Treatment Of Cranial Cruciate Ligament Research Articles

Long-term clinical and goniometric follow-up of lateral suture surgery in dogs with cranial cruciate ligament rupture

The aim of this study was to evaluate the complications and the short-, medium-, and long-term outcomes following treatment of cranial cruciate ligament (CCL) rupture in dogs using the lateral fabello-tibial suture technique. The patients were ten dogs of various breeds, 62.5 ± 18.8 months of age, weighing 30.2 ± 3.3 kg, with unilateral CCL rupture. At 2, 6, 12, 24, and 52 weeks after surgery, the dogs were re-evaluated with clinical examination, gait and pain analysis, and radiography. A major complication was identified in one dog (10%), requiring second surgery due to implant failure and destabilisation of stifle joint. Minor complications occurred in two dogs postoperatively (one late meniscal injury and one case of seroma formation). The short-term outcome at two and six weeks postoperatively was considered good in six dogs and satisfactory in four dogs, while the mid-term outcome (between 12 and 24 weeks) was good to excellent in eight dogs and satisfactory in two dogs. All ten dogs had a good to excellent outcome 52 weeks after surgery. The lateral suture technique is generally safe and given the major benefits, such as lower costs, lower technical difficulty, and minimal requirement for specialised equipment, will probably remain a popular and alternative method for treatment of CCL insufficiency in dogs with good degree of owner satisfaction.

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.

Histologic Analysis of Retrieved Synthetic Ligaments Implanted in Dogs for Treatment of Cranial Cruciate Ligament Disease

Objective: To histologically analyze retrieved synthetic liagments implanted in canine stifles for the treatment of cranial cruciate ligament disease.Animals: 6 client-owned dogsProcedures: Synthetic ligaments (SL) were retrieved from 6 dogs. Five had experienced postoperative complications which necessitated their removal and 1 dog died of unrelated causes. The formalin fixed SLs were stained with hematoxylin and eosin, Masson’s trichrome, Alcian blue, Vimentin and Reticulin stains using standard histologic staining protocols and examined histologically via normal light microscopy. The histologic evaluation involved both a qualitative description and semiquantitative assessment of each dog’s cellular response to the implanted SL. Additionally, a semiquantitative scoring system was used for describing the distribution and amount of fibroblasts around and within the central (inner 1/2) and peripheral (outer 1/2) zones and individual core fibers of the synthetic ligaments.Results: Sheath and core segments had amounts of cellular infiltration which ranged from minimal to moderate which consisted primarily of fibroblasts with rare multinucleate giant cells present and no evidence of lymphoid or inflammatory cellular infiltrates. Peripheral zone fibroblast ingrowth ranged from minimal to moderate and infiltration consistently decreased into the central (inner ½) zones. There was a minimal amount of fibroblast infiltration and encircling of individual core fibers. Infiltrating fibroblasts deposited collagen matrix and mild to moderate amounts of reticulin fibers within the hypercellular regions of the sheath with lesser amounts in the core segments.Conclusions and Clinical Relevance: The structure and composition of this synthetic ligament supported variable amounts of fibroblast ingrowth and activity while inducing a minimal amount of inflammatory cell infiltration.

Physical rehabilitation for canine patients post cranial cruciate ligament surgery

Surgical treatment of cranial cruciate ligament (CCL) disease is commonly performed in veterinary practice. Perioperative rehabilitation is standard of care in human patients with anterior cruciate ligament injury. Evidence is slowly mounting showing benefits of post-operative rehabilitation in canine patients following CCL surgery. A rehabilitation programme should be developed and guided by a professional trained and certified in canine rehabilitation, and progress through the programme should be based on individual patient assessment and functional goals rather than time elapsed since surgery. This article presents an example of progression through a post CCL surgery rehabilitation programme utilising clinic-based therapies and a home exercise plan. The purpose of this article is to educate primary care veterinary surgeons on what a trained and certified veterinary physiotherapist/rehabilitation therapist may recommend during the rehabilitation period. This manuscript is NOT intended to be used as a formula for all patients following CCL surgery, and examples are NOT intended to be provided to pet owners without individual patient assessment and guidance of a veterinary physiotherapist/rehabilitation therapist.

Outcome of Tibial Closing Wedge Osteotomy in 55 Cranial Cruciate Ligament-Deficient Stifles of Small Dogs (

To describe the outcome of cranial closing wedge osteotomy (CWO) of the tibia for treatment of cranial cruciate ligament (CrCL)-deficient stifles in dogs with a body weight of <15 kg. Retrospective case series. Forty-five client-owned dogs (n=55 stifles). Medical records (2005-2014), radiographs, and owner questionnaire were used to identify the surgical procedure performed, associated complications and outcome in 45 dogs undergoing CWO in 55 stifles. Data for 55 stifles from 45 dogs were included. Bichon Frise was the most frequent dog breed (n=11). Mean pre- and postoperative tibial plateau angle (TPA) were 36.3° (95% CI 35.1-37.5) and 7.5° (95% CI 6.7-8.2), respectively. Pin and tension bands were placed in 38/55 stifles (69%). The most frequent complication at short-term follow-up (2 weeks) was incisional complications in 8 stifles; all resolved with systemic antibiotic administration alone. Data were available for all stifles at 8 week follow-up with an overall complication occurrence in 16/55 stifles (28%); 1 dog required revision surgery. Tibial osteotomy healing was evident on radiographs at 8 weeks postoperative in 53 stifles (96%), considered complete in 27 stifles, and good in 26 stifles. Follow-up owner questionnaire was available for 36 dogs at a mean of 24 months and 34/36 owners (94%) were satisfied with the procedure and considered their dog had a good quality of life with minimal long-term complications. Dogs with a body weight <15 kg undergoing CWO for treatment of a CrCL-deficient stifle had a good outcome based on clinical status, radiographic evaluation, and owner questionnaire.

