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Treating Cranial Cruciate Ligament Tears

Clinician's Brief (Capsule)

Orthopedics

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February 2015

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Cranial cruciate ligament (CCL) tears are arguably the most common orthopedic disease in dogs. Identifying and treating meniscal injury is crucial when treating CCL disease as meniscal pathology affects surgical outcomes. This prospective study evaluated how meniscal injury affects the prognosis in dogs being treated for CCL tears. The CCL tears were treated with 1) arthroscopy and TightRope (arthrex.com) stabilization; 2) arthroscopy and tibial plateau leveling osteotomy (TPLO); or 3) open arthrotomy and TPLO. The authors evaluated 163 dogs (223 stifles) with CCL tears.

The type of surgical technique used to repair a CCL rupture did not affect whether the dog developed a subsequent tear in the meniscus. In 83% of stifles evaluated by arthroscopy a meniscal tear was diagnosed, compared with only 44% with arthrotomy. Subsequent meniscal tears were diagnosed in 1.3% of cases with concurrent meniscal tears at CCL treatment, and in 21% of cases without concurrent meniscal tears at CCL treatment. Dogs treated with a meniscal release did not develop subsequent meniscal tears; however, 11% of dogs that did not have a meniscal release developed a subsequent meniscal tear.

Global Commentary

Part of this complex pathology is meniscal injury, which plays an important role in postoperative recovery. According to the results in this study, meniscal injury can actually be more common than we thought, in part because we are missing them. Dogs with concurrent meniscal injuries present a lower risk of future meniscal pathology, which is the most common postoperative complication, and better long-term outcome. A thorough intraoperative evaluation of the menisci is therefore imperative. As confirmed by this study, stifle arthroscopy is a superior technique for the diagnosis of meniscal injury, as it involves an enlarged visualization of the menisci and palpation of these structures with a probe. Although bucket handle tears that have flipped cranially are easy to diagnose, I spend a significant amount of time exploring and carefully probing apparently healthy menisci. You would be surprised how some meniscal tears can hide! Even if arthroscopy is not available and arthrotomy is the technique performed, I would recommend to always probe the menisci.—Pilar Lafuente, DVM, PhD, DACVS, DECVS (Hertfordshire, England)

This capsule is part of the Global Edition of Clinician's Brief

References

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