Cruciate Ligament Disease In Dogs Research Articles

Objective comparison of a sit to stand test to the walk test for the identification of unilateral lameness caused by cranial cruciate ligament disease in dogs.

The purpose of this study was to evaluate a sit to stand test with the walk test for the identification of unilateral cranial cruciate ligament rupture in dogs. Peak vertical force and vertical impulse were measured on a pressure-sensitive walkway, during a sit to stand test and walk test, and in 10 dogs with unilateral cranial cruciate ligament rupture and 18 non-lame dogs. Data collected were used to calculate symmetry indices (SI) of ipsilateral and contralateral hindlimbs (HL), diagonal limb pairs (DLP) and ipsilateral limb pairs (ILP). The symmetry indices of peak vertical force of HL during the walk test and sit to stand test were 100% and 90% sensitive for discriminating lame and non-lame dogs respectively. The symmetry indices of vertical impulse of HLs during the walk test and sit to stand test were 100% and 50% sensitive for discriminating lame and non-lame dogs respectively. Analysis of ipsilateral and diagonal limb pairs did not improve the discrimination in either test. The time taken to collect data from the sit to stand test data was shorter than for the walk test. Whilst the sit to stand test required a shorter time for collection of data than the walk test, it did not accurately identify all dogs with lameness associated with CCLR, and thus has relatively limited clinical utility in its tested form.

Economic Considerations on Costs and Pricing of Two Surgical Techniques for Treating Cranial Cruciate Disease in Dogs.

In surgical treatment of cranial cruciate ligament disease in dogs, Tibial Plateau Levelling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) are commonly established procedures and have proven effective in restoring limb function. Unlike clinical outcome, economic aspects have not been studied as extensively. However, the surgical intervention poses an enormous financial burden on patients' owners. In a veterinary practice setting, this study compares prices for TPLO and TTA and examines prices differences as well as potential cost drivers. Charges for veterinary treatments are based on the Gebührenordnung für Tierärztinnen und Tierärzte (GOT), which is mandatory for veterinarians in Germany but allows a certain range in billing. This study found that TPLO is charged at a higher price than TTA; however, this might not cover the additional costs of this procedure. The price is also associated with weight, heavier dogs being more expensive. The underlying strategies for pricing decisions may be based on costs, as efforts for TPLO and heavier dogs are higher in terms of a prolonged surgical time, the number of staff involved and in surgeons' training. Price setting may also be based on a quality promise, suggesting better clinical outcome in a more expensive procedure. Future investigations should involve economic considerations and consider cost-effectiveness analysis when evaluating surgical treatment options.

Evaluating the relationship between osteoarthritis and cruciate ligament disease in dogs.

Veterinary RecordVolume 192, Issue 7 p. 289-291 Research comment Evaluating the relationship between osteoarthritis and cruciate ligament disease in dogs Anke Langenbach, Corresponding Author Anke Langenbach [email protected] Veterinary Surgical Centers, Vienna, Virginia, USASearch for more papers by this author Anke Langenbach, Corresponding Author Anke Langenbach [email protected] Veterinary Surgical Centers, Vienna, Virginia, USASearch for more papers by this author First published: 31 March 2023 https://doi.org/10.1002/vetr.2920Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume192, Issue71–15 April 2023Pages 289-291 RelatedInformation

Histologic evidence for a humoral immune response in synovitis associated with cranial cruciate ligament disease in dogs.

To investigate histopathological features of synovium from dogs with cranial cruciate ligament disease (CCLD) to seek mechanisms of osteoarthritis (OA) associated with CCLD. Retrospective, single-institution case series. Thirty client-owned dogs. Synovial biopsies (n=30) obtained from stifles with CCLD were assessed by using two synovitis histopathology grading systems (Krenn and Hospital for Special Surgery [HSS]). The Krenn synovitis score was interpreted as "no synovitis," "low-grade," or "high-grade," while inflammatory subtype (low, mixed, or high) was determined by a computational algorithm within the HSS system. Comparison of synovitis scores was based on degree of CCL rupture and presence of meniscal tears. Histopathological changes and synovitis scores were similar regardless of degree of rupture (partial n=5, complete n=25) or presence of meniscal injury (n=12) and were characterized by hyperplastic and lymphoplasmacytic synovitis with increased vascularity (30/30) and the presence of hemosiderin deposits (28/30), binucleated plasma cells (28/30), mucoid change (25/30), and Mott cells (16/30). Thirteen (43%) specimens were consistent with high-grade synovitis according to the Krenn system, while 11 (37%) specimens fit into the high-inflammatory subtype with the HSS system. Synovitis associated with canine CCLD in this study population was lymphoplasmacytic and was often highly inflammatory, with the presence of cells pertaining to humoral immunity. Humoral immune responses may play key roles in the synovitis associated with CCLD. Modulation of biological factors that provoke humoral immune responses may mitigate symptoms of OA that persist and progress even after surgical treatment of CCLD in dogs.

