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Clinical Outcomes after

Surgical Treatment of Cruciate

Ligament Rupture

Mary Sarah Bergh and Steven C. Budsberg

Introduction

Surgical therapy has been recommended as the
optimal treatment to manage pain, discomfort,
and stifle instability secondary to canine cru-
ciate ligament rupture (CR), due to the belief
that it will provide a provide a more rapid
return to function of the limb as compared
to non-surgical management. Interestingly, rel-
atively limited data are available to support
this idea (Pond & Campbell 1972; Vasseur 1984;
Wurchereret al. 2013). Wucherer and cowork-
ers prospectively documented that dogs under-
going tibial plateau leveling osteotomy (TPLO)
had improved subjective and objective out-
come scores compared to dogs undergoing non-
surgical management (weight loss, physiother-
apy, and pain management with nonsteroidal
anti-inflammatory drugs) at 24 and 52 weeks
after surgery. Their surgical group had a higher
probability of a successful outcome at the 12-,
24-, and 52-week evaluation time points.
While hundreds of studies have been pub-
lished describing various surgical procedures
to treat CR in dogs, relatively few report clin-
ical outcomes for naturally occurring disease,
and even fewer compare surgical therapies or
compare a surgical treatment to non-surgical
treatment (Berghet al. 2014). At the present

time, the most commonly performed surgi-

cal procedures, including TPLO, lateral extra-

capsular suture stabilization (LS), and tibial

tuberosity advancement (TTA), are all reported

to improve clinical function in dogs postoper-

atively (Slocum & Slocum 1993; Lafaveret al.

2007; Voss et al. 2008; Gordon-Evans et al.

2013; Duerr et al. 2014). A clear consensus

on the amount of clinical improvement with

each procedure is difficult to ascertain because

study designs, follow-up time frame and out-

come assessment methods are highly variable

between studies. From an evidence-based per-

spective, the most useful data are generated

from prospective, randomized blinded clinical

trials, utilizing objective (i.e., kinetic or kine-

matic gait analysis) or validated subjective out-

come data. Unfortunately, these types of study

are scarce in veterinary medicine.

Early postoperative clinical outcomes

(<6 months)

Most studies report an initial decrease in limb

function, followed by a progressive increase

in limb function, which generally plateaus

around 6 months after surgery, regardless of the

surgical procedure employed (Auet al. 2010;

Advances in the Canine Cranial Cruciate Ligament, Second Edition. Edited by Peter Muir. © 2018 ACVS Foundation.
This Work is a co-publication between the American College of Veterinary Surgeons Foundation and Wiley-Blackwell.

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