Cruciate Disease - advanced nursing Flashcards
What do the cranial cruciate ligaments do?
- resist stifle extension
- resist internal rotation
- prevent tibia moving cranially
What is the cranial cruciate ligament made up of?
cranial medial band and caudolateral band
What does degenerative disease do?
ruptures occur secondary to minimal trauma through ligaments that show evidence of degeneration and ageing
What is a traumatic cruciate rupture?
rupture caused by a heavy fall, catching a foot in a rabbit hole or RT, there will be no evidence of degenerative joint disease on radiographs
What condition can cause ruptureof the cruciate caused by inflammation?
rheumatoid arthritis
How can cruciate ruptures be diagnosed?
cranial draw, tibial compression (tibial thrust) test, radiographs
How can you see changes in joints using radiographs?
- take orthogonal views
- radiograph both stifles
-slightly under-expose images - mediolateral and craniocaudal views
What classic changes would you see with cruciate ligament disease in radiographs?
joint effusion - compression of the parapatellar fat pad
What might you see with chronic cases of cruciate ligament disease on a radiograph?
degenerative joint disease or osteoarthritis
What conservative management can you do for cruciate disease?
- strict exercise rest for 6-8 weeks
- minimal lead exercise fortoileting only
- more successful in dogs under 15kg
What surgical management can you do for cruciate disease?
- extra-articular stabilisation
- altering limb alignment / osetotomies
What is an example of extra-articular stabilisation?
lateral suture or DeAngelis suture
What is an example of altering limb alignment/osteotomies?
TPLO - tibial plateau levelling osteotomy
What is a lateral suture procedure?
a suture is placed medial to the lateral femorofabella ligament, under the patella ligament and through a small tunnel in the tibial tuberosity
What can happen to the femur when the cranial cruciate ligmanet ruptures?
the femur can slide backwards down the slope of the tibial plateau
What is the average angle of the tibial plateau?
24 degrees
What are complications involved in the lateral suture?
- suture failure e.g breakage, stretching, pull through crimp
- instability
- infection
- meniscal tear
anchor pull-out
Which muscle is a fixed length?
gastrocnemius
What angle is the tibal plateau reduced to for a TPLO?
5-7 degrees
What are the benefits of using a locking plate during a TPLO?
increased stability and better alignment
What pre-operative planning should be done when using a locking plate for a TPLO?
- measure the tibial plateau angle
- determine the size of the saw blade to be used
- location of the tibial osteotomy from the radiogrpah
What is the cranial tibial thrust?
the force created by compression between the femur and the tibia,force is proportional to the slope of the tibial plateau
How do you measure the tibial slope?
measure the most cranial and caudal points of the tibia
What does a TPLO do?
prevents tibial thrust by altering the slope of the plateau
How is a cranial cruciate rupture diagnosed?
arthroscopy or imaging
How is the TPLO performed?
- oscilating saw and bi-radial or crescntric blade
- continuous saline lavage to minimise heat necrosis
Where is the radial osteotomy performed?
proximal tibia then through the bone
What postoperative tibial plateau angle are weaiming for after TPLO?
6 degrees
How is the tibial plateau segment temporarily fixed?
with a 1.6mm kirschner wire
What possible complications are associated with a TPLO?
- fibula fracture
- peroneal nerve damage
- popliteal artery trauma
- tibial tuberosity avulsion fracture
- patella ligament desmitis
- pivot shift
- osteomyelitis
Why might you do a cranial closing wedge?
if a dog has a large tibial slope such as west highland white terriers who are often prone to large tibial slopes and in dogs where TPLO might be too demanding
What post-op care do dogs need to follow after TPLO surgery?
- confinement and minimal exercise for 4-6 weeks post-op
- careful controlled and gradual increased in exercise for the following 6-10 weeks
- physiotherapy and hydrotherapy
- radiogrpahs at 6 weeks and further 12 weeks if needed
What attchment does the medial meniscus have?
medial collateral ligament
What meniscus is more commonly torn?
medial
What percentage oftears occur in cranial cruciate ligament rupture?
50%
What would you hear if the meniscus has torn?
a clicking sound when walking
How do you treat a meniscal tear?
remove ruptured portion
What medinscal horn usually gets torn?
caudal horn
What is a meniscal probe used for?
used to inspect under the meniscus
What do the meniscus look like?
two ācā shaped pads of fibrocartilage
What does the meniscus do?
absorbs shock and aids in fluid shift and nutrition in the stifle joint
