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Long-term radiographic comparison of TPLO versus extracapsular stabilization
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TPLO (tibial plateau leveling osteotomy) is a very popular new technique to treat the ruptured cranial cruciate ligament in the dog. Is it really better than older techniques, e.g. extracapsular stabilization? A very informative study compares these two methods of surgical management of cranial cruciate ligament (CCL) injury in 66 large-breed dogs using a radiographic osteoarthrosis (OA) scoring system.
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Only client-owned dogs (n=66) were included in this study.
Radiographs were evaluated from dogs weighing >/=22.7 kg, with surgical management of CCL rupture using extracapsular repair (ECR) or tibial plateau leveling osteotomy (TPLO).
Radiographs were taken immediately before surgery and >/=12 months later. An OA score was assigned to each set of radiographs taken at the preoperative and final examinations by evaluating 32 specific features of stifle OA.
The difference between preoperative and final OA scores were subtracted and 2 final score categories of a change 5 were created.
A logistic regression model was used to evaluate the effect of right versus left pelvic limb, age, preoperative weight, postoperative weight, days from surgery until final radiographic recheck, cranial cruciate status at surgery, medial meniscus status at surgery, and ECR versus TPLO.
Results: The ECR group had 27 stifles (22 dogs) and the TPLO group had 52 stifles (44 dogs).
ECR dogs had a preoperative weight of 33.4+/-9.3 kg (range 22.7-54.1 kg) and a preoperative OA score of 13.0+/-8.4 (range 1-34) compared with TPLO dogs that had a preoperative weight of 38.9+/-9.1 kg (range 25-63.9 kg) and preoperative OA score of 15.9+/-8.4 (range 4-44). Postoperative weights for ECR and TPLO dogs were 33.6+/-9 kg (range 21.8-54.6 kg) and 39.4+/-10.1 kg (range 24-72 kg), respectively.
Final OA scores were: ECR dogs, 26.3+/-10.8 (range, 10-54); TPLO dogs, 23.3+/-9.5 (range, 12-50).
Dogs with a final change in OA score of >/=6 were 5.78 times more likely to have had ECR compared with those that had TPLO as stabilization procedure (odds ratio=5.78; Log-likelihood test P-value=.025). Other dependent variables were not significant.
Conclusions: Based on logistic regression analysis, dogs with larger OA score differences were 5.78 times more likely to have had ECR than TPLO.
Prospective, randomized surgical trials with pre-defined objective measures would be required to further evaluate the clinical importance of these preliminary findings which suggest that TPLO may help stabilize the cranial tibial thrust as originally proposed.
Source: Lazar TP, Berry CR, deHaan JJ, Peck JN, Correa M. (2005): Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization for cranial cruciate ligament rupture in the dog. In: Vet Surg. 2005 Mar-Apr;34(2):133-41.
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