DOI
https://doi.org/10.18849/ve.v11i3.749Abstract
PICO Question
In dogs with a naturally occurring ruptured cranial (anterior) cruciate ligament [P] does surgical treatment using tibial plateau levelling osteotomy (TPLO) [I] compared to a surgical repair using tibial tuberosity advancement (TTA) [C] result in a reduction in the risk of developing postoperative osteoarthritis? [O]
Clinical bottom line
Category of research
Treatment.
Number and type of study designs reviewed
Three papers were reviewed. These were a prospective, randomised, non-controlled clinical trial; a prospective, randomised, controlled clinical trial; and a retrospective, non-controlled, blinded cohort study.
Strength of evidence
Weak.
Outcomes reported
The first clinical trial showed that TTA was associated with less osteoarthritis OA progression than TPLO at 6-month follow-up. However, the opposite was reported in the second clinical trial, where less OA was recorded following TPLO than TTA surgery. In both the first and second studies, the difference between groups was not significant. The third study reports a significant increase in OA score in TTA over TPLO group at end of follow-up period. Despite the third study claiming a noticeable difference in recorded OA between these two surgeries, evidence is presently scant.
Conclusion
At the time of writing of this Knowledge Summary there is minimal evidence to conclude either TTA or TPLO reduces the rate of postoperative osteoarthritis progression for dogs treated for naturally occurring cranial cruciate ligament rupture.
Additional comments and caveats
All three studies possess various limitations, such as a lack of controls, absent confidence intervals, lacking blinding, small sample sizes, presence of confounders, bias, and short follow-up, all of which limit the value of their conclusions.
References
Cox, J.S., Nye, C.E., Schaefer, W.W. & Woodstein, I.J. (1975). The Degenerative Effects of Partial and Total Resection of the Medial Meniscus in Dogs’ Knees. Clinical Orthopaedics and Related Research. 109, 178–183. DOI: https://doi.org/10.1097/00003086-197506000-00026
Ertelt, J. & Fehr, M. (2009). Cranial cruciate ligament repair in dogs with and without meniscal lesions treated by different minimally invasive methods. Veterinary and Comparative Orthopaedics and Traumatology. 22(1), 21–26. DOI: https://doi.org/10.3415/VCOT-07-06-0063
Knebel, J., Eberle, D., Steigmeier-Raith, S., Reese, S. & Meyer-Lindenberg, A. (2020). Outcome after Tibial Plateau Levelling Osteotomy and Modified Maquet Procedure in Dogs with Cranial Cruciate Ligament Rupture. Veterinary and Comparative Orthopaedics and Traumatology. 33(3), 189–197. DOI: https://doi.org/10.1055/s-0040-1701502
Livet, V., Baldinger, A., Viguier, É., Taroni, M., Harel, M., Carozzo, C. & Cachon, T. (2019). Comparison of Outcomes Associated with Tibial Plateau Levelling Osteotomy and a Modified Technique for Tibial Tuberosity Advancement for the Treatment of Cranial Cruciate Ligament Disease in Dogs: A Randomized Clinical Study. Veterinary and Comparative Orthopaedics and Traumatology. 32(4), 314–323. DOI: https://doi.org/10.1055/s-0039-1684050
Luther, J. K., Cook, C.R. & Cook, J.L. (2009). Meniscal Release in Cruciate Ligament Intact Stifles Causes Lameness and Medial Compartment Cartilage Pathology in Dogs 12 Weeks Postoperatively. Veterinary Surgery. 38(4), 520–529. DOI: https://doi.org/10.1111/j.1532-950X.2009.00520.x
Moore, E. V., Weeren, R. and Paek. M. (2020). Extended long-term radiographic and functional comparison of tibial plateau leveling osteotomy vs tibial tuberosity advancement for cranial cruciate ligament rupture in the dog. Veterinary Surgery. 49(1), 146–154. DOI: https://doi.org/10.1111/vsu.13277
Pozzi, A., Litsky, A.S., Field, J., Apelt, D., Meadows, C. & Johnson, K.A. (2008). Pressure distributions on the medial tibial plateau after medial meniscal surgery and tibial plateau levelling osteotomy in dogs. Veterinary and Comparative Orthopaedics and Traumatology. 21(1), 8–14.DOI: https://doi.org/10.3415/VCOT-06-12-0099
Rayward, R.M., Thomson, D.G., Davies, J.V., Innes, J.F. & Whitelock, R.G. (2004). Progression of osteoarthritis following TPLO surgery: a prospective radiographic study of 40 dogs. Journal of Small Animal Practice. 45(2), 92–97.DOI: https://doi.org/10.1111/j.1748-5827.2004.tb00209.x
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