Test 2: 21: CCL

Question 1

what are the 4 ligaments of the stifle

Answer 1

cranial CL
caudal CL
medial collateral
lateral collateral

Question 2

cruciate ligaments are made of

Answer 2

type 1 collagen

Question 3

how to tell cranial from caudal CL

Answer 3

attachment on the femur

Question 4

what part of the CL tends to tear and why?

Answer 4

middle of ligament
poor blood supply

Question 5

innervation to stifle allows for

Answer 5

sensory and mechanoreceptors (proprioception) of the knee

Saphenous (medial articular), tibial, common peroneal nerves

Question 6

CCL
prevents — tibial translation
— rotation of the tibia
stifle —

Answer 6

cranial
internal
hyperextension

Question 7

CCL limits stifle —

Answer 7

varus/valgus
(medial or lateral)

Question 8

what does it mean for a ligament to be viscoelastic

Answer 8

can be stretchy

can be stiff depending on rate of load applied

Question 9

— are C shaped wedges of cartilage in the knee

Answer 9

meniscus

Question 10

meniscus are made of

Answer 10

fibrocartilage
type 1 collagen

Question 11

where is blood supply to meniscus

Answer 11

edge gets blood from joint capsule and abaxial, then passive diffusion to center of cartilage

Question 12

what kind of innervation to meniscus

Answer 12

mechanoreceptors

Question 13

what kind of ligaments on the meniscus

Answer 13

Meniscotibial ligaments
Intermeniscal ligament - between both meniscus
Meniscofemoral ligament of the lateral meniscus
Coronary ligament: medial is firmer than lateral

Question 14

the medial or lateral coronary ligament of the meniscus is firmer

Answer 14

medial

Question 15

the meniscofemoral ligament attaches —

Answer 15

lateral meniscus to the femur

Question 16

what are some functions of the meniscus

Answer 16

load and force distribution
stability
proprioception
cushion
joint lubrication

Question 17

what is hoop stress of the stifle

Answer 17

meniscal fibers will convert compressive forces radially through longitudinal oriented fibers and its attachments, into tensile forces

distributes load over a larger surface area to avoid focal load concentration at a single site

Question 18

CCL disease can be caused by

Answer 18

Acute trauma
Traumatic avulsion
Chronic degenerative of unknown cause

Question 19

what happens to CCL disease over time

Answer 19

chronic progressive degenerative process

ligament becomes fibrocartilage
increased laxity with age
increased degradative enzyme (MMPs, proteases)

Question 20

which meniscus is more common to tear and why

Answer 20

medial

has firmer attachment to the tibia, everytime you move the knee the femur will hit meniscus- over time causes repeated trauma

lateral meniscus is not attached to the tibia and can move with the femur- preventing injury to that meniscus

Question 21

PE of dog with CCL disease

Answer 21

Decreased or NWB lameness

Muscle atrophy of affected PL

Stifle joint effusion

Medial buttress – thickening of the medial joint capsule, palpated on medial stifle joint

Pain on hyperextension

Positive cranial drawer/tibial thrust

Meniscal tear – sometimes a “click” sound through ROM

Question 22

CCL will cause pain on flexion or extension?

Answer 22

hyperextension

Question 23

thickening of the medial joint capsule

Answer 23

medial buttress

Question 24

enthesophytes

Answer 24

bony growths where tendons or ligaments attatch to bone

Question 25

what can you see on XRay of CCL

Answer 25

**effusion**: fat pad will be cranially displaced **osteophytes** **enthesophytes**- distal patella and where CCL attaches

Question 26

medical management of CCL

Answer 26

**exercise restriction**: trying to let body form fibrocartilage at ligament **same treatment for OA**: weight loss rehab NSAID pain meds neutroceuticals

Question 27

surgery for complete tears of CCL

Answer 27

many different approaches go into joint and **cut out damaged tissue**

Question 28

2 passive stabilization procedures for CCL

Answer 28

**extracapsular**: lateral femorotibial suture **intacapsular**

Question 29

how does extracapsular stabilication of CCL work

Answer 29

add biologic or synthetic material through the femur and tibia to provide stabilization and allow periarticular fibrosis to occur many techniques: **lateral femorotibial suture** **passive stabilization**

Question 30

complications of extracapsular stabilization

Answer 30

**premature break** of stabilizing material before fibrosis can occur infection tissue reaction meniscal tear nerve damage continued lameness or pain

Question 31

what is a type of dynamic stabilization procedures for CCL

Answer 31

Tibial Plateau Leveling Osteotomy **(TPLO)** Tibial tuberosity advancement **(TTA)** Tibial wedge osteotomy – multiple

Question 32

what will TPLO do

Answer 32

change formation of tibia to prevent femur from falling off dynamic stabilization **decrease cranial tibial thrust**- cause femur now pushes down instead of forward of tibia **Does NOT eliminate cranial drawer**

Question 33

what will happen for cranial drawer test and cranial tibial thrust test for patient with TPLO

Answer 33

negative cranial thrust positive cranial drawer

Question 34

main complications of TPLO

Answer 34

fracture of fibula or tibial tuberosity implant failure

Question 35

how does TTA work

Answer 35

move tibial tuberosity forward will put most of the force onto the patella which acts as new "CCL" **decreased cranial tibial force**= decrease shear force between tibia and femur

Question 36

what is the most common meniscal injury

Answer 36

displaced bucket handle tear

Question 37

surgical treatment of meniscal injury

Answer 37

cut out torn piece but try to leave as much normal meniscus as possible to prevent OA and keep hoop stress

Question 38

latent subsequent meniscal injury

Answer 38

present at time of surgery but not identified

Question 39

postliminary subsequent meniscal injury

Answer 39

tear that occurs after surgery

Question 40

how to prevent post op meniscal tears

Answer 40

meniscal release cut meniscus during surgery to try to prevent future tears can lead to cartilage damage and OA in the future do this on older dogs