Conservative Cruciate updates?

[lehughes]

I am looking for references that indicate outcomes for nonsurgical treatment of CCL injury in dogs. Cant find anything published since 2013. Can you point me somewhere?

[lehughes]

So, sadly nobody is doing research in this area… (because clinicians are usually the ones doing conservative management and clinicians aren’t usually the ones in the Uni's doing research.)
Anyways, I’ll cut and paste from my updated Conservative Rehab document / handout from the most recent presentation I gave on the topic.

Comerford et al 2013 surveyed British small animal veterinarians and found that conservative
management is still widely used for treatment of CCL ruptures in dogs less than 15kg.

• – Conservative management consisted of NSAIDS (91.1%), short leash walks (91.1%),
  weight loss (89%), hydrotherapy (53.6%), physiotherapy (41.9), and cage rest (24.2%).

Wucherer et al 2013 compared nonsurgical (PT, wt. loss, & NSAIDS) and surgical (TPLO)
management in overweight dogs with CCL ruptures. They found:

• – Body fat % decreased in both groups
  – Owner questionnaires revealed both groups improved.
  – Surgical group had significantly higher peak vertical forces on affected limbs
  – Successful outcomes (GRF >85% & Questionnaire variables >10%) for the surgical group
  were (67.7%, 92.6%, and 75.0% for 12-, 24-, and 52-week evaluations, respectively)
  – Successful outcomes for the conservative group were (47.1%, 33.3%, and 63.6% for 12-,
  24-, and 52-week evaluations, respectively).

** 2/3 of the dogs in the conservative group had successful outcomes at the 52-week mark

Stifle bracing may be of assistance as well:

• – Stifle joint biomechanics were improved following orthosis implementation compared
  to CCL-D stifle joints.
  – Stiffness of the hinge influences stifle joint mechanics
  – Owner satisfaction for stifle bracing is high and comparable to satisfaction with surgical
  intervention for CCL-D
  – Owners contemplating management of CCL-D with an orthoses should be advised of
  potential complications such as persistent lameness, skin lesions, patient intolerance of
  the device and the need for a subsequent surgery.

Bertocci et al 2017; Hart et al 2016

And still, I think the strongest argument for conservative management is as follows:
Argument:
Some dogs are not surgical candidates due to any of the following:
• age
• weight
• breed issues
• poor health
• additional factors / issues
• an inadequate state of fitness
• financial constraints, or owners’ beliefs
This subset of patients deserves a chance at optimal function as much as those that are prime surgical candidates with owners willing and able to bear the financial burden of surgery.

I hope this helps!

Cheers,

Laurie