Lecture 8- Cranial Cruciate Ligament Injury/Disease II

What are the two major treatment categories for CCL disease?

Surgical treatment and conservative/medical management.

Why is surgery recommended for most dogs with CCLD?

Slows progression of arthritis and minimizes lameness ("Surgery recommended to slow down progression of arthritis & eliminate/minimize lameness.")

Which dogs may improve without surgery?

Dogs <20-25 lbs, though progressive DJD still occurs.

What degenerative changes occur with conservative therapy?

Periarticular osteophytes, articular erosions, meniscal damage.

What does conservative therapy typically include?

Medications, exercise modification, joint supplements, possibly braces/orthotics.

What is the effect of activity restriction and NSAIDs?

Lameness waxes/wanes; improves with pain meds and rest; small dogs may become sound, large dogs usually retain some lameness.

What limits return to normal activity in conservatively managed dogs?

Progression of arthritis.

What is the role of rehabilitation therapy?

Speeds recovery post‑surgery; limited evidence as a standalone alternative.

When might rehab be used instead of surgery?

Concurrent injuries, advanced age, patient size, financial limitations.

What is the role of custom knee bracing?

Useful for selected patients; temporary solution; not ideal for young active dogs.

Does surgery fully restore normal stifle anatomy?

No — stabilization slows arthritis but does not reverse it ("Surgery does NOT completely restore normal joint anatomy & function.")

What must be performed in all surgical CCL cases?

Arthrotomy or arthroscopy.

What is the purpose of CCL surgery?

Not to repair the ligament, but to stabilize the stifle.

What are the two broad categories of CCL surgical techniques?

Extra‑articular and intra‑articular.

What do extra‑articular techniques do?

Exert restraints on joint motion; mimic CCL action.

What is the clinical success rate of current surgical methods?

~90% good to excellent outcomes.

Do any techniques prevent progressive DJD?

No — arthritis continues regardless of technique.

How common is isolated caudal cruciate ligament (CaCL) injury?

Rare; usually occurs with CCL and collateral ligament injury.

How is CaCL injury diagnosed?

Caudal drawer movement; tibia appears caudally subluxated; cranial drawer may actually be reduction of subluxation.

What imaging is important for CaCL injury?

Radiographs to assess associated injuries.

What surgical approach is used for CaCL rupture?

Extracapsular imbrication; correct all injuries simultaneously.

What are the functions of the menisci?

Shock absorption, stability, lubrication; peripheral 15% vascularized, central 85% nourished by synovial diffusion.

Are isolated meniscal lesions common?

No — usually secondary to stifle instability.

Which meniscus is more commonly injured?

Medial meniscus.

Why is the lateral meniscus less commonly injured?

Meniscofemoral ligament increases mobility and protects it.

What is the most commonly damaged part of the meniscus?

Caudal horn of the medial meniscus.

What causes meniscal injury in CCL rupture?

Crushing/shearing forces during abnormal internal rotation.

What are the types of meniscal tears?

Radial (axial→abaxial), circumferential/longitudinal, bucket‑handle (circumferential with separation).

What is a meniscal release?

Midbody or meniscotibial incision to prevent future impingement.

What clinical sign suggests meniscal injury?

Meniscal click — clicking/snapping on palpation or weight‑bearing.

What does sudden lameness in a chronic CCL dog indicate?

Possible meniscal tear.

How can a displaced meniscus affect drawer testing?

Acts as a wedge preventing drawer movement.

What is the gold standard for diagnosing meniscal injury?

Arthroscopy or surgical exploration.

What are the main surgical options for ruptured CCL?

Intracapsular reconstruction, extracapsular stabilization, corrective osteotomy (TPLO, TTA, TWO, CBLO).

How common is contralateral CCL rupture?

>50%; increases to 60% if radiographic changes present in "uninjured" joint.

What factors determine surgical method selection?

Surgeon preference, patient size/function, cost.

What do intracapsular techniques involve?

Passing autogenous tissue ("over‑the‑top") through predrilled bone tunnels.

What is the most common intracapsular graft material?

Autogenous fascia lata.

What are disadvantages of intracapsular reconstruction?

Invasiveness; graft stretching or failure; risk of inflammation/infection.

What is the advantage of intracapsular reconstruction?

Most closely mimics original CCL position and biology.

Why are synthetic grafts rarely used?

Stretching, rupture, inflammatory reactions.

Why are allografts not widely used?

Limited adoption for CCL reconstruction.

What is the goal of extracapsular and intracapsular procedures?

Recreate passive constraints of the stifle (CCL, capsular fibrosis).

What is the purpose of corrective osteotomy techniques?

Alter biomechanics to neutralize cranial tibial thrust (e.g., TPLO).

What is the meniscofemoral ligament's significance?

Protects lateral meniscus → isolated lateral tears are rare.

What are the classifications of meniscal injuries?

Transverse radial tear, longitudinal/bucket‑handle tear, medial peripheral detachment, folded caudal horn.

What is the most common meniscal tear pattern in CCL rupture?

Medial meniscus caudal horn bucket‑handle tear.

What is the mechanism of medial meniscal crushing?

Medial femoral and tibial condyles shear the meniscus during weight‑bearing.

What is the role of radiology in meniscal injury?

Limited; used mainly to rule out other pathology.

What is the role of arthroscopy in CCL surgery?

Direct visualization of meniscus and joint structures; gold standard.

What is the key principle of CCL surgery?

You are stabilizing the stifle, not repairing the ligament.

What should surgeons be prepared for intraoperatively?

Alter procedure based on findings ("Something changes intraoperatively!")

What is the long‑term prognosis after CCL surgery?

Good to excellent function in ~90% of cases, but arthritis progresses.