Stifle Flashcards
What does TPLO stand for? What is it used for?
Tibial plateau levelling osteotomy
Periarticular technique used to repair crania cruciate ligament rupture
What does TTA stand for? What is it used for?
Tibial tuberosity advancement
Periarticular technique used to repair cranial cruciate ligament rupture
How can stifle conditions be diagnosed?
History and clinical signs
Radiography and other imaging
Arthrocentesis
Diagnostic analgesia
Give examples of developmental conditions of the stifle
Osteochondrosis
Growth disturbances (genu valgum)
Patella luxation
What is genu valgum?
Knees angled to touch each other instead of being straight
Give examples of acquired conditions of the stifle
Cruciate disease
Osteoarthritis
Immune-mediated arthritis
Neoplasia
What are the causes of cranial cruciate ligament (CCL) rupture?
Disease or degeneration in older dogs (+ minor trauma)
Young large breed dogs
Trauma = least common
What breeds are predisposed to CCL rupture?
Older dogs = Lab, Terriers
Young large breed dogs = Great Dane, Bull Mastiff
What diseases/degenerations can cause cranial cruciate ligament rupture?
Increased collagen metabolism (in predisposed breeds) Increased joint laxity Narrowed intercondylar notches Sloping angle of tibial plateau Immune mediated disease
What are the clinical signs of cranial cruciate ligament (CCL) rupture?
Chronic/acute onset of HL lameness
Leg carried flexed (‘toe touching’
Stifle effusion - patellar ligament
Medial buttress and OA (if chronic)
What is a medial buttress?
Firm swelling on medial aspect of proximal tibia
What 2 tests can be used to test the integrity of the CCL?
Tibial compression test (if torn CCL, tibial tuberosity with move cranial when hock flexed)
Cranial drawer test (moving joint laterally - should have little movement)
How is CCL tear/ruptured diagnosed?
Clinical exam and history - v important
Radiography
Arthrocentesis
MRI
What are the treatment options of CCL tears/rupture?
Conservative - restricted exercise and analgesia (if <15kg)
Surgery - intracapsular, extracapsular or periarticular (TPLO or TTA)
What is an example of an intracapsular technique to repair the CLL?
Over the top (OTT)
What are examples of periarticular techniques used to repair the CLL?
TTA - tibial tuberosity advancement
TPLO - tibial plateau levelling osteotomy
After cruciate surgery, when should the patient re-examined?
Re-examine at 4-6 weeks and again at 12 weeks
Progress x-rays for osteotomies at 8 wks
What are potential complications of cruciate surgery?
Infection
Menisci tears
Are meniscal injuries usually medial or lateral?
Medial
(‘Bucket handle’ caudal pole - most common)
Can be iatrogenic (surgery) or later
What are the treatment options for meniscal injuries?
Conservative - 4-6 weeks
Surgical removal of meniscus (if persistently lame)
Is patellar luxation more common medially or laterally?
Medial
What can cause patellar luxation?
Trauma
Congenital - predisposed breeds
Developmental problems- malalignment of quadriceps
Patellar lunation is more common in what size dogs
Toy breeds
Large breeds
Can gets get patellar luxation?
Yes - often asymptomatic
What are the 4 grades of patellar luxation?
Grade 1 = intermittent patellar luxation, reduction immediate
Grade 2 = frequent/spontaneous luxation, reduction not always immediate, skipping
Grade 3 = permanent luxation, reduction possible but reluxates
Grade 4 = permanent luxation, reduction not possible
How is patellar lunation diagnosed?
History
Clinical signs
Radiography
What are the treatment options for patellar lunation?
Conservative (if intermittent clinical signs) - restricted, controlled exercise and NSAIDs
Surgery (if recurrent clinical signs) - many techniques
What surgery can be done to correct patellar luxation?
Wedge or block trochleoplasty
Many techniques
What breed is predisposed to osteochondrosis? Which sex?
Lab retrievers
Males > females
How common is osteochondrosis?
Not very common
What location in the HL is osteochondrosis most likely to be found?
Lateral or medial femoral condyle
Articular surface
What are the clinical signs of osteochondrosis?
Lameness from 5 months old
Bilateral crouching gait
Joint effusion and discomfort upon palpation
How is osteochondrosis diagnosed?
History
Clinical signs
Radiography
How is rupture of the collateral ligaments diagnosed?
Abnormal joint movement in medial or lateral direction Stress radiographs (take contralateral limb to check for normality) - widening of joint space
How is rupture of the collateral ligaments treated?
Parapatellar approach to affected side
Primary repair of ligament with screws and washers
Multiple ligament injuries are uncommon, but are usually seen in what type of dogs?
Working dogs
How are multiple ligament injuries diagnosed?
Clinical exam
Stress radiography
How are multiple ligament injuries treated? What is the prognosis?
Repair of CCL and collateral ligaments
Removal of damaged meniscus and joint capsule
Prognosis = good
Is stifle osteoarthritis common?
Yes
Secondary to CCL rupture
Give an example of a neoplasia seen in the stifle of larger breed dogs
Osteosarcoma