Recommendations for rehabilitation after surgical treatment of cranial cruciate ligament disease in dogs: A 2017 survey of veterinary practitioners

To report current recommendations made by veterinarians for rehabilitation after surgical treatment of cranial cruciate ligament (CrCL) disease. Anonymized electronic survey. Veterinarians performing CrCL stabilization. An electronic survey was created to collect information on general attitudes toward postoperative rehabilitation and recommendations regarding therapeutic modalities and bandaging. Quantitative data are reported by descriptive statistical analysis, percentage of responses, or mean (±SD). The recommendations for postoperative bandaging beyond 24 hours and for postoperative rehabilitation after extracapsular stabilization compared with after tibial osteotomy were tested by using Cochran-Mantel-Haenszel tests, with P < .05 considered statistically significant. The data analysis included 376 responses (13% response rate). Most (71%) respondents consistently recommended postoperative rehabilitation. Rehabilitation was more than twofold more likely to be recommended after extracapsular stabilization than after osteotomies (P = .0142). Most respondents did not recommend bandaging beyond 24 hours postoperatively (P = .00012). Most respondents recommended either formal or informal postoperative rehabilitation therapy. If the survey respondents are representative of veterinarians performing CrCL surgery, the current attitude is supportive of postsurgical rehabilitation. Most respondents would welcome evidence-based guidelines for rehabilitation protocols.

Lyophilized and gamma-sterilized allogeneic bone implant used as a spacer for advancement of a modified tibial tuberosity in the treatment of cranial cruciate ligament disease in dogs.

The objective of this study was to evaluate the use of a lyophilized and gamma-sterilized allogeneic freeze-dried bone wedge as a spacer for advancement of a modified tibial tuberosity (mTTA) in 16 knees that were clinically diagnosed with cranial cruciate ligament disease. Patients underwent radiography before the surgical procedure as well as immediately after surgery and at 30, 60, 90 and 120 days post-surgery, and their locomotion was evaluated at the same time points except for the immediate postoperative period. The surgical wounds were evaluated for signs of infection and rejection of the bone implant. Locomotion was graded on a scale of 0–5, with 0 indicating no limping and 5 indicating limb functional impotence. The "tibial-tibial bone-tibial implant" interfaces were evaluated radiographically, and each interface was assigned scores of 0–3, with 0 indicating no contact between the implant and adjacent bone and 3 indicating a bone bridge throughout the interface. The patients showed good clinical and radiographic recovery. The lyophilized bone spacer allowed for easy storage and transport and rapid and satisfactory execution of mTTA while showing resistance to drilling and fixation with screws in 87.5% of cases and a mean surgical time of 45.9 minutes. No immunogenic reactions were observed in 93.7% of the cases. One patient presented infection of the surgical focus, which showed remission after antimicrobial therapy. All patients showed functional recovery of the operated limb, with the number of clinically healthy patients being higher than those with claudication at 120 days (p ≤ 0.05). In all patients, it was possible to verify the incorporation of the bone implant into the tibia. Bone union occurred progressively, and the degrees of bone union observed on radiographs at postoperative days 60, 90, and 120 were significantly greater (p < 0.05) than those observed in the immediate postoperative period and at 30 days.

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.

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.

MMP-2 as an early synovial biomarker for cranial cruciate ligament disease in dogs

To measure the activity of matrix metalloproteinases (MMP)-2 and -9 in synovial fluid from the stifle joints of dogs with cranial cruciate ligament (CrCL) rupture and to compare that to values from contralateral stifle joints and dogs with clinically normal stifle joints. Additionally, the C-reactive protein (CRP) levels were also measured. Fourteen large breed dogs with unilateral CrCL rupture and 11 large breed normal dogs were included in this prospective clinical study. Synovial fluid was collected from CrCL-ruptured stifle joints, contralateral clinically normal stifle joints of the same dogs, and stifle joints of normal dogs. Serum was also collected. Synovial fluid activities of MMP-2 and MMP-9 and serum CRP level were measured. The MMP-2 activity in synovial fluid was significantly higher in CrCL-ruptured joints compared to contralateral joints and to stifles from normal dogs. There was no significant difference in activity of MMP-2 in contralateral joints of CrCL-ruptured dogs compared to normal dogs. Both serum CRP level and MMP-9 activity did not differ significantly between the studied conditions. It was confirmed that MMP-2 activity is significantly related to CrCL rupture, but there was a failure to demonstrate any significant increase in the contralateral joints compared to the stifle joints of normal dogs. The MMP-2 involvement in progressing CrCL disease still has to be defined.

