8. Cranial Cruciate Lig Injury/Disease 2

to slow down progression of arthritis and eliminate/minimize lameness

when is sx. indicated for CCL injury/disease

always indicated

sx. for CCL injury/disease in large breed dogs

depends on state of disease and if conservative tx. may be helpful

sx. for CCL injury/disease in small breed dogs

dogs <20-25lbs

what is the cut off point for conservative therapy for CCL injury/disease in dogs

1. periarticular osteophytes

2. articular erosions

3. meniscal damage

what are some of the degenerative changes associated with progressive DJD

1. medications

2. exercise modification

3. joint supplements

4. braces/orthotics

what does conservative therapy for CCL injury/disease involve

speed recovery from sx.

rehabilitation therapy by a trained rehab practitioner can _____ but there is little evidence it is an alternative to sx.

1. sx. does NOT completely restore normalcy

2. despite sx. arthritis will still progress

ket considerations for sx. tx. of CCLD

stabilization

what is a key aspect to slowing the progression of arthritis following sx. tx. of CCLD

non-reversible

arthritis is a (non-reversible/reversible) disease

arthrotomy/arthroscopy

we should perform ____ on all surgical cases for CCLD

extra-articular techniques can exert restraints on joint motion and will mimic the action of CCL

why is the surgical consideration of extra-articular vs. intra-articular CCLD important...

repairing the cruciate; stabilizing the stifle

when you are performing cruciate sx. you are NOT ______ but rather _____

offer appropriate referral options to clients

in terms of clinical conclusions for cruciate sx., you should be able to...

90% subjective evaluation of good to excellent

it is currently reported that any current sx. method (extracapsular or intracapsular) results in a _____ results

no techniques...

are there currently techniques to prevent progressive DJD

caudal cruciate/CaCL

_____ injury alone is rare and is often associated with concurrent dommage to CCL or collateral lig.

done by caudal drawer but more importantly...RADs

in terms of CaCL diagnostics

caudal cruciate lig. rupture

what is shown here...

CaCL rupture w/ medial collateral lig. tear

what is shown here...

extracapsular imbrication...done in opposite direction of CCLD placement

what technique is used to sx. repair CaCL rupture

shock absorber, increase stability, aid in lubrication

primary roles of meniscus

15%

the peripheral ___ of the meniscus is vascularized

synovial diffusion

the central 85% of the meniscus is nourished by ____

isolated meniscal lesions are rare and are typically a secondary injury

in terms of general incidence of meniscal injury...

meniscofemoral lig

what structure attaches lateral meniscus to femur and helps to spare lateral meniscus following CCL tear

medial collateral lig/MCL

what structure firmly attached medial meniscus to joint capsule...makes the medial meniscus more likely to be damaged

medial meniscus

in terms of meniscal pathophysiology, injury most commonly occurs to ____ during abnormal internal rotation

rupture of CCL

meniscal injuries are often associated with ____

caudal horn of medial meniscus

what is the most often damaged part of the meniscus----can be folded

medial femoral and tibial condyles crush and shear meniscus

how does meniscus actually suffer damage during weight bearing....

radial tears

what form of meniscal tears run in acial to abaxial damage

follow curvature of meniscus

how would you describe circumferential/longitudinal tears of the meniscus

form of circumferential/longitudinal tear w/ separation of meniscus at site of tear

define the bucket handle tears of the meniscus

meniscotibial incision of medial meniscus intended to prevent future meniscus impingement and damage

what is meniscal release

transverse radial tear

A

longitudinal or bucket handle tear

B

medial peripheral detachment w/ shredding of cartilage

C

folded caudal horn

D

meniscofemoral ligament

what makes isolated lateral meniscal tears RARE

clicking or snapping sound during palpation or wt. bearing

what is the "meniscal click"

meniscal injury

sudden lameness in dog w/ CCL rupture may indicate ____

arthroscopy and surgical exploration

what are the primary diagnostics for meniscal injury

reviewed

you should review this...meniscofemoral lig, CaCL, CCL, M and L meniscus/horns

1. intracapsular and extracapsular reconstruction

2. corrective osteotomy like TPLO, TTA, TWO, CBLO

3. primary repair w/ augmentation

what are the sx. tx. options for a ruptured CCL

>50%

injury of contralateral cruciate lig. occurs in ____ of patients following sx. tx. of ruptured CCL

radiographic changes are visible in "uninjured joint"

the percent of patients that suffer contralateral CCL rupture following sx. to 60% if ____

1. surgeon preference

2. patient size and function

3. cost of procedure

what factors determine CCL sx. repair method

90%

there is a success rate of near _____ regardless of the CCL sx. repair technique

most closely mimic original position and biology of original CCL

primary advantage of intracapsular reconstruction using autogenous tissue

invasiveness and tendency of graft to stretch/fail due to inability to properly restrict dogs

primary disadvantages of intracapsular reconstruction using autogenous tissue