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ACL rupture rates and disparities: Using dog CCL rupture as a translational medical model for humans

Toth, Sharon (2022) ACL rupture rates and disparities: Using dog CCL rupture as a translational medical model for humans. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Knees are the second most physically injured site with anterior cruciate ligament (ACL) ruptures accounting for over 50% of those injuries with an accumulated incidence rate of 68.6 per 100,000 person-years. Men account for most injuries, but women rupture it at a 2-8 times greater rate and the reason for this disparity is not well understood. Comparatively in dogs, cranial cruciate ligament (CCL) (dog’s ACL) rupture is the leading canine orthopedic problem and primary cause of stifle lameness. Gonadectomized dogs rupture their CCL significantly more than their intact counterparts and the reason for this disparity is also not well recognized. Nearly 75% of rupture in both humans and dogs are caused by non-traumatic means, suggesting biological factors are a component in rupture susceptibility. This study used dogs as a comparative anatomical model to identify biological variables associated with rupture using databases from the Oklahoma State University Veterinary Hospital and the Morris Animal Foundation Golden Retriever Lifetime Study. Gonadectomy and rupture were significantly associated (chi-square = 21.7, p < .01, n = 57) with different probabilities of rupture in those gonadectomized at <6 months and >13 months (OR = .12, p < .01, n = 3,044). There was a significant association between rupture and height (OR = 1.21, p = .02, n = 3,044) and weight (OR = 1.04, p < .01, n = 3,044) overtime. Females reported more significant and trending results than males overall, including between rupture and other musculoskeletal conditions (OR = 4.67, p < .01, n = 68) and infectious diseases (OR = .38, p = .05, n = 68). The age at gonadectomy impacts limb length and ossification rates, modifying overall limb conformation and ligament properties that become more susceptible to secondary microtraumas, weakening the CCL. The limb is potentially further influenced by additional musculoskeletal conditions and vitamin D absorption. This is more prevalent in large breed dogs because they are gonadectomized at the same age as small breeds despite requiring longer development time. In humans, these results indicate ACL rupture as a multifactorial process predisposed through biological means with hormone levels being an essential component.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Toth, Sharonsharon.toth@pitt.edu0000-0002-9365-7807
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSiegel,
Committee MemberKrafty,
Committee MemberWanderer,
Committee MemberAlvarado,
Date: 6 June 2022
Date Type: Publication
Defense Date: 9 February 2022
Approval Date: 6 June 2022
Submission Date: 16 February 2022
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 200
Institution: University of Pittsburgh
Schools and Programs: Dietrich School of Arts and Sciences > Anthropology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: anterior cruciate ligament; ACL; cranial cruciate ligament; CCL; rupture; animal model; translational medicine; One Health; biomedical research; biological anthropology
Date Deposited: 06 Jun 2022 15:59
Last Modified: 06 Jun 2022 15:59


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