Browsing by Author "Mattila, Jan"

Cranial cruciate ligament (CrCL) deficiency is the leading cause of degenerative joint disease (DJD) in the canine stifle. The anatomy of the canine stifle is complex and the pathogenesis of CrCL rupture is not fully understood. Several competing theories on the pathogenesis and several techniques based on these theories have been presented mostly during the last 40 years. The main categories of techniques are intra-articular, extra-capsular and osteotomy, of which techniques of the two latter categories are still widely in use. The uncertainty about the pathogenesis and thus the correct technique of repair may be a reason for the multitude of proposed surgical techniques and the lack of preventive measures. This literature review attempts to cover the main surgical techniques from the three categories of techniques which are currently or have lately been in use and to determine if a preferred method exists. Approximately half of the literature is from 2000–2012 and half from 1926–2000. The literature encompasses both the original publications of each technique as well as studies on the outcomes and complications of follow-up studies using larger populations of patients. The reporting on the research regarding new surgical techniques is varied and the urge to perform surgery and not research is evident in the amount of surgical procedures reported before any peer-reviewed studies have been published. There are no meta-analyses of studies covering different techniques nor are there robust prospective double blinded placebo controlled studies on any of the alternative techniques. Most of the literature is case reports with some retrospective cohort or statistically insignificant prospective studies. Due to the non-uniform reporting, comparisons between techniques are more difficult. The literature does seem to favor TPLO, one of the oldest and the most researched technique, if the surgeon is able to invest the time and resources to acquiring the equipment and mastering the technique. If combined with the cTTA technique, a newer technique which uses some of the same equipment as the TPLO with very promising preliminary results, a surgeon could be well equipped to handle surgical treatment of CrCL deficiency.