Hindlimb Lameness- Stifle Joint Flashcards
What is the most common cause of Hindlimb lameness in dogs?
Cranial cruciate ligament disease
Are there any predispositions to Cranial cruciate ligament disease?
Can occur in any breed (but not really greyhounds lol)
But neutered females and obese dogs generally more at risk
What are the three types/ causes of cranial cruciate ligament disease?
Traumatic avulsion
Traumatic rupture
Degenerative Weakening (this is the major pathogenesis)
What disease can Cranial Cruciate Ligament Disease lead to?
Arthritis because the joint becomes unstable
What is the role of the Cranial Cruciate Ligament? (3)
Knee stability
Allows craniotibial translation (internal rotation)
Also stops the stifle joint falling backwards by attaching the front and back of the joint together
50% of dogs with Cranial Cruciate rupture also have damage to the …
Meniscus (medial)
What do the Meniscus have that allow load bearing/ shock absorbtion?
Collagen fibre arrangement converts compression into tension
Where do the Meniscus attach?
Medial- attaches to the Tibia
Lateral- attaches to the femur
How will an animal with Cranial Cruciate Ligament Disease present?
Lameness or non weight bearing with an unwillingness to flex the stifle
May sit with the leg extended or out to the side
What are we paying attention to when examining the stifle? (5)
Effusion- should be firm with clear ligament boundaries- if not then suggests fluid
Medial Buttress- feel medial side of femur- if one side is bigger it suggests fibrous tissue deposition
Patellar Tracking
Range of Motion
Pain
What two tests do we perform on the stifle to assess stability of the joint?
Cranial Draw (sliding of the patella)
Tibial Thrust (mimics walking)
What diagnostic tests can we undertake to diagnose Cranial Cruciate Ligament Disease?
Radiographs- multiple views!
MRI/ Contrast CT
Arthroscopy for surgical confirmation
How should we treat Cranial Cruciate Ligament Disease?
Conservative management (not preferred)- if no response after 8 weeks than surgical stabilisation
Dogs with meniscal injuries definitely need surgery!
What three types of surgery can we perform to correct Cranial Cruciate Ligament Disease?
Intra articular
Extra articular
Osteotomy
Briefly describe the process of Intra articular surgery to treat Cranial Cruciate Ligament Disease?
It’s a type of Graft through the bone tunnels- Take fascia from inside the joint, run it through the tunnels and fix it with screws
How does Extraarticular surgery differ from Intraarticular?
Extraarticular- Band is placed on the OUTSIDE of the joint- it remains and provides stability until scar tissue forms
This method is preferred over Intra articular!!
What material is used for Extra articular surgery and how long does it last?
Metal wire e.g. Nylon
Breaks in 6-8 weeks
What is the aim of an Osteotomy to correct Cranial Cruciate Ligament Disease?
works on the basis that the femoral condyle is like a ball rolling down the tibial slope so if you flatten the slope then the knee is more stabilised and the tibial thrust neutralises
What is the prognosis of an Osteotomy?
Has a more rapid return to function than other surgeries especially for large breeds
But it is an advanced surgical technique
What should we warn owners about after we have treated the initial Cranial Cruciate Ligament Disease? (2)
50% of dogs will get a bilateral rupture in the next 2 years
And Osteoarthritis will progress irrespective of treatment
What is a patella luxation?
Is it developmental or congenital?
Abnormal tracking of the patella
Developmental disorder
What can cause the patella luxate? (3)
- Problems with quadricep mechanism- could be due to hip/femoral neck development which causes the quads to deviate
- Uneven pressure on the physes which alters growth dynamics
- Boney deformation
How common are patella luxations in domestic/ pet species?
Common cause of INTERMITTENT lameness in young, small dogs
Can occur in cats but usually not clinical because cats have very mobile patellae
What is the key clinical presentation of a patella luxation?
Skipping Lameness- intermittent non weight bearing
On a clinical examination, what would we expect to see if the animal has a patella luxation?
Muscle atrophy with possible effusion
No tibial thrust or cranial draw
If you can push patella out of groove- abnormal
Retropatellar/ luxation pain
Briefly explain how we grade a Patellar Luxation.
Grades I- IV with IV being most painful and severe
With I being the patella returns in normally after being pushed out
II- Stays out when pushed out
III- When patella is out normally but can be returned in with force
IV- when patella is out normally and cannot be returned in at all
When would we NOT perform surgery in cases of patellar luxation?
Low grade luxation’s- with no lameness, discomfort or highly infrequent skipping lameness
When is surgery indicated to fix a patellar luxation?
All Grade IV’s and III
Or mild luxation’s that have pain, pressure and frequent lameness
What can we do surgically to deepen the groove of the patella?
Give 2.
Trochleoplasty- rasp off cartilage, but can encourage fibrocartilage formation
Chondroplasty- elevate cartilage flap to remove underlying bone (only animals <6months old)
Wedge Recession Sulcoplasty- Cartlidge and bone removed
Block recession Sulcoplasty- like wedge recession but do a whole block -better results but difficult to perform
What may we also have to perform whilst the patient is undergoing surgery to fix the patellar luxation?
Hint- think ligaments to better aid outcome
Tibial Tuberosity Transposition- straighten femur and tibia with pin and tension band wire
What sutures are used to tighten and close the surgical sight in a tibial tuberosity transposition?
Modified mayo mattress suture- basically one tissue is sutured over the other to provide stability
When is a tibial tuberosity transposition contraindicated and why?
In skeletally immature patients (younger than 10 months)- may lead to abnormal distal positioning of the patellar tendon and therefore patella fractures later in life
