Collateral and Multiple Ligament Injury/Meniscal Injury

Lecture 10

A ligament injury is referred to as what?

sprain

A muscle tendon unit injury is referred to as what?

strain

What is the function of the medial and lateral collateral ligaments?

limit varus-valgus motion of stifle joint

The stifle joint must be in what position to examine for collateral ligament injury?

extension

The valgus stress test evaluates the ____ collateral ligament.

medial

The varus stress test evaluates the ____ collateral ligament.

lateral

Describe how to perform the valgus stress test.

patient in lateral recumbency

one hand stabilizes femur while other hand grasps distal tibia and applies upward force (abduction)

if medial joint restraint is torn then you see opening of medial joint line

Describe how to perform the varus stress test.

patient in lateral recumbency

one hand stabilizes femur while other hand grasps distal tibia and applies inward force (adduction)

if lateral joint restrain is torn, then you see opening of lateral joint

Why should you perform radiographs in cases of collateral ligament rupture?

determine presence of bony fragments associated with ligament damage

stress radiographs show increase in medial or lateral joint space

What differential diagnoses are associated with collateral ligament tear?

muscle strains

cranial or caudal cruciate ligament tears

nondisplaced physeal fractures in immature animals

What is the criteria for conservative treatment of collateral ligament injury?

minimal swelling and only slight opening of joint space with stress test

1st degree sprain

Conservative or surgical treatment for isolated colalteral ligament injury is based on what?

degree on injury

What is the criteria for surgical treatment of a collateral ligament injury?

moderate to severe swelling and significant opening of joint space with stress test

2nd and 3rd degree sprains

Surgical treatment of a collateral ligament injury includes what?

reconstruction of all injured ligaments, tendons, and joint capsule

In what cases is a primary surgical repair of collateral ligaments performed?

point of failure is origin or insertion of ligament

an intrasubstance tear with large segments of ligament intact

What should be done prior to surgery for collateral ligament injury to prevent additional damage to articular cartilage or menisci?

place modified robert jones bandage on limb

limit activity to leash walking

What should be done during preoperative management for collateral ligament injury repair?

prevent additional damage to articular cartilage or menisci

for patients HBC —> thoracic, CV, abdominal evals

perioperative antibiotics and preemptive pain management with NSAIDs, opioids, and epidural analgesia

The medial collateral ligament runs deep to what muscle?

sartorius

The medial collateral ligament originates from where?

medial femoral epicondyle

The medial collateral ligament inserts where?

proximal tibial metaphysis

As the medial collateral ligament crosses medial joint line, it has a strong attachment to what?

joint capsule and medial meniscus

The lateral collateral ligament originates from where?

oval area on lateral femoral epicondyle

The lateral collateral ligament inserts where?

fibular head

The lateral collateral ligament lies deep to what?

fascia lata

You have to be careful when dissecting near the lateral collateral ligament to preserve what nerve?

peroneal (fibular) nerve

Describe the basics of a repair of a lateral restraint injury.

craniolateral approach

proximal to distal parapatellar incision

continue incision distally 4cm below tibial creat parallel to joint line (protect peroneal nerve)

reflect fascia lata caudally to expose collateral ligament and lateral joint capsule

repair ligament

Describe the basics of a repair of a medial restraint injury.

incise insertion caudal head of sartorius muscle and deep fascia long craniomedial border of proximal tibia

replace ligament to its anatomically site ad secure with screw and spiked washer

What is the prognosis for isolated collateral ligament tears?

good to excellent

What is the prognosis if multiple ligaments are torn?

fair

Injuries where cranial or caudal cruciate ligaments and collateral ligaments are damaged simultaneously are caused by what?

HBC or other major trauma

What makes identification of surgical anatomy challenging during collateral ligament repair?

swelling and bruising of soft tissue

ligaments encased in edematous connective tissue

menisci displaced from normal positions and folded cranially or caudally

What is the common triad seen in mutliple stifle ligament injuries?

cranial and caudal cruciate ligament tears

failure of primary and secondary medial restraints

peripheral medial meniscal tears

What are the two locations of release for the medial meniscus?

transection of meniscotibial ligament

transection of midbody of meniscus

True or false: There is uncertain efficacy associated with meniscsal release and no clinical study demonstrates efficacy of meniscal release in decreasing incidence of post TPLO meniscal injury.

True

What results from midbody release or transection of meniscotibial ligament?

femoral condyle increases contact with articualr cartilage of tibial plateau which contributes to OA

impairs functions of meniscus to provide stability and congruence

True or false: Conservative treatment is not an option in cases of meniscal injuries.

True

Meniscal injuries accelerates what other condition?

DJD

What are the three methods of surgical treatment for meniscal injuries?

partial meniscectomy

primary repair of peripheral meniscal injuries

total meniscectomy

Which carries less morbidity: total meniscectomy or partial meniscectomy?

partial meniscectomy

What is the treatment of choice for bucket handle tears of the medial meniscus?

partial meniscectomy

In dogs, a primary repair is reserved for what type of meniscal injuries?

peripheral tears

Total meniscal removal induces what in the stifle?

severe DJD

What procedure is considered only when the peripheral rim of the meniscus is so damaged that primary suturing of the meniscocapsular tissue is not possible?

total meniscectomy

True or false: The more meniscal tissue removed, the more rapidly OA develops.

True