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134 Cards in this Set
- Front
- Back
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What is the most common cause of hind limb lameness in the dog?
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cranial cruciate ligament rupture
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What movements does the stifle have in the following planes?
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X = flexion/extension
Y = axial rotation Z = translation |
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What are the functions of the CCL?
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1 - limits cranial translation of the tibia with respect to the femur
2 - prevents hyperextension of the stifle 3 - limits internal rotation of the tibia 4 - SOME varus and valgus support to the flexed stifle |
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What is a typical signalment of a CCL rupture?
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higher incidence in females (esp spayed because they are heavier), active, large breeds, straight legged breeds
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What is the etiology of a CCL rupture?
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1 - acute trauma
2 - chronic degenerative changes 3 - conformation |
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What type of acute trauma in dogs commonly causes a CCL rupture?
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avulsion in young dogs
-typically failure of the tibial attachment site |
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What type of conformational changes predispose a dog to getting a CCL rupture?
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1 - postural arthrosis = inflammatory reaction in the joint because of abnormal carriage
2 - stifle hyperextension - straight rear limbs 3 - femoral and tibial conformation 4 - obesity |
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What type of conformational changes specific to the femur predispose a dog to getting a CCL rupture?
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narrowing of intercondylar notch
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What type of conformational changes specific to the tibia predispose a dog to getting a CCL rupture?
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-internal rotation
- abnormal slope of TPA (increased TPA puts stress on the ligament |
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What CS are seen with an acute CCL tear?
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sudden onset of non-weight bearing lameness followed by improvement
*May not improve if there is concurrent meniscal injury |
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What CS are seen with a chronic CCL tear?
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prolonged weight-bearing lameness
-difficulty rising and sitting -sit with affected limb out to the side of the body |
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What CS are seen with a partial CCL tear?
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-mild weight bearing lameness associated with exercise
-may resolve with rest -may last for months |
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What must you differentiate a bilater CCL tear from?
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neuro injury
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What three techniques can you use to help diagnose a CCL injury?
What other two tests are SPECIFIC for CCL? |
-imaging --> radiographs, MRI, US
-arthroscopy -arthrocentesis cranial drawer motion and tibial compression test |
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What are physical exam findings with a CCL injury?
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1 - joint effusion
2- medial buttress 3 - periarticular fibrosis 4 - posture during sitting and standing 5 - crepitus 6 - atrophy is chronic |
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What positions do you perform the cranial drawer motion?
What is normal cranial drawer? |
extension
standing angle - 135 90 flexion -normal is 0-2mm and may need sedation or anesthesia to perform |
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When may it be difficult to elicit a cranial drawer motion?
When might a cranial drawer of 4-5 mm of movement be normal? |
hard if there is periarticular fibrosis
-4-5 mm of movement is normal in immature dogs |
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How many bands does the CCL have and how are they when they are in extension and flecion?
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two bands
- Craniomedial band = taught in extension AND in flexion Caudolateral band = taught in extension and Relaxed in flexion |
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What is the difference when telling apart a CCL partial or complete tear?
How long does it usually take a partial tear to progress to a complete? |
partial = no cranial drawer in extension , drawer in flexion
complete = drawer in extension and flexion - about 1 year |
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What contracts with the cranial tibial thrust?
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the gastrocnemius muscle when the hock is flexed
-must be in 135 deg. in lateral recumbency |
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What is felt on a tibial compression test in a CCL-deficient stifle?
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cranial advancement of the tibial crest as the hock is flexed
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On radiographs, where do osteophytes develop with CCL teat?
What is seen with joint effusion? |
-trochlear ridge
-caudal tibial plateau -distal pole of patella - cranial compression of the fat pad |
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Other than osteophytes and joint effusion, what 4 other things might you find on a radiograph of a CCL rupture?
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1 - articular cartilage degeneration
2 - capsular fibrosis 3 - subchondral sclerosis 4 - thickening of medial fibrous joint capsule |
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When is arthrocentesis indicated in a CCL tear?
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if joint palpation and rads are inconclusive
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What is considered a non-inflammatory arthropathy?
