Cruciate disease Flashcards
What provides internal stability in the stifle
cranial and caudal cruciates
medial and lateral menisci
collateral ligaments
joint capsule and surrounding musculature
What movement does cranial cruciate prevent
cranial movement of the tibia when weight bearing and limits internal rotation
What does the caudal cruciate do
this prevents caudal translation of the tibia when weight bearing.
Describe the history associated with cruciate ligament rupture
chronic lameness with sudden deterioration
a clicking sound may be heard
an unexplained lamness in hindlimb
Describe the acute presentation of cruciate disease
traumatic injury
List the clinical signs of cruciate ligament disease
lame
variable amounts of pain demonstrated
hold limb from ground when standing
stifle swollen?
pain on stifle flexion
pain in acute phase on attempting cranial draw
lameness is severe at first but slowly improves over next few weeks
the presence of medial buttress
DEcsribe the medial buttress
fibrous thickening on the medial aspect of the stifle
List the 2 definitive diagnosis test for cranial cruciate disease
the cranial drawer
the tibial thrust or compression test
Describe how to perform tibial compression test
weight bearing is mimicked and the front of the tibia can be noted to be pushing forward in relation to the femur
Describe how to perform the cranial drawer test
the abnormal movement elicited during a physical examination that is caused by the tibia sliding cranially in relationship to the femur in the absence of the cranial cruciate ligament
Which one tibial compression or cranial draw elicts less pain
tibial compression test
what is the first radiographic sign of cruciate disease
joint effusion with loss of the sub-patella fat pad
List the potential treatment options for cruciate disease
Conservative management- NSAIDSs, restricted exercise
surgical management:
1. alter joint mechanics
2. place an artifical ligament
which animals is conservative management of cruciate disease appropraite
<15 kg or 5 kg
Describe conservative mangament of cruciate disease
6 weeks restrictive exercise
NSAIDs- first 2 weeks
List 3 indications for surgical management of cruciate disease
Large and athletic dogs
Small dogs with steep tibial plateau angles e.g. >30 degrees
Those with a strong index of suspicion of meniscal injury (e.g. a meniscal click on manipulation of the joint)
List the surgical options for cruciate disease
fabello-tibial suture, over the top, tightrope technique
surgeries to manage the tibial thrust - TPLO, TTA, TTT
Describe the post-op care after cruciate surgery
3 week lead walk
physio can start 7-10 days
NSAIDs and paracetamol
ice-packs
full exercise not until 3-4 months after
Describe the prognosis of cranial cruciate disease
good to excellent
OA inevitable consequence of the condition
Is there a difference in the degree of instability if only part of the cranial cruciate ruptures
Yes
if the craniomedial component tears, there is instability only in the flexion
If the caudolateral component tears, there may be no discernible instability
What is the function of the menisci in the stifle
they improve the congruity of the curved femoral condyles and the flat surface of the tibial plateau
what is the tibial plateau
the top, flat portion of the tibia
when may the cranial drawer or tibial thrust be difficult to perform
if the animal is painful, tense or nervous
chronic cases with periarticular fibrosis
cats
what osteoarthiritic changes are seen with cruciate disease
periosteal new bone on the fabellae
poles of the patella
tibial plateau
trochlea ridges
what is TPLO
tibial plateau levelling osteotomy
what is TTA
tibial tuberosity advancement
What is TTO
triple tibial osteotomy
DEscribe fabellotibial suture for cruciate disease
wire suture loops around the tibia and the fabella and holds the joint in place
when is radiograph useful for cranial cruciate diagnostics
in chronic cases where periarticular changes have reduced the degree of the cranial drawer
