Lecture 8: Cranial Cruciate Ligament Injury/Dx II (Exam 2) Flashcards
Why is surgery recommended
- To slow down progression of arthritis & eliminate/minimize lameness
- Always in large breeds
Who does conservative therapy help
< 20 - 25 lbs may improve w/o sx but progressive DJD occurs
What does conservative therapy consist of
- Medications
- Exercise modification
- Joint supplements
- Possibly brace/orthotics
Describe rehabilitation for CCLD
- Can speed recovery if done by a trained rehab practitioner
- Little evidence this is good alternative to surgical management for most dogs
- May be alternative option to sx
Describe custom knee bracing/orthotic
- Rel new to canine ortho
- Little scientific evidence ava
- Valuable for selected px
- Temporary solution & not ideal for young active animals
Describe the Tx of CCLD
- Sx does not completely restore norm joint anatomy & fxn
- Despite sx = progression of arthritis (stabilization likely slows the process)
- Arthritis is a non reversible dx
What is the clinical conclusion of cruciate sx
- Use most comfortable tech for you
- Be prepared to alter the procedure
- You are not repairing the cruciate
- You are stabilizing the stifle
- Be able to discuss w/ clients & offer appropriate referral options
What % of surgical methods are subjective eval to good to excellent results
90%
T/F: No tech prevents progressive DJD
True
what are the general consideration of caudal cruciate (CaCL) injuries
- CaCL injury alone is rare
- Usually seen w/ cranial cruciate & collateral lig damage
How is CaCL dxed
- Demonstration of caudal drawer movement
- Due to muscle pull
- Drawer movement of tibia cranially
- Radiographs may be more impt in assessing this injury
What are the surgical techs for CaCL
- Extrascapular imbrication techs
- Surgically correct all injuries simultaneously
Describe meniscal fxn
- Acts as a shock absorber
- Increases stability
- Aids in lubrication
What % of the meniscus is vascularized? What % is nourished by synovial diffusion
- Vascular: the peripheral 15%
- Synovial: The central 85%
What are general consideration about the menisci
- Isolated meniscal lesions are rare
- Typically a secondary injury due to stifle instability
Describe meniscal anatomy
- Lateral meniscus is attached to the femur (meniscofemoral lig; more moveable & spares injury after CCL tear)
- Medial miscus firmly attached to the joint capsule & medial collateral lig
Label the following
Describe meniscal pathophysiology
- Most common injury occurs to the medial meniscus during abnorm internal rotation
- Meniscal injuries often assoc w/ rupture of CCL
Caudal horn of the medial meniscus is most often the damaged part & can be folded - Medial femoral & tibial condyles crush/shear the meniscus during wt bearing
When do meniscal injuries occur
When excessive crushing or shearing forces w/ stifle instability result in meniscocapsular detachment or separation in the substance of meniscus
What is a radial tear
Rin in an axial to abaxial direction
What are circumferential tears (longitudinal)
Follow the curvature of the meniscus
What is a bucket handle tears
Circumferential tears w/ separation of the meniscus @ the site of the tear
What is meniscal release
Midbody ormeniscotibial incision of the medial meniscus intended to prevent future meniscal impingement & damage
What are the classification of meniscal injuries
- Transverse radial tear (A)
- Longitudinal or bucket handle tear (B)
- Medial peripheral detachment w/ shredding of the cartilage (C)
- folded caudal horn (D)
Describe isolated lateral meniscal tears
- Occur in the caudal horn
- Are rare & usually occur in conjunction w/ CCL tear
- Rare b/c of the meniscofemoral lig
What is the meniscal click
- Dx of meniscal injuries
- Clicking or snapping sound can be heard on palpation or during wt bearing
How can meniscal injuries be dx
- Sudden lameness in a dog w/ a chronic cruciate rupture may indicate meniscal injury occurred
- Displaced meniscus may act as a wedge & prevent drawer movement in acutely injured stifle
- Arthroscopy
- Surgical exploration
Describe surgical tx of ruptured CCL
- Injury of contralateral cruciate lig occurs in > 50% of px
- Percent increases to 60% if radiographic changes are visible in an uninjured joint
What does the sx method used depend on
- Surgeon preference
- Px size & function
- Cost of procedure
What is intracapsular reconstruction
- Consist of passing autogenous tissue through the joint using an over the top method
- Passes tissue through predrilled holes in the femur, tibia, or both
What is the advantage of intracapsular reconstruction
Most closely mimics original position & biology of the original CCL
What is the disadvantages of intracapsular reconstruction
- Invasiveness
- Tendency of the graft to stretch or fail
