Surgeons’ preferences in treating cranial cruciate ligament ruptures in dogs

Abstract

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.