Cruciate Ligament Disease

Question 1

Where does the CCL originate?

Answer 1

Medial surface of lateral femoral condyle

Question 2

What is the function of the CCL?

Answer 2

Prevent cranial drawer, excessive hyperextension, and excessive internal rotation

Question 3

What type of legs are predisposed to CCL rupture?

Answer 3

Straight-legged dogs

Question 4

What age is more frequently affected with CCL ruptures?

Answer 4

Middle aged to older

Question 5

What types of presentation can be assoc. w/CCL rupture?

Answer 5

Acute lameness or chronic lameness that does not improve w/rest but may improve w/NSAID tx

Question 6

What is a positive sit test?

Answer 6

Sitting w/knee rotated outward

Question 7

What orthopedic exam findings are consistent with CCL rupture?

Answer 7

Positive cranial drawer, positive tibial thrust, painful on extension

Question 8

What is a good indicator of chronicity of CCL disease?

Answer 8

Presence of medial buttress

Question 9

What is a medial buttress?

Answer 9

Accumulation of fibrous tissue deposited in an effort to stabilize the knee

Question 10

What will you hear if there is meniscal damage concurrent w/CCL rupture?

Answer 10

Clicking

Question 11

What will you see on radiographs that is suggestive of CCL rupture?

Answer 11

Osteophytes, joint effusion

Question 12

What are surgical treatment options for CCL rupture?

Answer 12

Lateral suture, TPLO, TTA

Question 13

What dogs is a lateral suture usually performed on?

Answer 13

Smaller dogs <20kg

Question 14

What are cons of a lateral suture?

Answer 14

Can cycle, stretch, and break

Question 15

Where is the heavy suture placed for an extracapsular lateral suture repair?

Answer 15

Around lateral fabella and through a hole in the tibia

Question 16

Where is the osteotomy of a TPLO performed?

Answer 16

Proximal tibia

Question 17

Which part of the tibia is rotated and stabilized for a TPLO?

Answer 17

Tibial plateau

Question 18

Does TPLO fix a cranial drawer?

Answer 18

No

Question 19

Does TPLO fix a tibial thrust?

Answer 19

Yes

Question 20

How does a TPLO distribute load within the joint?

Answer 20

More load on caudal cruciate ligament

Question 21

Where is the osteotomy of a TTA performed?

Answer 21

Cranial aspect of proximal tibia

Question 22

Which surgical correction of CCL rupture requires a cage?

Answer 22

TTA

Question 23

Which surgical correction of CCL rupture requires a bone plate?

Answer 23

TPLO

Question 24

What is the goal of a TTA?

Answer 24

Make patellar tendon perpendicular to the tibial plateau

Question 25

Does surgery eliminate progression of osteoarthritis in the joint?

Answer 25

No, just slows it down

Question 26

Can cage rest treat a CCL rupture?

Answer 26

In small dogs if very strict

Question 27

What is the duration recommended for cage rest to treat a CCL rupture?

Answer 27

8-12 weeks

Question 28

How will a CCL rupture progress if surgery is not performed?

Answer 28

Stabilized via fibrosis, quicker progression of arthritis

Question 29

Why should you not give a CCL rupture corticosteroids?

Answer 29

Will weaken the ligaments

Question 30

Which meniscus is more likely to be injured with a CCL rupture?

Answer 30

Medial

Question 31

What type of injuries do you see to the medial meniscus assoc. w/CCL rupture?

Answer 31

Bucket handle tear or “crush” of the caudal horn