What should you consider if you find a 2-3 fold increase in cell numbers? |
WBC < 5,000/mm3
-consider a partial tear (6,000-9,000 WBC_ |
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What type of synovitis is seen on an arthrocentesis in an animal with a CCL tear?
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lymphoplasmacytic
with increased volume of synovial fluid |
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Elevated collagenase and anticollagen antibodies and immune complexes are often found on arthrocentesis in an animal with a CCL tear. What makes collagenase and what is it inhibited by?
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cartilage cells
doxycycline |
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When is conservative treatment recommended for a CCL tear and what is it?
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-dogs <15 kg and cats
- lameness often resolves in 6 weeks -cage rest, PT, anti-inflammatory pain meds |
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What are the goals of CCL surgery?
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1- remove damaged and abnormal tissue - cruciate and meniscus
2 - stability for periarticular fibrosis or functional stability 3 - retard or prevent severe DJD |
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What 3 techniques can a surgeon choose from for a CCL repair?
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1 - primary repair of the ligament
2 - reconstruction/substitution of the ligament 3 - stabilization of the joint |
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What is the success rate of CCL surgery regardless of the procedure?
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90%
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Primary repair of an avulsion of a CCL is mainly done in patients less than 1 year old. Where is the more frequent site of failure?
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tibial plateau insertion
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What are the 3 categories of surgeries for a CCL?
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-intracapsular
-extracapsular -osteotomies |
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What are the 3 types of osetotomies used for CCL rupture repair?
- biomechanical stabilization to stop tibial thrust movement |
1 - TPLO
2 - Tibial wedge osteotomy 3 - tibial tuberosity advancement |
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What type of autogenous tissue is typically used for intracapsular repair of a CCL?
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fascia lata
(patellar ligament) |
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What are main disadvantages to using an intracapsular CCL repair technique?
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1 - extensive tissue trauma
2- injury to the caudal cruciate 3 - relative technical difficulty and extended surgical time 4 - tendency of graft to stretch and fail - avascular necrosis |
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What technique is most often used with extracapsular technique?
What is important with this tech? |
Lateral fabellar-tibial suture
isometry - isometric points --> maintain equal distance or tension throughout the range of motion |
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What are common origin and insertion points for the lateral fabellar-tibial suture?
What type of needles facilitate easy passage of the suture? |
origin - *lateral fabella (bone anchors are also used in the distal femur)
insertion - *tibial crest (hole is made 1 cm caudal to the tibial tuberosity) --> (also cranial prominance of the extensor groove for the long digital extensor) -J needles |
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True or False. No attempt is made to reconstruct or mimic the action of the CCL with osteotomies?
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TRUE --> stifle stabilization is dependent on active restraint
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What type of forces does the TPLO neutralize?
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tibiofemoral shear forces
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When measuring for a TPLO, what is considered the functional axis of the tibia?
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intercondylar eminences and center of tarsal joint
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What is the ultimate aim of a TPLO and what is the ideal TPA?
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Aim = to reduce the TPA such that the cranial tibial thrust changes from a cranioproximal direction to a neutral or caudal direction (CTT should be gone after surgery)
Ideal TPA is 5-7 degrees --> over rotation would put excessive starin on the caudal cruciate ligament |
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After a TPLO, what is thrust controlled by?
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caudal cruciate and active stifle contraints - Quads
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What type of osteotomy may be beneficial in immature dogs?
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tibial wedge osteotomy
lower osteotomy and not affecting growth plates. |
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What is the aim of a tibial tuberosity advancement?
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to eliminate CTT
to eliminate tibiofemoral shear force during weight bearing |
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In what location is the patellar tendon angled with a Tibial tuberosity advancement?
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perpendicular to the slope of the tibial plateau
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Which procedure affects joint congruency - a TTA or a TPLO?
What does each procedure put strain on? |
TPLO
TTA - more strain on caudal cruciate TPLO - more strain on patellar ligament |
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What is the function of the craudal cruciate ligament?
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-prevents caudal translation of the tibia during flexion
-provides rotational stability in flexion and varus-valgus stabiity in extension |
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What type of options for surgery are there with repairing a caudal cruciate ligament?
