Investigation of Variables Associated with Surgical Site Infection following the Management of Canine Cranial Cruciate Ligament Rupture with a Lateral Fabellotibial Suture

Abstract

Objectives This study investigated variables associated with surgical site infection (SSI) in dogs with cranial cruciate ligament rupture managed with stifle joint examination and lateral fabellotibial suture stabilization. Study Design A retrospective study of dogs that had stifle arthroscopy, stifle arthrotomy, or a combination of both, followed by lateral fabellotibial suture stabilization for cranial cruciate ligament rupture. All cases had a minimum follow-up of 90 days. Lameness grades were recorded preoperatively, and at 6-week and final follow-up. Results One hundred fifty procedures in 130 dogs met the inclusion criteria. Overall, SSI rate was 17.3% and removal of the lateral fabellotibial suture was performed in 53% of SSI. Multivariable analysis showed significant association between SSI and bodyweight (p = 0.013), and induction using propofol (p = 0.029). Multilevel ordinal logistic regression analysis showed a greater proportion of dogs had a higher lameness grade at 6-week (p = 0.021) and final follow-up (p = 0.002) assessments in the infected compared with non-infected dogs. Conclusion Our study demonstrated a higher SSI incidence than previously reported in dogs undergoing a lateral fabellotibial suture for cranial cruciate ligament rupture. Bodyweight and induction with propofol were identified as significant risk factors for postoperative SSI. Owners could be advised of an increased SSI risk in larger dogs and consideration should be given to selection of induction agent. Dogs that develop an SSI have a worse lameness grade at 6-week and final follow-up.

Update on the management of canine cruciate disease

“…Infection rates following TTA have been reported in 4.6 per cent to 15.4 per cent of cases, with between 1.3 per cent and 39 per cent of cases requiring implant removal for resolution (although the cage was not removed in the majority of cases) (Yap and others 2015, Hans and others 2017, Ferrell and others 2019). Similar infection rates of up to 14.5 per cent for CTCWO and 17.3 per cent for ECS have been reported, with the suture requiring removal in 53 per cent cases for resolution (Campbell and others 2016, Cox and others 2020).…”

“…Factors associated with significantly increased infection rates include increased bodyweight, being a GSD, undergoing meniscectomy, surgeon experience (<20 procedures), increased surgical and anaesthesia time, and induction with propofol (Fitzpatrick and Solano 2010, Yap and others 2015, Lopez and others 2018, Giannetto and Aktay 2019, Cox and others 2020). Although some authors reported a significantly reduced risk of infection and/or major complications when antibiotics were given postoperatively (Fitzpatrick and Solano 2010, Hans and others 2017), others reported no benefit (Yap and others 2015, Campbell and others 2016, Lopez and others 2018, Ferrell and others 2019, Cox and others 2020).…”

Dogs undergoing surgical excision of mast cell tumors are not at increased risk of incisional complications

“…Propofol use has been identified as a risk factor for surgical site infections in previous studies, 33,34 where it has been proposed that the lipid-based emulsion provides an environment suited for microbial growth and may contribute to surgical wound infection. In the present study, propofol administration was not associated with incisional complications.…”

Complications and postoperative non‐steroidal anti‐inflammatory use of three extracapsular cruciate ligament repair techniques performed in a general practice clinic environment

“…It was demonstrated that at least 53 large dogs and 159 small dogs were required (a total of 212 dogs), under the assumption that there was no difference in complications between the three procedures, 20% complications in the large dogs compared to 5% in the small dogs, with 80% power and a 95% confidence level for a two-tailed test. The predicted complication rates were based on previous studies (Casale & McCarthy 2009, Cook et al 2010a,b, Ritzo et al 2014, Cox et al 2020.…”

“…The material used is typically a monofilament suture. Prior studies have shown that weight and age significantly influence the complication rates associated with this procedure (Casale & McCarthy 2009, Cox et al 2020. However, despite complications, acceptable outcomes have been reported for heavy dogs (>40 kg) especially when adequate physiotherapy is provided (Guénégo et al 2007, Jerre 2009.…”