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Y4 SA - Orthopaedics > Common conditions of the stifle joint > Flashcards

Common conditions of the stifle joint Flashcards

1
Q

Which bones make up the stifle joint?

A

Femur
Patellar
Tibial and fibula
Fabellae

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2
Q

Same some of the soft tissue structures at the level of the stifle joint

A

Cranial cruciate ligament
Caudal cruciate ligament
Medial and lateral collateral ligaments
Medial and lateral meniscus
Patellar ligament
Long digital extensor

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3
Q

Where is useful for a fluid tap in the stifle

A

Joint capsule
– needle in either side of the patellar ligament

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4
Q

Which test is used to assess for cruciate ligament tear/damage?

A

Cranial draw

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5
Q

‘toe touching’ on a clinical exam can indicate which disease?

A

Cruciate ligament

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6
Q

How can conditions of the stifle be diagnosed?

A

History and clinical signs:
- Which limb? Can you localise where?
- Does the pateint need to be triaged?
Radiography
Arthrocentesis
Scintigraphy
Ultrasound
MRI

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7
Q

Describe how to correctly radiograph the stifle - which views?

A

Two views (CrCd and ML) of both stifles
Others- stressed and skyline, flex/ext, include tibia
ML- most useful and don’t forget trochlear ridges!
Also TPLO and TTA views

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8
Q

How could you tell if there was effusion of the stifle?

A

Displacement/change of shape of the fat pad on the cranial aspect of the stifle

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9
Q

Name 3 developmental conditions of the stifle

A

Osteochondrosis
Growth disturbances e.g genu valgum
Patella luxation

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10
Q

Name 4 acquired conditions of the stifle

A

Cruciate disease
Osteoarthritis
Immune-mediated arthritis
Neoplasia

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11
Q

Name 3 traumatic conditions of the stifle joint

A
  • Fractures
  • Ruptured ligaments (CCL, CaCL, Patella, Collaterals and multiple)
  • Avulsions (Long digital extensor tendon, gastrocnemius, tibial tuberosity)
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12
Q

What is the most common cause of hindlimb lameness in the dog?

A

Damage to the cranial cruciate ligament

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13
Q

What is the function of the cranial cruciate ligament?

A

Important role in stifle joint stability (craniocaudal and internal/external rotation)
- Runs from the caudal aspect of the lateral condyle in the dog to the cranio-medial aspect of the tibia
- Prevents the joint from rotating and hyperextending

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14
Q

Describe how the cranial cruciate ligament is made up of two bands

A

Macroscopically CCLs are comprised of functional bands: Cranial(cr) and Caudal (cd)

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15
Q

Describe the functions of the cranial and caudal bands of the cranial cruciate ligament and how this is important if there is damage to the ligament

A
  • Craniomedial band is taught in flexion and extension
  • Caudolateral band is taught in extension only
  • If there is a partial tear of the cranial cruciate ligament the craniomedial band will always go first – caudolateral band is still left so the limb will be taught in extension (when you do the cranial draw) and in flexion there is a cranial draw
    If there is a complete tear there will be a cranial draw in flexion and extension
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16
Q

Describe the possible aetiologies of cranial cruciate ligament disease

A
  1. Trauma (least common)
  2. “Disease” or degeneration in older dogs (+ minor trauma) or in predisposed breeds e.g. Labrador Retriever, Terrier breeds
  3. Young large breed dogs e.g Great Dane, Bull Mastiff
  4. Increased collagen metabolism in CCLs of predisposed dog breeds
  5. Increased joint laxity
  6. Narrowed Intercondylar notches
  7. Sloping angle of tibial plateau
  8. Immune mediated disease
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17
Q

List the clinical signs of cranial cruciate ligament disease

A
  • Chronic/Acute onset hindlimb lameness
  • Leg carried flexed or “Toe Touching”
  • Stifle effusion - (patellar ligament-not pencil like - feels thickened)
  • Medial Buttress (laying down of fibrosis due to an unstable joint) and OA-chronic
  • Tibial compression test/Cranial drawer test
18
Q