Comparison of Complication Rates and Clinical Outcome Between Tibial Plateau Leveling Osteotomy and a Modified Cranial Closing Wedge Osteotomy for Treatment of Cranial Cruciate Ligament Disease in Dogs

To report complication rates and clinical outcomes after tibial plateau leveling osteotomy (TPLO) and a modified cranial closing wedge osteotomy (mCCWO) for treatment of cranial cruciate ligament disease in dogs. Prospective cohort study. Dogs weighing 20-60 kg with unilateral cranial cruciate ligament disease treated by either TPLO (n = 97) or mCCWO (n = 74). Clinical and radiographic assessments including lameness score, morphometric measurements and tibial plateau angle (TPA) were made before surgery and 8 weeks after either TPLO or mCCWO. Long-term outcome assessment by owner questionnaire or interview was undertaken at ≥6 months postoperatively. Significant differences in lameness scores between groups were not identified at short- or long-term follow-up. Major complication and reoperation rates did not differ significantly between groups (TPLO 7.2% and 6.1%; mCCWO 9.5% and 5.4%). Median postoperative TPA did not differ significantly between groups (TPLO group 5.5°; mCCWO group 6.5°). At >6 months owner assessed lameness, disability, quality of life and satisfaction were not different between groups and were good in 90-97% of dogs. In dogs weighing 20-60 kg, TPLO and mCCWO are associated with similar complication rates and clinical outcomes when performed by surgeons experienced with the surgical techniques.

Comparison of Long‐Term Outcomes Associated With Three Surgical Techniques for Treatment of Cranial Cruciate Ligament Disease in Dogs

To evaluate long-term (>1 year) outcomes with respect to function and complications in dogs undergoing TightRope (TR), tibial plateau leveling osteotomy (TPLO), or tibial tuberosity advancement (TTA) for treatment of cranial cruciate ligament (CCL) disease. Retrospective clinical cohort study. Medical records from 2006 to 2009 were searched and cases included when all data were available and clients returned a completed questionnaire based on their assessment of their dog at least 1 year after surgery. Outcomes associated with TPLO, TTA, and TR were determined and compared based on medical records and questionnaires data regarding return to function, presence and degree of pain, and complications. Case meeting inclusion criteria were: TPLO (n = 65), TR (n = 79), and TTA (n = 18). TTA was associated with significantly (P < .03) higher rates of major complications and subsequent meniscal tears than TPLO and TR, and TPLO had significantly higher rates of major complications and meniscal tears than TR. Percent of function >1 year after surgery was 93.1% + 10.0% for TPLO, 92.7% + 19.3% for TR, and 89.2% + 11.6% for TTA. Significantly (P = 0.016) more TPLO and TR cases were classified as reaching full function than TTA. The highest levels, frequency, and severity of pain were noted in TTA cases, however, no significant differences were noted among groups. Long-term outcomes for TPLO and TR were superior to TTA based on subjective client and DVM assessments. Each technique was associated with a high long-term success rate with TR showing the highest safety-to-efficacy ratio.

Complications of tibial plateau levelling osteotomy in dogs

The tibial plateau levelling osteotomy (TPLO) is one of the most common surgical procedures used to treat cranial cruciate ligament disease in dogs. Complications occurring during or after TPLO can range in severity from swelling and bruising to fracture and osteomyelitis. Ten to 34% of TPLO surgical procedures are reported to experience a complication and approximately two to four percent require revision surgery to address a complication. Although the risk factors for many complications have not been fully assessed, the best available evidence suggests that complications of TPLO can be reduced with increased surgeon experience, careful surgical planning, and accurate execution of the surgical procedure. Identification of known or suspected risk factors and intra-operative technical errors allow subsequent action to be taken that is aimed at decreasing postoperative morbidity. There is a need for prospective studies with consistent data reporting in order to fully reveal the incidence risk factors for complications associated with TPLO.

Cranial Cruciate Ligament Disease in Dogs: Biology versus Biomechanics

The stifle joint of dogs is an organ comprised of multiple tissue types that must work in concert to maintain joint health and function. Cruciate disease in dogs is caused by a spectrum of causal and risk factors that result in a final common pathway of abnormal biomechanics and abnormal biology causing osteoarthritis, or organ failure, of the stifle and the clinical signs of lameness, pain, and limb dysfunction. It is vital to understand the components of the biologic and biomechanical pathologies to improve our understanding of cruciate disease in dogs so that we can improve preventative, diagnostic, and therapeutic strategies for our canine patients.

