Reported accuracy of cranial closing wedge ostectomy variants for management of canine cranial cruciate ligament insufficiency: A systematic review and meta-analysis
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Reported accuracy of cranial closing wedge ostectomy variants for management of canine cranial cruciate ligament insufficiency : A systematic review and meta-analysis. / Miles, J. E.; Nielsen, M. B.M.
In: Veterinary Journal, Vol. 295, 105989, 2023.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Reported accuracy of cranial closing wedge ostectomy variants for management of canine cranial cruciate ligament insufficiency
T2 - A systematic review and meta-analysis
AU - Miles, J. E.
AU - Nielsen, M. B.M.
N1 - Funding Information: The authors would like to thank Dr Thomas Eriksen for his critical input. Departmental funding was used. Supplementary data including protocol, meta-analysis data, and R code associated with this article can be found, in the online version, at doi: …. Publisher Copyright: © 2023 The Authors
PY - 2023
Y1 - 2023
N2 - Concerns have been raised about the predictability of achieving appropriate tibial plateau angles (TPA), the occurrence of axis shift and tibial length reduction following cranial closing wedge ostectomy (CCWO). The primary objective of this review was to quantify typical errors in achieving target TPA with CCWO, with secondary objectives of assessing axis shift and length reduction. Retrospective or prospective studies of CCWO used as the primary treatment, from any date and in English, were eligible for inclusion. Searches were performed in EMBASE, Ovid MEDLINE, Agricola, Scopus, Web of Science, and CAB abstracts. Risk of bias was assessed, and data were screened for outliers and influential cases. Extracted data from 11 included studies were tabulated and underwent meta-analysis using R. Mean errors in TPA after CCWO ranged from − 0.6–2.9°, indicating the possibility of both under- and over-correction depending on the selected technique. Errors were relatively consistent for technique subgroups. Mean axis shifts ranged from 3.4° to 5.2°, and length reduction ranged from 0.4% to 3.2% of initial length, based on 6/11 and 3/11 studies, respectively. Data had high heterogeneity, many studies had small populations, and reporting standards were inconsistent. Concerns about the predictability of postoperative TPA may be overstated. With the limited data available, limb shortening does not appear to be a clinically important consideration. Axis shift will occur to varying degrees and must be considered during CCWO planning, as it influences the postoperative TPA. Careful choice of CCWO technique may allow clinicians to reliably achieve predictable TPA values.
AB - Concerns have been raised about the predictability of achieving appropriate tibial plateau angles (TPA), the occurrence of axis shift and tibial length reduction following cranial closing wedge ostectomy (CCWO). The primary objective of this review was to quantify typical errors in achieving target TPA with CCWO, with secondary objectives of assessing axis shift and length reduction. Retrospective or prospective studies of CCWO used as the primary treatment, from any date and in English, were eligible for inclusion. Searches were performed in EMBASE, Ovid MEDLINE, Agricola, Scopus, Web of Science, and CAB abstracts. Risk of bias was assessed, and data were screened for outliers and influential cases. Extracted data from 11 included studies were tabulated and underwent meta-analysis using R. Mean errors in TPA after CCWO ranged from − 0.6–2.9°, indicating the possibility of both under- and over-correction depending on the selected technique. Errors were relatively consistent for technique subgroups. Mean axis shifts ranged from 3.4° to 5.2°, and length reduction ranged from 0.4% to 3.2% of initial length, based on 6/11 and 3/11 studies, respectively. Data had high heterogeneity, many studies had small populations, and reporting standards were inconsistent. Concerns about the predictability of postoperative TPA may be overstated. With the limited data available, limb shortening does not appear to be a clinically important consideration. Axis shift will occur to varying degrees and must be considered during CCWO planning, as it influences the postoperative TPA. Careful choice of CCWO technique may allow clinicians to reliably achieve predictable TPA values.
KW - Axis shift
KW - Cranial closing wedge
KW - Cranial cruciate ligament
KW - Dogs
KW - Tibial plateau angle
U2 - 10.1016/j.tvjl.2023.105989
DO - 10.1016/j.tvjl.2023.105989
M3 - Review
C2 - 37148995
AN - SCOPUS:85159071605
VL - 295
JO - The Veterinary Journal
JF - The Veterinary Journal
SN - 1090-0233
M1 - 105989
ER -
ID: 347476941