Exam 2: Lecture 7: Cranial Cruciate Ligament Injury Disease I Flashcards
What is the most important / major conditions of the stifle responsible for OA
cruciate - meniscal syndrome
What is the most common canine orthopedic condition
cranial cruciate ligament injury
What is a major cause of DJD in the canine stifle
Cruciate instability
What are the two types of cruciate ligament ruptures we can have in dogs?
partial and complete
Degree of ______ varies with cranial cruciate ligament disease (CCLD)
lameness
Cruciate ligaments invariably cause which disease?
Arthritis - OA
In humans, what is the most common cause of cruciate ligament problems
trauma
Are traumatic cruciate ligament ruptures common in dogs?
no, they are rare. Can occue due to
- hyperextension
- excessive internal rotation
- applied load exceeds strength
How would you define the rate of disease with CCLD in dogs?
slow degenerative process
- occurs over a few months to years
- NOT a result of sudden trauma to healthy ligament
CCLD is influenced by what factors (4)
- Aging of ligament (degeneration)
- obesity
- Poor physical condition
- Conformation + breed
more than 50% of dogs with cruciate ligament problems in one knee develop?
similar problems in the other knee
EXTREMLY IMPORTANT TO KNOW
Partial tearing of CCL is common and typically progresses to?
a full tear
EXTREMLY IMPORTANT TO KNOW
What is the Incidence and Prevelance for CCLD?
- affects dogs all sizes and ages
- uncommon in cats
- certain dog breeds higher incidence of CCLD
(some breeds less often affected) - Female and neutered dogs at a greater risk of CCLD
What are the 8 dog breeds with higher incidence of CCLD
- rottweiler
- newfoundland
- staffordshire terrier
- mastiff
- akita
- saint bernard
- chesapeake bay retriever
- labrador retriever
What are the breeds with lower incidence with CCLD
- greyhound
- dashhund
- basset hound
- old english sheepdog
What is the relationship with cruciate ligament degeneration and aging
cruciate ligament degeneration occurs as aging increases
Do both postural and anatomical deformities contribute to cruciate injuries
yes, they do
What is #1
cranial tibial ligament of the lateral meniscus
What is #2
lateral meniscus
What is #3
menisofemoral ligament
What is #4
caudal ligament of the lateral meniscus
What is #5
caudal cruciate ligament
What is #6
medial mensicus
What is #7
caudal ligament of the medial meniscus
What is #8
cranial cruciate ligament
What is #9
transverse ligament
What is #10
cranial tibial ligament of the medial meniscus
What is #11
patellar ligament
The medial and lateral collateral ligaments limit medial and lateral movement of which bone?
tibia
What is #5
cranial cruciate ligament
What is #7
caudal cruciate ligament
How are the ligamentous support of the stifle, such as the CCL and CaCL named?
from where they attach to the tibia
CCL restrains ______ translation of tibia on the femur
cranial translation
CCL restraints ________ of the stifle joint
hyperextension
Does the CCL limit internal or external rotation of tibia on femur
- by twisting on caudal cruciate ligament (CaCL)
internal rotation
Does the CCL limit varus, valgus or both in motion of the flexed joint
varus and valgus
CaCL restrains ______ translation of tibia on the femur
caudal
CaCL helps restrain _____ of stifle joint
hyperextension
Does the CaCL limit external or internal rotation of tibia on the femur
- twisting with CCL
internal rotation
Does the CaCL limits varus, valgus or both in regards to motion in flexed joint
both varus and valgus
During flexion or extension, does the cruciate ligament twist on each other
flexion
Does the cruciate ligament imite excessive internal or external rotation of the tibia on the femur
internal rotation
What is #1
fabella
What is #2
fibula
What is #3
femur
What is #4
patella
What is #5
cruciate ligaments
What is #6
patellar ligaments
What is #7
tibia
What is indicated by the color purple
cranial cruciate ligament
What is indicated by the color pink
meniscus
What is indicated by the color green
Caudal cruciate
What does the image in the circle show
shows ruptured CCL
- tibia is displaced foward and crushing meniscus
When we have a larger tibial plateau angle what happens to the force on the tibia
greater cranial force on tibia at weight bearing
What is #1a
caudolateral bundle of CrCL
- large band
What is #1b
Craniomedial bundle of CrCL
- small band
What is #2
CaCL
What is #3
Medial Meniscus
What is #4
lateral meniscus
What is #5
long digital extensor tendon
What is #6
medial humeral condyle
What is #7
tibial tuberosity
How would the caudolateral band be in extension and flexion
- taut in extension
- laxity in flexion
How would the craniomedial band be in flexion and extension
taut in all positions
With CCL does involvement of caudolateral band alone produce a drawer sign
no, they do not
With CCL does a partial rupture of the craniomedial band produce a small amount of drawer movement?
they do produce a small amount of drawer movement in flexion
- NO drawer observed in extension
Diagnosis of CCL rupture may require advanced imaging, such as?
