Results of a survey of Veterinary Orthopedic Society members on the preferred method for treating cranial cruciate ligament rupture in dogs weighing more than 15 kilograms (33 pounds)

Abstract

OBJECTIVE To determine which method (lateral fabellotibial suture [LFS], tibial plateau leveling osteotomy [TPLO], tibial tuberosity advancement [TTA], or tightrope-like braided multifilament suture secured with metallic buttons [TR]) Veterinary Orthopedic Society (VOS) members preferred for treating cranial cruciate ligament rupture (CCLR) in dogs weighing > 15 kg (33 lb), identify factors associated with this preference, and assess concerns related to surgical implant material used. DESIGN Cross-sectional study. SAMPLE 187 VOS members. PROCEDURES All registered VOS members received an online survey from June to July 2016. Responses were compiled and evaluated for associations with method preferences and perceived complications. RESULTS Overall response rate was 38.4% (221/575). Respondents had graduated from veterinary school a mean of 23 years prior to survey completion, and collectively they performed approximately 30,000 CCLR surgeries annually. The most commonly preferred method was TPLO (147 [78.6%]), followed by TTA (26 [13.9%]), the LFS procedure (11 [5.9%]), and the TR procedure (3 [1.6%]). The preference for TPLO was independent of board certification or college of training (American, European, or other College of Veterinary Surgeons). Non-board-certified surgeons, including general practitioners, also favored TPLO. The most common perceptions were that titanium implants (used for TTA) were associated with the lowest incidence of major complications, whereas braided multifilament suture (used for the TR procedure) was associated with the highest incidence of major complications. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that TPLO was preferred for treating CCLR in dogs weighing > 15 kg and that the TR procedure was perceived as having the highest complication rate. With results of this survey in mind, use of the TR procedure should be considered cautiously when treating CCLR.

Fortetropin inhibits disuse muscle atrophy in dogs after tibial plateau leveling osteotomy

“…The TPLO is the most common orthopedic surgery for stabilization of cranial cruciate ligament deficient stifles in dogs [12,13]. Patients undergoing a TPLO and other orthopedic procedures are often subjected to activity restriction, and the development of disuse muscle atrophy following orthopedic injuries has been documented [15].…”

“…Cranial cruciate ligament (CCL) rupture is the most common stifle injury in medium and large breed dogs, ultimately resulting in pain, lameness, and secondary muscle atrophy of the affected limb [9]. While various surgical procedures are described for the repair of CCL rupture, the tibial plateau leveling osteotomy (TPLO) is the most common repair technique for the cranial cruciate ligament deficient stifle, with the ultimate goal of providing functional stifle joint stability [10][11][12][13]. There have not been any studies addressing the effect of disuse muscle atrophy on stifle joint stability or on interventions to mitigate disuse muscle atrophy in dogs with CCL rupture.…”

Ex vivo mechanical properties of a 2.5‐mm bone anchor for treatment of cranial cruciate ligament rupture in toy breed dogs

“…The abrasive characteristics of this suture to soft tissues (cheese‐wiring effect) and suture breakage of biodegradable and metal bone anchors have been reported . In addition, von Pfeil et al surveyed veterinary orthopedic surgeons who reported only a 1.6% preference for using the same suture materials in dogs with CCL deficient stifles weighing >15 kg primarily because of major complications, among which infection rather than cheese‐wiring or implant failure was most common. Although this is a cause for concern, the impact of the abrasive nature of the suture has not been documented in toy breed dogs.…”

<p>Tibial Plateau Leveling Osteotomy for Cranial Cruciate Ligament Rupture in Canines: Patient Selection and Reported Outcomes</p>

“…The TPLO is currently the most commonly recommended procedure by veterinary surgeons for the treatment of CCL rupture. 10,27 That said, several other procedures exist and may be alternatively selected for the treatment of CCL rupture. The TPLO is a dynamic osteotomy-based procedure that neutralizes tibiofemoral shear force during weight bearing.…”

“…A variety of static and dynamic stifle joint procedures have been previously described, with the tibial plateau leveling osteotomy (TPLO) emerging as the preferred treatment option for present-day surgeons. 10 This is due to the TPLO demonstrating exceptional and repeatable clinical outcomes when compared to other surgical options.…”