Cruciate disease

Question 1

What provides internal stability in the stifle

Answer 1

cranial and caudal cruciates
medial and lateral menisci
collateral ligaments
joint capsule and surrounding musculature

Question 2

What movement does cranial cruciate prevent

Answer 2

cranial movement of the tibia when weight bearing and limits internal rotation

Question 3

What does the caudal cruciate do

Answer 3

this prevents caudal translation of the tibia when weight bearing.

Question 4

Describe the history associated with cruciate ligament rupture

Answer 4

chronic lameness with sudden deterioration
a clicking sound may be heard
an unexplained lamness in hindlimb

Question 5

Describe the acute presentation of cruciate disease

Answer 5

traumatic injury

Question 6

List the clinical signs of cruciate ligament disease

Answer 6

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

Question 7

DEcsribe the medial buttress

Answer 7

fibrous thickening on the medial aspect of the stifle

Question 8

List the 2 definitive diagnosis test for cranial cruciate disease

Answer 8

the cranial drawer
the tibial thrust or compression test

Question 9

Describe how to perform tibial compression test

Answer 9

weight bearing is mimicked and the front of the tibia can be noted to be pushing forward in relation to the femur

Question 10

Describe how to perform the cranial drawer test

Answer 10

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

Question 11

Which one tibial compression or cranial draw elicts less pain

Answer 11

tibial compression test

Question 12

what is the first radiographic sign of cruciate disease

Answer 12

joint effusion with loss of the sub-patella fat pad

Question 13

List the potential treatment options for cruciate disease

Answer 13

Conservative management- NSAIDSs, restricted exercise
surgical management:
1. alter joint mechanics
2. place an artifical ligament

Question 14

which animals is conservative management of cruciate disease appropraite

Answer 14

<15 kg or 5 kg

Question 15

Describe conservative mangament of cruciate disease

Answer 15

6 weeks restrictive exercise
NSAIDs- first 2 weeks

Question 16

List 3 indications for surgical management of cruciate disease

Answer 16

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)

Question 17

List the surgical options for cruciate disease

Answer 17

fabello-tibial suture, over the top, tightrope technique

surgeries to manage the tibial thrust - TPLO, TTA, TTT

Question 18

Describe the post-op care after cruciate surgery

Answer 18

3 week lead walk
physio can start 7-10 days
NSAIDs and paracetamol
ice-packs
full exercise not until 3-4 months after

Question 19

Describe the prognosis of cranial cruciate disease

Answer 19

good to excellent
OA inevitable consequence of the condition

Question 20

Is there a difference in the degree of instability if only part of the cranial cruciate ruptures

Answer 20

Yes
if the craniomedial component tears, there is instability only in the flexion
If the caudolateral component tears, there may be no discernible instability

Question 21

What is the function of the menisci in the stifle

Answer 21

they improve the congruity of the curved femoral condyles and the flat surface of the tibial plateau

Question 22

what is the tibial plateau

Answer 22

the top, flat portion of the tibia

Question 23

when may the cranial drawer or tibial thrust be difficult to perform

Answer 23

if the animal is painful, tense or nervous
chronic cases with periarticular fibrosis
cats

Question 24

what osteoarthiritic changes are seen with cruciate disease

Answer 24

periosteal new bone on the fabellae
poles of the patella
tibial plateau
trochlea ridges

Question 25

what is TPLO

Answer 25

tibial plateau levelling osteotomy

Question 26

what is TTA

Answer 26

tibial tuberosity advancement

Question 27

What is TTO

Answer 27

triple tibial osteotomy

Question 28

DEscribe fabellotibial suture for cruciate disease

Answer 28

wire suture loops around the tibia and the fabella and holds the joint in place

Question 29

when is radiograph useful for cranial cruciate diagnostics

Answer 29

in chronic cases where periarticular changes have reduced the degree of the cranial drawer