Tear CCL - TPLO - arthritis

RE: Tear CCL - TPLO - arthritis

Julian Earl — Sun, 08 May 2016 10:04:05 GMT

Considering just how common this injury is, ie we see huge numbers of them, I am not convinced that any technique prevents the development of osteoarthritis in the long-term. It seems an inevitable consequence of this injury. I would be happy to be corrected in this belief.

RE: Tear CCL - TPLO - arthritis

James Dunne — Fri, 06 May 2016 22:12:19 GMT

Hi John. A fair point, well made. However, some of these papers do in fact state whether the surgeries were performed by board-certified surgeons, residents or general practitioners. I agree that there is still variation in the execution of certain techniques from surgeon to surgeon and that it makes certain comparisons odious. The recent reviews of cruciate ligament surgery in JSAP would seem to indicate that at least some of the things we hold to be absolute are on shaky foundations at best. The best we can hope for as individuals is to record our results and critique our outcomes and when we have reasonable numbers after experience, compare them ourselves to published results - it gives a reasonable target for personal assessment. It can be eye-opening in both a good and bad way!

RE: Tear CCL - TPLO - arthritis

John Flynn — Thu, 05 May 2016 00:04:22 GMT

The biggest problem I have with most surgery papers, including cruciate ones, is that they are rather hard to extrapolate from (should they actually have results that you think worthy of extrapolation).

Given that small nuances in surgical technique often make big differences there's not usually a lot more in one of these papers than surgeonX possibly had better short-term results with technique Y than technique Z.

Don't get me wrong, I find these an interesting and informative read, but I don't usually conclude that one "technique" is universally more effective than another.

If I was to have published my experiences with combined urethropexy/colposuspension rather than some more skilled surgeons who did, one may have risked concluding that this "technique" was inferior to either technique performed independently for instance.

RE: Tear CCL - TPLO - arthritis

Lara Brunori — Wed, 04 May 2016 23:58:38 GMT

Hi James,

The Beale article is exactly what I was looking for!! Thanks so much!!

Lara

P.S. this forum is amazing!!

RE: Tear CCL - TPLO - arthritis

James Dunne — Wed, 04 May 2016 18:37:36 GMT

Hi Lara

I think Brian Beale had a paper published in Veterinary Surgery demonstrating that TPLO was effective at preventing further degeneration of the CrCL and modifying the progression of arthritis. His series was backed up with second-look arthroscopy. I don't think the article was level 1 evidence but it is in a peer reviewed journal; I think about 2012. The only level 1 evidence for TPLO does demonstrate superior effectiveness compared to other techniques. I will dig out the papers and post the links here