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Better Method to Assess CCL Surgical Outcome

Clinician's Brief (Capsule)

Orthopedics

|June 2012

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Surgical techniques for repairing ruptured cranial cruciate ligaments (CCLs) are broadly classified as intracapsular ligament replacements, extracapsular suture techniques, neutralizing dynamic techniques, and modified methods. All eliminate cranial tibial thrust during weight bearing, but there is no defined gold standard. Postsurgical limb function and stifle joint morphology are usually evaluated by clinical and radiographic examination, but these have limitations and computer-based gait analysis is increasingly being used to eliminate subjective influences that might bias clinical outcome.

Using computer-based gait analysis, this study compared the improvement in degree of lameness after CCL repair in dogs using 2 surgical methods: capsular-fascial imbrication and tibial plateau-leveling osteotomy (TPLO). Two groups of 14 dogs were included. All dogs underwent gait analysis before surgery and at 4 days, 4 weeks, and 4 months after surgery. Symmetry indices of vertical ground reaction forces, vertical ground reaction forces in percent body weight, joint angles, and certain gait cycle parameters were assessed. Four months after surgery, the TPLO group achieved better symmetric weight bearing of hindlimbs when compared with the capsular-fascial imbrication group. A significantly increased ability to extend the stifle joint 4 months after surgery was also noted in the TPLO group. The complication rate in this group, however, was higher.

Commentary
The debate regarding the best surgical option for CCL disease seems endless, but no clear answer exists. The strength of this study is in the objectivity provided by computerized gait analysis. Force-plate analysis allows quantified computer information, such as amount of weight placed on a limb, instead of subjective visual attempts at lameness scores. Unfortunately, the surgical method compared with TPLO (ie, capsular-fascial imbrication) is not widely used. With computer-assisted gait analysis, studies can compare techniques with greater objectivity, thereby helping veterinarians better guide clients in understanding their best options.
—Kristy Broaddus, DVM, DACVS


Source
Computer-assisted gait analysis of the dog: Comparison of two surgical techniques for the ruptured cranial cruciate ligament. Böddeker J, Drüen S, Meyer-Lindenberg A, et al. VET COMP ORTHOP 25:11-21, 2012.

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