Tendon and Ligament Disease in Small Animals Flashcards
What are the main ways tendons/muscles are injured in small animals?
Tendon: Traumatic eg lacerations Strains Breaking/dehiscence of fibres Mechanically induced/degeneration
Muscle:
Similar but less commonly specifically diagnosed
How do tendon and ligament injuries present in SAs?
Lameness
Acute = trauma
Chronic
Swelling
Diffuse, painful, oedema = acute
Organised and established = chronic
Specific functional disability
eg. unable to extend specific joint
What do you see with degenerative tendon injuries rather than laceration?
Enlargement of the tendon rather than complete dysfunction
How can you diagnose tendon injury?
CS Radiography \+ Swelling \+ Gap US \+ Gap \+ Loss of linear fibres
Describe the pathophysiology of tendon repair…
Fibroblasts and collagen fibres line up along line of action
Sheathed tendons have poorer blood supply and heal slower
Takes 6 weeks to regain 50% normal strength (repair needs to be supported for this time)
1yr to regain 80% normal strength
How can you treat tendon injury in SAs?
Rest
Support
Primary surgical repair of lacerations
Which suture patterns are commonly used in tendon repair?
Locking loop
3 loop pulley
Debride ends of the tendon so you can suture it properly. These sutures are designed to incorporate the collagen fibres so it doesn’t just pull through.
What are the differences between first, second and third degree ligamentous injuries?
First degree = laxity of ligament but still functional
Second degree = rupture of some of the fibres
Third degree = complete rupture and instability of the joint
What is a sprain?
Ligamentous injury
What are the presentations of ligamentous injury?
Acute and chronic
PE - range of motion
Further diagnosis with radiography, ultrasound and manipulation under anaesthesia
Joint pulled open (seen on stress radiographs)
How can you treat ligamentous injuries in the small animal?
Rest, reduce swelling
External coaptation
Ligament repair
Arthrodesis
Is suturing ligaments practical?
Majority of times it cannot be done as not strong enough. Use prosethesis.
What are the problems associated with the treatment of ligament injury?
Long aftercare periods
Not always acceptable function
Secondary OA
How common is ligament injury in small animals?
Uncommon with on exception…
Canine cranial cruciate injury
When you are repairing cruciate injuries, what else should you check for?
Injury to the menisci
Describe canine cranial cruciate disease…
Normally related to degeneration, can be acute due to trauma or degeneration giving way. It is associated with the medial patella ligament and 60% involve medial meniscus
What is the cranial cruciate ligament important for?
Preventing movement of the tibia when the animal moves forward. As the dog moves forward it must thrust its weight forward and resist the reactive forcing acting caudally.
How does the tibia move is the cranial cruciate ligament ruptures?
Femur moves across the tibia and menisci can become damaged
What is the presentation associated with cranial cruciate disease?
Middle aged, overweight, middle-large breed dogs.
History of insidious onset pelvic limb lameness which may be bilater
What may you find on PE with a cranial cruciate injury?
Pelvic limb lameness Muscle atrophy Stifle effusion Medial buttress - soft tissue thickening on the medial aspect of the joint Craniocaudal stifle instability Pain on manipulation
What is the sit test?
Instead of sitting with legs straight (painful) they sit with the leg abducted with cranial cruciate injury
What tests can you do for cranial cruciate injury?
Cranial drawer
Tibial thrust
What are the radiographic signs of canine cranial cruciate disease?
Vary between mild effusion and OA to massive effusion and severe OA
When is conservative treatment for canine cranial cruciate injury appropriate?
Minimal lameness
Low grade pain
Weight <15kg
Financial
Describe the recovery of cranial cruciate injury with conservative measures…
Very slow return to function
Continuous stimulation of OA
No control over meniscal damage
What are the advantages of surgical treatment for cruciate disease?
Improves joint stability
Speeds up recovery
Allows meniscal lesions to be repaired
Describe the type of recovery of cranial cruciate injury with surgical treatment..
Joint never 100% stable
DJD will always be present
Limb function good
What are the surgical treatments for cranial cruciate injury?
- Using implants in a postion analogous to cranial cruciate
+ Restores joint stability
+ Allows fibrous tissue to stabilise stifle - Change mechanisms of stifle to negate the need for CCL support
Give example of implant placed surgical treatment for cruciate disease…
Lateral tibio-fabella suture
Place in same line as cruciate ligament extracapsular
What is tibial plateau levelling osteotomy (TPLO?
A surgery that changes the angle that tibia meets femure that allows articular surface to bear more of caudal shear froce from tibial thrust
Make cut so tibia doesn’t move forward anymore and therefore cruciate no longer required
What is tibial tuberosity advancement (TTA)?
Line of patella tendon advanced making it parallel to line of force transferred across joint
Tension in the tendon cancels out compression across the joint negating need for CCL
What is a closed wedge tibial ostectomy (CWTO)?
Similar to a TPLO but distal displacement of tibial tuberosity
What is a triple tibial osteotomy?
Mixture of TTA and CWTO
What is the post operative management of cranial cruciate surgery?
Fast weight bearing Rest 6-8wks Cold packs Warm packs and PROM Radiographs No hydrotherapy initially Physio important
