tendons/ligs (combo smallies + equine) Flashcards

1
Q

stages of tendon healing

A
  1. Inflammation days 0-3
  2. Early proliferation days 1-7
  3. Late proliferation days 7-21d
  4. Remodelling up to 18months
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2
Q

describe process of inflammatory stage of healing

A
  • blood clot formation stabilises torn tendon edges + scaffold for cells
  • fibroblasts produce type III collagen
  • macrophages remove devitalised tissue
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3
Q

describe process of early proliferation stage of healing

A
  • angiogenesis commences

- tenocytes produce type III collagen

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4
Q

describe process of late proliferation stage of healing

A
  • fibroblasts from epitenon + synovial sheath, intrinsic fibroblasts from endotendon
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5
Q

describe process of remodelling stage of healing

A
  • type III collagen replaced by type I collagen

- rel. strength 56% @ 6wks, 80% at 1 yr

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6
Q

6 principles of tendon repair

A
  1. Clean the wound
  2. Appose tendon ends
  3. Placement of holding and circumferential sutures
  4. Reinforce the repair
  5. Immobilisation
  6. Strict post-op plan
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7
Q

3 parts of the common calcaneal tendon (dogs)

A
  • tendons of gastrocnemius m. (paired)
  • combined tenxons of gracilis, semitendionsus, biceps femoris muscles
  • tendon of SDFT muscle
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8
Q

compare surgical approach to traumatic and atraumatic common calcaneal disruption

A
  • traumatic usu. involves wound cleaning and minimal debridement of tendon (as acute - still viable) + apposition of ends w/ circumferential/holding sutures
  • chronic atraumatic disruption usu. involves considerable debridement/resection resulting in limited tendon volume distally thus sx tx may involve tunnels, polyethylene terephthalate prosthesis
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9
Q

presentation of atraumatic common calcaneal disruption

A

1 Sign:. F>M, medium-large breed, dobermans, labs

  1. Hx: chronic progressive lameness w/ acute deterioration + no hx of trauma
  2. Px: thickened calcaneal tendon esp. at insertion
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10
Q

post-op care of common calcaneal disruption

A

tarsus maintained in extension for 6-8wks (bivalved cast, ESF, calcaneotibial screws)

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11
Q

px of common calcaneal disruption (dogs)

A

excellent (w/ sx) 72-94% success

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12
Q

failure to ID lacerations in the DDF tendon (concurrent to SDFT) may result in…
dogs

A
  • flattened digits, weight bearing or metatarsal/carpal pad
  • pressure sores
  • chronic pain + lameness
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13
Q

bandaging regime for DDFT lacerations (dogs)

A

3 wks w/ foot in flexion followed by 3 wks w/ foot in normal weight bearing position

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14
Q

radiographic findings of biceps tendinopathy (dogs)

A
  • intertubercular groove mineralisation, tendon mineralisations
    req. orthogonal views + skyline
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15
Q

US findings of biceps tendinopathy (dogs)

A
  • enlarged, hypoechoic tendon, fibre pattern disruption, irreg. synovium
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16
Q

why is MRI useful to investigate biceps tendinopathy?

A

concurrent assessment of intra-articular structures, substance tears, impingement ID w/ intra-articular contrast

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17
Q

medical tx of biceps tendinopathy

A
  1. Intra-articular methylprednisolone 1mg/kg 1-2doses 4-6wks apart
  2. Strict rest 4-6wks
18
Q

sx tx of biceps tendinopathy

A
  1. tenodesis: good outcomes reported but implant assoc. complications
  2. tenotomy: preferred - can be arthroscopic
19
Q

common lig/tendon issues in dogs

A
  • common calcaneal disruption
  • DDFT lacerations
  • biceps tendinopathys
  • traumatic lig injuries: collateral lig injury, carpal hyperextension
20
Q

repair options for collateral lig injury (dogs)

A
  1. Primary repair w/ locking loop pattern
  2. Internal splint: augment + mimic action of ligament
    - bone anchors, screws w/ washers
    - bone tunnels, nylon sutures + wire
21
Q

what structures may be damaged by carpal hyperextension in the dog?

A
  • damage to flexor retinaculum, palmar fibrocartilage

- collateral ligs

22
Q

rad dx of carpal hyperextension injuries

A

orthogonal views + stress rads

23
Q

principles of arthrodesis

A
  1. Cartilage removed from all aspects of joints
  2. Cancellous bone graft placed in joints
  3. Apposed jt surfaces
  4. Rigid internal fixation
  5. Post-op immobilisation
  6. Follow-up rads @ 6-12wks
24
Q

indications for arthrodesis in dogs

A
  • implant failures for tendon repairs

- severe joint instability w/ primary repair not a viable option

25
complications of arthrodesis in dogs
- swelling, infection, dehiscence - implant/fusion failure - fractures
26
common equine tendon/lig issues
1. Bowed tendons: flexor tendonitis 2. Tendon lacerations: SDFT/DDFT/SL 3 Suspensory lig. desmitis 4. Palmar/plantar annular lig. constriction 5. Tendon sheath injuries
27
predilection sites for bowed tendons
- forelimb (inc. weight bearing) | - mid cannon (narrow cross section)
28
inc. risk for bowed tendons
- wet track - >6yo - conformation/shoeing
29
initial tx for bowed tendons
1. Control inflammation (cold therapy, NSAIDs, bandaging) 2. Limb support (Robert jones bandage, splint, heel elevation- DDFT) 3. Stall rest
30
intra-lesional medications for tendon injuries (horses)
- IGF-1 (tendotrophine) + other GFs - autologous bone marrow implantation - stem cell therapy - platelet rich plasma
31
potential surgeries for equine flexor tendonitis
- percutaneous tendon stab - superior check lig desmotomy - palmar/plantar annular lig. desmotomy (fetlock canal syndrome)
32
action of tendon stab/splitting
evacuates core lesion haematoma + may promote intrinsic healing
33
action of palmar/plantar annular lig transection
used to relieve tension on flexors in PAL constriction
34
action of superior check lig. desmotomy
inc. elasticity in muscle tendon unit
35
compare prognosis of flexor vs extensor tendon lacerations (horse)
``` extensor = excellent flexors = poor - fair dt inc. load and propulsive movements ```
36
tx of tendon sheath injuries
- tenoscopy + cont. lavage + regional limb perfusions + intralesional ABs
37
px of PAL post-sx
fair to good dependent on adhesions (chronicity) + damage to flexor tendons
38
proximal suspensoty desmitis blocks to what nerve block?
high 4 point
39
indications for neurectomy + fasciotomy w/ suspensory lig desmitis
chronic HL desmitis only
40
predilection sites for SL desmitis
HLs in STBs FLs in TBs - proximal