Tendon and LIgament Dz Flashcards
How can tendon be damaged? LOOK UP
> trauma - lacerations > strains - breaking/dehiscnece of fibres - mechanically induced or weakening d/t degeneration
How can muscles be damaged?
> less commonly specifically dx
- injuries similar to tendon
How can tendon/lig dz present?
> Lameness - acute with trauma - chronic > swelling - diffuse, painful, oedema if acute - organised and established in chronic cases > specific functional disability
Is laeration always traumatic?
- no can be chronic
Dxx for tendon and liggament dz?
> clinical signs - dysfunction > radiography - swelling, gap > ultrasound - gap, loss of linear orientation of fibres
Outline pathophysiology of tendon injury repair. Which tendons will heal faster? Eg?
- fibroblasts and collage fibres line up along line of actio
- SHEATHED tendons less vascular so hal slower (eg. digital extensors) cf. vascular (eg. common calcaneal Achilles)
Time to heal tendon injuries?
- 6 weeks to regain 50% normal strength (repair must be supported for 6 weeks)
- 1 year to regain average 80% normal strengt h
Tx tendon injury?
> Rest
specific support to protect tendon from loading
- dressings/casts
- trans-articular fixator
1* surgical repair for lacerations
- tendon sutures to manage load
- direc contact of healthy edges (debride if necessary)
- suture of epitendon to promote healing
ultrasound monitoring healing (@6/8 weeks etc.)
How long should ESF be left on for tendon repair?
- 6 weeks
- then bandage for 2 weeks
HOw big a gap will interfere with tendon healing?
3mm
What ar ethe 2 most common tendon repair sutures?
- locking loop
- 3 loop pulley
What is a sprain?
Ligamentous damage
- can be mild/moderate/severe
- 1/2/3* degree (stretch, rupture, total laceration)
- ^ level of soft tissue damage, swelling, pain and instability
What suture material should be used for TENDON repair?
- non-absorbable eg. Prolene
- sheath simple interrupted absorbable
Presentation of strains ? PE?
- acute and chronic presentation > PE: - especially ROM - palaptoin > Dxx: - radiography + stressed views (to demonstrate strains, pull limbs in direction of strains etc.) - ultrasound (not very useful fr ligament) - manipulation under GA > always check for ancillary damage
Tx sprains?
- rest, reduce swelling (drugs, cooling)
- external coaptation (suppot)
- ligament repair
- internal ligament splintage
- attention to oher structures
- arthrodesis (salvage)
- degree of tx depedns on instability, pain and healing potential
LIkely damage associated with ddrop from a height? Tx?
- palmar carpal ligaments sprained
- need arhrodesis, will not heal conservatively
Surgical repair of ligament?
- screws at insertion of the ligament, figure of 8 suture between the 2
How long do ligament injuries take to heal?
slow healing ~ 6-8 weeks
- not always acceptable function (reevaluate)
- extra chronic capsular tisue formed
- 2* OA
> may require arthrodesis at a later stage
What angle is normal for stress radiographs of the carpus?
10*
How is an arthrodesis carreid out? Which joints is this always required in (first line ?
- remove articular cartilage
- bone graft to stimulate bone healing
- stabilise joint
> TMT (tarsal luxation??)
> Carpal ligaments (carpal hyperextension)
Is ligament dz common in smallies?
NO except for cranial cruciate in dogs!
Which direction does cranial and caudal cruciate run?
Cranial = cranial tibia, caudal femur (proximal and lateral to distal and medial) Caudal = caudal tibia, cranial femur
Pathophysiology of cruciate disease?
- normally related to degeneratin
- can be acute (trauma/degenerative ligament gicing way)
- assocated with MPL (medial patella luxation) which is seen in young growing animals so even if only found incidentally in older animals check the cruciates!
- causes a debilitating cranio-caudal instability in the stifle
- 60% cases involve medial meniscus
Does meniscal injury occour spontaneously in animals?
