In dogs with cranial cruciate ligament disease treated non-surgically with rehabilitation, is the outcome inferior/equivalent/superior as measured by owner and/or veterinarian evaluation to dogs treated non-surgically without rehabilitation?
Clinical bottom line
Category of research question
The number and type of study designs reviewed
Four papers were critically appraised. One paper reviewed was a prospective, randomised clinical trial. The remaining three papers were retrospective cohort studies
Strength of evidence
There are no studies available that directly compare dogs managed non-surgically with and without rehabilitation following cranial cruciate ligament injury. In one study, 66% of dogs treated non-surgically with rehabilitation are reported to have successful outcomes 1 year following initiation of treatment. For dogs managed non-surgically without rehabilitation, successful outcomes varied from 19%–90% of cases among several retrospective studies
There is evidence suggesting the addition of rehabilitation to conservative therapy is beneficial, but based on the current literature, it is impossible to say whether it is superior to conservative treatment without rehabilitation
How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
Chauvet, A.E., Johnson, A.L., Pijanowski, G.J., Homco, L. & Smith, R.D. (1996). Evaluation of fibular head transposition, lateral fabellar suture, and conservative treatment of cranial cruciate ligament rupture in large dogs: a retrospective study. Journal of the American Animal Hospital Association. 32(3), 247–255. DOI: https://doi.org/10.5326/15473317-32-3-247
Pond, M.J. & Campbell, J.R. (1972). The canine stifle joint. I. Rupture of the anterior cruciate ligament. An assessment of conservative and surgical treatment. Journal of Small Animal Practice. 13(1), 1–10. DOI: https://doi.org/10.1111/j.1748-5827.1972.tb06791.x
Vasseur, P.B. (1984). Clinical Results Following Nonoperative Management for Rupture of the Cranial Cruciate Ligament in Dogs. Veterinary Surgery. 13, 243–246. DOI: https://doi.org/10.1111/j.1532-950X.1984.tb00801.x
Wucherer, K.L., Conzemius, M.G., Evans, R. & Wilke, V.L. (2013). Short-term and long-term outcomes for overweight dogs with cranial cruciate ligament rupture treated surgically or nonsurgically. Journal of the American Veterinary Medical Association. 242(10), 1364–1372. DOI: https://doi.org/10.2460/javma.242.10.1364
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