Advances in the Canine Cranial Cruciate Ligament, 2nd edition

Clinical Outcomes after Surgical Treatment of Cruciate Ligament Rupture 315

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PVF(%BW)

Normal dogs

LS

TPLO

TTA

Pre-operative

2 weeks 8 weeks 6 months 12 months

Figure 38.2 Canine pelvic limb use at the trot (mean peak vertical force (PVF)×% body weight) measured by dual
force plates in normal dogs and before and after unilateral lateral suture (LS), tibial plateau leveling osteotomy (TPLO),
and tibial tuberosity advancement (TTA) in prospective clinical studies. The black boxes indicate a lack of significant
difference between values. Data from Nelsonet al. 2013 and Krotschecket al. 2016.

Factors affecting clinical outcome

Patient, owner, and surgeon factors may affect
clinical outcome. Currently, the evidence sup-
ports similar clinical outcomes for small-, large-,
and giant-breed dogs after LS and TPLO
(Gordon-Evanset al. 2013; Nelsonet al. 2013;
Bergeret al. 2015). Postoperative TTA compli-
cations decrease PVF, although with appropri-
ate treatment PVF returns to a level similar to
dogs without complications (Vosset al. 2008).
Data suggest that the method of joint explo-
ration (arthrotomy versus arthroscopy) and
meniscal treatment do not affect the speed or
extent of recovery in naturally occurring canine
CR (Thiemanet al. 2006; Nelsonet al. 2013).
However, arthroscopic evaluation does provide
improved examination of the menisci, which
may potentially affect outcome, as failure to
identify a meniscal tear at the time of initial
surgery leads to lameness in the postoperative
period (Thiemanet al. 2006; Pozziet al. 2008).
Stifle osteoarthritis is progressive regardless
of treatment, though the severity of osteoarthri-
tis is not reported to affect clinical function in
dogs (Auet al. 2010; MacDonaldet al. 2013;
Bergeret al. 2015). However, in the intermediate

or long term, progressive osteoarthritis and

periarticular fibrosis may account for the

observed reduction in stifle range of motion

after some techniques (MacDonaldet al. 2013;

Mols ̈ a ̈ et al. 2014). Physical rehabilitation

improves the speed and extent of recovery

in the early postoperative time period, and

some evidence suggests that there may also be

long-term benefits (Auet al. 2010; Romano &

Cook 2015).

Conclusions

Scientific evidence supports an improvement in

clinical function after surgical therapy for CR

in dogs. However, not all surgical procedures

offer an equivalent level of recovery. At the cur-

rent time, the best available evidence provides

strong support that TPLO allows dogs to regain

normal clinical function. The evidence suggests

that the clinical outcome after TPLO is supe-

rior to the LS and TTA. Data do not support the

ability of the TTA to consistently allow dogs to

return to normal clinical function. Longer-term

studies are necessary to evaluate clinical func-

tion following all surgical procedures.