- MRI = not really
- Surgical exploration
What type of surgical exploration is needed for a CCL rupture
- arthrotomy
- arthroscopy
- typically combined with surgical stabilization procedure
(since both procedures require full anesthesia and surgery)
What are 5 results of stifle instability
- joint capsule inflammation
- synovial membrane inflammation
- degeneration of the articular cartilage
- production of osteophytes
- meniscale damage
What is the end result of CCL deficiency
- progressive DJD
- loss of muscle mass
- decreased limb use
- decreased performance
What is the number 1 common complication of CCLD
long term impairment due to OA
What is the number 2 common complication of CCLD
tearing of meniscus
Long term impairment due to OA is?
- list 6
- loss of ROM in joint
- muscle atrophy
- loss of full function of limb
- decreased activity (unwillingness to play)
- stiffness
- evidence of pain
What test is this showing?
drawer test
What test is this?
Test for medial buttress
What is the best way to diagnose CCLD?
Palpation/PE
When would severe lameness with CCLD may not be noticed initally
if the disease is bilateral
What are the clinical signs in animals with CCLD
- severe lameness may not be noticed initally
- will not sit “square”
- difficulty rising + jumping
- decreased activity level
- muscle atrophy
- decreased ROM
- popping noise = meniscal click
- medial buttress
- shifts weight away from damaged leg when standing or walking
- non weight bearing lame
What type of noise can be heard with CCLD
meniscal click
Define the medial buttress with CCLD
- palpable thickening of medial aspect of stifle
- may be grossly + radiographically visible
When would you see non-weight bearing lamess in an animals with CCLD
- partially damaged ligament ruptures completely
- meniscus is torn
What are the 10 differential diganoses for CCLD
- canine hip dysplasia
- ligament sprains or muscle strains
- luxating patella
(can occur in combo with CCLD) - neurologic disease (IVDD)
- bone / soft tissue cancer
- fractures
- joint luxation
- tendon ruptures (Achilles tendon)
- panostenitis
- OCD (osteochondritis dessicans)
Is medial or lateral tearing of the meniscus frequently damaged?
medial
Besides initial surgery or later on, when else can tearing of the meniscus occur?
after stabilization
Meniscal damage in dogs is too small to repair. What must be done for repair?
excise damaged parts of meniscus
partial meniscectomy
Meniscal tears are very painful. If they are not treated with excision what is the result?
they will not regain optimal function
What test is MANDATORY for CCLD
radiographs
with CCLD palpation of the knee is essential. what are the 2 test to check?
- cranial drawer test
- tibial thrust test
During PE of the stifle when would you use Sedation?
- try without sedation first usually compliant
- more reliable results in painful patients with sedation
(increased patient comfort)
During PE of the Stifle the patient should be relaxed. What are some considerations that are important to keep in mind?
- Able to respond to painful stimuli
- Dexmedetomidine / Butrophanol combon (may sedate too heavily in some patients)
- is working dog scheduled to work that day
How do we check Asymmetry of the stifle on PE
- joint effusion
- Medial buttress
How do we check Range of motion during PE or Stifle
- Crepitus
- meniscal click
- pain on extension
What does the image show
tibial thrust
What is the tibial compression test used during PE
tibial thrust
- cranial translation of tibia
When the dog with CCLD does a sit test during PE of the stifle, what does that show?
affected limb out to side
What type of test does this define?
- Flexion
- Extension
- Negative drawer doesnt r/o CCL tear
(periarticular fibrosis and Meniscal entrapment)
Cranial Drawer test
What does this image show?
Tibial compression test
Where are the points of contact for Tibial compression test?
- index finger over the patella
- index fingertip over the tibial tubercle
What are the cranial drawer landmarks
- Patella
- lateral fabella
- tibial tubercle
- fibular head
What test is shown here?
Cranial drawer test
For a cranial cruciate radiologic diagnosis, radiographs can be used to?
- assess joint effusion
- assess degree of arthritis
- aid surgical planning - TPLO / TTA
- rule out concurrent disease - bone neoplasia
T/F: Radiographs show status of CCL or meniscus
false!!
- radiographs do not show status (EX: intact or damaged) of CCL or meniscus
The surgeon must evaluate which two structures when performing surgery of cranial cruciate diagnosis
- CCL
- meniscus
What does the image show?
Lateral radiograph of dog with chronic CCL rupture
- loss of fat pad definition + distension of caudal joint capsule
- Osteophyte formation along trochlear ridge and subchrondral bone sclerosis of tibial plateau