Which two tests are used to assess the cruciate ligaments

A

Cranial draw
Tibial thrust

19
Q

Describe the conservative treatment options for CCL disease

A

Dogs < 15kg
Restricted exercise and analgesia for 6-8 weeks
85% will have satisfactory function
Cats???
Weight loss is extremely important in overweight patients

20
Q

Describe the surgical treatment options for CCL disease

A
  1. Intracapsular (e.g Over the Top technique (OTT))
  2. Extracapsular (e.g Fabellotibial nylon sutures)
  3. Periarticular (e.g Tibial Plateau levelling Osteotomy (TPLO) or Tibial tuberosity advancement (TTA)
  4. Stifle arthroscopy
21
Q

Describe the aftercare following surgical CCL repair

A

Re-examine at 4-6 weeks/12 weeks
Progress x-rays for osteotomies at 8 weeks.
Complications: infection, menisci tears

22
Q

When performing surgery of the stifle what should you always check for?

A

Meniscal injury

23
Q

Is the lateral or medial meniscus most commonly injured?

A

Medial

24
Q

How are meniscal injuries treated?

A

May respond to conservative management for 4-6 weeks
Surgical removal if persistent lameness

25
Q

Describe the aetiology of patellar luxation

A
  • Congenital/ Developmental or Traumatic
  • Medial>Lateral
  • Patellar sits out of the groove
  • Toy breeds/large breeds more common?
  • Cats - often asymptomatic
  • Due to developmental malalignment of quadriceps complex
26
Q

Describe the 4 grades of patellar luxation

A

1 - Intermittent patellar luxation, reduction immediate
2 - Frequent luxation, reduction not always immediate
3 - Permanent luxation, reduction possible but reluxates
4 - Permanent luxation but reduction not possible

27
Q

How is patellar luxation diagnosed?

A

History and clinical signs
Radiography

28
Q

Describe conservative management for patellar luxation

A

If none or intermittent clinical signs
Restricted, controlled exercise and NSAIDs

29
Q

Describe surgical management for patellar luxation

A

If recurrent clinical signs
Restore normal alignment of quadriceps mechanism by a combination of:
- Reinforcement of lateral retinaculum
- Release of medial retinaculum
- Deepening of the trochlear groove
- Transposition of the tibial tuberosity

30
Q

Describe the aetiology of osteochondrosis

A
  • Not very common
  • Lateral/Medial femoral condyle (articular surface)
  • Breed predisposition (e.g. Labrador Retriever)
  • Male > Female
  • If “joint mouse” then OCD (Osteochondritis dissecans)
31
Q

List the clinical signs of osteochondrosis

A

Lameness from 5 months old
Bilateral crouching gait
Joint effusion and discomfort upon palpation

32
Q

How is osteochondrosis diagnosed?

A

History and clinical signs
Radiography (CrCd most use-but can see flattening on ML view)

33
Q

Describe the aetiology of rupture of the collateral ligaments

A

Alone or in combination with CCL rupture
Medial or Lateral

34
Q

How is rupture of the collateral ligaments diagnosed?

A

Abnormal joint movement in medial or lateral direction
Stressed radiographs (take contralateral limb to check for normality)
Widening of the lateral joint space seen on radiography

35
Q

How is rupture of the collateral ligaments treated?

A

Parapatellar approach to side affected
Primary repair of ligament and repair protected by screws and washers at insertion sites

36
Q

Describe the aetiology of multiple ligament injuries

A

Uncommon injuries usually working dogs

37
Q

Describe how to treat multiple ligament injuries

A

Repair of CCL, collateral ligament(s), removal of damaged meniscus and joint capsule- good prognosis but don’t underestimate repair!!

38
Q

Describe the aetiology of multiple ligament injuries in cats

A

Usually in association with CCL rupture
Meniscal injuries

39
Q

Describe how to treat multiple ligament injuries in a cat

A

Transarticular pin across stifle joint for 4 weeks

40
Q

Describe the main features of stifle osteoarthritis

A

Common
Secondary to CCL rupture
Manage as for OA patient

Y4 SA - Orthopaedics (7 decks)

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