cruciate disease Flashcards
What is the signament of cruciate disease?
- Breed predispositions- Rottweiler, Labrador retriever, Bull mastiff, West Highland white terrier, Border terrier
- In larger breeds it is more commonly a degenerative condition seen in the younger patient
- The West Highland terrier appears to be older at presentation
- Traumatic injuries are uncommon
- This condition is seen in the cat-older and often overweight
What is the top differential for a mature dog with hindlimb lameness?
cruciate disease
What is the anatomy of the stifle and what causes the stability of the stifle
Internal stability of the stifle results from the cranial and caudal cruciates, the medial and lateral menisci, collateral ligaments, joint capsule and surrounding musculature particularly the quadriceps, hamstrings (biceps femoris) and gastrocnemius. The cranial cruciate also prevents internal rotation as well as cranial movement of the tibia/caudal movement of the femur during weight bearing (see later)
The tibial plateau is set at an angle to the long axis of the limb
When the animal weight bears there is a tendency for the tibia to move cranially (tibial thrust) which is counteracted by the cranial cruciate.
What are these structures?
1 cranial cruciate
2 lateral meniscus
3 medial meniscus
4 insertion of the cranial cruciate and
inter-meniscal ligament
What is the tibial plateau angle?
The tibial plateau angle is that set by a line at right angles to the long axis of the tibia and the plateau
The greater this angle the more strain is placed on the cranial cruciate ligament
This might explain the greater incidence of cruciate disease in those breeds with a large TPA e.g. the West Highland white terrier although recent investigations have cast doubt on this suggestion
What is the role of the cranial cruciate ligament (CCL)?
Prevents cranial tibial movement and internal rotation.
What is tibial thrust?
The forward movement of the tibia during weight bearing.
What is the typical tibial plateau angle (TPA) in dogs?
Around 26 degrees.
What is the common history in cruciate disease?
Chronic lameness with sudden deterioration.
What is a medial buttress?
Fibrous thickening on the medial aspect of the stifle.
What two tests diagnose cruciate instability?
Cranial drawer and tibial thrust tests.
What is the first radiographic sign of cruciate disease?
Joint effusion with loss of sub-patellar fat pad.
What is the recommended treatment for small dogs with cruciate disease?
Conservative management (restricted exercise, NSAIDs).
What Tibial Plateau Leveling Osteotomy (TPLO). techniques are there?
- Slocum technique with radial cut - most common
- Cranial closing wedge osteotomy
- CORA based levelling osteotomy (CBLO)
What is the goal of TPLO surgery?
To level the tibial plateau and eliminate tibial thrust.
What complication occurs in up to 10% of cruciate surgeries?
Late meniscal tears.
What is the primary function of menisci?
Improve joint congruity and absorb shock.
What is a bucket handle tear?
A specific type of meniscal tear common in cruciate disease.
How long should dogs be confined post-TPLO surgery?
Three weeks.
What percentage of dogs develop cruciate disease in the other limb?
Up to 50% within 2 years.
What surgical technique for cruciate disease is falling out of favor due to a 30% complication rate?
Tibial Tuberosity Advancement (TTA).
What is an advantage of CORA-Based Leveling Osteotomy (CBLO)?
In what dogs it is useful in?
It limits the caudal movement of the tibial plateau seen with the standard Slocum technique
It is useful in dogs with steep tibial plateau angles and those with open growth plates
What is a risk factor for cruciate disease, that is particularly seen in West Highland White Terriers?
Steep tibial plateau angle.
which meniscus is more prone to injury? why?
Medial meniscus - is attached to the medial collateral, cannot move with the tibia and therefore is prone to injury when the stifle is unstable due to shearing force
What is the primary goal of extra-capsular repair of cruciate disease?
To support the joint while fibrosis stabilizes it.
What postoperative therapy is recommended after cruciate surgery?
Physiotherapy and controlled exercise.
What material is used in the DeAngelis suture technique?
Polyester or monofilament nylon.
What is the prognosis for cruciate disease with treatment?
Generally good to excellent.
What is the primary reason for failure of artificial ligament surgery?
Lack of proper anatomical replication.
What postoperative complication can increase treatment costs?
Late meniscal tear.
How is the TPA adjusted in TPLO surgery?
A radial cut is made and rotated to a suitable level then held in place with a plate
