Evaluation of the Femoral and Tibial Alignments in Dogs: A Systematic Review

The assessment of limb conformations in veterinary orthopedics is a significant tool used to determine the quantitative degree of limb malalignments. As in human medicine, various studies have been undertaken in veterinary medicine to determine the values in different dog breeds and to determine the values in healthy and diseased dogs. The objectives of this systematic review were to evaluate the reported values in these articles separately, to compile the standard values, and to compare the values between dogs with and without various orthopedic diseases. All of the articles included in this systematic review were collected by screening the Scopus, PubMed/Medline, and Web of Science databases. The articles were evaluated according to the measured alignments, imaging methods, dog breeds, and the health status of the dogs. Each alignment was investigated separately, and the results are summarized. Twenty-nine studies were included in this systematic review. According to the studies, in the frontal plane, distal femoral alignments, as well as proximal and distal tibial alignments, corresponded to the severity of the medial patellar luxation. The difference between affected and non-affected dogs with cranial cruciate ligament disease was limited to the proximal tibial alignments in the sagittal plane.

Do dogs with non-surgically managed cranial cruciate ligament disease have better outcomes with rehabilitation?

PICO question In dogs with cranial cruciate ligament disease treated non-surgically with rehabilitation, is the outcome inferior/equivalent/superior as measured by owner and/or veterinarian evaluation to dogs treated non-surgically without rehabilitation? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Four papers were critically appraised. One paper reviewed was a prospective, randomised clinical trial. The remaining three papers were retrospective cohort studies Strength of evidence Weak Outcomes reported There are no studies available that directly compare dogs managed non-surgically with and without rehabilitation following cranial cruciate ligament injury. In one study, 66% of dogs treated non-surgically with rehabilitation are reported to have successful outcomes 1 year following initiation of treatment. For dogs managed non-surgically without rehabilitation, successful outcomes varied from 19%–90% of cases among several retrospective studies Conclusion There is evidence suggesting the addition of rehabilitation to conservative therapy is beneficial, but based on the current literature, it is impossible to say whether it is superior to conservative treatment without rehabilitation How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Comparison of Outcome and Complications in Dogs Weighing Less Than 12 kg Undergoing Miniature Tibial Tuberosity Transposition and Advancement versus Extracapsular Stabilization with Tibial Tuberosity Transposition for Cranial Cruciate Ligament Disease with Concomitant Medial Patellar Luxation

Objective The aim of this study was to describe a technique for performing miniature tibial tuberosity transposition and advancement (mTTTA). The secondary objective of this study was to compare the short-term outcome and complications in small breed dogs weighing less than 12 kg undergoing surgical correction of cranial cruciate ligament disease with concurrent medial patellar luxation via either extracapsular stabilization with tibial tuberosity transposition (ECS + TTT) or mTTTA. Study Design This is a retrospective case comparison study. Results There was no significant difference in overall outcome between the ECS + TTT group and the mTTTA group when comparing 8-week postoperative radiographic healing scores as well as 2- and 8-week postoperative lameness scores. Conclusion This study concluded that the mTTTA procedure was feasible and the overall outcome and complications for the dogs that underwent ECS + TTT and those that underwent mTTTA were comparable.

Comparative Analysis of Vertical Forces in Dogs Affected with Cranial Cruciate Ligament Disease and Tibial Plateau Angles Greater or Less than 25 Degrees

Objective Our objective was to compare the peak vertical force (PVF) and vertical impulse (VI) between dogs with cranial cruciate ligament disease and a tibial plateau angle (TPA) greater or less than 25 degrees. Methods A retrospective study was performed in 18 dogs with cranial cruciate ligament disease in which kinetic gait data were obtained with a pressure walkway system. Dogs were distributed in two groups: dogs with a TPA ≤ 25 degrees (n = 8) and dogs with a TPA > 25 degrees (n = 10). Mean PVF and VI in per cent of body weight (%BW) were compared between groups with an unpaired t-test (p < 0.05). Results Mean PVF and VI for the cranial cruciate ligament disease limb were 14.39%BW and 3.57%BWs for dogs with a TPA >25 degrees and 14.44%BW and 3.47%BWs for dogs with a TPA ≤ 25 degrees. There was no significant difference in mean PVF and VI between the groups. Conclusion The results suggest that there is no difference in kinetic data between dogs with cranial cruciate ligament disease and a TPA greater or less than 25 degrees. Other factors such as body weight, time of injury or meniscal lesion could be more related to the magnitude of cranial cruciate ligament disease lameness.

In dogs weighing under 15 Kg with unilateral cranial cruciate ligament disease, does tibial tuberosity advancement lead to better long-term functional outcomes than lateral fabellar suture?

PICO question In dogs weighing under 15 kg with unilateral cranial cruciate ligament disease, does tibial tuberosity advancement lead to better long-term functional outcomes than lateral fabellar suture? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed There were no papers that answered the PICO question Strength of evidence Zero Outcomes reported Between TTA and LFS none of the techniques was shown to provide better long-term functional outcomes than the other in dogs weighing less than 15 kg Conclusion Given the absence of evidence answering the PICO question, choice and recommendation of procedure between TTA and LFS in dogs weighing under 15 kg should be guided by what the surgeon deems to be in the best interest of the patient How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.