Surgical treatment of cranial cruciate ligament disease in dogs using Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement–A systematic review with a meta-analytic approach

Abstract

Tibial Plateau Leveling Osteotomy (TPLO) or Tibial Tuberosity Advancement (TTA) are commonly used surgical techniques for correction of cranial cruciate ligament (CCL) rupture in dogs. This systematic review aims to investigate whether one technique is superior to the other. Seventy-two studies on surgical management of CCL rupture have been identified and evaluated in regard of subjective and objective gait analysis criteria, development of osteoarthritis (OA), thigh circumference measurements, goniometry, joint stability, pain and complication rates. Almost half (47.2 %) of the studies were considered of low quality of evidence, leading to high heterogeneity in quality among studies; this posed a major limitation for an evidence-based systematic review of both surgical techniques. Out of 72 studies, there were only eleven blinded randomized clinical trials, of which five were rated with a low overall risk of bias. However, both techniques were considered to be successful management options. Subjective and objective gait analysis revealed no lameness at long-term evaluation for the majority of the patients. However, it appeared that TTA lead to better OA scores up to 6 months postoperatively, while TPLO had a lower rate of surgical site infections. In summary, no method can be clearly preferred, as most of the study evaluated were subpar. Studies with a high level of evidence are therefore urgently needed for such a common surgical procedure.

Long‐term outcome in dogs with cranial cruciate ligament disease evaluated using the canine orthopaedic index

“…Increasing bodyweight has been reported as a risk factor for complications after CCLD surgery, for OA development and for CCLD-related euthanasia, but the effect of bodyweight on the outcome in dogs with CCLD is not commonly evaluated in the literature. 17,[49][50][51][52][53][54][55] Based on the results of the current study, bodyweight could possibly affect long-term stiffness and lameness in dogs with CCLD, with an increased risk in heavier dogs. Future prospective randomised clinical trials that evaluate the effect of treatment and bodyweight on the long-term outcome in dogs with CCLD are warranted.…”

“…[6][7][8][9] The outcome after surgical treatment of CCLD is generally reported as successful, [10][11][12][13][14][15][16] although highquality studies comparing the intermediate-to longterm outcome in dogs treated with different surgical techniques are sparse. 8,17 According to a recent review of TPLO and TTA, there is not enough evidence to support one method over the other. 17 However, a couple of earlier reviews concluded that TPLO is the method most likely to return dogs to normal function 8 and is associated with lower complication rates, improved clinical-functional outcomes and less osteoarthritis (OA) progression than TTA.…”

“…The outcome after surgical treatment of CCLD is generally reported as successful, 10–16 although high‐quality studies comparing the intermediate‐ to long‐term outcome in dogs treated with different surgical techniques are sparse 8,17 . According to a recent review of TPLO and TTA, there is not enough evidence to support one method over the other 17 .…”

“…11,12,[19][20][21] Treatment outcome in dogs with CCLD has been evaluated in several ways, for example, by using force plate gait analysis, visual gait observation, orthopaedic and physiotherapeutic examination, radiography for evaluation of OA progression and owner questionnaires. 8,17,[22][23][24][25][26][27][28][29] Owner questionnaires based on behaviour are considered one of the most reliable tools for assessment of chronic pain in dogs. [30][31][32] There are several questionnaires available, such as the canine orthopaedic index (COI), the Helsinki chronic pain index (HCPI), the Liverpool osteoarthritis in dogs, the canine brief pain inventory (CBPI) and the Bologna healing stifle injury index (BHSII).…”

“…8,17 According to a recent review of TPLO and TTA, there is not enough evidence to support one method over the other. 17 However, a couple of earlier reviews concluded that TPLO is the method most likely to return dogs to normal function 8 and is associated with lower complication rates, improved clinical-functional outcomes and less osteoarthritis (OA) progression than TTA. 18 However, OA progresses in the affected joint regardless of the treatment method, and chronic pain is frequently reported in dogs with CCLD despite surgical treatment.…”