Common Conditions of the Stifle Joint

Question 1

What is included with the stifle joint? Ligaments / tendons?

Answer 1

• Cranial / Caudal cruciate ligament
• Medial / lateral collateral ligaments
• Medial / Lateral meniscus
• Patellar ligament
• Long digital extensor tendon
• Trochlea
• Sesamoid
• Fibula + Tibia + Femur

Question 2

What will dogs with cruciate disease have?

Answer 2

• Cranial drawer - might need to sedate
• Positive tibial compression test

Question 3

How can you diagnose stifle problems?

Answer 3

• Hx + CS
• Radiography
• Arthrocentesis (joint tap)

Question 4

What is a Ddx if a dog is lame on both back legs

Answer 4

Hip + hock + lumbosacral disease

Question 5

What are developmental conditions of the stifle?

Answer 5

• Osteochondrosis
• Growth disturbances - (e.g. genu valgum)
• Patella luxation

Question 6

What is traumatic conditions of the stifle?

Answer 6

• Fractures of stifle region
• Ruptured ligaments (CaCL/CCL)
• Avulsions (long digital extensor tendon, gastrocnemius)

Question 7

What do you check joint fluid for?

Answer 7

• Volume
• Vicosity
• Colour
• Turbidity

Question 8

What are acquired conditions of the stifle?

Answer 8

• Cruciate disease
• OA
• Immune mediated arthritis
• Neoplasia

Question 9

If you have a partial rupture of the CCL which band has torn?

Answer 9

• Craniomedial band is gone
• if still taut in extension = Craniolateral band intact
• Need to do cranial drawer in flexion + extension

Question 10

What is aetiology of cranial cruciate disease?

Answer 10

• Trauma (least common)
• “Disease” or degeneration in older dogs (+ minor trauma) or in predisposed breeds e.g. Labrador Retriever
• Young large breed dogs e.g Great Dane, Bull Mastiff
• “Disease” related to:
  -increased collagen metabolism in CCLs of predisposed dog breeds
  -Increased joint laxity
  -Narrowed Intercondylar notches
  -Sloping angle of tibial plateau
  -Immune mediated disease

Question 11

What are clinical signs of CCL?

Answer 11

• Chronic/Acute onset hindlimb lameness
• Leg carried flexed or “Toe Touching”
• Stifle effusion- (patellar ligament-not pencil like)
• Medial Buttress and OA-chronic
• Tibial compression test/Cranial drawer test

Question 12

What is treatment of CCL?

Answer 12

• Conservative =
  -Dogs <15Kg, restricted exercise + analgesia for 6-8wks
• Surgical =
  -Intrascapular - over the top technique
  -Extrascapular - fabellotibial nylon sutures
  -Periarticular - TPLO / TTA
  -Stifle arthroscopy

Question 13

What is aftercare of CCL? What are complications?

Answer 13

• Re examine at 4-6wks + 12 wks
• Progress x-rays for osteotomies at 8 wks
• Complication =
  -Infection
  -Meniscal tears (medial)

Question 14

What is the aetiology of patellar luxation?

Answer 14

• Congenital / developmental or traumatic
• Toy breeds predisposed

Question 15

How would you grade patellar luxation?

Answer 15

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

Question 16

How would you diagnose patellar luxation?

Answer 16

• Hx + CS
• Radiography

Question 17

What is Tx of patellar luxation?

Answer 17

• Conservative =
  -If none or intermittent CS
  -Restricted, controlled exercise + NSAIDs
• Surgical =
  -If recurrent CS
  -Restore normal alignment of quads by
  Reinforcement of lateral retinaculum +
  Release of medial retinaculum
  -Deepening of trochlear groove

Question 18

What is aetiology of osteochondrosis?

Answer 18

• Breed diposition = Labrador retriever
• Male > Female
• If joint mouse = OCD

Question 19

CS + Dx of osteochondrosis?

Answer 19

• CS =
  -Lameness from 5 m/o
  -Bilateral crouching gait
  -Joint effusion + discomfort upon palpation
• Dx =
  -Hx + CS
  -Radiography

Question 20

What are other conditions of stifle?

Answer 20

• OA = secondary to CCL
• Neoplasia - poor recovery in CCL case