Management of cruciate ligament rupture: what is 'best practice'?

摘要

The cranial cruciate ligament acts to stabilise the stifle joint. It resists cranial translation and internal rotation of the tibia with respect to the femur, as well as preventing over-extension of the stifle joint (Figure 1). Cranial cruciate ligament rupture (CCLR) is probably the most common canine orthopaedic condition to receive a surgical treatment. Annual spend on canine CCL disease in the US in 2003 was estimated at $1.32bn. With such staggering sums of money suggesting such a large canine health problem, appropriate recommendations for surgical treatment are important. Current popular surgical techniques include the lateral suture stabilization (or variations thereof), tibial plateau levelling osteotomy (TPLO), tibial tuberosity advancement (TTA) and triple tibial osteotomy (TTO). However, is our obsession with the 'best' surgical technique misplaced? Certainly, we should endeavour to choose a technique that has face validity and evidence to support efficacy, but we should also balance efficacy against safety. However, critically, we should also consider other variables that may, in fact, be greater determinants of eventual outcome than the particular surgical technique that is used. This paper will describe the currently popular techniques and also some approaches to understand the current literature on surgical treatments but will also discuss other factors that may be important in outcome.