Surgery of the Stifle Flashcards
Recap of Stifle anatomy?
SIG & history of CCL rupture?
Medium to large breeds (E.g. Retrievers, Rottweilers)
Describe the three groups of onsets for CCL rupturee?
A) Acute onset, non-weight bearing, gradual improvement. Quadricep atrophy may be present → any age→
related to trauma (normal ligament).
B) As above → middle age → degeneration → rupture
C) Chronic development + acute exacerbation (e.g. partial to complete rupture, meniscal damage), concomitant
pathologies (OA or patella luxation) → any age, young in large breeds → unknown aetiology.
Prediposing factors?
Obesity +/_ conformation
Histories for CCL?
A) and B) Acute, non-weight bearing, improvement (toe touching) after a week, atrophy of the muscle.
C) Gradual onset + acute episode.
Physical exam of stifle?
- Examination of the stifle may be difficult due to
pain - Crepitus
- Click (meniscal)
- Positive cranial drawer test
- Positive tibial compression test
- Abnormal sitting position
- Lameness (different degrees).
- Joint effusion
- Muscle atrophy
- Medial buttress (medial fibrosis)
DIAGNOSTIC for CCL rupture ?
- Xray
- US
- MRI
- Arthotomy
ARTHORCOPY IMAGING?
What tx options for CCL rupture?
A) Osteotomies: TPLO, TTA, CCWO, CBLO
B) Ligament replacement/intraarticular
C) Extracapsular techniques
D) Conservative management: weight loss, analgesia, restricted exercise, physio and/or hydrotherapy, chondroprotectants
Meniscal sx?
TPLO?
TTA?
CCWO?
Cranial Tibial Closing Wedge Ostectomy
EXTRACAPSULAR TEHCNIQUE- LAtral (circumfabellar) suture
Extracapsular technique -tightrope?
Extracapsular techniques - bone ancors?
Extracapsular technique - isometry?
Isometry vs quasi-isometry -> F2-T3 is the most isometric
Signalment - for medial patellar luxation?
- Smaller Breeds (Pomeranians, Yorkshire Terrier..)
- Labrador & Mastiffs
History & PE?
- ‘Skipping’ no but lameness
- Can be bilateral
- manual luxation
- Grade IV: abnormal sitting position
Grades of Medial Patellar luxation?
- Spontaneous luxation rarely happens, but can be luxated manually, it reduces after releasing It
II- After manual luxation, needs to be manually reduced or reduces when the patient de-rotates
the tibia
III- Patella is luxated most of the time, can be manually reduced. Re-luxates when released.
IV- Patella is always luxated. IT cannot be manually reduced.
Diagnostic for Medial patellar lux?
Radiographs will show medial displacement - full limb -> deformities
Pathophysiology:
- Patella luxation is the result of other abnormalities
- Most cases are developmental (but they can be also congenital, traumatic or iatrogenic)
Describe what happens with each part of the Medial patellar lux?
- Femur: Femoral inclination angle, torsions, distal varus or valgus. Shallow trochlea.
- Tibia: Torsions, proximal varus/valgus, position of the tibial tuberosity.
- Patella: alta/baja (high/low)
Surgical techniques for MPL?
- “Vest over pants”
- Deepening of the Trochlear Groove:
- Trochlear wedge recession
- Trochlear block recession - Tibital tuberosity Transposition (TTT)
- Distal femoral Osteotomy (DFO)
