% CI: 3.8-6.0]) and Z angle (69.9° ± 5.6; p<0.001 with a mean difference of 6.1° ([95% CI: 4.9-7.4]) than the large dog group. Sex and neutered status further influenced the TPA and Z angle values. No significant effect was observed on the rTTW values. A strong correlation was found between the TPA and the Z angle (r = 0.61, p <0.001). Variances were not significantly different between observers. Overall the interobserver variability was low suggesting that agreement was good. Small dogs with CCLD have a steeper tibial plateau than large dogs with CCLD. Sex and neutered status also had an effect on some measured variables. This anatomical difference could influence the surgical technique, which may affect the outcome. The good interobserver agreement suggests the observer is unlikely to influence surgical planning.

Tibial plateau levelling osteotomy in 69 small breed dogs using conically coupled 1.9/2.5 mm locking plates. A clinical and radiographic retrospective assessment.

To report clinical experiences with the tibial plateau levelling osteotomy (TPLO) procedure in small breed dogs with cranial cruciate ligament (CCL) disease using specific, conically coupled, 1.9/2.5 mm locking plates and evaluating short-term complications and outcome. Medical records of small breed dogs (<15 kg) that underwent TPLO using 1.9/2.5 mm locking plates were reviewed retrospectively. The preoperative, postoperative and six to eight weeks postoperative tibial plateau angle (TPA) measurements were determined from the radiographic images. Lameness evaluation was assessed subjectively preoperatively and six to eight weeks postoperatively. Sixty-nine small breed dogs (n = 79 stifles) were included in the study. Mean (± SD) preoperative TPA was 29.0 ± 3.4°, postoperative TPA was 5.8 ± 2.5°, and six to eight weeks postoperative TPA was 7.3 ± 4.1°. Sixteen complications occurred in 12 out of 79 TPLO procedures: three were intra-operative (intra-articular screw placement) and 13 were postoperative complications, of which nine were identified as minor complications not requiring surgical reintervention, and four as major complications requiring additional surgical intervention, including tibial tuberosity fracture (n = 1), osteomyelitis (n = 1), screw failure (n = 1), and plate breakage (n = 1). Lameness scores by clinical assessment reduced from a median value of 3/4 preoperatively to 1/4 at six to eight weeks postoperatively. 1.9/2.5 mm locking plates appear to be a valid choice of implant for the stabilization of unilateral TPLO in small breed dogs.

Long-term functional outcome after surgical repair of cranial cruciate ligament disease in dogs.

BackgroundCranial cruciate ligament (CCL) rupture is a very common cause of pelvic limb lameness in dogs. Few studies, using objective and validated outcome evaluation methods, have been published to evaluate long-term (>1 year) outcome after CCL repair. A group of 47 dogs with CCL rupture treated with intracapsular, extracapsular, and osteotomy techniques, and 21 healthy control dogs were enrolled in this study. To evaluate long-term surgical outcome, at a minimum of 1.5 years after unilateral CCL surgery, force plate, orthopedic, radiographic, and physiotherapeutic examinations, including evaluation of active range of motion (AROM), symmetry of thrust from the ground, symmetry of muscle mass, and static weight bearing (SWB) of pelvic limbs, and goniometry of the stifle and tarsal joints, were done.ResultsAt a mean of 2.8 ± 0.9 years after surgery, no significant differences were found in average ground reaction forces or SWB between the surgically treated and control dog limbs, when dogs with no other orthopedic findings were included (n = 21). However, in surgically treated limbs, approximately 30% of the dogs had decreased static or dynamic weight bearing when symmetry of weight bearing was evaluated, 40-50% of dogs showed limitations of AROM in sitting position, and two-thirds of dogs had weakness in thrust from the ground. The stifle joint extension angles were lower (P <0.001) and flexion angles higher (P <0.001) in surgically treated than in contralateral joints, when dogs with no contralateral stifle problems were included (n = 33). In dogs treated using the intracapsular technique, the distribution percentage per limb of peak vertical force (DPVF) in surgically treated limbs was significantly lower than in dogs treated with osteotomy techniques (P =0.044).ConclusionsThe average long-term dynamic and static weight bearing of the surgically treated limbs returned to the level of healthy limbs. However, extension and flexion angles of the surgically treated stifles remained inferior to healthy joints, and impairment of AROM and weakness in thrust from the ground in the surgically treated limbs were frequently present. Ground reaction forces may be inadequate as a sole method for assessing functional outcome after cranial cruciate ligament repair.