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- bilateral extracapsular sutures
-redirecting medial collateral ligament -popliteal tendon tenodesis |
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What type of meniscal injury is most common and why?
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-medial meniscal injury
-has a firm attachment to the tibial plateau and is often wedged between the medial femoral condyle and tibial plateau |
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Does the medial meniscus have a femoral attachement/
The lateral? |
no
yes |
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What is the typical history of a dog with a meniscal injury?
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-acute lameness followed by improvement (initial CCL rupture) with worsening lameness after initial improvement --> meniscal damage
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How often are meniscal tears seen with a CCL rupture and what is the most common type?
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50-75%
long. tear in the caudal body (bucket-handle tear) |
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When is a meniscal release done?
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to preserve grossly normal menisci and prevent injury
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What percentage of dogs that rupture a CCL will rupture the other one within 2 years?
What results regardless of the treatment? |
30-40%
-increases to 60% if there are already radiographic changes in the uninjured leg -osteoarthritis |
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What must you give to the animal if you are to put in an orthopedic implant?
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antibiotics
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What must you be careful of during extracapsular surgery to repair the CCL?
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peroneal nerve (lateral and caudal to stifle)
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What must you be careful of during a TPLO to repair the CCL?
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popliteal artery and vein - just caudal to the tibia proximally
-also medial saphenous vein when inserting distal jig pin |
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How long do animals with osteotomies need to be restricted of exercise?
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8-12 weeks
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Where does the patella normally sit?
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in the femoral trochlea
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What is the patella held in place by?
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-lateral fascia lata and medial femoral fascia
-medial and lateral retinaculum |
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What is medial patellar luxation often associated with?
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femoral and tibial deformitis
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What happens if there is medial malalignment of the quadriceps?
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-increased pressure on the distal medial physis and decreased pressure on the distal lateral physis
-lateral bowing of distal femur |
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What is needed for normal development of the trochlear groove?
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articulation of the patella within the groove
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What type of tibial abnormalities can aid in medial patellar luxation?
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-medial displacement of tibial tuberosity
-medial bowing (varus) of proximal tibia -lateral torsion of distal tibia |
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What is the most common breed to have medial patellar luxation?
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miniature and toy breeds
-Min and toy poodles, yorkshire terrier, pomeranian, pekingese, chihuahua, boston terrier -females more at risk |
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What percentage of luxations are medial in dogs?
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75-80%
-also more common in large breed dogs, but a higher percentage of lateral luxation in large breeds |
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What percentage of medial patellar luxations are bilateral and what percentage have concurrent CCL rupture?
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20-25% are bilateral
-15-20% have concurrent CCL rupture |
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How many grades of there of medial patellar luxation?
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Grade 0 - Grade 4
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What grade is the following: the patella is found (at least once) spontaneously luxated with the animal in a standing position, or is permanently luxated but can be repositioned manually or by manipulating the limbb. Rotation of the tibial tuberoity 30-60degrees.
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Grade 3
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What is the difference in CS of a grade 2 and 3 MPL?
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2 - occasional skipping, but use the limb normally most of the time
3 - occassional skip to weight-bearing lameness |
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What are 6 differentials for MPL?
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1 - avascular necrosis of the femoral head
2 - coxofemoral luxation 3 - ligamentous strain 4 - CCL rupture 5 - muscle strain 6 - hip dysplasia |
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When should you consider surgical treatment for medial patellar luxation
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-lameness or active growth plates
- consider bone reconstruction or soft tissue reconstruction |
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What are the 4 basic techniques for MPL surgery?
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1 - Tibial tuberosity transposition (TTT)
2 - Trochlear Groove deepening (Wedge recession, Block recession are used most commonly) 3 - Medial Retinacular Release 4 - Lateral Retinacular Imbrication |
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What is the basic point of the tibial tuberosity transposition?
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-realigns extensor mechanism
-repositions the patella within the trochlear groove |
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When doing a tibial tuberosity transposition why do you make an osteotomy of the tibial crest?
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that is the insertion of the patellar ligament
-make a transposition of the bone fragment and fixation of the bone fragment with kirschner wires or a tension band (medially) |
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When performing a trochlear wedge recession and removing a V-shaped wedge, what must the wedge include? Where do you widen the defect?
