Cruciate ligament disease Flashcards
Breed predisposition for CCLD?
- Rottweiler
- West highland white terrier
- golden retriever
- Staffordshire bullterrier
Related to the joint and synovia, where is the CCL?
Intraarticular, extrasynovial
Which band is always taught of the two bands in CCL?
Craniomedial is always taught
Caudolateral is only taught when extention
What is the role of the CCL?
Restrain the tibia, limit internal rotation
What are the three types of CCLD?
1) Traumatic avulsion - uncommon - puppies - avulsion from tibia
2) Traumatic rupture - very uncommon - humans
3) Degenerative weakening - the vast majority of our patients
What are the biomechanical factors of CCLD?
1) Steepness of tibial plateau
2) Conformation of distal femur/intercondylar notch
3) Hindlimb conformation -> non-straight limb, added pressure to CCL
4) Alignement of the patella tendon relative to quadriceps/hamstring muscles
What are the biological factors of CCLD?
1) Arhtritis (lymphocytic plasmocytic synovitis)
2) Degradation, degeneration
3) Impaired synthesis and turnover of cellular matrix
4) Necrosis and apoptosis
What are the roles of the meniscus?
- bearing and distribution
- shock absorption
- improve joint congruency, stability
- lubrication
- revent synovial impingement
how many % of CCLD have meniscal injury, which meniscus and what type of injury?
50%
Medial meniscus
Bucket handle tear - often at caudal horn
What is the gold standard for determining meniscal damage?
Meniscal probing - Dandy Nervehook
What does the cranial drawer test screen for?
Passive femoropatellar instability in the stifle
What does the tibial compression test mimic?
Mimic loading of the stifle and assesses cranial tibial thrust
What are typical XR changes of CCLD?
- joint effusion -> Fat pad sign (cranial, caudal)
- OA, osteophytes at trochlear ridges, tibial condyles, insertion of collat lig, distal pole of atella, osteophytes at intsertion of CCL
- distal displacement of popliteal sesamoid
- very rare: Avulsion
Conservative treatment?
Not recommended
<15kg - 85% no or minimal lameness at 6m BUT
more reliable and rapid results with surgery
Intraarticular repair of CCL?
1) Autografts - bone patellar tendon bone, hamstring tendon, fascia lata
2) allograft - from cadaver
3) synthetic - goretex, dacron, LARS, silk fibre
Extra articular repair?
1) Lateral suture/DeAngelis
2) Tightrope
3) Fibular head transposition (not recom)
4) CCWO - closing weadge ostectomy
5) TPLO
6) CORA based TPLO
7) TTA
8) TTO - tripple tibial osteotomy
General complications of CCLD repair?
- surgical site infection
- septic arthritis
- implant associated infeciton
- implant failure
- late meniscal injury
General complications of CCLD repair?
- surgical site infection
- septic arthritis
- implant associated infeciton
- implant failure
- late meniscal injury
Complications or intraarticular techniques?
- peroneal nerve injury
- caudal cruciate ligament injury
- graft failure
Complications of extraarticular techniques?
Suture Failure
Fibular nerve injury
Complications of tibial osteotomies?
Hemorrhage
Fracture (tibia, tibial tuberosity, patella, fibula)
Osteomyelitis
Delayed union, mal-union, non-union
Patellar ligament injury
intraarticular screw placement
When does lateral suture break?
around 12w, if prior 6w -> failure
Why is there a higher risk of infeciton with tightrope?
braided
What is the aimed tibial plateau angle for CWO - closing wedge ostectomy?
5 degrees
What is the goal post op angle TPA of TPLO?
5 degrees
BUT: due to rockback and shift of saw -> aim for 6,5 degrees
How does TTA stabilize the joint?
TTA stabilize the stifle joint during weightbearing by neutralizing the cranial tibiofemoral shear force (CrTT)
What is the goal of TTA? PTA angle
A patellar tendon angle (PTA) of 90 degrees to the tibial plateau
Which has a higher degree of late meniscal injury?
TTA
Complication rate, re-op, late meniscal injury in:
- lateral suture
- TPLO
- TTA
What is the angle of the stifle joint at full weightbearing stance?
135*
Why is diagnosis of partial CCL tear difficult?
Can be challenging when there is no/minimal drawer
-> partial: craniomedial band rupture
Cranial cruciate ligament disease in the cat - cause, prognosis, treatment?
CCLD in the cat
- Cause: Trauma or degenerative
- Prognosis: With conservative treatment, good
- surgical: extracapsular stabilization, TPLO an option but not proven
How many dogs have bilateral CCLD?
up to 50%
Stifle disruption - cause and common injury?
Trauma (trapped leg)
Cranial, caudal cruciate, collateral lig (lateral > medial), menisci, capsule damage
Who presents with stifle disruption?
cats more frequently
Treatment of stifle disruption?
extralateral suture + prosthesis
or TPLO + prosthesis IF CAUDAL CRUCIATE intact
Cause for caudal cruciate ligament rupture?
trauma, avulsion or due to overcorrection of TPLO
treatment of caudal cruciate ligament rupture?
conservative
surgery if due to overcorrection (prosthesis or fixation of avulsed bone)
