Preliminary Study Evaluating Tests Used To Diagnose Canine Cranial Cruciate Ligament Failure
Preliminary Study Evaluating Tests Used To Diagnose Canine Cranial Cruciate Ligament Failure
Preliminary Study Evaluating Tests Used To Diagnose Canine Cranial Cruciate Ligament Failure
224
INTRODUCTION
Failure of the cranial cruciate ligament
(CCL) and associated secondary stifle osteoarthritis (OA) is the most common cause
of chronic hindlimb lameness in the dog
(Ness and others 1996). Lameness caused
by complete or partial failure of the CCL
may be acute or insidious in onset, and
although secondary osteoarthritis is inevitable, the character and severity of the resultant lameness are variable.
The diagnosis of CCL failure is usually
made by physical and radiographic examination. The physical examination should
Journal of Small Animal Practice
were, in fact, normal. For the second analysis, all the dont knows were counted as if
they were, in fact, abnormal. For each test,
the sensitivity and specificity were estimated along with PPV and NPV.
Sensitivity is defined as the proportion
of true positives identified as such; specificity is the proportion of true negatives identified as such. PPV is the proportion of test
positives that are truly positive, and NPV is
the proportion of test negatives that are
truly negative.
Statistical analysis
Each set of results was analysed twice using
a 22 table method: the first time, all the
dont know results were counted as if they
RESULTS
The results are summarised in Tables 1
and 2.
DISCUSSION
Table 1. Sensitivity, specificity, PPV and NPV calculated for each test with all dont
know results counted as if they were normal
Tests
Specificity
PPV
NPV
60
64
100
68
92
88
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
6296
6538
100
68
8947
85
100
PPV Positive predictive value, NPV Negative predictive value, CP Conscious patient, GA Under general anaesthesia
Table 2. Sensitivity, specificity, PPV and NPV calculated for each test with all dont
know results counted as if they were abnormal
Tests
Specificity
PPV
NPV
60
64
100
8235
8235
100
8333
8421
100
5833
6086
100
76
9411
95
7272
96
92
100
8823
8235
100
9230
8846
100
9375
875
100
PPV Positive predictive value, NPV Negative predictive value, CP Conscious patient, GA Under general anaesthesia
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LIMITATIONS
Affected dogs were confirmed by direct
inspection of the damaged CCL either at
arthrotomy or by arthroscopy at the time
of therapeutic surgery. Control dogs were
considered normal on the basis of a single
radiographic examination plus two normal
clinical examinations at least six weeks apart.
However, because dogs in the control group
did not undergo CCL inspection, there is
a possibility of false negatives in this group.
All tests were performed by two surgeons
(one board certified and the other a thirdyear surgical resident with substantial veterinary orthopaedic experience), and it is likely
that different testers will generate different
results. The investigation of interobserver
variability relating to these diagnostic tests
would be an area for further study.
Although CDT and TCT could be
claimed to be evaluating primary evidence
of CCL failure, all the other tests are evaluating evidence of secondary stifle joint
arthrosis. As such, they can be expected
to be positive with any stifle joint arthrosis,
irrespective of cause; so they are not specific
indicators of CCL failure. This is a potential source of false positive results, which
could influence our analysis of the diagnostic accuracy of these tests. However, this
effect is likely to be small because CCL failure is by far the most common cause of
canine stifle joint arthrosis.
References
HENDERSON, R. A. & MILTON, J. L. (1978) The tibial compression mechanism: a diagnostic aid in stifle injuries. Journal of American Animal Hospital
Association 14, 474-479
JERRAM, R. M. & WALKER, A. M. (2003) Cranial cruciate ligament injury in the dog: pathophysiology,
diagnosis and treatment. New Zealand Veterinary
Journal 51, 149-158
JOHNSON, J. M. & JOHNSON, A. L. (1993) Cranial cruciate
ligament rupture. Pathogenesis, diagnosis, and postoperative rehabilitation. Veterinary Clinics of North
America: Small Animal Practice 23, 717-733
MOORE, K. W. & READ, R. A. (1996) Rupture of the cranial cruciate ligament in dogs part II. Diagnosis
and management. Compendium of Continuing
Education for Veterinarians 18, 381-391
NESS, M. G, ABERCROMBY, R. H, MAY, C, TURNER, B. M, &
CARMICHAEL, S. (1996) A survey of orthopaedic conditions in small animal veterinary practice in Britain. Veterinary and Comparative Orthopaedics
and Traumatology 9, 43-52