Lecture 10- Collateral and Multiple Ligament Injury & Meniscal Injury

What does the valgus stress test evaluate?

MCL integrity; opening of the medial joint line indicates injury ("If medial joint restraints torn → see opening of medial joint line.")

How is the valgus stress test properly performed?

Patient in lateral recumbency; stabilize femur with one hand, apply upward/abduction force to distal tibia ("One hand stabilizes femur... applies upward force (abduction).")

What does the varus stress test evaluate?

LCL integrity; opening of the lateral joint line indicates injury ("If lateral joint restraints are torn → see opening of lateral joint.")

How is the varus stress test properly performed?

Patient in lateral recumbency; stabilize femur, apply inward/adduction force to distal tibia ("Applies inward force (adduction).")

What is the purpose of valgus/varus stress testing?

Assess integrity of medial and lateral collateral ligaments by observing joint line opening under stress.

What is the common triad of injuries in multiple ligament stifle injury?

Cranial & caudal cruciate ligament tears + failure of primary/secondary medial restraints + peripheral medial meniscal tears ("Common Triad of Injuries includes...")

What is meant by "deranged stifle"?

Multiple ligamentous injuries, often with meniscal injury, resulting in stifle luxation ("Term 'Deranged Stifle'... resulting in luxation of stifle joint.")

What does current literature show about efficacy of meniscal release in preventing post‑TPLO meniscal tears?

No clinical studies demonstrate decreased incidence; technique remains widely used despite uncertain efficacy ("No clinical studies demonstrate efficacy... but technique remains in widespread use.")

Why is meniscal release controversial?

Compromises meniscal function by eliminating hoop stresses; increases femoral condyle contact with tibial cartilage; contributes to OA ("Function... compromised... contributes to osteoarthritis.")

What are the two locations where meniscal release may be performed?

Transection of meniscotibial ligament OR mid‑body transection ("Locations... A. meniscotibial ligament; B. midbody.")

What are advantages of partial meniscectomy?

Less morbidity than total meniscectomy; preserves more meniscal function; treatment of choice for bucket‑handle tears ("Partial meniscectomy carries less morbidity... treatment of choice...")

What are disadvantages of partial meniscectomy?

Still removes tissue → some loss of stability and congruence; may contribute to OA progression.

What are advantages of total meniscectomy?

Allows removal when peripheral rim is too damaged for repair ("Considered only when peripheral rim... not possible.")

What are disadvantages of total meniscectomy?

Induces severe DJD; more meniscal tissue removed → more rapid OA development ("Total meniscal removal induces severe DJD... more tissue removed → more rapidly OA develops.")

When is total meniscectomy indicated?

Only when peripheral rim is so damaged that primary suturing is not possible.

When is primary meniscal repair indicated in dogs?

Peripheral tears only; uncommon due to difficulty and low morbidity of partial meniscectomy ("In dogs: primary repair reserved for peripheral tears... uncommon.")

Why is conservative management NOT an option for meniscal tears?

Sliding of torn meniscus causes severe pain, will not improve, accelerates DJD ("Causes severe pain... will not improve... accelerates DJD.")

When might rest/splinting be considered for meniscal injury?

Only if the joint is stable ("May be appropriate in stable joint.")

What is the function of the collateral ligaments?

Limit varus-valgus motion of the stifle ("Limit varus‑valgus motion of stifle joint.")

What degree sprain corresponds to complete ligament tear?

3rd degree ("3rd degree ⇒ complete.")

What findings support conservative management of collateral ligament injury?

Minimal swelling + slight joint opening on stress test; 1st‑degree sprain ("Minimal swelling & only slight opening... 1st degree sprain.")

What is the conservative treatment protocol for 1st‑degree collateral sprain?

Fiberglass cast 2 weeks → controlled activity 6 weeks.

What findings indicate need for surgical repair of collateral ligament injury?

Moderate-severe swelling + significant joint opening; 2nd-3rd degree sprains ("Moderate to severe swelling & significant opening...")

What structures must be repaired in surgical treatment of collateral ligament injury?

Collateral ligament(s), meniscocapsular ligaments, joint capsule ("Be sure to repair all injured ligaments, tendons, & joint capsule.")

What is the prognosis for isolated collateral ligament tears?

Good to excellent.

What is the prognosis for multiple ligament injuries?

Fair ("If multiple ligaments are torn prognosis is fair.")

What imaging modality confirms collateral ligament injury severity?

Stress radiographs showing increased medial or lateral joint space ("Stress radiographs... show increase in medial or lateral joint space.")

What is the best diagnostic method for meniscal injury?

Arthroscopy or surgical exploration ("Arthroscopy! Surgical exploration!")

What are common associated injuries in multiple‑ligament trauma?

Collateral tears, cruciate tears, displaced/folded menisci ("Menisci often displaced... torn cruciates... disruption of medial restraints.")

What preoperative management is recommended to protect joint structures?

Modified Robert Jones bandage + leash walking until surgery.

What analgesia is recommended perioperatively for stifle reconstruction?

NSAIDs, opioids, epidural analgesia ("Indicated for animals undergoing stifle reconstruction.")