Canine cruciate ligament ruptures: Implications for financial costs and human health

The association between gonadectomy and timing of gonadectomy, and the risk of canine cranial cruciate ligament disease: A systematic review and meta-analysis

OBJECTIVE

To determine if gonadectomy in dogs is associated with the risk of cranial cruciate ligament disease (CrCLD) and to quantify the magnitude of the association.

STUDY DESIGN

Systematic review and meta-analysis.

SAMPLE POPULATION

Comparative studies with gonadectomized and entire dogs, with CrCLD as an outcome measure.

METHODS

A systematic search of the primary and gray literature was performed. The effect size of the outcome measure was defined as the OR and 95% CI. Subgroup analysis was performed with sex, breed, and age at gonadectomy. A pooled OR (95% CI) was generated from meta-analysis of relevant studies. Certainty in the body of evidence was rated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

RESULTS

The literature search yielded 1398 results and 24 relevant studies were included for synthesis. Gonadectomized female (pooled OR = 2.293, 95% CI = 1.768-2.945) and male (pooled OR = 2.117, 95% CI = 1.665-2.691) dogs were both at increased odds of developing CrCLD in comparison with entire female and male dogs, respectively. Subgroup analysis showed that gonadectomy at 1 year or less was consistently associated with an increase in odds of developing CrCLD in both sexes. Overall certainty in the evidence was rated as moderate. All included studies were observational and no controlled trials were available.

CONCLUSION

In data with moderate certainty, gonadectomy is associated with increased odds of developing CrCLD in both sexes, particularly in dogs gonadectomized at 1 year of age or less.

CLINICAL SIGNIFICANCE

This study provides an estimate of the true effect size of gonadectomy on the odds of developing CrCLD, which may be useful for clinical decision making surrounding gonadectomy and the timing of gonadectomy.

Risk factors for unilateral cranial cruciate ligament rupture diagnosis and for clinical management in dogs under primary veterinary care in the UK

This study aimed to evaluate demographic risk factors associated with unilateral cranial cruciate ligament (CCL) rupture diagnosis and to explore demographic and clinical risk factors associated with management of unilateral CCL rupture in dogs under primary veterinary care in the UK. A retrospective cohort study design was used. Clinical records were automatically searched and manually verified for incident cases of unilateral CCL rupture during 2019 and additional clinical management information extracted. Multivariable logistic regression modelling was used to evaluate associations between risk factors and: (1) CCL rupture diagnosis; and (2) clinical management (surgical or non-surgical). The analysis included 1000 unilateral CCL rupture cases and a random selection of 500,000 non-cases. After accounting for confounding factors, dogs aged 6 to < 9 years, male neutered and female neutered dogs, insured dogs, and Rottweiler, Bichon Frise, and West Highland White terrier breeds, in particular, had increased odds of unilateral CCL rupture diagnosis. Insured dogs and dogs ≥ 20 kg had increased odds of surgical management, while dogs ≥ 9 years and dogs with one non-orthopaedic comorbidity at diagnosis with CCL rupture had reduced odds. These findings inform identification of at-risk dogs, with Rottweilers and Bichon Frise particularly predisposed. Additionally, they contribute to a greater understanding of the clinical rationales used in primary-care veterinary practices to decide between surgical or non-surgical management of unilateral CCL rupture.

Enhanced bone formation in locally-optimised, low-stiffness additive manufactured titanium implants: An in silico and in vivo tibial advancement study

A tibial tuberosity advancement (TTA), used to treat lameness in the canine stifle, provides a framework to investigate implant performance within an uneven loading environment due to the dominating patellar tendon. The purpose of this study was to reassess how we design orthopaedic implants in a load-bearing model to investigate potential for improved osseointegration capacity of fully-scaffolded mechanically-matched additive manufactured (AM) implants. While the mechanobiological nature of bone is well known, we have identified a lower limit in the literature where investigation into exceedingly soft scaffolds relative to trabecular bone ceases due to the trade-off in mechanical strength. We developed a finite element model of the sheep stifle to assess the stresses and strains of homogeneous and locally-optimised TTA implant designs. Using additive manufacturing, we printed three different low-stiffness Ti-6Al-4 V TTA implants: 0.8 GPa (Ti1), 0.6 GPa (Ti2) and an optimised design with a 0.3 GPa cortex and 0.1 GPa centre (Ti3), for implantation in a 12-week in vivo ovine pilot study. Static histomorphometry demonstrated uniform bone ingrowth in optimised low-modulus Ti3 samples compared to homogeneous designs (Ti1 and Ti2), and greater bone-implant contact. Mineralising surfaces were apparent in all implants, though mineral apposition rate was only consistent throughout Ti3. The greatest bone formation scores were seen in Ti3, followed by Ti2 and Ti1. Results from our study suggest lower stiffnesses and higher strain ranges improve early bone formation, and that by accounting for loading environments through rational design, implants can be optimised to improve uniform osseointegration. STATEMENT OF SIGNIFICANCE: The effect of different strain ranges on bone healing has been traditionally investigated and characterised through computational models, with much of the literature suggesting higher strain ranges being favourable. However, little has been done to incorporate strain-optimisation into porous orthopaedic implants due to the trade-off in mechanical strength required to induce these microenvironments. In this study, we used finite element analysis to optimise the design of additive manufactured (AM) titanium orthopaedic implants for different strain ranges, using a clinically-relevant surgical model. Our research suggests that there is potential for locally-optimised AM scaffolds in the use of orthopaedic devices to induce higher strains, which in turn encourages de novo bone formation and uniform osseointegration.

