Collateral and Multiple Ligament Injury

Question 1

what is a collateral ligament injury?

Answer 1

complete or partial tear of medial or lateral collateral lig

Question 2

what does a ligament injury lead to?

Answer 2

sprain

Question 3

what does a muscle tendon unit injury lead to?

Answer 3

strain

Question 4

when do injuries to the medial or lateral collateral ligaments occur?

Answer 4

with injury to other primary and secondary restraints of stifle joint

Question 5

when do multiple lig injuries occur?

Answer 5

result from severe trauma to stifle joint

Question 6

how is the stifle joint manipulated for examination of collateral injury?

Answer 6

stifle joint is extended

Question 7

what does the valgus stress test evaluate

Answer 7

medial collateral lig

Question 8

what does the varus stress test evaluate

Answer 8

lateral collat lig

Question 9

what do radiographs show in regards to collateral lig damage?

Answer 9

determine if bone fragments associated with lig damage

Question 10

when are craniocaudal and medial-lateral radiographs indicated?

Answer 10

confirm presence or absence of bony avulsions

Question 11

what are ddx for collateral lig injuries

Answer 11

muscle strains, cranial or caudal cruciate lig tears, nondisplaced physeal fractures

Question 12

conservative or sx tx for isolated collateral lig injury is based on degree of injury to:

Answer 12

collateral lig itself, secondary joint restraints

Question 13

what is the criteria for medical management of collateral lig?

Answer 13

minimal swelling and slight opening of joint space with stress test

Question 14

what is a 1st degree sprain?

Answer 14

minimal swelling and slight opening of joint space w stress test

Question 15

when is surgical treatment indicated?

Answer 15

moderate to severe swelling and significant opening of joint space with stress test

Question 16

what does surgical tx include reconstruction of?

Answer 16

collateral lig, meniscocapsular lig, joint capsule

Question 17

what must you be sure to do during sx tx of collateral lig

Answer 17

be sure to repair all injured lig, tendons, and jt capsule

Question 18

primary repair of collateral lig done if…

Answer 18

point of failure is origin or insertion of lig, or an intrasubstance tear w large segments of lig intact

Question 19

to prevent additional damage to articular cartilage or menisci, what bandage is placed?

Answer 19

modified Robert Jones

Question 20

What should be evaluated on patients with injuries from hit by cars?

Answer 20

Thoracic, cardiovascular and abdominal evaluation

Question 21

What can be used as preoperative antibiotics and preemptive pain management?

Answer 21

Nsaid, opioids, epidural analgesia

Question 22

what is important to know about collateral ligaments?

Answer 22

Origin and insertion points

Question 23

where does the medical collateral ligament attached to?

Answer 23

Strong attachment to joint capsule and medial meniscus

Question 24

what muscle does medial collateral ligament lie deep to

Answer 24

caudal sartorius muscle

Question 25

what is important to preserve when dissecting near the lateral collateral ligament?

Answer 25

Preserve the peroneal or fibular nerve

Question 26

During repair of a medial restraint injury, what is incised?

Answer 26

Sartorius muscle and deep fascia along cranial medial border of proximal tibia

Question 27

if the ligament injury is intrasubstance tear, primary repair by ligament ends with what

Answer 27

Locking loop suture pattern

Question 28

if the ligament injury is intrasubstance tear, how is the primary repair supplemented

Answer 28

screws and figure 8 support

Question 29

what is this?

Answer 29

Locking loop

Question 30

what is this?

Answer 30

Three loop pulley

Question 31

What is this?

Answer 31

bunnell suture

Question 32

what is this?

Answer 32

far-near-near-far

Question 33

What approach is used to expose the lateral collateral ligament?

Answer 33

Craniolateral approach

Question 34

what type of incision is made through the fascia lata from proximal to distal approach

Answer 34

Parapatellar incision

Question 35

how is the incision continued for centimeters below the tibial crest parallel to the joint line during repair of lateral restraint injury

Answer 35

Continue incision distally

Question 36

during repair of a lateral restraint injury, The fascia lata is reflected caudally to expose what

Answer 36

Collateral ligament and lateral joint capsule

Question 37

what is the prognosis for isolated collateral ligament tears

Answer 37

good to Excellent

Question 38

if multiple ligaments are torn, What is the prognosis?

Answer 38

Fair

Question 39

injuries where cranial or caudal cruciate ligaments and collateral ligaments are damaged simultaneously are caused by what

Answer 39

Hit by car, or other major trauma

Question 40

why are torn collateral ligaments difficult to identify

Answer 40

Often encased in edematous connective tissue

Question 41

what structures are commonly injured with multiple ligament derangement of the stifle joint?

Answer 41

medial collateral ligament, caudal cruciate ligament, cranial cruciate ligament

Question 42

what are the common triad of injuries?

Answer 42

Cruciate ligament tears, failure of medial restraints, medial meniscal tears

Question 43

what is the prognosis of multiple ligament injuries

Answer 43

fair

Question 44

what are the locations of release of the medial meniscus?

Answer 44

Transection of meniscotibial ligament, and transection of mid body of meniscus

Question 45

why is Meniscal release controversial

Answer 45

uncertain efficacy

Question 46

by transecting meniscus, how is the function of meniscus compromised?

Answer 46

elimination of hoop stresses

Question 47

with mid body release or transection of meniscotibial ligament what does the femoral condyle do?

Answer 47

Femoral condyle increases contact with articular cartilage of tibial plateau -> contributes to OA

Question 48

with mid body release or transection of the meniscotibial ligament, how does this impair the function of the meniscus?

Answer 48

Impairs functions of meniscus to provide stability and congruence

Question 49

do clinical studies demonstrate efficacy of meniscal release in decreasing incident of post TPLO meniscal injury

Answer 49

no, but technique remains in widespread use

Question 50

For medical management of meniscal injuries is conservative treatment an option

Answer 50

No, this accelerates DJD

Question 51

a medial meniscectomy is easiest to perform through which approach?

Answer 51

medial surgical approach

Question 52

experimentally: this procedure carries less morbidity than this procedure

Answer 52

a partial meniscectomy carries less morbidity than total meniscectomy

Question 53

the partial meniscectomy is tx of choice for what?

Answer 53

bucket handle tears

Question 54

in dogs, when is a primary repair reserved for meniscal injuries?

Answer 54

reserved for peripheral tears

Question 55

what induces severe DJD in the stifle?

Answer 55

total meniscal removal

Question 56

the more meniscal tissue removed, what rapidly develops?

Answer 56

the more rapidly OA develop