Fracture of the patella after TPLO in dogs.

To the Editor. I read with interest the article by Rutherford et al. entitled “Fracture of the patella after TPLO in 6 dogs. ” I compliment the authors on reporting this complication and increasing awareness of this potential problem for veterinary surgeons. I would like to point out a part of the authors’ discussion though that may be glossed over when reading this article, but that we should all carefully consider, in my opinion. The authors stated on page 872 that “standard stifle arthrotomy for meniscal inspection or partial meniscectomy was not performed, because we believe this is unnecessary and the morbidity, specifically pain and poor limb use, outweighs any perceived benefit to the patient. It has been shown that a standard arthrotomy increases the progression of osteoarthritis in the stifle compared to amini arthrotomy. ”They go on to state that “it is also our opinion that medial meniscal pathology after TPLO with medial meniscal release is rarely clinically significant in the dog. ” The single reference they use to support these very bold statements is the work by Lineberger et al., in which those authors report a statistically significant difference in radiographic OA progression between groups for a single assessment in a range between 12 and 30 months postoperatively (not matched) using a 4‐point categorical scoring system that has not been validated. However, the actual data provided in the table show that the mini‐arthrotomy group went from a pre‐op OA score of 3.16 0.48 to a 12–30 month postop OA score of 2.53 0.51 compared to the full arthrotomy group which went from a pre‐op OA score of 3.24 0.57 to a 12–30 month postop OA score of 2.51 0.53. The difference between the two then is 0.10 using a subjective scoring system with variability in time point of up to 18 months and standard deviations of 0.48–0.57. The scores that were considered statistically significant were within the “mild to moderate radiographic OA” categories for both groups leading the authors to the conclusion that “OA advanced after TPLO surgery irrespective of the arthrotomy performed. ” Even if these radiographic differences were valid and clinically significant, Rutherford et al. provide no evidence for their statement regarding pain and poor limb use. This, in combination with the fact that numerous peer‐reviewed articles provide clear evidence that medial meniscal pathology after TPLO is in fact very often clinically significant in the dog (in fact, it is the most common cause for re‐operation for all techniques), with or without meniscal release, coupled with the peer‐reviewed evidence for the morbidity associated with “blind meniscal release” and the complete inability to assess cartilage pathology, lateral meniscal pathology, caudal cruciate ligament pathology, patellar pathology, and degree of synovitis, all of which contribute significantly to joint health, pain, function, and outcome, make these authors’ statements completely unsupported and potentially dangerous, surgically and legally. I think it is imperative that authors, reviewers, and editors make sure that such bold statements, which can have significant influence on surgeons, and in turn our patients, be made with documented support and that we all are cautious in how we use data to support the things we want to say to rationalize an approach or an outcome. We need to hold ourselves to the highest standards in data reporting and recommendations for treatment for our patients.