Etiopathogenesis of Canine Cruciate Ligament Disease: A Scoping Review

The spontaneous rupture of the cranial cruciate ligament in dogs remains a pathoetiologic puzzle. Despite much progress in research over the past years, the systemic and local mechanisms leading to ligament degeneration and structural failure remain largely obscure. This scoping review focuses on pathogenesis and aims at summarizing and interpreting today's knowledge on causes of canine cruciate ligament rupture, i.e., the multifactorial mechanisms leading to degenerative stifle joint disease with collagen matrix degeneration and structural failures. Thus, the initial view of traumatic ligament rupture, fostered by "wear and tear", has clearly been replaced by a new concept of systemic processes linked to progressive degenerative joint disease and ligament failure; thus, the term "cranial cruciate ligament disease" has been coined and is generally accepted. In addition, cruciate ligament rupture in people shares some similarities with the lesion in dogs; therefore, the review also includes comparative studies. The methods used were based on the PRISMA-ScR model (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews).

Cranial Cruciate Ligament Rupture in Dogs: Review on Biomechanics, Etiopathogenetic Factors and Rehabilitation

Cranial cruciate ligament (CrCL) rupture is one of the most common orthopaedic conditions in veterinary medicine. CrCL plays a fundamental role in the stability and biomechanics of the femoral-tibio-patellar joint, and its incorrect functionality severely impacts on the quality of life of patients. In dogs, the structural weakening of this joint due to the progressive degeneration of the ligament is the most accredited etiopathogenetic hypothesis in relation to the dog signalment (breed, sex and age) and the stifle joint conformation. In humans, this injury is often traumatic and generally occurs during sporting activities. CrCL rupture can be managed conservatively or surgically, and decisions regarding treatment are due to numerous factors: the patient’s age and health, the degree of stifle instability, and cost. Physiotherapy protocols play an important role in rehabilitation, with similar goals in humans and dogs: pain management, physiological articular range of motion recovery, periarticular and core muscle strengthening, and proprioceptive deficit correction. Physiotherapy, even if often neglected in veterinary medicine, is mandatory for the recovery of the correct functionality of the injured limb and for the return to normal daily and sporting activities.

Perceptions of Body Condition, Diet and Exercise by Sports Dog Owners and Pet Dog Owners

Simple Summary

Dog obesity is a serious problem around the world. We investigated factors that contribute to dog obesity in pet dogs versus dogs that participate in sports with their owners. We found that pet dogs were more obese than pet dogs that participate in canine sports. This relationship had several contributing factors. One such factor is the ability of the pet owner to correctly identify the body condition of the dog. Inability to identify a dog as overweight/obese is a critical barrier to intervening in their dog’s health. Pet dogs were also fed more per feeding and given larger treats than the sports dogs. This increase in calories per day over time will result in weight gain. Lastly, many of our participants walked regularly with their dogs, but pet dog owners were more likely to report dog activities that did not directly involve the owner. This likely results in less exercise than that predicted by the owners. Overall, pet and sports dog owners put a high value on their dog’s health and well-being, but better education with regard to body condition, feeding and exercise is critical to improve the pet obesity problem.

Abstract

The purpose of this study was to investigate the variables that contribute to obesity in pet dogs. The working hypothesis was that sports dog owners will better estimate their dog’s body condition and report stronger belief and control over their dogs’ feeding and exercise compared to traditional pet owners. We collected data on 171 pet owners (101 participated in canine sports) for this study. Each owner completed the Dog Owner Attitude Questionnaire. Each dog was measured for percent fat and Purina body condition scale. For the pet dogs, the median Purina body condition score was 6 (too heavy), but for the sports dogs it was 5 (ideal) (p < 0.05 different from pet dogs). The average percent fat for the pet dogs was 19.1 ± 8.6%, and for the sports dogs it was 13.8 ± 5.3% (p < 0.05 different from pet dogs). Among pet owners, 52% were able to correctly estimate their dog’s body condition. Sports dog owners were 57% correct. Pet dog owners fed approximately 60% more per day compared to sports dog owners. Pet and sports dog owners exercised their dog via walking, but sports dog owners reported more activity with the dog, while pet dog owners reported more activity than the dog did by themselves. Overall, pet and sports dog owners put a high value on their dog’s health and well-being, but better education with regard to body condition, feeding and exercise is critical to improve the pet obesity problem.