Without doubt the mainstay of the work carried out by veterinary orthopaedic surgeons is the management of cruciate disease in the dog. Unlike the truly traumatic injury often seen in people, cruciate disease in dogs typically involves a spontaneous degenerative process. We are passionate about providing the very best outcome for dogs placed under our care and follow evidence-based practice and regularly seek expert opinion as to what the “best” treatment is. Our canine friends come in many shapes and sizes. Expectation for outcome also varies, from a handbag pooch to a working / agility high performance athlete. What is clear to me is one treatment will not suit all individuals. When I discuss options with owners and colleagues we consider many aspects of the different treatment modalities. These include the functional outcome, the complication risks (major and minor), post-operative care and the cost of the procedure. My goal is to allow an owner to make an informed decision for the treatment choice for their pet. After that we do everything we can to optimise the outcome.
The evidence behind cruciate repair can be baffling for both owners and clinicians alike and is beyond the scope of this post. However, what I would like to bring to attention is a more recent publication and how this led us to now recommend the tibial plateau leveling technique (TPLO) for many of our patients. Lacking in the literature is much by way of blinded prospective studies comparing outcome for the wide variety of surgical techniques used for management of cruciate disease in the dog. Krotscheck et al 2016 compared long-term functional outcome of tibial tuberosity advancement (TTA) vs. TPLO and extracapsular repair (ECR) in a mixed population of dogs. Using force plate gait analysis the team from Cornell University found TPLO resulted in operated limb function that was similar to the control population by 6–12 months postoperatively at the walk and the trot. At the trot, neither TTA nor ECR achieved normal ground reaction force. There are limitations with any study and I would guard against strong conclusions from one study with a relatively small number of dogs. As mentioned many factors are very important when making a decision. I still perform many other techniques including tibial levelling procedures by closing wedge osteotomies (CCWO) in smaller dogs and the TTA procedure when a rapid recovery is critical. However considering this study and several other aspects of current TPLO surgery, including the use of highly specialised locking plates, this technique does appear to have certain advantages. We have trialled many different TPLO saws and recently invested in a very effective model from Freelance Surgical.
I am always happy to discuss the management of cruciate disease in dogs. It is a complex and interesting topic. Who knows what future options will be out there for our pets?!
Krotscheck U, Nelson SA, Todhunter RJ, Stone M, Zhang Z. Long term functional outcome of tibial tuberosity advancement vs. tibial plateau leveling osteotomy and extracapsular repair in a heterogeneous population of dogs. Veterinary Surgery. 2016 Feb 1;45(2):261-8.