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.

Uso de plasma rico em plaquetas intra-articulares como tratamento pós-cirúrgico da ruptura do ligamento cruzado cranial num cão

Relata-se o caso de um cão que recebeu injeções intra-articulares de plasma rico em plaquetas (PRP) durante o pós-operatório do tratamento cirúrgico de ruptura do ligamento cruzado cranial (RLCCr). Os resultados clínicos e da avaliação da marcha mediante plataforma de força neste paciente sugerem a utilização de injeções intra-articulares de PRP como terapia pós-cirúrgica no tratamento da RLCCr.

The Effect of Cancellous Autograft and Novel Plate Design on Radiographic Healing and Postoperative Complications in Tibial Tuberosity Advancement for Cranial Cruciate‐Deficient Canine Stifles

To assess the effect of autogenous cancellous bone graft (autograft) and novel plate use on radiographic healing and complications in tibial tuberosity advancement (TTA) for treatment of cranial cruciate ligament (CrCL)-deficient stifles in dogs. Prospective clinical study. Consecutive dogs (n=125) with unilateral CrCL-deficient stifles. Four treatment groups: CPG, conventional plate with autograft; CPNG, conventional plate without autograft; NPG, novel plate with autograft; NPNG, novel plate without autograft were studied. Radiographs from 60 dogs were scored for healing at 6 and 10 weeks postoperatively; all 125 dogs were assessed for radiographic complications. Variables evaluated for relationship with healing scores and radiographic complications were age, weight, sex, cage and plate size, implant type, and graft use. Dogs with autograft had overall higher healing scores at 6 and 10 weeks. Radiographic complications occurred in 13 dogs (12 minor, 1 major), and were not influenced by graft or novel plate use. Autograft increases healing scores, but was not found to have a significant impact on the rate of complications in TTA. The novel plate was not found to have healing scores or radiographic complication rates significantly different from the conventional plate design.

Tibial Osteotomies for Cranial Cruciate Ligament Insufficiency in Dogs

To review the biomechanical considerations, experimental investigations, and clinical data pertaining to tibial osteotomy procedures for treatment of cranial cruciate ligament (CrCL) insufficiency in dogs. Literature review. Literature search through Pub Med, Veterinary Information Network, Commonwealth Agricultural Bureau Abstracts, and conference proceedings abstracts (November 1977 to March 2007). Reported tibial osteotomy procedures attempt to eliminate sagittal instability (cranial tibial thrust) in CrCL-deficient stifles by altering the conformation of the proximal tibia. Functional stability can be achieved by decreasing the tibial plateau slope (cranial tibial closing wedge osteotomy [CTWO], tibial plateau leveling osteotomy [TPLO], combined TPLO and CTWO, proximal intraarticular osteotomy, chevron wedge osteotomy), altering the alignment of the patellar tendon (tibial tuberosity advancement), or both (triple tibial osteotomy). Clinical reports assessing the efficacy of these procedures frequently use subjective outcome measures, and the periods of follow-up evaluation are highly variable. Satisfactory results have been reported in most (>75%) dogs irrespective of the type of tibial osteotomy procedure. Currently available data does not allow accurate comparisons between different tibial osteotomy procedures, or with traditional methods of stabilizing the CrCL-deficient stifle. Carefully designed long-term clinical studies and further biomechanical analyses are required to determine the optimal osteotomy technique, and whether these procedures are superior to other stabilization methods. Limb function in dogs with CrCL insufficiency can be improved using the currently described tibial osteotomy techniques.

Incidence of Motion Loss of the Stifle Joint in Dogs with Naturally Occurring Cranial Cruciate Ligament Rupture Surgically Treated with Tibial Plateau Leveling Osteotomy: Longitudinal Clinical Study of 412 Cases

To report the incidence of loss of stifle extension or flexion and its relationship with clinical lameness after tibial plateau leveling osteotomy (TPLO) for treatment of cranial cruciate ligament (CCL) rupture. Longitudinal study. Dogs (n=280) with CCL rupture (n=412). TPLO was performed without meniscal release or arthrotomy. Angles of extension and flexion of the stifle were measured by goniometry to determine range of motion. Based upon motion loss, stifles were divided in 3 groups: no loss of extension or flexion (n=322), <10 degrees loss of extension or flexion (n=78), > or =10 degrees loss of extension or flexion (n=12). Loss of extension or flexion > or =10 degrees was associated with significantly (P=.001) higher clinical lameness scores in comparison with no loss, or loss of extension or flexion <10 degrees. Osteoarthrosis in the cranial femorotibial joint was significantly correlated (P<.005, r(2)=0.55) with loss of extension. Loss of extension > or =10 degrees was less tolerable and less amenable to physical rehabilitation than flexion loss. Loss of extension or flexion > or =10 degrees was responsible for higher clinical lameness scores. Osteoarthrosis in the cranial femorotibial joint led to extension loss. Loss of extension or flexion should be assessed in dogs with persistent clinical lameness after TPLO so that early intervention can occur. Our study provides guidelines to define clinically relevant loss of extension or flexion of stifle joint after TPLO.

Combination Tibial Plateau Leveling Osteotomy and Cranial Closing Wedge Osteotomy of the Tibia for the Treatment of Cranial Cruciate Ligament‐Deficient Stifles with Excessive Tibial Plateau Angle

To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling osteotomy and cranial closing wedge osteotomy (TPLO/CCWO). Retrospective clinical study. Fifteen client-owned dogs (18 stifle joints). Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview. Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status. Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone. TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity.