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2025 Exam Block 6 > Exam 2: Lecture 10: Collateral and Multiple Ligament Injury/Meniscal injury > Flashcards

Exam 2: Lecture 10: Collateral and Multiple Ligament Injury/Meniscal injury Flashcards

1
Q

Multiple Ligament Injury can also be defined as?

A

Deranged Stifle

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2
Q

Define collateral ligament Injury

A

Complete or partial tear of medial or lateral collateral ligament

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3
Q

Is ligament injury a sprain or strain

A

sprain

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4
Q

Is Muscle tendon unit a sprain or strain

A

strain

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5
Q

Do sprains or strains have grading

A

sprains = Ligament Injury
- 1st, 2nd and 3rd degrees

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6
Q

Do sprains or strains have no grading and most resolve with conservative management with rest

A

strain = Muscle tendon unit

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7
Q

What defines a 1st degree sprain

A

mild

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8
Q

What defines a 2nd degree sprain

A

moderate

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9
Q

What defines a 3rd degree sprain

A

complete tear

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10
Q

What is the function of medial and lateral collateral ligaments?

A

limit varus +valgus motion of stifle joint

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11
Q

Are isolated medial or lateral collateral ligament tears common or rare in small animals

A

rare

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12
Q

What does #1 describe

A

Caudal head of sartorius muscle reflected

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13
Q

What does #2 describe

A

Medial collateral ligament

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14
Q

Injuries to medial or lateral collateral ligaments occur with injury to other primary + secondary restraints of which joint

A

stifle joint

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15
Q

Multiple ligament injuries result from what type of trauma to the stifle joint and involve injury to other stifle joint ligaments

A

Severe trauma

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16
Q

What does #1 in this image show?

A

lateral collateral ligament

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17
Q

What is the signalment for animals with injuries to the medial or lateral collateral ligaments

A
  • dog or cat
  • any age or breed
  • either gender
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18
Q

What history may an animal present with when they come in for medial and lateral collateral ligament problems?

A

May occur while exercising
- without evidence of trauma

Traumatic incident (vehicular accident)
- where animal has sustained major injuries

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19
Q

How do you diagnose collateral ligament injury

A

based on palpation

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20
Q

Do you flex or extend the stifle joint to examine for collateral image and why?

A

extend
- to tighten the muscle belly
- THE BEST WAY TO TEST

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21
Q

What is labeled as #1

A

lateral collateral ligament

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22
Q

What is labeled as #2

A

Cranial cruciate ligament

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23
Q

What is labeled as #3

A

lateral meniscus

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24
Q

What is labeled as #4

A

caudal cruciate ligament

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25
Q

What is labeled as #5

A

medial meniscus

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26
Q

What is labeled as #6

A

Medial collateral ligament

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27
Q

Which type of stress test evaluates the medial collateral ligament

A

valgus stress test

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28
Q

Which type of stress test evaluates the lateral collateral ligament

A

Varus stress test

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29
Q

When you apply medial and lateral pressure to the tibia you are assessing integrity of?

A

collateral ligaments

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30
Q

What does this image show?

A

testing of the collateral ligaments

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31
Q

How should the patient be positioned for a valgus stress test

A

lateral recumbency

  • One hand stabilizes femur
  • other hand grasps distal tibia + applies upward force
  • ABDUCTION
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32
Q

Which stress test check for abduction of the joint

A

valgus stress test

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33
Q

If the medial joint restraints are torn you can see the opening of medial joint line, which includes?

A
  • medial collateral ligament (MCL)
  • joint capsule
  • peripheral meniscal ligaments
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34
Q

How should the patient be positioned for a Varus stress test

A

Patient in lateral recumbency

  • one hand stabilizes femur
  • other hand grasps distal tibia + applies inwards force
  • ADDUCTION
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35
Q

Which stress test checks for adduction of the joint

A

varus stress test

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36
Q

If the lateral joint restraints are torn you will see the opening of the lateral joint, which includes?

A
  • Lateral collateral ligament (LCL)
  • Joint capsule
  • Peripheral meniscal ligaments
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37
Q

Do isolated tears show minimal or maximal openings

A

minimal

  • obvious opening occurs with more extensive injuries
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38
Q

What kind of problem does the image show?

A

MCL tear

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39
Q

What kind of test does the image show?

A

Valgus stress test

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40
Q

Which tool determines if bone fragements are associated with ligament damage

A

radiographs

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41
Q

When are craniocaudal + medial-lateral radiographs indicated?

A

Confirm the presence or absence of bony avulsions

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42
Q

What are stress radiographs for?

A

Show increase in medial or lateral joint space

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43
Q

What does this image show?

A

Stress radiograph of a cat with MCL injury

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44
Q

What type of test is used in the image below?

A

Valgus stress applied to joint

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45
Q

What laboratory findings are common in animals with MCL and LCL tears/rupture?

A
  • consistent laboratory findings not seen
  • Laboratory evaluation depends on signalment + physical findings in animals with trauma
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46
Q

What are the differential diagnosis for animals with MCL and LCL problems?

A
  • Muscle strains
  • Cranial or caudal cruciate ligament tears
  • Nondisplaced physeal fractures in immature animals
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47
Q

Medical management of animals with MCL and LCL include?

A
  • conservative or surgical treatment for isolated collateral ligament injury based on degree of injury
  • Assessment based on palpation + radiographs
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48
Q

Conservative or surgical treatment for isolated collateral ligament injuries are based on the degree of injury. What is being assessed?

A
  • collateral ligament itself
  • Secondary joint restraints
    = joint capsule
    = peripheral meniscal ligaments
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49
Q

What is the criteria for medical management of animals with MCL and LCL

A
  • minimal swelling + only slight opening of joint space with stress test
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50
Q

Minimal swelling + only slight opening of joint space with stress test are indications for what type of treatment and what degree of sprain

A
  • Indications for conservative treatment
  • 1st degree sprain
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51
Q

How would you treat a 1st degree sprain in an animal with minimal swelling and only slight opening of joint space with stress test?

A
  • fibroglass cast applied for 2 weeks
  • followed by controlled activity for 6 additional weeks
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52
Q

Moderate to severe swelling and significant opening of joint space with stress test indicates what issues and what degree of sprain?

A
  • indicates greater injury to collateral restraints
  • 2nd and 3rd degree sprains
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53
Q

Treatment of moderate to severe swelling and significant opening of joint space with stress test includes?

A

RECONSTRUCTION
- collateral ligaments
- meniscocapsular ligaments
- Joint capsule

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54
Q

What is the goal of surgical treatment in animals with MCL and LCL tear/rupture

A

repair all injured ligaments, tendons, and joint capsule

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55
Q

What ligament is responsible for holding the lateral meniscus to the femur

A

Meniscofemoral Ligament

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56
Q

What is labeled #1

A

cranial tibial ligment of the lateral meniscus

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57
Q

What is labeled #2

A

lateral collateral ligament

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58
Q

What is labeled #3

A

Meniscofemoral ligament

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59
Q

What is labeled #4

A

caudal ligament of the lateral meniscus

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60
Q

What is labeled #5

A

caudal cruciate ligament

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61
Q

What is labeled #6

A

caudal ligament of the medial meniscus

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62
Q

What is labeled #7

A

cranial cruciate ligament

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63
Q

What is labeled #8

A

medial collateral ligament

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64
Q

What is labeled #9

A

transverse ligament

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65
Q

What is labeled #10

A

cranial tibial ligament of the medial meniscus

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66
Q

What is labeled #11

A

Patellar Ligament

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67
Q

When is primary repair of collateral ligament done?

A
  • Point of failure is origin or insertion of ligament
  • An intrasubstance tear with large segments of ligament intact
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68
Q

Occasionally small fragment of bone is present on the ligament - can they be incorporated into the repair?

A

yes

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69
Q

What can be done preoperatively to prevent additional damage to articular cartilage or meniscus?

A
  • place modified robert jones bandage on limb
  • Limit activity to leash walking

UNTIL SURGERY

animal evaluated for evidence of trauma to other ligaments or bones

70
Q

What areas of the animal should be evaluated in patients with injuries by HBC?

A
  • thoracic
  • cardiovascular
  • abdominal evaluation
71
Q

Perioperative antibiotics and pre-emptive pain managment include?

A
  • NSAIDs
  • Opioids
  • epidural Analgesia
72
Q

Perioperative antibiotics and preemptive pain management are indicated for which animals?

A

those undergoing stifle reconstruction

73
Q

What is important for surgical anatomy of collateral ligaments?

A

origin and insertion

74
Q

Where does the MCL originate?

A

medial femoral epicondyle

75
Q

The MCL run distally to insert where?

A

proximal tibial metaphysis

76
Q

As MCL crosses medial joint line, what strong attachment are important?

A

Strong attachement to joint capsule and medial meniscus

77
Q

The MCL lies deep to which muscle

78
Q

Where does the LCL originate?

A

oval area on lateral femoral epicondyle

79
Q

Where does LCL insert?

A

fibular head

80
Q

the LCL lies deep to which msucle

A

fascia lata

81
Q

Be careful when dissecting near the lateral collateral ligament because of which nerve?

A

Peroneal (fibular) nerve

82
Q

the Peroneal (Fibular) nerve is a branch of which nerve?

A

sciatic nerve

  • obliquely crosses distal aspect of stifle joint
  • superficial to gastrocnemius muscle
  • send articular branch to LCL
83
Q

How is the pt positioned for surgery with a LCL injury

A

lateral recumbency with affected leg up

84
Q

How is the pt positioned for surgery with a MCL injury

A

dorsal recumbency

85
Q

How do you position a pt with multiple ligament tears for surgery

A
  • dorsal recumbency to facilitate exposure of both sides of limb
  • Suspend limb and prepare for aseptic surgery
86
Q

What does this image show (#1)

A

rupture of medial collateral ligament and joint capsule

87
Q

How do you repair medial restraint injury

A
  • incise insertion caudal head of sartorius muscle + deep fascia along craniomedial border of proximal tibia
88
Q

If the bone is attached do we have a better or worse prognosis

A

repair is amazing and almost 100%

89
Q

What does this image show?

A

Replace collateral ligament to its anatomic site + secure with screws and spiked washer

  • used as an alternative to suture anchors
90
Q

What does the image show?

A

If ligament injury is intrasubstance tear
- primary repair by suturing ligament ends with locking-loop suture pattern

  • Supplement primary repair with screws and figure eight support
91
Q

What is the most common ligament and tendon suture?

A

three-loop pulley

92
Q

What suture type os used for flat tendons?

A

Locking-loop

93
Q

What is shown by #1

A

Locking loop

94
Q

What is shown by #2

A

three-loop pulley

95
Q

What is shown by #3

A

Bunnell Suture

96
Q

What is shown by #4

A

Far-near
near-far

97
Q

Which approach is used to expose lateral collateral ligament

A

craniolateral

98
Q

In the craniolateral approach for a LCL injury make a proximal to distal _______ incision throigh the fascia Lata.
- continue incision distally ____ cm below tibial crest parallel to joint line
(use caution isolate and protect peroneal nerve)
- reflect fascia lata caudally
(expose collateral ligament + lateral joint capsule
- repair ligament

A

Paratellar incision

4 cm

99
Q

What is the prognosis for isolated collateral ligament tears?

A

good to excellent

100
Q

What is the prognosis if multiple ligaments are torn?

101
Q

What is the prognosis for a LCL or MCL tear if bone is attached?

A

excellent
- almost 100%

102
Q

What is said to be the cause of injuries where the cranial or caudal cruciate ligaments and collateral ligaments are damaged simultaneously?

A

caused by HBC or other major trauma

103
Q

During surgical anatomy how does the tissue look surrounding the joint

A

swelling + bruising of soft tissue

104
Q

Torn collateral ligaments are difficult to identify during surgical anatomy, why?

A

because they are encased in edematous connective tissue

105
Q

During surgical anatomy of a cruciate ligament repair, which structure is often displaced from normal positions and folded cranially or caudally?

A

Menisci

  • not a good situation
106
Q

Knowledge of normal origins + insertions of ligaments in joints required which two concepts?

A
  • collateral ligaments
  • Meniscocapsular ligaments
107
Q

What is shown by #1

A

medial meniscus

108
Q

What is shown by #2

A

patellar ligament

109
Q

What is shown by #3

A

caudal cruciate ligament

110
Q

What is shown by #4

A

cranial cruciate ligament

111
Q

What is shown by #5

A

Intermeniscal ligament

112
Q

What is shown by #6

A

Lateral meniscus

113
Q

What does the image show?

A

Loss of cranial and caudal cruciate ligaments and disruptions of the medial restraints

114
Q

What is shown by #1

A

displaced meniscus

115
Q

What is shown by #2

A

torn medial collateral ligament

116
Q

What is shown by #3

A

torn caudal cruciate ligament

117
Q

What is shown by #4

A

torn cranial cruciate ligament

118
Q

What is shown by #5

A

Lateral collateral ligament

119
Q

Common triad of injuries include?

A
  • cranial and caudal cruciate ligament tears
  • failure of primary and secondary medial restraints
  • peripheral medial meniscal tears
120
Q

What is the prognosis in animals with multiple ligament injuries / common triad of injuries

121
Q

What does the following image show?

A

Deranged Stifle

122
Q

What does the term “Deranged Stifle” mean?

