Orthopaedics: Common Conditions of the Stifle Flashcards
Describe how to perform a clinical exam of the stifle?
Pelvic limb
* Draw test- pulling below stifle forward like pulling a draw out
* Feel for landmarks
* Toe touching
What radiographical views are used for stifle diagnosis?
- Cranial caudal and mediolateral
- Others- stressed, skyline, flexed/extended
- Views for TTA/TPLO- surgeries
- What developmental conditions affect the stifle?
- What traumatic conditions affect the stifle?
- What acquired conditions affect the stifle?
1) Developmental
* Osteochondrosis
* Growth disturbances- genu valgum
* Patella luxation
2) Traumatic
* Avulsions- LDE, gastrocnemius, titial tuberosity
* Fractures
* Ruptured ligaments
3) Acquired
* Cruciate disease
* OA
* Immune-mediated arthritis
* Neoplasia
- What is the most common cause of hindlimb lameness in the dog?
Cranial cruciate ligament
- What is the role of the cranial cruciate ligament?
- What is the aetiology of CCL disease?
1) Important role in stifle joint stability
* Craniocaudal and internal/external rotation
* Origin caudal medially to insertion cranialy lateraly
2) Aetiology
* Trauma (least common)
* disease/degeneration in older dogs- young large breed dogs
* Disease from increased collagen metabolism- increased laxity, narrowed intercondylar notches, sloping angle of tibial plateau
What are the clinical signs of cranial cruciate ligament disease?
- Chronic/acute hindlimb lameness
- Leg carried flexed- toe touching
- Stifle effusion (patellar ligament- not pencil like)
- Medial buttress and OA- chronic
- Tibial compression test/cranial draw test
How is CCL rupture diagnosed?
How is it treated?
- Clinical exam and history
- Radiography
- Others- arthrocenthesis, MRI
- Cranial draw test and tibial thrust test
Treatment
* Conservative- under 15kgs, restricted excercise for 6-8 weeks
* Surgical
How can the CCL be surgically treated?
Controversial
* Intracapsular- over the top
* Extracapsular- fabellotibial nylon sutures
* Periarticular- tibial plateau levelling osteotomy
* Arthroscopy
What CCL surgical method is this?
Over the top
Intracapsular
What CCL surgical technique does this radiograph show?
Periatricular technique
* Closing wedge or tibial plateau levelling osteotomy
* Tibial tuberosity advancement or modified Macquet procedure
Will still have +ve cranial draw
What does CCL surgery aftercare entail?
What are potential complications?
- Re-examine at 4-6 weeks and 12 weeks
- Progress X-rays for osteotomies at 8 weeks
Complications:
* Infection
* Menisci tears
CCL complication
- What is the most common meniscal tear?
- How is meniscal injury managed?
- Most medial- bucket handle caudal pole most common
- May respond 4-6 weeks with conservative- surgical removal if persistent lameness
What is the aetiology of patellar luxation?
- Congenital or traumatic
- Due to developmental malalignment of quadriceps complex
How is patellar luxaiton graded?
- Intermittent patellar luxation- reduction immediate
- Frequent luxation- not always immediate reduction
- Permanent luxation- reduction possible but reluxates
- Permanent luxation- reduction not possible
What does this radiograph show?
Patellar luxation
Diagnosis- history/CS, radiography
How is patellar luxation treated conservatively and surgically?
Conservative
* If none or intermittent CS
* Restricted, controlled excersise, NSAIDs
Surgical
* If recurrent
* Restore normal alignment of quadriceps mechanism
How is normal alignment of quadriceps mechanism achived surgically?
- Reinforcment of lateral retinaculum
- Release of medial retinaculum
- Deepening of trochlear groove
- Transportation of tibial tuberosity
- Wedge or block trocheoplasty
- Where is osteochondrosis more commonly found in dogs?
- What is the breed predisposition?
- When is it OCD?
- Lateral/medial femoral condyle
- Labrador retriever
- If joint mouse- OCD
- What are the clinical signs of osteochondrosis?
- How is it diagnosed?
- Lameness from 5mo, bilateral crouching gait, joint effusion and discomfort upon palpation
- Hx and CS, radiography (CrCd)
How is collateral ligament rupture diagnosed?
How is it treated?
- Abnormal joint movement in medial or lateral direction
- Stressed radiographs
Treatment:
* Parapatellar approach to side affected
* Primary repair of ligament and repair protected by screws and washers at insertion sites
- When are multiple ligament injuried more common?
- How are they diagnosed?
- How are they treated?
- Usually working dogs- uncommon
- Careful examination- stress radiography
- Repair of CCL, collateral, removal of damaged meniscus- good prognosis- TAESF
Cats- usually CCL rupture and meniscal injuries
Treatment: transarticular pin across stifle for 4 weeks
What does this image show?
What can it be secondary to?
Osteoarthritis
CCL rupture
What does this image show?
What can it be secondary to?
Osteoarthritis
CCL rupture
How is the stifle joint tapped?
What is the cranial cruciate ligament bands made up of?
How can you distinguish which is ruptured?
Cranial medial band and a caudal lateral band
Cranial medial- flexion and extension
Cauda lateral- extension only
Full rupture- draw and lax in extension/ flexion
Partial- cranial medial goes first, so taught in extension
What is the purpose of the DeAngelis or lateral fabellotibial suture?
Encourage fibrosis of the joint capsule
