Section VI
Future Directions
Introduction
Recent advances in knowledge regarding
cruciate ligament rupture have begun to chal-
lenge past dogma regarding this condition.
New knowledge will undoubtedly lead to
innovations in treatment in the future. These
advances are likely to include improvements in
both surgical and medical management. Given
the emerging role of joint inflammation in the
pathogenesis of cruciate ligament rupture, a
combination of both medical and surgical treat-
ment will likely be required for improved out-
comes. Genetic research suggests that cruciate
ligament rupture is a highly polygenic complex
trait, although specific causal variants have
yet to be identified. Such discoveries would be
expected to provide knowledge of how distur-
bances to biological pathways lead to altered
ligament homeostasis and eventual rupture.
A major controversy in this field has been
how to evaluate clinical outcomes in dogs that
receive surgical treatment for stifle arthritis.
Although force platform or pressure mat gait
analysis remains the ‘gold standard’ method for
the objective quantification of lameness, client-
specific outcome measures for assessment of the
activity of canine patients and use of accelerom-
eters have now been validated as alternative
measures of outcome. In future studies, fur-
ther careful validation and evaluation of such
instruments used in combination with objective
analysis of gait are likely to generate higher
levels of evidence (Innes 2007) from clinical
trials.
This section provides details of emerging
areas of investigation relevant to the manage-
ment of dogs with cruciate ligament rupture.Reference
Innes JF. Outcomes-based medicine in veterinary
surgery: Levels of evidence. Vet Surg 2007;36:610–
612.353