Systematic review of surgical treatments for cranial cruciate ligament disease in dogs.

Surgery for cranial cruciate ligament disease is often recommended; however, it is unclear if one procedure is superior. The aim of this systematic review was to answer the a priori question, "Is there a surgical procedure that will allow a consistent return to normal clinical function in dogs with cranial cruciate ligament disease and is that procedure superior to others?" A systematic literature search was performed through September 2013. Peer reviewed publication in the English language and 6 mo of postoperative follow-up were required. In total, 444 manuscripts were identified and reviewed, and 34 met the inclusion criteria. Two studies provided level 1, 6 provided level 2, 6 provided level 3, and 20 provided level 4 evidence relative to the study question. The most common surgical procedures included tibial plateau leveling osteotomy (TPLO, n = 14), lateral extracapsular suture (n = 13), tibial tuberosity advancement (n = 6). The strength of the evaluated evidence most strongly supports the ability of the TPLO in the ability to return dogs to normal function. It also provided strong support that functional recovery in the intermediate postoperative time period was superior following TPLO compared with lateral extracapsular suture. There was insufficient data to adequately evaluate other surgical procedures.

Surgical Treatment of Cranial Cruciate Ligament Disease

Surgical Treatment of Cranial Cruciate Ligament Disease

Incidence and type of meniscal injury and associated long-term clinical outcomes in dogs treated surgically for cranial cruciate ligament disease.

To evaluate factors related to meniscal pathology and their effect on clinical outcome in dogs treated for cranial cruciate ligament (CCL) disease. Prospective cross-sectional study. Dogs (n = 163) with CCL disease (n = 223 stifles). CCL disease was treated by (1) arthroscopy and TightRope (TR) stabilization; (2) arthroscopy and tibial plateau leveling osteotomy (TPLO); or (3) open arthrotomy and TPLO. Incidences of concurrent and subsequent meniscal tears, meniscal treatments, mid-(6 months) and long-(>1 year) term outcomes by owner assessment were compared among surgical treatment groups. Concurrent meniscal tears were diagnosed in 83% of stifles assessed by arthroscopy and 44% of stifles assessed by arthrotomy, with concurrent tear diagnosis being 1.9 times more likely by arthroscopy than arthrotomy (P < .001). Incidence of diagnosis of subsequent meniscal tears was 6.7% with median time to diagnosis of 5.8 months. Differences in proportion of subsequent meniscal tears among treatment groups were not significant (P = .69). Subsequent meniscal tears were diagnosed in 21% of cases without concurrent meniscal tears, but only 1.3% of cases with concurrent meniscal tears (P < .001). Cases treated with meniscal release did not have subsequent meniscal tears, whereas dogs not treated with meniscal release had a subsequent meniscal tear rate of 11% (P = .0013). Cases diagnosed and treated for concurrent meniscal tears were 1.3 times more likely to have a successful long-term outcome (P = .007). CCL surgical technique did not affect subsequent meniscal tear rate or mid-term or long-term functional outcomes, whereas diagnosis and treatment of concurrent meniscal tears did significantly affect both.

Tibial plateau leveling osteotomy in small breed dogs with high tibial plateau angles using a 4-hole 1.9/2.5 mm locking T-plate.