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wedge must include the sulcus
-widen the defect on the side of the luxation and remove subchondral bone from the wedge |
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What are the benefits of a trochlear block recession?
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- increased depth of proximal sulcus
-increased patellar articular contact -greater resistance to luxation when stifle extended -recesses a larger percentage of trochlear surface area |
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What type of procedure is the trochlear sulcoplasty and chondroplasty?
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-trochlear groove deepening
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What animals can you use a trochlear sulcoplasty on and what do you remove articular cartilage and subchondral bone with?
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small
rongerus |
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What is another name for a trochlear chondroplasty and what age dogs is it best on?
What is the idea behind this? |
"Cartilage Flap"
-best on young dogs <5 months old (up to 10 months) - remove subchondral bone and press cartilage flap back into place |
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What are "OTHER" surgical techniques used for a MPL?
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1 - femoral and tibial osteotomy
2 antirotational sutures 3 - quadriceps release 4 - transposition of origin of rectus femoris 5 - transplantation of the cranial head of the sartorius muscle 6 - total patellectomy |
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What type of grade MPL is a quadricpes release used on?
and in what conditions? |
3 and 4
-severe misalignment of quadriceps |
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With a sartorius transplantation used to correct a MPL, how is the CRANIAL head transplanted?
-What does this result in? |
cranial head is transplanted craniolaterally
-decreases medial traction on the patella |
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When would you use a total patellectomy?
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patellar erosion is severe
-other techniques have failed |
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How is a rectus femoris transposition preformed when correcting a MPL?
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-origin is detached from pelvis
-passed thru a tunnel in vastus lateralis -reattached to greater trochanter |
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What grades of MPL have a good prognosis?
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up to and including grade 3
-successful in over 90% of all cases -50% recurrence of grade 1 luxations, but do not need surgery |
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What advice to owners of breeding dogs would you give if you diagnosed a MPL?
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don't breed
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What must you also do with a MPL other than deeping the groove?
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realign the quads
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What is the most common cause of treatment failure with a MPL?
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neglecting to transpose the tibial tuberosity
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Hip Joint laxity/instability leads to what?
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poor joint congruence (subluxation), and abnormal hip development
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Progressive Degeneration leading to canine hip dysplasia consists of what?
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-periarticular osteophyte formation
-deformation of the cartilagious femoral head and acetabulum -structural and biochemical changes in cartilage |
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What 3 factors lead to hip dysplasia?
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genetic --> polygenic (20-60% heritable)
nutritional environemntal |
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What affects growth rate and can cause overloading of soft tissue support and thus hip dysplasia?
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high planes of nutrition --> rapid bone growth and weight gain
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What may excess synovial fluid lead to?
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increased joint laxity and surface tension and hydrostatic pressure --> HD
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What does a low dietary anion gap result in?
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less subluxation (affects synovial fluid volume)
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How does excess dietary Calcium lead to HD?
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1 - increased calcitonin
2 - decreased osteoclast activity and remodeling 3 - decreased hip and cartilage maturation |
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Other than Calcium, what 3 nutrients may aid in the formation of HD?
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1 - Vitamin C --> increases Calcium retention
2 - Vitamin D -- >increases Calcium 3 - Protein |
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Does exercise change the development of hip dysplasia?
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no
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Do growth plates close earlier or later with over fed dogs?
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earlier
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What is the age distribution of dogs with hip dysplasia?
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bimodal
3-12 monts > 3years |
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What are typical CS in young dogs with hip dysplasia?
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acute lameness with coxofemoral laxity
-bunny hopping gait -hard time climbing stairs -hard time rising -UNUSUAL to have non-weight bearing lameness |
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What are DD for young dogs with HD?
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1 - HOD
2 - panosteitis 3 - OCD 4 - Physeal fractures 5 - CCL rupture |
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What are DD for mature dogs with HD?
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1 - LS Disease
2 - Discospondylitis 3 - IVDD 4 - degenerative myelopathy 5 - polyarthritis 6 - CCL rupture 7 - bone neoplasia |
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What type of test is done in young patients to shoe evidence of HD?
