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Ortho > Intra-articular sprains > Flashcards

Intra-articular sprains Flashcards

1
Q

What is the most common stifle injury/orthopedic problem in the dog?

A
  • Cranial cruciate ligament rupture
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2
Q

What is the most common type of cranial cruciate tear in the dog?

A
  • Partial
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3
Q

What comprises the cranial and caudal cruciate ligaments?

A
  • Craniomedial and caudolateral bands

- Fascicles - vessels, nerves, mechanoreceptors

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4
Q

What is the mechanical function of the cranial cruciate ligament

A
  • Prevent cranial displacement of the tibia relative to the femur
  • Limit excessive internal rotation of the tibia on the femur
  • Prevent hyperextension of the stifle
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5
Q

What is a 1° sprain of the cranial cruciate ligament?

A
  • Stretched
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6
Q

What is a 2° sprain of the cranial cruciate ligament?

A
  • Partial tearing or partial rupture
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7
Q

What is a 3° sprain of the cranial cruciate ligament?

A
  • Complete tearing or complete rupture
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8
Q

Underlying pathogenesis of the CCL rupture?

A
  • Excessive forces or trauma (rare)

- Progressive, immune-mediated, inflammatory arthropathy (degeneration of the ligament)

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9
Q

Trauma causing CCL rupture

A
  • Sudden rotation of the flexed stifle (20-30°)
  • Hyperextension of the stifle
  • Very rarely occurs in dogs
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10
Q

Progressive, immune-mediated, inflammatory arthropathy leading to CCL rupture

A
  • No traumatic history
  • Bilateral disease is common
  • Ligaments are extra-synovial and thus self-antigenic
  • Anti-collagen antibodies
  • Tartrate-resistant Acid phosphatase and Cathepsin K
  • Pro-inflammatory cytokines
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11
Q

What is the most likely suggested cause of recent increase in CCL rupture?

A
  • Early spay and neutering in Labrador retrievers and Golden retrievers
  • 5% of gonadally intact males and females had 1 or >1 joint disorders
  • Neutering labs at <6 months doubled the incidence of one or more joint disorders in both sexes
  • Neutering Goldens at <6 months increased the incidence of a joint disorder to 4-5x that of intact dogs
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12
Q

Clinical history of cranial cruciate ruptures

A
  • Acute lameness initially, 1-2 weeks later recovered (probably a small sprain)
  • Acute lameness with chronic progressive lameness (most common); worse after activity
  • May have had previous cruciate rupture/repair on contralateral stifle (40-50% of all unilateral patients)
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13
Q

Clinical findings for cranial cruciate ruptures

A
  • Mild to moderate weight bearing lameness
  • Enlarged stifle joint (effusion, fibrosis, medial buttress)
  • Disuse muscle atrophy
  • Meniscal “click” or “clunk”
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14
Q

Pathognomonic sign for cranial cruciate rupture

A
  • Cranial drawer sign
  • May not pick it up!
  • May be significantly reduced with chronicity (fibrose into cranial drawer)
  • May only be slightly present at a point of flexion or extension
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15
Q

Other tests for cranial cruciate rupture

A
  • +/- Cranial tibial thrust test (tibial compression test) - will usually have if you have a cranial drawer sign, but not the other way around
  • Increased internal rotation of the tibia (for partial tears
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16
Q

What are the 3 over-represented breeds?

A
  1. Lab
  2. Rottweiler
  3. Newfoundland
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17
Q

Genetic component for cranial cruciate rupture

A
  • No genetic component except in Newfies
  • Commonly come in with a bilateral presentation
  • No risk factors to develop a CCL rupture on the contralateral side based on chronicity of a unilateral rupture, weight, etc.
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18
Q

What can puppy drawer be mistaken for?

A
  • Cranial cruciate ligament rupture
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19
Q

Radiographic findings of cranial cruciate ligament

A
  • Mild to severe osteoarthritis
  • Joint effusion (patellar fat pad, caudal joint capsule)
  • Medial buttressing (thickening of the medial aspect of the joint capsule, but not pathognomonic)
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20
Q

What are two differentials for medial buttressing?

A
  • Cranial cruciate ligament and medial collateral ligament of the medial buttress
21
Q

Diagnosing cranial cruciate rupture injury

A
  • Radiographs are probably some of the best
  • MRI is not
  • Arthroscopic examination is definitive
22
Q

What can you do with arthroscopic examination of the cranial cruciate ligament?

