Journal Scan: Ruptured CCL surgery: TPLO vs. extracapsular repair

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Sep 01, 2013

Why they did it

You have a variety of options to choose from for surgical repair of a cranial cruciate ligament (CCL) rupture in your canine patients. This study sought to determine which of two common repair techniques results in faster recovery and better overall results.

What they did

Researchers evaluated force plate gait analysis preoperatively and two weeks, eight weeks, six months, and 12 months after repair of a CCL rupture with either extracapsular repair (ECR; n=23) or tibial plateau leveling osteotomy (TPLO; n=15). These results were compared with force plate gait analysis in normal adult dogs (n=79). Symmetric indices including peak vertical force, contact time, and vertical impulse were calculated between the operated and unoperated limbs.

What they found

The researchers found more symmetric limb loading at eight weeks among patients in the TPLO group compared with those in the ECR group at a walk and trot. Symmetric indices were similar between the TPLO and control groups six months and one year postoperatively but were less symmetric among the ECR group for all time periods. Median time to normal function was shorter for the TPLO group for vertical impulse and peak vertical force, but there was no difference at a walk between groups.

Take-home message

After TPLO surgery, dogs were able to bear weight on the operated leg faster than those that underwent ECR surgery. In addition, limb function in dogs in the TPLO group was indistinguishable from the control dogs by one year. The researchers acknowledge that the sample size of the study was small and the assignment to a treatment group was not randomized, which may have introduced bias. The long evaluation period also resulted in a number of dogs being lost to follow-up. Whether the type of surgery chosen has an effect on the development or progression of osteoarthritis over time will require further study.

Nelson SA, Krotscheck U, Rawlinson J, et al. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. Vet Surg 2013;42(1):38-50.

Link to article: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-950X.2012.01052.x/full

Jennifer L. Garcia, DVM, DACVIM, is a veterinary internal medicine specialist at Sugarland Veterinary Specialists in Houston, Texas.