Knees have a political economy? Since when?

A pawprint from a perfectly-functioning cranial cruciate ligament!

Humphrey is feeling much better with rest and anti-inflammatories. However, he felt very compelled to seek out other things that might help him recover better and faster. He spent more time than he should have looking at peer-reviewed veterinary journals (a fringe benefit of a university-employed guardian!), and he learned lots and lots of new words. He also found out a lot of the political economy of knee health!

For starters, a 2005 article in the Journal of the American Veterinary Medical Association reports that in the US, the annual expenditure by dog owners on cranial cruciate ligament surgery (CCL, a fancy name for a certain part of the knee) and follow-up is a whopping $1.32 billion!  Wow, perhaps his plan to become a CEO earlier in the week was premature. He may wish to join the ranks of canine surgeons instead.

Back in the 1980s,[1] some studies were done to compare dogs treated with rest only versus those who had surgery. The “gold standard” of this research seems to be a 1984 study by Dr. P.B. Vasseur, published in Veterinary Surgery. Dr. Vasseur’s finding that the size of the dog impacts outcomes appears to be often quoted (but not cited) among practicing vets. Among dogs weighing under 15kg, over 85% fully recovered from a CCL rupture on average within 8 months, treated only with rest and restricted movement (“on leash walks” only). By contrast, only 19% of dogs over 15 kg (or roughly 30 lbs) recovered without surgery. 

What’s especially fascinating about all Humph's research is that best sort of surgical treatment for CCL injuries remains questionable! A 2005 meta-analysis of peer-reviewed research on this topic published in the journal Veterinary Surgery found that no single surgical procedure that has enough data to recommend that it can consistently return dogs to normal function after CCL injury. And yet, the meta-analysis coupled with Dr. Vasseur's conservative treatment findings seem to have little effect on the political economy of the Cruciate Ligament Industrial Complex.

So, this all leaves a bunch of questions in Humph’s inquiring mind:

(1)   If most dogs under 15kg recovered fully without CCL surgery, are we to assume that the number of large dogs requiring CCL surgery account for a $1.32 billion market? Is this a valid example of a political economy within veterinary care?

(2)   What accounts for the absence of control groups with no surgical interventions?

(3)   How does all this relate to the alarming growth of pet healthcare markets, and the healthy injection that pets infuse into “big pharma”?

(4) How long till we eat?

For the time being, Humphrey will continue to try very, very hard to stay still (you have no idea how difficult this is), and to expend his energy on constructive, non-physical pursuits such as refining his ability to use scholarly databases. He will do his best to stay away from terms like "political economy" and "industrial complex," but he suspects this might be a side effect of the Metacam NSAID he's on.

Update: An 11-year study of outcomes for patellar surgery in 91 small dogs conducted by Drs. Linney, Hammer & Schott in the Journal of the American Veterinary Association (2011, 238[9], 1168-1172) found that there's no great benefit to small dogs over time when they have patellar surgery - this is different from CCL surgery, but it seems that studies seem to result in evidence against knee surgery in small dogs.

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[1] Notably absent: any recent studies on non-surgical intervention, which leaves Humphrey questioning the girth of the political economy, funding sources, and researcher bias in their methodology! How can efficacy studies ignore a control group of injured dogs with no intervention????