New RVC research proves clinical benefits from surgical intervention for dogs with cranial cruciate ligament rupture

A new study from the Royal Veterinary College (RVC) has revealed that surgical management of cranial cruciate ligament (CCL) ruptures in dogs causes better outcomes for reducing lameness compared to non-surgical management.

The study demonstrated substantial clinical benefits following surgical management for CCL, with short-term lameness reduced by a quarter and long-term lameness by a third. The study’s findings provide a strong evidence base for veterinarians and owners when deciding on the most appropriate treatment for CCL rupture in dogs.

Previous RVC VetCompass research* had reported that CCL rupture affects approximately 1 in 180 dogs and that Rottweilers, Bichon Frise, West Highland White Terriers and Golden Retrievers are at greatest risk of CCL rupture, with dogs most commonly affected in middle-age.

Decision-making on treatment for CCL ruptures often hinges on deciding between surgical and non-surgical management. However, until now, the evidence comparing clinical outcomes between surgical versus non-surgical management in dogs has been limited. Previous observational studies were limited to reporting associations that can be confounded rather than showing the truer causal link between treatment and outcome.

To fill these data gaps, this new study measured clinical outcomes following surgical vs non-surgical treatment for CCL rupture to report on shortand long-term lameness as well as the use of pain relief medication prescription. These data were analysed using novel causal inference methods and demonstrated a substantial causal link between receiving surgical management and better outcomes.

Led by the RVC’s VetCompass Programme and supported by an award from Dogs Trust, the study was based on anonymised clinical records from more than two million dogs under first opinion veterinary care in the UK in 2019.

This study applied causal inference methods to the analysis of random samples of 815 dogs with CCL rupture aged between 1.5- and 12-years-old to replicate a randomised clinical trial and explore the impact of the different treatment methods. Balancing the arms of the study for variables including age, breed and bodyweight, the researchers compared the outcomes for the dogs who received surgical management for CCL ruptures to those that were managed non-surgically.

The results showed that dogs managed surgically were 25.7% less likely to show short-term lameness at 3 months post-diagnosis and 31.7% less likely to show long-term lameness at 12 months post-diagnosis than dogs managed non-surgically.

Surgically managed dogs were 38.9% less likely to have a pain relief prescription at 3 months post-diagnosis, 34.1% less likely at 6 months and 32.7% less likely at 12 months than dogs managed non-surgically. These findings also similarly demonstrate lower longer term pain in surgically managed dogs.

Camilla Pegram, VetCompass PhD candidate at the RVC and lead author of the paper, said:

"This study used an exciting new approach that allowed us to determine ’cause’ rather than being limited to ’association’. Surgical management for CCL rupture is often considered as providing better outcomes than non-surgical management, but this study now provides an evidence base to support this. Whilst surgical management might not always be feasible for some dogs, the findings allow vets to quantify the benefit in their discussions with owners."

Dr Dan O’Neill, Associate Professor in Companion Animal Epidemiology at the RVC and co-author of the paper, said:

"Uncertainty when deciding on the best treatment option for their ill dog is one of the hardest challenges for any owner. This new VetCompass research uses Big Data analyses from millions of dogs to give owners of dogs with cruciate rupture the best evidence to support the best possible treatment decisions. Good science should be caring as well as scientific."

Paula Boyden, Veterinary Director at Dogs Trust, said:

"We’re delighted that Dogs Trust can support a wide range of groundbreaking studies through its Canine Welfare Grants. This study has revealed useful data that can help vets guide owners to make the most appropriate decision to deliver the best outcome for their dog. We hope this new insight will lead to improved dog welfare."


The new paper:

PEGRAM, C., DIAZ-ORDAZ, K., BRODBELT, D. C., CHANG, Y., FRYKFORS VON HEKKEL, A., WU, C., CHURCH, D. B. & O’NEILL D.G. 2024. Target Trial Emulation: Does surgical versus non-surgical management of cranial cruciate ligament rupture in dogs cause different outcomes? Preventive Veterinary Medicine.

The full paper is available from Preventive Veterinary Medicine and can be accessed here:­revetmed.2­024.106165

Previous supporting paper:

*PEGRAM, C., DIAZ-ORDAZ, K., BRODBELT, D. C., CHANG, Y., FRYKFORS VON HEKKEL, A., WU, C., CHURCH, D. B. & O’NEILL D.G. 2023. Risk factors for unilateral cranial cruciate ligament rupture diagnosis and for clinical management in dogs under primary veterinary care in the UK. Vet J.

The full paper is available from Vet J. and can be accessed here:­023.105952

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About the RVC

  • The Royal Veterinary College (RVC) is the UK’s largest and longest established independent veterinary school and is a Member Institution of the University of London.
  • It is one of the few veterinary schools in the world that hold accreditations from the RCVS in the UK (with reciprocal recognition from the AVBC for Australasia, the VCI for Ireland and the SAVC for South Africa), the EAEVE in the EU, and the AVMA in the USA and Canada.
  • The RVC is ranked as the top veterinary school in the world in the QS World University Rankings by subject, 2023.
  • The RVC offers undergraduate and postgraduate programmes in veterinary medicine, veterinary nursing and biological sciences.
  • The RVC is a research led institution with 88% of its research rated as internationally excellent or world class in the Research Excellence Framework 2021.
  • The RVC provides animal owners and the veterinary profession with access to expert veterinary care and advice through its teaching hospitals and first opinion practices in London and Hertfordshire.

About the VetCompass? Programme

VetCompass? (The Veterinary Companion Animal Surveillance System) is an epidemiological research programme at the Royal Veterinary College (RVC) which investigates anonymised clinical records from veterinary practices to generate evidence to support improved animal welfare. VetCompass shares information from more than 1,800 veterinary practices in the UK (over 30% of all’UK practices) covering over 28 million companion and equine animals. To date, VetCompass? has led to over 120 peer-reviewed publications that have supported welfare-focused work across the range of animal stakeholders including the wider general public, owners, breeders, academics, animal charities, universities and government.

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