NO rarely, always affected d/t cruciate dz
How do human and animal cruciate injuries differ?
- human traumatic
- animals gradual degneration n
What is MPL?
- medial patella luxation
What caues the clinical signs seen with cruciate dz? LOOK UP
> forces
- as dog ,oves forwards, weight thrust forwards, must resist reactive forces acting caudally
- stifle is vulnerable to this caudal force (d/t round profile of the femur slipping accross the tibial plataeu)
- cranial cruciate resists this force so if ruptured, joint becomes unstable when loaded
- > if femur can move across tibia, mensci can be damaged stuff
Presentation and predisposed animals of cruciate rupture?
- middle aged (2-10 yrs)
- overweight, neutered
- medium/large breed (lab, rotty, spanial, bull breeds, NOT sighthounds)
> Hx: insiduous onset pelvic limb lameness - may be bilateral
- acute onset can occour
Main Ddx for pelvic limb lamensss seen with cruciate dz?
- hip and LS disease
> cruciate usually more unilateral
FIndings on PE with cruciate rupture?
> muscle atrophy (quads and hamstrings)
stifle effusion
medial buttress
- soft tissue thicking medial aspect of joint
craniocaudal stifle instability (cranial drawer and tibial thrust)
pain on manipulation
- sit test (sit with leg to the side)
When may PE tibial thrust/cranial drawer be unhelpful? How cna these be ID?
- partial degeneration (not complete)
> Radiograph - effusion
- OA
Most common reason for OA In the stifle?
> cranial cruciate MOST COMMON
- paella luxation
- articular fx
Conservative tx of cruciate dz? When is this indicated?
> appropriate if:
- lameness liinal
- low pain
- small dogs slow return to function, stimulation of OA change, no control of meniscal damage (so cant tell if recovery slow d/t crusiate or menisci)
Advantages of surgical tx? Problems?
- improve joint stability
- speed up recovery
- tx meniscal lesions (always necesary)
> joint still never be 100% stable, DJD sill present though less (residual lameness)
Surgical tx options of cranial cruciate repair? LOOK UP
> implant in a position analgous to cranial cruciate (CCL)
- temporarily restores joint stability
- allows fibrous tissue to stabilise stifle
changing mechanics of stifle
- negates the need for CCL support
Any surgery should involve inspection and debridement of menisci
Outline lateral suture technique. What suture material is used? How long does it need to remain for before brekaing down?
- lateral tibio-fabella suture placed
- extracapsular but same line as the CCL
- meniscus inspected via arthrotomy
OUtline TPLO
= tibial plateau levelling osteotomy
- changes angle tibia meets the femur, allows articular surfaces to bear more of caudal shear force from tibial thrust
- will start bearing weight straight after sx
Outline TTA
= tibial tuberosity advancement
- line of patella tendon advanced
- makes it parallel to line of force transfer across joint
- tension in tendon cancels out compression across the joint
- prevents caudal movement of the femur
Outline CWTO
= closed wedge tibial ostectomy
- similar to TPLO but displacement of tibial tuberosity
- tendinitis possible d/t strain on patella tendon
- wedge rather than circular osteotomy to collapse bone
Outline TTO
= triple tibial osteotomy
- mixture TTA/CWTO
- decreases displacmeent
- tendinitis
- more complex surgery
- specialist equipement needed
How long do most cruciate surgeries take to heal? Post op care?
> lead walks for 6-8weeks (rest) - ^ 5min/2w > coldp ack 48hrs > warm packs and PROM BID/TID > rads @ 6-8weeks (not lateral suture) > NO hydrotherapy initially
Rehabilitation after cruciate surgery?
- physio and gradual increase in lead excercise
Which tendon is prone to damage? ECHO
common calcaneal tendon?? achilles (extends and flexxes the ???
Which procedures have the best outcome @ 12 weeks?
All have similar!! Despite numerous claims for advantages of new procedures
