Diagnostics

Question 1

Imaging

Pacheco JAVMA 2023: rads under tibial compression

Danielski Animals 2022: femur positioning on TPA

Buirkle VS 2019: effect of tibial rotation on TPA

Fox VCOT 2022: TPA 3922 stifles average TPA

Todorovic VCOT 2022: REVIEW on TPA

Answer 1

Using the distance between points of CrCL origin and insertion standard rads vs tibial compression rads, a novel variable, ratios >1.18 indicate CrCL rupture

> 3mm non superimposition of femoral condyles should be interpreted with caution

tibial rotation up to 30deg internally and externally did not change TPA

neutered dogs higher TPA than non neutered

Question 2

Laxity tests

Lampart VS 2023: cranial drawer, tibial compression test, new tibial pivot compression test

Answer 2

External rotation and valgus stress then tibial compression and release -> subluxation in CrCL deficient stifle
Allows palpation of rotational instability; better for chronic or subtle instability

potential for grading schemes for stile laxity

Question 3

Lateral suture

Cox VCOT 2020: retrospective lateral fabellotibial sutures 150 stifles

Tinga JAVMA 2020: Lateral suture for 9 med-large dogs

Franklin JSAP 2023: 370 surgeries (fabellotibial, tightrope, ligafibre isotoggle)

Schuster JSAP 2023: accelerometer pre and post extracap

Answer 3

17% SSI, removal in 50% of these

Joint instability slightly migitated 6m postop though lameness improved in med-large dogs

weight and age were risk factors influencing complications and postop NSAID use
-older dogs and <15kg lowest risk
-younger dogs and >15kg highest risk

no change to accelerometer findings but lameness and pain scores improved with 100% reported return to normal

Question 4

Risk factors for CrCL rupture

Answer 4

Santarossa VS 2020: overweight

Pegram VJ 2023: 6-9yo, neutered dogs, Rotties, WHWT, Bichon, >20kg

Murphy VCOT 2024: risk factors for contralateral in >15kg and >8yo
-20% will rupture contralateral side median 1y
-age, breed (retrievers) were factors a/w contralateral CrCL

Question 5

Walker VS 2022

modified radiographic union scale for tibial fractures
TPLO

Answer 5

mRUST improved inter-rater reliability compared to subjective

1 - no callus
2 - callus
3 - bridging callus
4 - remodelled, # not visible

Question 6

Agnello VCOT 2022

CdCL lig damage in arthroscopic video of CrCL recordings

Answer 6

94% CdCL tearing
portion of CdCL not exposed to synovium was not affected
synovitis was a/w degree of CdCL tearing - synovitis could be contributor to CdCL injury

Question 7

Brioschi JSAP 2021 (REVIEW)

CrCL rupture in <15kg

Answer 7

steep TPA 29-36deg
lack of evidence for optimal mx
conservative tx prolonged recovery (4m)
early failure of extracap a/w steep TPA
CCWO and TPLO low major comp and good subjective outcome
controversial if TTA suitable for steep TPA