Applications of evidence-based medicine: cranial cruciate ligament injury repair in the dog.
OBJECTIVE
To evaluate the literature reporting surgical interventions pertaining to canine cranial cruciate ligament (CCL) injury using an evidence-based medicine paradigm.


METHODS
Systematic literature review.


METHODS
An on-line bibliographic search through Medline, PubMed, Veterinary Information Network, and Commonwealth Agricultural Bureau Abstracts was performed during August 2004. Two hundred and forty resources of information were identified. Studies were compared and evaluated with regard to study design (retrospective, prospective, randomization), surgical technique, short- and long-term follow-up, and evidence classification.


RESULTS
Twenty-eight resources qualified to assist with evidence classification. No class I or class II studies were present, 5 studies were categorized as a class III and 23 studies were categorized as a class IV. Seventeen studies were retrospectively designed and 11 studies were prospectively designed. Proposed results ranged from a wide variety of subjective findings including clinical impression, radiographic analysis, synovial fluid analysis, gross pathology, and histopathology. Objective results, although infrequent, included force plate analysis and cadaveric biomechanical testing.


CONCLUSIONS
At this time, the application of evidence-based medicine in analyzing the current available evidence suggests that there is not a single surgical procedure that has enough data to recommend that it can consistently return dogs to normal function after CCL injury. The requirement for assessing and categorizing the available evidence becomes increasingly important as more data becomes available and the quality of research improves.


CONCLUSIONS
An evidence-based medicine paradigm did not provide sufficient evidence favoring 1 surgical technique for management of canine CCL injury.
Aragon
Carlos L
CL
Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602-7390, USA. aragon8@msn.com
Budsberg
Steven C
SC
D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D004285:Dogs / Q000293:injuries* / Q000601:surgery*; D019317:Evidence-Based Medicine; D007794:Lameness, Animal / Q000601:surgery; D012189:Retrospective Studies; D013264:Stifle / Q000293:injuries; D013514:Surgical Procedures, Operative / Q000379:methods / Q000662:veterinary*; D016896:Treatment Outcome