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Year 4 Small Animal Studies > Orthopaedics: Common Conditions of the Stifle > Flashcards

Orthopaedics: Common Conditions of the Stifle Flashcards

1
Q

Describe how to perform a clinical exam of the stifle?

A

Pelvic limb
* Draw test- pulling below stifle forward like pulling a draw out
* Feel for landmarks
* Toe touching

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2
Q

What radiographical views are used for stifle diagnosis?

A
  • Cranial caudal and mediolateral
  • Others- stressed, skyline, flexed/extended
  • Views for TTA/TPLO- surgeries
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3
Q
  1. What developmental conditions affect the stifle?
  2. What traumatic conditions affect the stifle?
  3. What acquired conditions affect the stifle?
A

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

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4
Q
  1. What is the most common cause of hindlimb lameness in the dog?
A

Cranial cruciate ligament

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5
Q
  1. What is the role of the cranial cruciate ligament?
  2. What is the aetiology of CCL disease?
A

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

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6
Q

What are the clinical signs of cranial cruciate ligament disease?

A
  • 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
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7
Q

How is CCL rupture diagnosed?
How is it treated?

A
  • 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

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8
Q

How can the CCL be surgically treated?

A

Controversial
* Intracapsular- over the top
* Extracapsular- fabellotibial nylon sutures
* Periarticular- tibial plateau levelling osteotomy
* Arthroscopy

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9
Q

What CCL surgical method is this?

A

Over the top
Intracapsular

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10
Q

What CCL surgical technique does this radiograph show?

A

Periatricular technique
* Closing wedge or tibial plateau levelling osteotomy
* Tibial tuberosity advancement or modified Macquet procedure

Will still have +ve cranial draw

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11
Q

What does CCL surgery aftercare entail?
What are potential complications?

A
  • Re-examine at 4-6 weeks and 12 weeks
  • Progress X-rays for osteotomies at 8 weeks

Complications:
* Infection
* Menisci tears

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12
Q

CCL complication

  1. What is the most common meniscal tear?
  2. How is meniscal injury managed?
A
  1. Most medial- bucket handle caudal pole most common
  2. May respond 4-6 weeks with conservative- surgical removal if persistent lameness
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13
Q

What is the aetiology of patellar luxation?

A
  • Congenital or traumatic
  • Due to developmental malalignment of quadriceps complex
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14
Q

How is patellar luxaiton graded?

A
  1. Intermittent patellar luxation- reduction immediate
  2. Frequent luxation- not always immediate reduction
  3. Permanent luxation- reduction possible but reluxates
  4. Permanent luxation- reduction not possible
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15
Q

What does this radiograph show?

A

Patellar luxation

Diagnosis- history/CS, radiography

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16
Q

How is patellar luxation treated conservatively and surgically?

A

Conservative
* If none or intermittent CS
* Restricted, controlled excersise, NSAIDs

Surgical
* If recurrent
* Restore normal alignment of quadriceps mechanism

17
Q

How is normal alignment of quadriceps mechanism achived surgically?

A
  • Reinforcment of lateral retinaculum
  • Release of medial retinaculum
  • Deepening of trochlear groove
  • Transportation of tibial tuberosity
  • Wedge or block trocheoplasty
18
Q
  1. Where is osteochondrosis more commonly found in dogs?
  2. What is the breed predisposition?
  3. When is it OCD?
A
  1. Lateral/medial femoral condyle
  2. Labrador retriever
  3. If joint mouse- OCD
19
Q
  1. What are the clinical signs of osteochondrosis?
  2. How is it diagnosed?
A
  1. Lameness from 5mo, bilateral crouching gait, joint effusion and discomfort upon palpation
  2. Hx and CS, radiography (CrCd)
20
Q

How is collateral ligament rupture diagnosed?

How is it treated?

A
  • 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

21
Q
  1. When are multiple ligament injuried more common?
  2. How are they diagnosed?
  3. How are they treated?
A
  1. Usually working dogs- uncommon
  2. Careful examination- stress radiography
  3. 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

22
Q

What does this image show?
What can it be secondary to?

A

Osteoarthritis
CCL rupture

22
Q

What does this image show?
What can it be secondary to?

A

Osteoarthritis
CCL rupture

23
Q

How is the stifle joint tapped?

A
24
Q

What is the cranial cruciate ligament bands made up of?

How can you distinguish which is ruptured?

A

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

25
Q

What is the purpose of the DeAngelis or lateral fabellotibial suture?

A

Encourage fibrosis of the joint capsule

Year 4 Small Animal Studies (97 decks)

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