Surgeons’ preferences in treating cranial cruciate ligament ruptures in dogs

Donna L. Korvick From the Department of Laboratory Animal Resources, University of Texas Health Science Center, San Antonio, TX 78284-7859 (Korvick), and Departments of Veterinary Clinical Sciences (Johnson) and Veterinary Bioscience (Schaeffer), University of Illinois, Urbana, 1L 61874.

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Ann L. Johnson From the Department of Laboratory Animal Resources, University of Texas Health Science Center, San Antonio, TX 78284-7859 (Korvick), and Departments of Veterinary Clinical Sciences (Johnson) and Veterinary Bioscience (Schaeffer), University of Illinois, Urbana, 1L 61874.

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David J. Schaeffer From the Department of Laboratory Animal Resources, University of Texas Health Science Center, San Antonio, TX 78284-7859 (Korvick), and Departments of Veterinary Clinical Sciences (Johnson) and Veterinary Bioscience (Schaeffer), University of Illinois, Urbana, 1L 61874.

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Summary

To characterize veterinary surgeons’ preferences in diagnostic, surgical, and postoperative management of cranial cruciate ligament ruptures in dogs, 175 surgeons, including American College of Veterinary Surgeons diplomates, surgery specialty-practice veterinarians, university surgeons, and surgery residents, were surveyed. Their experience with stifle surgery was evenly distributed from 1 to > 21 years. Approximately 70% (118/175) of surgeons treated 3 to 9 dogs with cranial cruciate ligament rupture each month. In diagnosis, 98% (172/175) of the surgeons used a cranial drawer test with the stifle joint at 140° of flexion. Stifle radiography was performed by 53% (93/175) of surgeons for acute and by 81% (141/175) of surgeons for chronic cases. In repair of cranial cruciate ligament ruptures, 32% (56/175) of surgeons did not use intra-articular procedures, whereas 8% (14/175) of surgeons did not use extra-articular procedures. Surgical preferences depended on dog size (P < 0.05). For small dogs (ie, < 11 kg), 80% (140/175) of surgeons used extra-articular methods, and 14% (24/175) used intra-articular methods. For medium dogs (ie, 11 to 29 kg), 52% (91/175) of surgeons used extraarticular and 43% (75/175) used intra-articular methods. For large dogs (ie, > 29 kg), surgeons’ preferences depended on the injury’s duration (P < 0.05). For large dogs with acute injuries, 39% (68/175) preferred extra-articular and 55% (96/175) preferred intra-articular, whereas in chronic cases, 52% (91/175) preferred extra-articular and 42% (73/175) preferred intra-articular. The most common extra-articular method was placement of a suture from the lateral fabella to a hole drilled in the tibial tuberosity. Nylon and polypropylene were the most common sutures used for extra-articular repairs. Placement of fascia lata over the lateral femoral condyle (over-the-top technique) was the most common intra-articular method. Seventy percent (83/119) of surgeons used sutures to attach the graft, whereas 30% (36/119) used a screw and spiked washer. In general, surgeons combined more surgical procedures for extra-articular repairs and fewer for intra-articular repairs. Most surgeons immobilized the affected joint for ≤ 3 weeks following surgery, however, 23% (52/224) of bandaging choices were to opt for no joint immobilization. Following surgery, house confinement and restricted activity for ≤ 12 weeks was preferred by 87% (152/175) of surgeons.

Summary

To characterize veterinary surgeons’ preferences in diagnostic, surgical, and postoperative management of cranial cruciate ligament ruptures in dogs, 175 surgeons, including American College of Veterinary Surgeons diplomates, surgery specialty-practice veterinarians, university surgeons, and surgery residents, were surveyed. Their experience with stifle surgery was evenly distributed from 1 to > 21 years. Approximately 70% (118/175) of surgeons treated 3 to 9 dogs with cranial cruciate ligament rupture each month. In diagnosis, 98% (172/175) of the surgeons used a cranial drawer test with the stifle joint at 140° of flexion. Stifle radiography was performed by 53% (93/175) of surgeons for acute and by 81% (141/175) of surgeons for chronic cases. In repair of cranial cruciate ligament ruptures, 32% (56/175) of surgeons did not use intra-articular procedures, whereas 8% (14/175) of surgeons did not use extra-articular procedures. Surgical preferences depended on dog size (P < 0.05). For small dogs (ie, < 11 kg), 80% (140/175) of surgeons used extra-articular methods, and 14% (24/175) used intra-articular methods. For medium dogs (ie, 11 to 29 kg), 52% (91/175) of surgeons used extraarticular and 43% (75/175) used intra-articular methods. For large dogs (ie, > 29 kg), surgeons’ preferences depended on the injury’s duration (P < 0.05). For large dogs with acute injuries, 39% (68/175) preferred extra-articular and 55% (96/175) preferred intra-articular, whereas in chronic cases, 52% (91/175) preferred extra-articular and 42% (73/175) preferred intra-articular. The most common extra-articular method was placement of a suture from the lateral fabella to a hole drilled in the tibial tuberosity. Nylon and polypropylene were the most common sutures used for extra-articular repairs. Placement of fascia lata over the lateral femoral condyle (over-the-top technique) was the most common intra-articular method. Seventy percent (83/119) of surgeons used sutures to attach the graft, whereas 30% (36/119) used a screw and spiked washer. In general, surgeons combined more surgical procedures for extra-articular repairs and fewer for intra-articular repairs. Most surgeons immobilized the affected joint for ≤ 3 weeks following surgery, however, 23% (52/224) of bandaging choices were to opt for no joint immobilization. Following surgery, house confinement and restricted activity for ≤ 12 weeks was preferred by 87% (152/175) of surgeons.

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