SA Ortho - Crainal Cruciate Flashcards by Mckenna Maloney

Most common cause of hind limb lameness in dog

Cranial cruciate ligament rupture

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Types of CCL tears

Complete tear
Partial tear
Avulsion

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Functions of CCL

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

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Preventive functions of CCL

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

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Types of receptors in CCL

Mechanoreceptors - propriceptive feedback

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Surrounding musculature include
-medial crural fascia

Caudal belly of Sartorius
Gracilis
Semitendinosus

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Functions of surrounding musculature

Stifle flexion
Internal rotation

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Active restraints of the stifle

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

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Passive restraints of the stifle

Cruciate ligaments
Collateral ligaments
Meniscal ligaments

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Features that prevent drawer motion

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Features that prevent hyperextension of stifle

CCL - cranial and caudal
Medial and lateral collateral ligament

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Typical signalment for CCL

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

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Acute trauma etiology

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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Chronic degenerative changes etiology

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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Conformation etiology

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

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femoral conformation

Narrowing of intercondylar notch

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Tibial conformation

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

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Physical factors

Obesity
Excessive stress on CCL
Chronic deterioration
Eventual rupture

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History for acute injury

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

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History for chronic injury

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

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History for partial tear

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

Likelihood luxation will become bilateral

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

Physical exam findings in joints/tests

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

“Click” during walking or on stifle

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

Types of invasive diagnosis

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

What is being tested in cranial drawer test

Cranial cruciate ligament

Difficulties of CDT

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

CCL bands

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

Partial tears

No cranial drawer in extension Drawer in flexion

Complete tear

Drawer in both extension and flexion

prognosis of untreated partial tears

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

Cranial tibial thrust

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

Tibial compression test - normal findings

Feel pressure from patella on index finger

Tibial compression test - CCL deficient stifle

Cranial advancement of the tibial crest as the hock is flexed

Findings for arthocentesis

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

Reasons for arthorcentesis

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

CCL fininds for arthroscopy

Gross tears Fibrillation Discoloration Rupture Menisci AC

Diagnostic use of arthroscopy

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

Therapeutic use for arthroscopy

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

Medial meniscal injury common

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

Lateral meniscus injury

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

Most common meniscal tear

Medial

Functions of menisci

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

History for meniscal injury

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

Inspection of menisci injury

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

% of patients w CCL

50-75% of patients w CCLR

Primary repair options for meniscal tears

Mid body Caudal release Menisectomy

Meniscal release

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

Meniscal release function

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

Meniscectomy - total

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

Client information

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