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Surgery > Cruciate disease > Flashcards

Cruciate disease Flashcards

1
Q

2 cruciates ligs - which one is usually injured?

A
  1. Cranial –> usu injured

2. Caudal

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2
Q

what direction does the cranial cruciate ligament run in the stifle?

A

the same direction you put your hands into your pock

from prox caudal to distal cranial.

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3
Q

what are the CrCL 3 functions?

A
  • prevent cranial displacement of tibia
  • limit internal tibial rotation
  • prevent stifle hyperextension
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4
Q

what cause CrCL rupture?

A
  • excessive stress on a normal ligament (uncommon)

- normal stress on an abnormal ligament ie. degeneration (most common form)

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5
Q

why do CrCLs degenerate?

A
  • the interior and the central part of the CrCL degenerate w/ age
  • occurs earlier and is more severe in larger breed dogs
  • DJD
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6
Q

what are the two functional bands of CrCL?

A
  • craniomedial band: taut during flexion + extension

- caudolateral band: only taut during extension

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7
Q

typical presentation of chronic degeneration of CrCL

A

intermittent lameness typical of OA is seen for several months –> eventually if ignored/not diagnosed lig degen will progress to rupture w/ sudden deteriorate to marked lameness dt complete rupture +/- meniscal damage

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8
Q

Pex findings of chronic progressive degeneration of the cruciate ligament

A
  • lameness
  • medial buttress (pathognomonic for cruciate disease)
  • muscle atrophy
  • periarticular fibrosis
  • joint effusion
  • +/- crepitus
  • decreased ROM stifle
  • +/- stifle joint instability (cranial drawer sign/cranial tibial thrust)
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9
Q

typical CrCL degen stance is:

A
  • tripod stance/forward press
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10
Q

what is the positive sit test?

A

dogs with cruciate disease will commonly avoid sitting squarely w/ full stifle joint flexion, as this if painful –> will sit unevenly and leave the sore stifle joint slightly extended.

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11
Q

cranial drawer is testing for..

A

passive laxity of the stifle joint

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12
Q

cranial tibial thrust is testing for…

A

CCL incompetence and stifle joint instability

‘pseudo-physiologic’ test of stifle joint laxity

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13
Q

if the only the craniomedial band of the CrCL is torn will there be cranial drawer?

A

Not in extension as the caudolateral band is functional during extension
Present in flexion.

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14
Q

if the only the caudolateral band of the CrCL is torn will there be cranial drawer?

A

No cranial drawer present as craniomedial band functional in extension and flexion

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15
Q

risk of meniscal injury is how many times higher if stifle joint instability exists

A

> 160times higher

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16
Q

classic radiographic signs of cruciate disease

A
  • osteophytes on distal ple of patella, trochlea ridge, tibial plateau
  • joint effusion (compresses radiolucent fat pad)
17
Q

how do you assess joint effusion in the stifle radiographically?

A

rule of thumb: there should be no fluid density/radiopacity cranial to a line drawn btwn the long digital extensor fossa of the femur and the cranial edge of the tibial condyle

18
Q

ddx for cruciate disease

A
  1. Other causes of stifle lameness:
    - medial patella luxation
    - primary/secondary OA
    - avulsion of LDE tendon
    - CdCruciate lig injury
  2. Other causes of HL lameness
19
Q

aims of surgical tx of cruciate disease

A
  • stabilise the stifle joint

- diagnose and tx any concurrent meniscal injury

20
Q

treatment of cruciate disease involves 3 parts

A
  1. Surgical resolution/prevention of stifle joint instability/load on cruciate
  2. Inspection of menisci for damage
  3. Lifelong OA management
21
Q

what are two passive stifle joint stabilisation techniques?

A
  1. Extracapsular reconstruction - Lateral fabello-tibial suture, lateral fascial imbrication
  2. Intracapsular reconstruction (rarely ever)
22
Q

what are the 3 tibial osteotomy surgeries

A
  1. Tibial plateau leveling operation
  2. Triple tibial osteotomy
  3. Tibial tuberosity advancement
23
Q

why are medial meniscal injuries more common secondary to cruciate rupture (vs. lateral meniscus)?

A
  • the medial meniscus is firmly attached to the tibial plateau and can not ‘escape’ the shear force of the femoral condyle
  • the lateral meniscus is only loosely attached to the tibial plateau, and unlike the medial meniscus is attached to the femoral condyle, so is able to move w/ the femoral condyle instead of being damaged by it
24
Q

meniscal injury treatment

A
  • ID via exploratory arthrotomy

- remove only damaged parts of meniscus (if entire meniscus damaged - remove all)

25
Q

total meniscectomy consequences

A

will promote DJD but leaving a damaged meniscus in situ will cause persistent lameness

26
Q

which stifle surgery has the best outcomes and complications?

A

TPLO

27
Q

what % of cases w/ stifle joint instability have meniscal injury?

A

60

Surgery (22 decks)

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