Stifle Flashcards
Cranial cruciate ligament
Runs from medial aspect of lateral femoral condyle to craniomedial aspect of proximal tibia
Caudal cruciate ligament
Inter condylar fossa of femur to caudal tibia
What are the functions of the cruciate ligaments?
Prevent rotation and hyperextension of the stifle
How can you usually differentiate stifle disease from hip disease?
Stifle disease - toe touching - won’t flex stifle
Hip disease - carry leg higher with stifle in flexion
How can you perform a cranial drawer?
Test the leg in both flexion and extension
Index finger on patella
Other index finger on tibial all tuberosity
= cranial movement and instability in the stifle
Note - caudolateral band can produce a false negative with the leg in extension (taught)
How can you perform a tibial thrust?
Hold stifle in extension
Flex the hock
Finger over the tibia tuberosity will be displaced cranially
Where can you perform synoviocentesis in the stifle?
Lateral femoral-tibial compartment
Femoropatellar compartment - yields lots of fluid
What are the two bands within the cranial cruciate ligament?
Craniomedial band - taught in both flexion and extension
= more commonly ruptured
Caudolateral band = only taught in extension
What is the most common aetiology of cranial cruciate ligament rupture?
Degeneration and minor trauma
Labrador, terriers and bull mastiffs predisposed
How does rupture of the cranial cruciate ligament present?
Acute or chronic onset hindlimb lameness
Leg carried flexed
Toe touching
Stifle effusion - loss of definition of the patellar ligament
Medial buttress (chronic thickening on medial stifle)
Positive tibial compression test (stifle in extension)
Positive cranial drawer (stifle in flexion and extension)
How can you diagnose cranial cruciate ligament tears?
History
Clinical exam
Radiography - mediloateral and craniocaudal views
When can conservative management of cranial cruciate ligament disease be attempted?
Patients under 15kg
Restricted exercise and analgesia for 6-8 weeks
85% have a satisfactory return to function
When is surgical management of cranial cruciate ligament disease indicated?
Patients over 15kg
Or failed to respond to conservative management
What surgical management options are available for CrCrLD?
Intra-capsular - over the top technique Extra-capsular - lateral suture (lateral fabellotibial suture) Peri-articular - tibial plateau level osteotomy (TPLO) - tibial tuberosity advancement (TTA)
What is the most common surgical method used for CrCrL disease?
Lateral fabellotibial suture
- nylon suture placed through a hole in the tibia and around the fabella
What is the prognosis of surgeries for CrCrL disease?
All similar - around 80%
But animals that have had a TPLO seem to have a faster recovery
What post-operative care is required follows stifle surgery?
Rest for 10 days
Gradually increased exercise after 10 days
Re-examine in 4-6w and again at 12w
Progress radiographs at 8w
What are some complications that can occur following stifle surgeries?
Meniscal tears - conservative management for 4-6 weeks - surgical removal if persistent lameness Infection Avulsion of osteotomy
How does patella luxation usually present?
Young toy breed dogs
Due to a developmental malalignment of the quadriceps
Skipping lameness
Bunny hopping or crouching if bilateral
Able to luxate the patella on clinical exam
How can you diagnose patellar luxation?
Radiography
History and clinical signs
How can you treat patella luxation?
Grade 1
Restricted and controlled exercise
NSAIDS
Grade 2 and above requires surgical treatment
- reinforcement of lateral retinaculum
- release of the medial retinaculum
- deepening of the patella groove
- transposition of the tibial tuberosity
How does stifle osteochondrosis often present?
Young male Labrador
Lameness from 5mo
Bilateral crouching gait
Stifle effusion and pain
Dx: radiography - medial and lateral femoral condyles
Tx: arthroscopy and debridement
How does rupture of the collateral ligaments present?
Trauma +/- CrCrL involvement
Rx - widening of joint space on stressed view
Tx - parapatellar approach - primary repair of ligament
How does multiple ligament injuries present and how can you treat them?
Working dogs
- CrCrL rupture
- meniscus tears
- collateral ligament tears
Tx - external fixation - transarticular pin
How can you treat distal femoral fractures and proximal tibia fractures?
Cross pin
Ensure the pins do not cross at the fracture site
Proximal tibial fractures are common in terriers - may heal spontaneously
How can you manage OA in the stifle?
Conservative
Stifle Arthrodesis
Total knee replacement
What neoplasia is found in the stifle?
Synovial sarcoma
Distal femoral osteosarcoma