A
  • when there are multiple ligamentous injuries
  • often with meniscal injury
    (resulting in luxation of stifle joint)
123
Q

What is shown by #1

A

cranial tibial ligament of the lateral meniscus

124
Q

What is shown by #2

A

lateral meniscus

125
Q

What is shown by #3

A

Meniscofemoral ligament

126
Q

What is shown by #4

A

caudal ligament of the lateral meniscus

127
Q

What is shown by #5

A

caudal cruciate ligament

128
Q

What is shown by #6

A

medial meniscus

129
Q

What is shown by #7

A

caudal ligament of the medial meniscus

130
Q

What is shown by #8

A

cranial cruciate ligament

131
Q

What is shown by #9

A

transverse ligament

132
Q

What is shown by #10

A

cranial tibial ligament of the medial meniscus

133
Q

What is shown by #11

A

patellar ligament

134
Q

What is shown by #12

A

cranial horn of the lateral meniscus

135
Q

What is shown by #13

A

Body of the lateral meniscus

136
Q

What is shown by #14

A

caudal horn of the lateral meniscus

137
Q

How can we diagnose Meniscal Injuries

A
  • Radiology
  • Arthoscopy
  • Surgical exploration
138
Q

Which meniscus can you diagnose a injury on with radiology?

A

medial meniscus

139
Q

What is shown by #1

A

medial femoral condyle

140
Q

What is shown by #2

A

Medial meniscus

141
Q

What is shown by #3

A

Tibial plateau

142
Q

What does the image on the left show?

A

Isolated tear of the meniscus

143
Q

What does the image on the right show?

A

Medial detachment with shredding

144
Q

What does both of the images show overall

A

Meniscal tear

145
Q

What does A show?

A

Transection of meniscotibial ligament

146
Q

What does B show?

A

Transection of midbody of meniscus

147
Q

What does this image overall describe?

A

Meniscal release

  • locations of release of medial meniscus
148
Q

What is a means of “protecting” medial meniscus following surgical stabilization of stifle

A

Meniscal release

149
Q

Meniscal release was developed in association with?

A

TPLO surgery

150
Q

Why is Meniscale release controversial?

A

controversial based on effects on meniscus / cartilage / uncertain efficacy

151
Q

By transecting meniscus the function of meniscus is compromised by elimination of what type of stresses?

A

hoop stresses

152
Q

With midbody release or transection of meniscotibial ligament the femoral condyle increases contact with articular cartilage of tibilar plateau. This impairs functions of meniscus to provide stability and congruence. What is the negative effect of this?

A

contributes to osteoarthritis

153
Q

T/F: No clinical studies demonstrate efficacy of meniscal release in decreasing incidence of post TPLO meniscal injury; but technique remains in widespread use

154
Q

Is conservative treatment an option with meniscal injuries

A

NOT an option

155
Q

In Meniscal injuries the continued back and forth sliding of torn meniscus can cause?

A
  • severe pain
  • will not improve conservative management
156
Q

What is the main / major impact of using Medical management to treat Meniscal Injures?

A

Accelerates DJD

157
Q

What conservative treatment is used with Meniscal injuries

A
  • rest plus or minus splint application? DOES NOT WORK WELL
  • May be appropriate in stable joint
158
Q

For Meniscal Injuries what are the 3 methods of treatment?

A
  • partial meniscectomy
  • Primary repair of peripheral meniscal injuries
  • Total menisectomy
159
Q

Out of the 3 methods for treating Meniscal injuries what is the most used, rarely used, and dont use

A

Most used = partial meniscectomy

rarely used = primary repair of peripheral meniscal injuries

dont use = total menicectomy

160
Q

partial meniscectomy can be done by what approach?

  • Removal of caudal horn
  • Bucket handle tear excision
A

lateral approach

161
Q

Is lateral or medial meniscectomy easiest to perform through a medial surgical approach

A

medial meniscectomy

162
Q

What is the treatment of choice for bucket handle tears of the medial meniscus?

A

Partial Meniscectomy

163
Q

Does a partial or total meniscectomy carry less morbidity?

A

partial meniscectomy

164
Q

In human orthopedics some surgeons advocate for what type of repair of the torn meniscal body?

A

primary repair

165
Q

In dogs (vet med) are primary repair reserved for peripheral tears common or uncommon? Support your answer

A

Uncommon
- Difficulty in suturing meniscal body tears in dogs bc joint is so small
- low morbidity associated with partial meniscectomy

166
Q

What type of primary repair allows meniscocapsular tissue to heal (challenging)

A

repair with absorbable interrupted sutures

167
Q

Damaged meniscus may not heal. Totoal or partial removal may be indicated. Why do they not heal?

A

low to very little blood supply

168
Q

Total meniscal removal induces which disease in the stifle?

169
Q

What does the image show?

A

Total Meniscectomy

170
Q

When is a total meniscectomy considered?

A

only when peripheral rim of meniscus is so damaged that primary suturing of meniscocapsular tissue is not possible

171
Q

The more meniscal tissue removed = the more rapidly what disease develops?

2025 Exam Block 6 (22 decks)

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