CCL III

Question 1

what does extracapsular reconstruction involve?

Answer 1

placement of sutures outside the joint

Question 2

what has significant effects on isometry of the joint regarding extracapsular reconstruction?

Answer 2

location of origin and insertion of extracapsular suture

Question 3

where are extracapsular sutures also secured from?

Answer 3

bone anchors

Question 4

what materials are used in extracapsular sutures?

Answer 4

monofilament nylon or fishing or leader line, manufactured orthopedic wire, braided ortho wire

Question 5

How are sutures tied or connected during extracapsular reconstruction?

Answer 5

with a crimp - crimping suture alters biomechanical properties of loop

Question 6

what method of reconstruction is this

Answer 6

extracapsular reconstruction

Question 7

how is suture passed during extracpasular reconstruction?

Answer 7

passes thru deep fascia surrounding lateral fabella and predrilled hole in tibial crest - tying suture eliminates cranial drawer

Question 8

what are true imbrication techniques?

Answer 8

usually in addition to another technique, performed by tightening fascia lata

Question 9

what does the CCL function as regarding stifle biomechanics?

Answer 9

functions as passive constraint to cranial tibial translation and internal rotation of tibia

Question 10

what does a larger tibial plateau angle indicate?

Answer 10

greater cranial force on tibia during wt bearing

Question 11

what does a vector force in tarsus create?

Answer 11

creates a simultaneous force through patellar ligament

Question 12

what is a vector force in the tarsus?

Answer 12

sum of resulting forces of weight bearing

Question 13

when the paw is loaded during weight bearing, what occurs?

Answer 13

force created through foot to metatarsus and tarsus, calcanean tendon reacts with second force to maintain stability

Question 14

what does the combination of forces in the stifle result in?

Answer 14

results in vector force in plane parallel to patellar ligament at standing weight bearing angle of stifle

Question 15

if the slope of the tibial plateau is not anatomically oriented perpendicular to the patellar ligament on weight bearing:

Answer 15

tibiofemoral shear force results - cranial tibial thrust force. This ctt force accommodated for in normal animal by CCL

Question 16

the shear component of compressive of tibia is referred to as

Answer 16

cranial tibial thrust

Question 17

how is CTT normally constrained?

Answer 17

by the CCL

Question 18

the CTT is proportional to what?

Answer 18

the slope of the tibial plateau

Question 19

why would the tibial plateau slope be reduced?

Answer 19

so tibial thrust changes from cranioproximal direction to a neutral or caudal direction

Question 20

the point where the tibial thrust changes direction to a caudal thrust does what?

Answer 20

increases reliance on caudal cruciate ligament

Question 21

what is the intent of the TPLO surgery?

Answer 21

attain a tibial plateau slope of approx 5-7 degrees

Question 22

where tibial thrust can be controlled by caudal cruciate ligament and active constraints of stifle?

Answer 22

quadriceps muscle group

Question 23

what does the CCL passively constrain?

Answer 23

internal rotation forces of tibia

Question 24

failure to control internal rotation resulting in what?

Answer 24

drawer w internal rotation referred to as “pivot shift”

Question 25

what is the significance of pivot shift to functional outcome following TPLO surgery?

Answer 25

uncertain

Question 26

when is TPLO effective?

Answer 26

for dogs with complete or partial tear of CCL

Question 27

what do many surgeons prefer the TPLO for?

Answer 27

treating larger, active dogs because long term rehabilitation and post op control is difficult

Question 28

how is the jig positioned to the long axis of the tibia?

Answer 28

perpendicular to long axis

Question 29

perform osteotomy of tibia to what depth?

Answer 29

depth of 1/3 of bone with saw parallel to jig pins

Question 30

what do preop rads of dog show prior to TPLO?

Answer 30

measurement of tibial slope

Question 31

what do postop lateral rads show of dog after TPLO?

Answer 31

show leveling of tibial slope for stabilization of CCL deficient stifle joint

Question 32

what is the forerunner of tplo

Answer 32

Tibial wedge osteotomy

Question 33

what may the TWO be associated with in regards to stifle extensor mechanism?

Answer 33

associated with complications because lower osteotomy results in change of relative position of tibial crest

Question 34

what is the TWO technique utilized for?

Answer 34

management of CCLR and increased TPA in young dogs with open proximal tibial physis

Question 35

does TWO affect physes like the TPLO surgery?

Answer 35

will not affect physes

Question 36

what does the tibial tuberosity advancement do to the patellar ligament?

Answer 36

positions patellar lig 90 degrees to slope of tibial plateau by advancing insertion in cranial direction

Question 37

the TPLO procedure does the same redirection of vector force as the TTA, but what does it do to the patellar ligament?

Answer 37

TPLO increases tension on patellar ligament, whereas TTA reduces patellar ligament tension

Question 38

true or false: the TPLO has less postopertive patellar ligament inflammation than TTA?

Answer 38

false: TTA has less postop patellar ligament inflammation than TPLO

Question 39

what are the biomechanics of TTA?

Answer 39

TTA places patellar ligament 90 deg to slope of tibial plateau by advancing insertion in cranial direction

Question 40

what does the TTA eliminate?

Answer 40

eliminates tibiofemoral shear force with wt bearing and relieving function of the CCL

Question 41

what should be done regardless of the technique used for surgical treatment of ruptured CCL

Answer 41

meniscus inspected by arthrotomy or arthroscopy, id tears or other evidence of trauma

Question 42

damage to the caudal body of the medial meniscus is seen in what percentage of patients with a torn CCL?

Answer 42

50-75%

Question 43

what type of meniscus tear do most patients have?

Answer 43

bucket handle tear

Question 44

what are complications of the CCL sx?

Answer 44

infection, lack of stabilization, meniscal injury, progressive OA

Question 45

what do patients with poor outcome following CCL repair need?

Answer 45

thorough evaluation for potential complications

Question 46

what are some complications of TPLO?

Answer 46

patellar tendon desmitis, tibial crest fracture

Question 47

what are some complications of TTA?

Answer 47

tibial crest fx, patellar luxation

Question 48

what is the prognosis for CCL surgery regarding long-term function?

Answer 48

good

Question 49

true or false: results of the CCL surgery are the same regardless of method of reconstruction

Answer 49

false: results conflicting regarding influence of method of reconstruction

Question 50

most published assessments of outcome state what percentage of dogs improve after CCL surgery?

Answer 50

85-90% of dogs improve

Question 51

what disease progresses regardless of treatment of CCL?

Answer 51

DJD

Question 52

what are the long term outcomes with CCL sx?

Answer 52

decline in activity over time, increasing level of disability, adverse response to cold, stiffness after inactivity due to DJD