Common conditions of the stifle joint Flashcards
Which bones make up the stifle joint?
Femur
Patellar
Tibial and fibula
Fabellae
Same some of the soft tissue structures at the level of the stifle joint
Cranial cruciate ligament
Caudal cruciate ligament
Medial and lateral collateral ligaments
Medial and lateral meniscus
Patellar ligament
Long digital extensor
Where is useful for a fluid tap in the stifle
Joint capsule
– needle in either side of the patellar ligament
Which test is used to assess for cruciate ligament tear/damage?
Cranial draw
‘toe touching’ on a clinical exam can indicate which disease?
Cruciate ligament
How can conditions of the stifle be diagnosed?
History and clinical signs:
- Which limb? Can you localise where?
- Does the pateint need to be triaged?
Radiography
Arthrocentesis
Scintigraphy
Ultrasound
MRI
Describe how to correctly radiograph the stifle - which views?
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
How could you tell if there was effusion of the stifle?
Displacement/change of shape of the fat pad on the cranial aspect of the stifle
Name 3 developmental conditions of the stifle
Osteochondrosis
Growth disturbances e.g genu valgum
Patella luxation
Name 4 acquired conditions of the stifle
Cruciate disease
Osteoarthritis
Immune-mediated arthritis
Neoplasia
Name 3 traumatic conditions of the stifle joint
- Fractures
- Ruptured ligaments (CCL, CaCL, Patella, Collaterals and multiple)
- Avulsions (Long digital extensor tendon, gastrocnemius, tibial tuberosity)
What is the most common cause of hindlimb lameness in the dog?
Damage to the cranial cruciate ligament
What is the function of the cranial cruciate ligament?
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
Describe how the cranial cruciate ligament is made up of two bands
Macroscopically CCLs are comprised of functional bands: Cranial(cr) and Caudal (cd)
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
- 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
Describe the possible aetiologies of cranial cruciate ligament disease
- Trauma (least common)
- “Disease” or degeneration in older dogs (+ minor trauma) or in predisposed breeds e.g. Labrador Retriever, Terrier breeds
- Young large breed dogs e.g Great Dane, Bull Mastiff
- Increased collagen metabolism in CCLs of predisposed dog breeds
- Increased joint laxity
- Narrowed Intercondylar notches
- Sloping angle of tibial plateau
- Immune mediated disease
List the clinical signs of cranial cruciate ligament disease
- 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
Which two tests are used to assess the cruciate ligaments
Cranial draw
Tibial thrust
Describe the conservative treatment options for CCL disease
Dogs < 15kg
Restricted exercise and analgesia for 6-8 weeks
85% will have satisfactory function
Cats???
Weight loss is extremely important in overweight patients
Describe the surgical treatment options for CCL disease
- Intracapsular (e.g Over the Top technique (OTT))
- Extracapsular (e.g Fabellotibial nylon sutures)
- Periarticular (e.g Tibial Plateau levelling Osteotomy (TPLO) or Tibial tuberosity advancement (TTA)
- Stifle arthroscopy
Describe the aftercare following surgical CCL repair
Re-examine at 4-6 weeks/12 weeks
Progress x-rays for osteotomies at 8 weeks.
Complications: infection, menisci tears
When performing surgery of the stifle what should you always check for?
Meniscal injury
Is the lateral or medial meniscus most commonly injured?
Medial
How are meniscal injuries treated?
May respond to conservative management for 4-6 weeks
Surgical removal if persistent lameness
Describe the aetiology of patellar luxation
- 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
Describe the 4 grades of patellar luxation
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
How is patellar luxation diagnosed?
History and clinical signs
Radiography
Describe conservative management for patellar luxation
If none or intermittent clinical signs
Restricted, controlled exercise and NSAIDs
Describe surgical management for patellar luxation
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
Describe the aetiology of osteochondrosis
- Not very common
- Lateral/Medial femoral condyle (articular surface)
- Breed predisposition (e.g. Labrador Retriever)
- Male > Female
- If “joint mouse” then OCD (Osteochondritis dissecans)
List the clinical signs of osteochondrosis
Lameness from 5 months old
Bilateral crouching gait
Joint effusion and discomfort upon palpation
How is osteochondrosis diagnosed?
History and clinical signs
Radiography (CrCd most use-but can see flattening on ML view)
Describe the aetiology of rupture of the collateral ligaments
Alone or in combination with CCL rupture
Medial or Lateral
How is rupture of the collateral ligaments diagnosed?
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
How is rupture of the collateral ligaments treated?
Parapatellar approach to side affected
Primary repair of ligament and repair protected by screws and washers at insertion sites
Describe the aetiology of multiple ligament injuries
Uncommon injuries usually working dogs
Describe how to treat multiple ligament injuries
Repair of CCL, collateral ligament(s), removal of damaged meniscus and joint capsule- good prognosis but don’t underestimate repair!!
Describe the aetiology of multiple ligament injuries in cats
Usually in association with CCL rupture
Meniscal injuries
Describe how to treat multiple ligament injuries in a cat
Transarticular pin across stifle joint for 4 weeks
Describe the main features of stifle osteoarthritis
Common
Secondary to CCL rupture
Manage as for OA patient
