Exam 2: Lecture 8: Cranial Cruciate Ligament Injury Disease II Flashcards
Why is surgical treatment recommended for CCLD?
slow down the progression of arthritis and eliminate / minimize lameness
- always in large breeds
In dogs 20-25 pounds with CCLD, the condition may improve without surgery, but what is the outcome
progressive DJD occurs
Degenerative changes with CCLD include?
- periarticular osteophytes
- articular erosion
- meniscal damage
Conservative therapy in animals with CCLD typically involves combination of what treatment plans?
- medications
- exercise modifications
- joint supplements
- possibly braces / orthotics (doesnt work well)
What is the effects of animals with CCLD when we restrict activity and give anti-inflammatories
- lameness typically waxes and wanes
- improves with pain medication and rest
- small dogs and dogs with partial tears lameness completely disappear with treatment but usually some lameness in larger dogs
- return to normal activity limited by progressive of arthritis
Return to normal activity is limited by which disease in animals with CCLD
limited by progression of arthritis
What type of therapy by trained practitioners can speed recovery from surgery
- but little evidence this is good alternative to surgical managment for most dogs
rehabilitation
- may be alternative to surgery
Rehabilitation therapy may be an alternative option to surgery depending on what other factors?
- concurrent injuries or disease
- advanced age
- patient size
- financial limitations
Define the use of Custom Knee bracing / orthotics
- relatively new to canine orthopedics
- little sceintific evidence available
- vluable for selected patients
- temporary solution + not ideal for young active animals
Are custom knee braces / orthotics good for young active animals
no they are not ideal
Does surgery completly restore the normal joint anatomy and function in animals with CCLD
no it does not completely
What is the benefit of surgery in animals with CCLD
progression of arthritis - stabilization likely slows process
Is arthritis a reversible or non-reversible disease
non-reversible disease
- everything done to prevent development or progression of arthritis
When you stabilize the joint do you increase or decrease the progression of OA
decrease the progression of OA
During Cruciate ligament surgery, what should be done in all surgical cases?
arthrotomy / arthoscopy
what does the image show?
folded meniscus
Extra-articular techniques exert restrains on joint motion. This mimics the action of?
CCL
What type of surgical consideration does this image show?
extra-articular technique
What is the goal of cruciate surgery?
stabilize the stifle joint
What are the main clinical conclusions with cruciate surgery
- use most comfortable technique for you
- be prepared to alter procedure and be ready for changes
- you are not repairing the cruciate = take it out
- you are stabilizing the stifle
- be familiar with advanced techniques
- be able to discuss with clients and offer appropriate referral options
It is reported that any concurrent surgical methods (extracapsular or intracapsular) results in 90% subjective evaluation of what type of results?
good to excellent results
- applies to newer osteotomy techniques
Does any technique prevent progressive DJD
no technique prevents
Are caudal cruciate injuries alone common or rare?
rare
- cranial cruciate + collateral ligaments damage usually also occurs with CaCL injury
can clinical signs can be complicated by concomitant injuries when demonstrating caudal drawer movement
yes
Caudal cruciate diagnosis due to muscle pull shows which bone appears to be subluxated caudally
tibia
How would you define the drawer movement of the tibia cranially in an animal with caudal cruciate diagnosis
actually is a reduction of subluxation
What type of diagnostic tools may be more important in assessing a CaCLD (caudal cruciate)
radiographs
What does the image on the left show?
caudal cruciate ligament rupture
What does the image on the right show?
CaCL rupture w/ medial collateral ligament tear
What does the image show?
caudal cruciate surgical technique
- extracapsular imbrication technique utilized
- surgically correct all injuries simultaneously
What are the 3 main functions of the Meniscus?
- acts as a shock absorber
- increases stability
- aids in lubercation
What does the red area of the meniscus show?
peripheral 15% vascularized
What does the white area of the meniscus show?
Central 85% nourished by synovial diffusion
Are isolated meniscal lesions rare or common
rare
- typically a secondary injury due to stifle instability
What is typically a secondary injury due to stifle instability
meniscal lesions
What is the shape / anatomy of meniscus
biconcave semilunar disc of fibrocartilage
Meniscus are attached to the tibia and femur by how many ligaments
6 ligaments
How is the lateral meniscus attached to the femur? (allows it to be more movable and usually spares it from injury after CCL injury)
Meniscofemoral ligament
Is the medial or lateral menicus firmly attached to joint capsule + medial collateral ligament (MCL)
medial meniscus
What is #1
cranial tibial ligament of the lateral meniscus
What is #2
lateral meniscus
What is #3
meniscofemoral ligament
What is #4
caudal ligament of the lateral meniscus
What is #5
caudal cruciate ligament
What is #6
medial meniscus
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
Is the most common injury occur to the medial or lateral meniscus during abnormal internal rotation
medial meniscus
Meniscal injuries are often associated with rupture of which ligament
CCL
Meniscal injuries occur when excessive crushing or shearing forces with stifle instability, resulting in?
