Tendon and Ligament Disease Flashcards
What are common causes of muscular injuries?
Often similar to those causing tendon injuries but less commonly specifically diagnosed
What commonly causes tendon injuries?
Trauma such as lacerations
Strains = breaking or dehiscence of fibres mechanically induced or due to weakening by degeneration
How do muscle/tendon injuries often present?
Acute lameness if due to trauma otherwise chronic lameness
Diffuse, painful oedema in acute causes
Organised and established swelling in chronic cases
Specific functional disability
How is diagnosis of tendon/muscle injury made?
Dysfunction shown in clinical signs
Swelling or gap in radiographs
Gap or loss of linear orientation of fibres on ultrasound
How do tendons repair themselves?
Fibroblasts and collagen fibres lining up along the line of action
Sheathed tendons have poorer blood supply and heal slower
Takes 6 weeks to regain 50% normal strength and 1 year to regain an average of 80% normal strength
What is the treatment for tendon injuries?
Rest
Specific support such as dressings, casts or transarticular fixator to protect tendon from loading
Primary surgical repair using locking loop or 3 loop pulley
Ultrasound used to monitor repair
What is a sprain?
Ligamentous injury which varies from mild to severe and are graded as 1st/2nd/3rd degree with increasing levels of soft tissue damage, swelling, pain, lameness and instability
How do sprains present and how should they be examined?
Acute and chronic sprains have similar presentation to strains
Pay attention to range of movement on examination
What further diagnostic techniques can be used for strains?
Radiography including stressed views, ultrasound and manipulation under anaesthesia
What are the treatment options for sprains?
Dependent on degree of instability
Rest and reduce swelling, external coaptation, ligament repair, internal ligament splintage, attention to other structures, arthrodesis (salvage)
How long does treatment for sprains take?
Can be a very long time and won’t always get back to acceptable function so need to check use before treatment
What is cranial cruciate disease often caused by?
Degeneration but can be acute either due to trauma or the degenerative ligament giving way
Can be associated with MPL (medial patellar luxation)
What does cranial cruciate disease cause?
Debilitating cranio-caudal instability at the stifle with 60% cases involving the medial meniscus
What is the normal function of the cranial cruciate ligament? What impact does this have when the ligament becomes diseased?
Resists reactive force that acts caudally when a dog propels itself forwards so joint becomes unstable when loaded if ligament breaks allowing the femur to move across the tibia damaging the menisci
How do dogs with cranial cruciate disease typically present?
Middle aged (2-10 yrs), overweight, neutered dogs, medium to large breed Insidious onset pelvic limb lameness and can be bilateral or acute
What is found on clinical examination of an animal with cranial cruciate disease?
Pelvic limb lameness, muscle atrophy of quadriceps and hamstrings, stifle effusion, medial buttress which is soft tissue thickening on medial aspect of joint, cranio-caudal stifle instability and pain on manipulation and sit test
When is the conservative treatment option for cranial cruciate disease appropriate?
Minimal lameness, low grade pain, <15kg, reason to avoid surgery
If not improved in 6 weeks then recommend surgery as likely associated meniscal injury
What are the risks of conservative treatment of cranial cruciate disease?
Very slow return to function, continuous stimulation of OA change and no control of meniscal injury
What are the advantages of surgical treatment of cranial cruciate disease?
Improved joint stability, faster recovery and allow treatment of meniscal lesions
What are the disadvantages of surgical treatment of cranial cruciate disease?
Joint will never be 100% stable, DJD will always be present resulting in residual lameness, limb function won’t be 100%
What are the surgical treatment options for cranial cruciate disease?
Implant analogous to CCL (lateral tibio-fabella suture extracapsularly)
Change mechanics of stifle to negate need for CCL by TPLO, TTA, TTO or CWTO
What is a TPLO? How does it work?
Tibial plateau levelling osteotomy
Changes the angle that femur and tibia meet at
What is a TTA? How does it work?
Tibial tuberosity advancement
Line of patellar tendon is advanced so it is parallel to force across joint with tension in tendon cancelling out compression negating caudal movement
What is a CWTO?
Closed wedge tibial osteotomy
Similar to TPLO but distal displacement of tibial tuberosity
What is a TTO?
Triple tibial osteotomy and is a mixture of a TTA and CWTO
What post-operative management is necessary for CCL surgery?
Fast weight bearing, rest for 6-8 weeks only lead walking, cold packs for 48-72 hours then warm packs and PROM 2-3 times a day
Radiograph at 6-8 weeks
No hydrotherapy initially
