Jury still out on best approach to cruciate repair
Julian Hoad
In a lively presentation at the BVNA Congress, orthopaedic vet, Julian Hoad, offered delegates a 'refresher' on cruciate ligament injuries and a hint of a question regarding the evidence to support surgical intervention.
Cranial cruciate ligament rupture is the single most common orthopaedic injury in dogs. It is painful; and irrespective of whether there is surgical or conservative management, it will inevitably lead to osteoarthritic changes in the joint. Despite all the current knowledge of the disease, it is still under-diagnosed.
The condition was first reported in 1926 and has been associated with many factors: including breed, diet, body weight, exercise and abnormal structure and gait. Theories as to contributory anatomical features include chronic ligament degeneration and the so-called 'tibial thrust', and any theory has to explain why cruciate disease rarely occurs in greyhounds.
Diagnosis is sometimes difficult, but there are classical signs in both the history and clinical examination. The 'cranial drawer' test is the most specific.
The aims of management are usually set against the future activity anticipated for the dog; and the relief of pain, restoration of normal gait and reduction of osteoarthritic changes are paramount. Monitoring of progress is difficult, with force plate analysis being the best option.
Treatment falls into two categories – either conservative or surgical. Historically, it was believed that in dogs under 10kg body weight, conservative management was acceptable, but that dogs over that weight should receive surgery. Received wisdom now is that all dogs should have surgery; however, despite the wide range of surgical techniques available, the definitive evidence to support this mantra is not available.
On average a new technique emerges for the treatment of cranial cruciate disease every two to three years!
RCVS Knowledge has called on vet practices to audit their post-operative neutering outcomes.