- meniscocapsular detachment
- seperation in substance of meniscus
What is #1
caudal cruciate ligament
What is #2
medial meniscus
What is #3
lateral meniscus
What is A
cranial cruciate ligament
- ignore the star, not more important than anything else
What is #B*
tear to the medial meniscus
- bucket hand tear
What is the most often damaged part to the medial meniscus
caudal horn
- may be folded
What effects do the medial femoral and tibial condyles have on the meniscus during weight bearing in animals with disease/issues?
crushing
shearing
What does the following define?
- runs in an axial to abaxial direction
radial tears
What does the following define?
- Follow the curvature of the meniscus
- bucket handle tears
Circumferential tears
- longitudinal
What does the following define?
- circumferential tears with seperation of meniscus at site of tear
bucket handle tear
- subtype of circumferential tears (longitudinal)
What does the following define?
- midbody or meniscotibial incision of medial meniscus intended to prevent future meniscal impingment and damage
meniscal release
What does A show?
caudal bucket handle tear in medial meniscus
What does B show?
seperation of caudal section of medial meniscus
What does C show?
Isolated lateral meniscal tear
What does D show?
Cranial bucket handle tear in medial meniscus
What does A show
transverse radial tear
What does B show
Longitudinal or bucket handle tear
What does C show
medial peripheral detachment with shredding of cartilage
What does D show
folded cadual horn of the meniscus
What does the image show?
isolated lateral meniscal tear
Isolated lateral meniscal tears occurs in which area of the meniscus
caudal horn
Isolated lateral meniscal tears are RARE, they usually occur in conjunction with?
CCL tear
Why are isolated lateral meniscal tears rare?
- very important to know
meniscofemoral ligament
Diagnosis of meniscal injuries have a sound that can be heard on palpation or while the animal is weight-bearing on that limb. What is the sound that can be heard?
Meniscal click
Sudden lameness in a dog with a chronic cruciate rupture may be an indication of what other type (concurrent) injury has occurred?
meniscal injury
A displaced meniscus may act as a wedge and prevent which movment in a acutely injured stifle
drawer movement
Are the following useful or useless in diagnosing meniscal injuries
- radiology
- arthroscopy
- Surgical exploration
Radiology
- ehhhh lets say no
Arthroscopy
- yes
Surgical exploration
- heck yeah
What is #1
medial femoral condyle
What is #2
medial meniscus
What is #3
tibial plateau
List 3 surgical treatment options for a ruptures CCL
- intracapsular + extracapsular reconstruction
- corrective osteotomy (TPLO, TTA, TWO, CBLO)
- primary repair with augmentation
What can we say for animals that have a cruciate ligament injury
injury of contralateral cruciate ligament occurs in more than 50% of patients
injury of contralateral cruciate ligament occurs in more than 50% of patients. When does the percentage increase by 60%
if radiographic changes are visible in “uninjured joint”
The surgical method for animals with ruptures CCL depends on which 3 factors?
- surgeon perference
- patient size and function
- cost of procedure
Most retrospective studies show success rates near _____% regardless of technique used to fix CCL rupture
90%
Intracapsular + extracapsular procedures focus on recreation of which movement constraints of the stifle joint
- CCL
- joint capsule fibrosis
passive contraints
What are the active restraints of the the stifle joint
muscles
Intracapsular reconstruction in CCL consist of?
passing autogenous tissue
Describe the method that consist of passing autogenous tissues during intracapsular reconstruction
- through joint using “over the top” method
- passing tissue through predrilled holes in femur or tibia (or both)
What is the most common material for intracapsular material?
autogenous fascia lata
Why are synthetic materials rarely used during intracapsular reconstruction
eventually stretching or rupture
- also common with fascia late
risk of an inflammatory reaction or infection
because you cant keep the animal down long enough for healing
What method of intracapsular reconstruction is not in widespread use for CCL reconstruction?
alloggrafts with and without bone plugs
What are the advantages of intracapsular reconstruciton
most closely mimics the original position and biology of CCL
What are the disadvatages of intracapsular reconstruction
- invasiveness
- tendency of graft to stretch or fail
What technique should we “just say no” to in CCL repair?
Just say no to intracapsular reconstruction
