Cruciate Disease - advanced nursing

Question 1

What do the cranial cruciate ligaments do?

Answer 1

• resist stifle extension
• resist internal rotation
• prevent tibia moving cranially

Question 2

What is the cranial cruciate ligament made up of?

Answer 2

cranial medial band and caudolateral band

Question 3

What does degenerative disease do?

Answer 3

ruptures occur secondary to minimal trauma through ligaments that show evidence of degeneration and ageing

Question 4

What is a traumatic cruciate rupture?

Answer 4

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

Question 5

What condition can cause ruptureof the cruciate caused by inflammation?

Answer 5

rheumatoid arthritis

Question 6

How can cruciate ruptures be diagnosed?

Answer 6

cranial draw, tibial compression (tibial thrust) test, radiographs

Question 7

How can you see changes in joints using radiographs?

Answer 7

• take orthogonal views
• radiograph both stifles
  -slightly under-expose images
• mediolateral and craniocaudal views

Question 8

What classic changes would you see with cruciate ligament disease in radiographs?

Answer 8

joint effusion - compression of the parapatellar fat pad

Question 9

What might you see with chronic cases of cruciate ligament disease on a radiograph?

Answer 9

degenerative joint disease or osteoarthritis

Question 10

What conservative management can you do for cruciate disease?

Answer 10

• strict exercise rest for 6-8 weeks
• minimal lead exercise fortoileting only
• more successful in dogs under 15kg

Question 11

What surgical management can you do for cruciate disease?

Answer 11

• extra-articular stabilisation
• altering limb alignment / osetotomies

Question 12

What is an example of extra-articular stabilisation?

Answer 12

lateral suture or DeAngelis suture

Question 13

What is an example of altering limb alignment/osteotomies?

Answer 13

TPLO - tibial plateau levelling osteotomy

Question 14

What is a lateral suture procedure?

Answer 14

a suture is placed medial to the lateral femorofabella ligament, under the patella ligament and through a small tunnel in the tibial tuberosity

Question 15

What can happen to the femur when the cranial cruciate ligmanet ruptures?

Answer 15

the femur can slide backwards down the slope of the tibial plateau

Question 16

What is the average angle of the tibial plateau?

Answer 16

24 degrees

Question 17

What are complications involved in the lateral suture?

Answer 17

• suture failure e.g breakage, stretching, pull through crimp
• instability
• infection
• meniscal tear
  anchor pull-out

Question 18

Which muscle is a fixed length?

Answer 18

gastrocnemius

Question 19

What angle is the tibal plateau reduced to for a TPLO?

Answer 19

5-7 degrees

Question 20

What are the benefits of using a locking plate during a TPLO?

Answer 20

increased stability and better alignment

Question 21

What pre-operative planning should be done when using a locking plate for a TPLO?

Answer 21

• measure the tibial plateau angle
• determine the size of the saw blade to be used
• location of the tibial osteotomy from the radiogrpah

Question 22

What is the cranial tibial thrust?

Answer 22

the force created by compression between the femur and the tibia,force is proportional to the slope of the tibial plateau

Question 23

How do you measure the tibial slope?

Answer 23

measure the most cranial and caudal points of the tibia

Question 24

What does a TPLO do?

Answer 24

prevents tibial thrust by altering the slope of the plateau

Question 25

How is a cranial cruciate rupture diagnosed?

Answer 25

arthroscopy or imaging

Question 26

How is the TPLO performed?

Answer 26

- oscilating saw and bi-radial or crescntric blade - continuous saline lavage to minimise heat necrosis

Question 27

Where is the radial osteotomy performed?

Answer 27

proximal tibia then through the bone

Question 28

What postoperative tibial plateau angle are weaiming for after TPLO?

Answer 28

6 degrees

Question 29

How is the tibial plateau segment temporarily fixed?

Answer 29

with a 1.6mm kirschner wire

Question 30

What possible complications are associated with a TPLO?

Answer 30

- fibula fracture - peroneal nerve damage - popliteal artery trauma - tibial tuberosity avulsion fracture - patella ligament desmitis - pivot shift - osteomyelitis

Question 31

Why might you do a cranial closing wedge?

Answer 31

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

Question 32

What post-op care do dogs need to follow after TPLO surgery?

Answer 32

- 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

Question 33

What attchment does the medial meniscus have?

Answer 33

medial collateral ligament

Question 34

What meniscus is more commonly torn?

Answer 34

medial

Question 35

What percentage oftears occur in cranial cruciate ligament rupture?

Answer 35

50%

Question 36

What would you hear if the meniscus has torn?

Answer 36

a clicking sound when walking

Question 37

How do you treat a meniscal tear?

Answer 37

remove ruptured portion

Question 38

What medinscal horn usually gets torn?

Answer 38

caudal horn

Question 39

What is a meniscal probe used for?

Answer 39

used to inspect under the meniscus

Question 40

What do the meniscus look like?

Answer 40

two "c" shaped pads of fibrocartilage

Question 41

What does the meniscus do?

Answer 41

absorbs shock and aids in fluid shift and nutrition in the stifle joint