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Moving Exam 3 > SA Ortho - Crainal Cruciate > Flashcards

SA Ortho - Crainal Cruciate Flashcards

1
Q

Most common cause of hind limb lameness in dog

A

Cranial cruciate ligament rupture

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2
Q

Types of CCL tears

A

Complete tear
Partial tear
Avulsion

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3
Q

Functions of CCL

A

Limits cranial translation of the tibia w respect to the femur
- cranial drawer motion
- cranial tibial thrust

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4
Q

Preventive functions of CCL

A

Prevents hyperextension of stifle joint
Limits internal rotation of tibia
Limited degree of valgus-varus supported to the flexed stifle

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5
Q

Types of receptors in CCL

A

Mechanoreceptors - propriceptive feedback

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6
Q

Surrounding musculature include
-medial crural fascia

A

Caudal belly of Sartorius
Gracilis
Semitendinosus

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7
Q

Functions of surrounding musculature

A

Stifle flexion
Internal rotation

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8
Q

Active restraints of the stifle

A

Medial crucial fascia
- caudal belly of Sartorius
- Gracilis
- Semitendinosus

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9
Q

Passive restraints of the stifle

A

Cruciate ligaments
Collateral ligaments
Meniscal ligaments

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10
Q

Features that prevent drawer motion

A
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11
Q

Features that prevent hyperextension of stifle

A

CCL - cranial and caudal
Medial and lateral collateral ligament

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12
Q

Typical signalment for CCL

A

Either gender, any age, breed
Young/middle age, active, large breeds, straight legged, higher incidence in females

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13
Q

Acute trauma etiology

A

Small % of cases/dogs
Distinct traumatic event/onset
Avulsion is common in young dogs (typically failure of the tibial attachment site)

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14
Q

Chronic degenerative changes etiology

A

Episodic lameness
Declining strength of CCL w age
Loss of fiber bundle organization & metaplastic changes
More marked at central core of ligament

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15
Q

Conformation etiology

A

Postural
Stifle hyper flexion
Femoral conformation
Tibial conformation
Obesity
Excessive stress on CCL
Chronic deterioration
Eventual rupture

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16
Q

femoral conformation

A

Narrowing of intercondylar notch

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17
Q

Tibial conformation

A

Internal rotation
Abnormal slope of TPA (increased TPA) - anatomy/posture

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18
Q

Physical factors

A

Obesity
Excessive stress on CCL
Chronic deterioration
Eventual rupture

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19
Q

History for acute injury

A

Sudden onset of NWB lameness with followed improvement
Failure to improve would indicate concurrent meniscal injury

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20
Q

History for chronic injury

A

Prolonged WB lameness
Difficulty rising/sitting
Sits w affected limb out to the side of the body

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21
Q

History for partial tear

A

Mild WB lameness w exercise
May resolve
May last for months
May have bilateral injury (diff from neuro disease)

22
Q

Likelihood luxation will become bilateral

A

30-40% of cases become bilateral
Of those cases 90% will experience contra lateral rupture

23
Q

Physical exam findings in joints/tests

A

Pain
Cranial drawer motion
Tibial compression test
Joint effusion
Periarticular fibrosis
Medial buttress

24
Q

“Click” during walking or on stifle

A

In flexion or extension is suggestive on meniscal injury
(Absence of noise doesn’t rule out injury)

25
Q

Types of invasive diagnosis

A

Arthroscopy - scope joint w camera
Arthrocentesis - stick needle in / aspirate

26
Q

What is being tested in cranial drawer test

A

Cranial cruciate ligament

27
Q

Difficulties of CDT

A

Hard to elicit due to periarticular fibrosis, esp if there’s a partial tear
Easier under anesthesia
0-2mm is normal, 4-5mM is normal in immature dogs

28
Q

CCL bands

A

Craniomedial band - taught in all parts of ext and flex
Caudolateral band - taught in ext, relaxed in flex

29
Q

Partial tears

A

No cranial drawer in extension
Drawer in flexion

30
Q

Complete tear

A

Drawer in both extension and flexion

31
Q

prognosis of untreated partial tears

A

Partial tears will eventually progress to complete tear usually within a year of lameness onset

32
Q

Cranial tibial thrust

A

Cranial movement of tibial tub in cranial cruciate ligament- deficient stifle when hock is flexed and calf muscle contracts

33
Q

Tibial compression test - normal findings

A

Feel pressure from patella on index finger

34
Q

Tibial compression test - CCL deficient stifle

A

Cranial advancement of the tibial crest as the hock is flexed

35
Q

Findings for arthocentesis

A

Anti collagen antibodies
Non-inflammatory arthropathy
Synovitis
Elevated collagenase (inhibited by doxycycline)
2-3x increase in cell numbers (partial tear, 6-9k WBC)

36
Q

Reasons for arthorcentesis

A

If joint palpation and radiographs are inconclusive
Consistent w secondary DJD
Increased volume of synovial fluid

37
Q

CCL fininds for arthroscopy

A

Gross tears
Fibrillation
Discoloration
Rupture
Menisci
AC

38
Q

Diagnostic use of arthroscopy

A

Confirm presence of CCL path
Determine meniscus path
Cultures
Biopsy if indicated - synovium

39
Q

Therapeutic use for arthroscopy

A

Removal of CCL remnants
Assisted CCL reconstruction
Treatment of meniscal injury
Joint lavage

40
Q

Medial meniscal injury common

A

Firm attachment to tibial plateau
No femoral attachment
Caudal pole often wedges between medial femoral condyle and tibial plateau

41
Q

Lateral meniscus injury

A

More mobile injury
Retains Femoral attachment
Incidence - more common than thought

42
Q

Most common meniscal tear

A

Medial

43
Q

Functions of menisci

A

Load distribution
Repercussion absorption
Rotational & varus-valgus stability
Lubricate joint
Joint congruity

44
Q

History for meniscal injury

A

Acute lameness w followed improvement (initial CCLR) followed by worsening lameness (meniscal damage)

45
Q

Inspection of menisci injury

A

Should always check status of meniscus when treating a CCLR vis arthrotomy (mini), arthroscopy

46
Q

% of patients w CCL

A

50-75% of patients w CCLR

47
Q

Primary repair options for meniscal tears

A

Mid body
Caudal release
Menisectomy

48
Q

Meniscal release

A

Goal is to preserve normal menisci anatomy
Remove damaged segments (promotes DJD)
May prevent subsequent meniscal injury

49
Q

Meniscal release function

A

Allows caudal horn of medial meniscus to remain in the caudal compartment of the joint during cranial translation of the tibia

50
Q

Meniscectomy - total

A

Due to completely torn or shredded meniscus
Peripheral rim is damaged
Primary suturing not possible

51
Q

Client information

A

30-40% of patients w CCLR will also rupture the other ligament within two years
Progressive OA occurs after regardless of treatment

Moving Exam 3 (34 decks)

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