To report clinical experiences with tibial plateau leveling osteotomy (TPLO) to address cranial cruciate ligament (CCL) disease in small breed dogs with high tibial plateau angles (TPA) using a specific 4-hole locking T-plate. Retrospective case series. Small breed dogs (<15 kg) with high TPA (>30°): n = 19 (29 CCL ruptures). TPLO was performed by standard technique using a 1.9/2.5 mm 4-hole locking T-plate. Preoperative, immediate postoperative, and 6-8 weeks postoperative TPA were measured from radiographs. Lameness was scored subjectively preoperatively and 6-8 weeks postoperatively. Mid to long term follow-up was by client telephone questionnaire (mean, 12.1 months after surgery). Mean ± SD preoperative TPA was 37.0 ± 4.9°, immediate postoperative TPA, 6.4 ± 2.8° and 6-8 weeks postoperative TPA, 8.0 ± 4.9°. Postoperative complications occurred in 4 dogs (13.8%) all of which had been operated as single-session bilateral procedures. Three stifles had failure of a single screw and postoperative increase in TPA. Periprosthetic infection necessitated plate removal in 1 dog. Lameness scores by veterinary assessment reduced from mean 3.4/5 preoperatively to 0.4/5 at 6-8 weeks postoperatively. Mid to long-term follow-up revealed no lameness by owner assessment. A 4-hole 1.9/2.5 mm locking T-plate may be used in the stabilization of unilateral TPLO in small breed dogs with high TPA.

Risk Factors and Diagnostic Accuracy of Clinical Findings for Meniscal Disease in Dogs With Cranial Cruciate Ligament Disease

To determine the risk factors for meniscal disease and diagnostic accuracy of physical examination in dogs with cranial cruciate ligament (CCL) deficiency. Prospective cohort study. Stifles (n = 80) of dogs with CCL deficiency. Each dog was evaluated preoperatively for factors that may increase the risk of, or aid in the diagnosis of meniscal disease including presence of pain on extension and flexion of the affected stifle, range of motion during flexion and extension, thigh circumference, positive cranial-drawer test, positive tibial compression test, tibial plateau angle, complete tear of the CCL, presence of a meniscal click, and gait analysis. Odds ratios were calculated for each of the factors and a multivariate approach was used to create an ROC curve. Subsequent sensitivity, specificity, and area under the curve was used to determine the diagnostic value of clinical tests. Dogs with pain upon flexion of the stifle were 4.3 times more likely to have medial meniscal disease than those without flexion pain and dogs with a complete CCL tear were 9.6 times more likely to have medial meniscal disease than those with partial tears. A meniscal click increased the likelihood of medial meniscal disease by a factor of 11.3. The diagnostic accuracy using a meniscal click and pain upon stifle flexion was 76%. Combining the presence of a meniscal click and pain during flexion of the stifle provide a more accurate diagnosis of medial meniscal disease in dogs with CCL disease over individual examination variables.

Accuracy of Tibial Osteotomy Placement Using 2 Different Tibial Plateau Leveling Osteotomy Jigs

To report the accuracy of osteotomy position in dogs undergoing tibial plateau leveling osteotomy (TPLO) and to evaluate the effect of 2 different TPLO jig and saw systems on tibial osteotomy position. Retrospective case series. Dogs (n = 124; 134 TPLO). Medical records (2004-2005; 2008-2011) and stifle radiographs of 2 groups of dogs that had TPLO to treat cranial cruciate ligament disease were reviewed. One group had a TPLO performed using an alignment jig system alone (Slocum group), whilst in the other group, an alignment jig system combined with a saw guide (Synthes group) was used. Postoperative radiographs were examined and the distance and direction of the centroid of the osteotomy was compared to the intended osteotomy position. The absolute distance of eccentricity (DOE) in the Slocum group (5.6 ± 2.5 mm) was significantly greater than that of the Synthes group (3.4 ± 1.8 mm; P < .01). DOE was caudal and distal in 79% of cases. Most tibial osteotomies were centered at a point distal and caudal to the intended osteotomy position. Use of a TPLO system with a saw guide was associated with more accurate placement of the osteotomy and more accurate leveling of the tibial plateau.