A
  • Arthroscopic debridement of the cruciate
  • Examination of articular structures including menisci
  • Meniscal debridement
23
Q

Conservative treatment statistics by weight for cranial cruciate ligament tears

A
  • <15 kg, 86% clinically normal or improved
  • > 15 kg, 19.3% clinically normal
  • Cats are 100% clinically normal
24
Q

What can determine surgery vs conservative therapy for cranial cruciate ligament tears on dogs less than 15kg?

A
  • May require surgical stabilization based on age, physical condition, and expected activity level
  • patient lameness and associated discomfort
25
Q

Conservative Treatment Plan

A
  • Restrict to leash walks only for 6 weeks
  • NSAIDs for 5-7 days
  • Looking for weekly improvement function
  • If not improving by 3 weeks recommend surgical intervention
26
Q

Why are animals with CCL tear lame?

A
  • Mechanical instability and not OA
27
Q

Will any single procedure allow an animal to regain perfect normal biomechanical function?

A
  • No
28
Q

What is favorable outcome of most CCL stabilization procedures?

A
  • 85-95%
  • OA is progressive with any procedures (including TPLO); animal will have improved function of stifle in face of osteoarthritis due to mechanical stabilization from surgery
29
Q

Surgical treatments for cranial cruciate ligament surgery?

A
  • Extra-articular procedures (e.g. lateral imbrication)

- Osteotomy stabilizations (TPLO or Tibial Tubercle Transposition)

30
Q

Complications of cranial cruciate ligament surgeries

A
  • Breakdown of stabilization
  • Latent or postliminal meniscal tear (10%)
  • Infection
31
Q

Cranial cruciate ligament post operative management

A
  • Restricted activity for 8-12 weeks
  • Leash walks only
  • 8 weeks post-op rads for TPLO and TTA
  • Gradual increase in activity for another 4 weeks
  • Physical rehabilitation can start 2 weeks after surgery (important!)
32
Q

When can physical rehabilitation start after cranial cruciate ligament surgery?

A
  • 2 weeks after surgery
33
Q

Tibial Plate Leveling Osteotomy vs Tibial Tuberosity Advancement

A
  • At a walk, TTA seems to be okay, but they differ at a trot
  • TPLO may allow a quicker return to function and a better function overall
34
Q

How common is a caudal cruciate ligament rupture?

A
  • Very rare as an isolated injury

- More common as a partial rupture with CCL ruptures

35
Q

Pathogenesis of caudal cruciate ligament rupture

A
  • Traumatic
36
Q

History and physical examination findings of caudal cruciate ligament rupture

A
  • History of lameness
  • Lameness more pronounced with activity
  • Caudal drawer
  • Joint effusion
37
Q

Treatment for caudal cruciate ligament repair

A
  • Conservative (nothing)

- Surgery

38
Q

TPLO with a caudal cruciate ligament rupture?

A
  • Contraindicated
39
Q

Meniscal anatomy

A
  • Biconcave, C shaped meniscus
40
Q

What are menisci made up of?

A
  • Fibrocartilage
41
Q

Blood supply for menisci

A
  • Vascular: outer 1/3

- Avascular: inner 2/3

42
Q

What are the primary functions of the menisci?

A
  • Mostly help with hoop stress and to prevent joint instability (like a golf tee)
  • Reduced joint friction
  • Axial shock absorption (minor function)
  • Load transfer
43
Q

Pathogenesis of meniscal injury

A
  • Trauma
  • During gait, the meniscus is exposed to constant shearin g
  • Caudal pole is pulled back and away
44
Q

Meniscal pathology type

A
  • Bucket handle tears
  • Radial tears
  • Transverse tears
  • Crushing of the caudal pole
  • Degenerative
45
Q

Meniscal injury diagnosis

A
  • Physical exam
  • Meniscal click or clunk on flexion*** (high likelihood of tear if it’s positive)
  • Discomfort on medial collateral palpation
  • Direct visualization (meniscal click/clunk on physical examination)
46
Q

Diagnosis for meniscal injury

A
  • Usually have to directly visualize with arthroscopy or arthrotomy
  • MRI is not beneficial
  • Ultrasound is difficult at best
47
Q

Treatment for meniscal tear

A
  • Arthrotomy with partial menisectomy (majority of procedures)
  • Arthroscopic assisted partial or complete menisectomy
  • People will have a primary repair or meniscal replacement
  • Dogs have no apparent morbidity to partial or total menisectomy
48
Q

Prognosis from menisectomy

A
  • Treatment prognosis is good, but may see slower return to function of the stifle
  • Menisectomy site following surgery will have regeneration of fibrocartilaginous mass in area of previous meniscus
  • Meniscal release does not appear to cause clinical morbidity

Ortho (10 decks)

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