Detection and Evaluation of Matrix Metalloproteinases Involved in Cruciate Ligament Disease in Dogs Using Multiplex Bead Technology

To measure matrix metalloproteinases (MMPs) suspected to be involved in the initiation or progression of osteoarthritis (OA) in cranial cruciate ligament (CCL) explant culture media using multiplex bead technology. In vitro experimental study. Adult dogs with (n=10) and without (n=10) CCL deficiency. Based on clinical, radiographic, and gross evidence of CCL deficiency, excised CCL were classified as normal and intact (n=10) or partially torn (n=10). The ligament was excised and immediately placed in tissue culture. Culture media were sampled and replaced on days 3 and 6. MMP-1, 2, 3, 9, and 13 were quantified in explant media using a multiplexing machine that uses flow cytometry, microspheres, spectral dyes, lasers, digital signal processing, and traditional chemistry. MMP concentrations were determined using a standard curve constructed from the serial dilution of positive controls. Media MMP concentrations comparing the type of ligament and the time frame were analyzed using a Mann-Whitney rank sum test. Media exposed to intact ligaments had >3 times the amount of MMP-2 than for partially torn ligaments on day 6 (P=.006). Media exposed to intact ligaments also had significantly higher levels of MMP-3 than for partially torn ligaments on day 3 (P=.035) and on day 6 (P=.05). MMP multiplexing is a reliable, cost-effective, efficient, and sample-sparing method of MMP quantification. MMP-2, 3, 9, and 13 are released from CCL explants exposed to culture media and can be detected using multiplex bead technology. CCL remnants exposed to the intra-articular environment may release degradative enzymes in vivo similar to that demonstrated in this in vitro study. Because MMPs are known to be involved in the initiation and progression of OA, debridement of these remnants as a component of treatment for cruciate disease in dogs deserves consideration.

Cranial Cruciate Ligament Disease in Dogs

Cranial cruciate disease has been repeatedly documented as one of the most common orthopaedic conditions in the dog. The term ‘disease’ describes a range of pathology from stretching of the ligament to partial or complete rupture. Treatment of this condition remains controversial and extensive research is continually being carried out to gain a greater understanding of the cause of this condition. A basic knowledge of the anatomy of the stifle might be useful to appreciate the different surgical options available.

Effect of conformation of the distal portion of the femur and proximal portion of the tibia on the pathogenesis of cranial cruciate ligament disease in dogs

To evaluate mediolateral radiographic views of stifle joints to identify conformational differences between athletically sound dogs and dogs with cranial cruciate ligament disease (CCLD). Radiographic images of 50 stifle joints of 43 dogs with surgically confirmed CCLD and 50 stifle joints of 38 dogs without clinical signs of stifle joint disease. Mediolateral radiographic views of stifle joints were obtained, and long axes of the femur, tibia, and femoral condyles were measured. Angles between long axes of the femur and femoral condyle and between long axes of the femur and tibia were measured. Circles were drawn representing the joint surface of femoral condyles (circle 1), area of contact on the tibial plateau (circle 2), and femoral trochlea (circle 3). Radii of circles 1, 2 (line F), and 3 were measured. Distances between midpoints of circles 1 and 2 (line K) and between midpoint of circle 2 and most cranial aspect of the tibial tuberosity (line G) were measured. To evaluate differences in conformation that could lead to CCLD, quotients derived from measurements were created for comparison; angles were compared between dog groups. Significant differences were found in the quotients created by the lengths of lines G and F and lines G and K between dogs with and without CCLD. No anatomic differences were detected in the distal portion of the femur between dogs with and without CCLD. Development of the tibial tuberosity and shape (convexity) of tibial condyles may be relevant in the pathogenesis of CCLD.

Luxation of the long digital extensor tendon as a complication to Tibial Plateau Levelling Osteotomy

Cranial cruciate ligament disease in dogs is frequently treated with Tibial Plateau Levelling Osteotomy (TPLO). Herein we describe four cases of dogs presenting with sudden lameness in the operated leg one to 12 months post TPLO surgery. On examination, all of the dogs had a luxation of the long digital extensor tendon (LDE) resulting from the TPLO surgery. All of the dogs underwent revision surgeries. The LDE tendon was either secured in its normal position or transected, and a tenodesis was performed. The dogs recovered well after surgery and lameness was resolved in all four cases.

Geometric implications of the tibial wedge osteotomy for the treatment of cranial cruciate ligament disease in dogs

The tibial wedge osteotomy (TWO), a procedure that reduces the tibial plateau slope, has become an established surgical technique for the treatment of cranial cruciate ligament injuries in dogs, yet variation from the desired postoperative tibial plateau slope of 6 degrees has been noted. The objectives of this study were to investigate the geometric implications of this procedure and to identify factors that affect the postoperative angles. The records of 35 consecutive cases that had a TWO performed were reviewed and comparisons were made between the alignment of the cortices and level of the osteotomy using duplicated tracings of a preoperative radiograph. The existing method for calculating the size of wedge to be removed was found to result in a postoperative slope greater than the expected 6 degrees. Our results indicate that the desired postoperative angle is more likely to be achieved if the cranial cortices are aligned and the osteotomy is performed proximally.