Cruciate ligament disease

Question 1

Breed predisposition for CCLD?

Answer 1

• Rottweiler
• West highland white terrier
• golden retriever
• Staffordshire bullterrier

Question 2

Related to the joint and synovia, where is the CCL?

Answer 2

Intraarticular, extrasynovial

Question 3

Which band is always taught of the two bands in CCL?

Answer 3

Craniomedial is always taught
Caudolateral is only taught when extention

Question 4

What is the role of the CCL?

Answer 4

Restrain the tibia, limit internal rotation

Question 5

What are the three types of CCLD?

Answer 5

1) Traumatic avulsion - uncommon - puppies - avulsion from tibia
2) Traumatic rupture - very uncommon - humans
3) Degenerative weakening - the vast majority of our patients

Question 6

What are the biomechanical factors of CCLD?

Answer 6

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

Question 7

What are the biological factors of CCLD?

Answer 7

1) Arhtritis (lymphocytic plasmocytic synovitis)
2) Degradation, degeneration
3) Impaired synthesis and turnover of cellular matrix
4) Necrosis and apoptosis

Question 8

What are the roles of the meniscus?

Answer 8

• bearing and distribution
• shock absorption
• improve joint congruency, stability
• lubrication
• revent synovial impingement

Question 9

how many % of CCLD have meniscal injury, which meniscus and what type of injury?

Answer 9

50%
Medial meniscus
Bucket handle tear - often at caudal horn

Question 10

What is the gold standard for determining meniscal damage?

Answer 10

Meniscal probing - Dandy Nervehook

Question 11

What does the cranial drawer test screen for?

Answer 11

Passive femoropatellar instability in the stifle

Question 12

What does the tibial compression test mimic?

Answer 12

Mimic loading of the stifle and assesses cranial tibial thrust

Question 13

What are typical XR changes of CCLD?

Answer 13

• 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

Question 14

Conservative treatment?

Answer 14

Not recommended
<15kg - 85% no or minimal lameness at 6m BUT
more reliable and rapid results with surgery

Question 15

Intraarticular repair of CCL?

Answer 15

1) Autografts - bone patellar tendon bone, hamstring tendon, fascia lata
2) allograft - from cadaver
3) synthetic - goretex, dacron, LARS, silk fibre

Question 16

Extra articular repair?

Answer 16

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

Question 17

General complications of CCLD repair?

Answer 17

• surgical site infection
• septic arthritis
• implant associated infeciton
• implant failure
• late meniscal injury

Question 18

General complications of CCLD repair?

Answer 18

• surgical site infection
• septic arthritis
• implant associated infeciton
• implant failure
• late meniscal injury

Question 19

Complications or intraarticular techniques?

Answer 19

• peroneal nerve injury
• caudal cruciate ligament injury
• graft failure

Question 20

Complications of extraarticular techniques?

Answer 20

Suture Failure
Fibular nerve injury

Question 21

Complications of tibial osteotomies?

Answer 21

Hemorrhage
Fracture (tibia, tibial tuberosity, patella, fibula)
Osteomyelitis
Delayed union, mal-union, non-union
Patellar ligament injury
intraarticular screw placement

Question 22

When does lateral suture break?

Answer 22

around 12w, if prior 6w -> failure

Question 23

Why is there a higher risk of infeciton with tightrope?

Answer 23

braided

Question 24

What is the aimed tibial plateau angle for CWO - closing wedge ostectomy?

Answer 24

5 degrees

Question 25

What is the goal post op angle TPA of TPLO?

Answer 25

5 degrees
BUT: due to rockback and shift of saw -> aim for 6,5 degrees

Question 26

How does TTA stabilize the joint?

Answer 26

TTA stabilize the stifle joint during weightbearing by neutralizing the cranial tibiofemoral shear force (CrTT)

Question 27

What is the goal of TTA? PTA angle

Answer 27

A patellar tendon angle (PTA) of 90 degrees to the tibial plateau

Question 28

Which has a higher degree of late meniscal injury?

Answer 28

TTA

Question 29

Complication rate, re-op, late meniscal injury in:
- lateral suture
- TPLO
- TTA

Answer 29

Question 30

What is the angle of the stifle joint at full weightbearing stance?

Answer 30

135*

Question 31

Why is diagnosis of partial CCL tear difficult?

Answer 31

Can be challenging when there is no/minimal drawer
-> partial: craniomedial band rupture

Question 32

Cranial cruciate ligament disease in the cat - cause, prognosis, treatment?

Answer 32

CCLD in the cat
- Cause: Trauma or degenerative
- Prognosis: With conservative treatment, good
- surgical: extracapsular stabilization, TPLO an option but not proven

Question 33

How many dogs have bilateral CCLD?

Answer 33

up to 50%

Question 34

Stifle disruption - cause and common injury?

Answer 34

Trauma (trapped leg)
Cranial, caudal cruciate, collateral lig (lateral > medial), menisci, capsule damage

Question 35

Who presents with stifle disruption?

Answer 35

cats more frequently

Question 36

Treatment of stifle disruption?

Answer 36

extralateral suture + prosthesis
or TPLO + prosthesis IF CAUDAL CRUCIATE intact

Question 37

Cause for caudal cruciate ligament rupture?

Answer 37

trauma, avulsion or due to overcorrection of TPLO

Question 38

treatment of caudal cruciate ligament rupture?

Answer 38

conservative
surgery if due to overcorrection (prosthesis or fixation of avulsed bone)