Cruciate Disease Flashcards
What does the cranial cruciate ligament do?
Resists stifle extension
Resists internal rotation
Prevents tibia moving cranially
What are the three general aetiologies for cruciate disease?
Degenerative
Traumatic (rare)
Inflammation
What tests can we do on ortho exam to test for cruciate disease?
Cranial draw test
Tibial compression/thrust test
What changes are we looking for on radiographs?
Orthogonal views, both stifles
Joint effusion
What treatment options do we have for cranial cruciate ligament disease?
Conservative
Surgical: intra-articular replacement of ligament / extra-articular replicate function of ligament / combination / alteration of joint angles
Describe conservative management of cranial cruciate ligament disease patients?
Strict crate rest for 6 weeks
Suitable for dogs/cats <15kg
Rely on fibrosis
If no improvement - surgery
Describe how to carry out a modified DeAngelis suture (extra-articular).
Arthrotomy, confirm diagnosis, debride cruciate rupture, check meniscus
Suture placed around femorofabella ligament and through bone tunnel in tibial tuberosity
Secure suture with metal crimps, repair fascia lata with modified mayo mattress suture
What complications can occur from a lateral suture surgery?
Suture failure - breakage, stretching, pull through crimp
Instability
Infection
Meniscal tear
Anchor pull-out
What forces occur in the stifle?
Gastrocnemius = fixed length
Tibial plateau slopes caudally
Tibia slides forward unless restrained by CCL
Compression forces - weight and muscular propulsive forces
Define cranial tibial thrust.
The force created by compression between femur and tibia
Force is proportional to slope of tibial plateau
Describe a TPLO procedure.
Medial parapatellar approach
Arthrotomy/arthroscopy
Confirm diagnosis - CrCL rupture
Debride ligament?
Remove torn meniscus
Close joint
Perform TPLO
What is the typical tibial plateau angle produced from a TPLO?
Reduced to approx. 6-7 degrees
What possible complications can occur from a TPLO?
Fibula fracture
Peroneal nerve damage
Popliteal artery trauma
Tibial tuberosity avulsion fracture
Patella ligament desmitis
Pivot shift
Osteomyelitis
etc…
What other tibial levelling procedures are available?
Triple tibial osteotomy (TTO)
Tibial tuberosity advancement (TTA)
Cranial closing wedge
Describe meniscal injuries.
Medial meniscus - has attachment to medial collateral ligament, more commonly torn
Tears in 50% of CCL rupture cases
Meniscal lesions can be painful
May be audible/palpable click
Variety of lesions seen
Can occur late after cruciate surgery