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Ortalanit Test
- subluxation -abduction - reduction |
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What are key PE findings of dogs with HD?
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- crepitus and pain on flexion and extension of the hip
-muscle atrophy -swaying gait - base -narrow stance -short, stiff stride |
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What views should you use to evaluate for HD radiographically?
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1 - hip extended view (OFA)
2 - Distraction View (PennHIP) |
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What is considered hip dysplasia on a hip extended view?
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coverage of <50-60% of the femoral head by the dorsal acetabular rim
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What is the hip extended view good for? (OFA)
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DJD
-moderate for laxity -poor repeatability -gets better with age |
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What are the 7 points of the OFA scoring system?
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normal: fair, good, excellent
borderline dysplastic: mild, moderate, severe |
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What does the OFA assess hip joints for?
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- degernerative OA
-congrucence: Wilberg angle and percent coverage |
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What age must dogs be in order to be reviewed by OFA?
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>2
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What are the major concerns with OFA?
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- subjective scoring, based on unnatural position for dogs
-Not sensitive to detect early/mild laxity -incidence of HD still high in population |
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What 3 views are used for Penn HIP?
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-hip extended
- compression -distraction --> distraction indices are obtained and compared to breed standards - need sedation |
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Why is Penn HIP better for detecting HD?
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- excellent for hip laxity - more objective
-excellent repeatability of method and interpretation -reliable predictability and consistency from 4 months of age - ONLY thing is that is is only moderate for DJD (compared to OFA) |
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What do the following numbers mean with the PennHIP distraction index?
0 1 0.5 What type of laxity does it measure? |
0 - fully congruent joint
1 - luxated joint 0.5 - 50% subluxation - measures passive laxity |
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What distraction index is considered disease suseptible?
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>0.3
-but some breeds are more laxity tolerant |
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How much more sensitive is pennhip than the hip extended view?
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2.5x
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Acetabular rotation is done on immature patients with HD and no osteoarthritis? What are these 2 procedures called?
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1 - pubic symphysiodesis
2 - triple pelvic osteotomy |
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What are the 2 salvage procedures done for HD?
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1 - total hip replacement
2 - femoral head and neck ostectomy |
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What are the 3 focus areas for conservative management for HD?
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1 - PT
2 - medical 3 - nutritional |
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What are NSAIDS you can give to a dog with HD?
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carprofen, etogesic, deracoxib, aspirin
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What are glycosaminoglycans you can give to a dog with HD?
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- adequan, cosequin
- good for immature dogs, but not for adult dogs with DJD |
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When is a juvenile pubic symphysiodesis done and what type of procedure is it?
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- done at 4-5 months of age (better if earlier)
- preventative procedure that induces pubic bone physeal closure (therefore needs open physes) |
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A juvenile pubic symphysiodesis causes closure of the pubic bone, but continued growth of what?
What does this result in? |
ilium and ischium
--> this results in a ventrolateral rotation of the acetabulum (15 degrees) - results in increased hip coverage and decreased hip laxity |
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What type of procedure is a triple pelvic osteotomy?
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-preventative
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What are the indications for a triple pelvic osteotomy?
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-clinical signs
-improve coxofemoral joint congruity -young dog -min to no degenerative changes |
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What are complications to a triple pelvic osteotomy?
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-pelvic canal narrowing --> constipation
- urethral injury -implant failure/infection - sciatic or internal obturator nerve damage -over rotation -progression of DJD |
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What is the success rate of tripple pelvic osteotomy?
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72--92%
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What type of procedure is an FHO for HD?
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salvage to relieve pain
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What is important in aftercare for FHO?
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-early, active use of the limb --> PT (PROM exercises)
-swimming and leash activity |
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What is the prognosis for a FHO?
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-depends on post-op rehab, activity of dog, muscle atrophy
-up to 83% satisfactory outcome |
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What are complications to a total hip replacement?
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1 - luxation
2 - infection 3 - aseptic loosening of implants 4- implant failure 5 - fracture of femoral shaft 6 - sciatic nerve injury 7 - sarcoma |
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What is the prognosis for a total hip replacement?
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91-95% excellent to good
-can return to normal function |
