Cranial Cruciate Ligament AND Patellar Luxation

Question 1

What are the functions of the cranial cruciate ligament?

Answer 1

Prevents cranial translation of the tibia, internal rotation of the tibia, and hyperextension of the stifle, the meniscus functions for jt congruity, load distribution, shock absorption, lubrication and stability

Question 2

What are the landmarks for examination of the stifle of a dog with suspected cranial cruciate ligament (CrCL) tear?

Answer 2

Patella, Lateral fabella, tibial tuberosity, fibular head Sedate

Question 3

hind limb lameness in a dog is a ? UNTIL proven otherwise!!!

Answer 3

cruciate rupture

Question 4

What are the clinical exam findings and radiographic findings for patients with a cranial cruciate ligament tear?

Answer 4

cranial tibial thrust, stifle effusion, stifle pain, cranial drawer present, meniscal “click”, joint crepitus

Question 5

What do we see on rads with CCL tear?

Answer 5

Joint effusion, +/- osteoarthritis and cranial drawer

Question 6

What are the ways to repair a cranial cruciate deficient stifle conservatively?

Answer 6

Conservative management- NSAIDs/OA modifying agents, analgesics, PT/rehab, custom made orthotic brace, rest

Question 7

What are the different ways to repair a cranial cruciate deficient stifle surgically?

Answer 7

Extrascapular Repair, tibial Plateau Leveling Osteotomy (TPLO), Tibial Tuberosity Advancement (TTA)

Question 8

Extrascapular Repair sx:

Answer 8

a. Building a prosthetic ligament to recreate the function of the ligament with synthetic suture material
b. Lateral fabella to tibial suture
c. Not good for large pets

Question 9

What are the two techniques used in the Extrascapular Repair that we went over in class?

Answer 9

Modified retinacular imbrication technique (MRIT) to prevent cranial translocation and hyperextension, and the tight rope procedure

Question 10

What sx requires a lot of practice and learning, alters bone geometry to create dynamic stability during ambulation where the goal is to eliminate cranial tibial thrust by neut. the femorotibial shear and final goal is to level the tibial plateau to 5-7 degrees

Answer 10

TPLO

Question 11

goldddd standard*** for CrCL tear, large and small breeds is what sx????

Answer 11

TPLO

Question 12

You have a patient that got a TPLO surgery a while back but still has drawer movement. Did the surgeon fail to do their job in repairing this ccl?

Answer 12

No, the TPLO not eliminate drawer, just alters the anatomy to prevent cranial tibial thrust, therefore stabilizing the knee

Question 13

What sx is similar to TPLO but newer, positions the tibial plateau perpendicular to patellar ligament?

Answer 13

Tibial Tuberosity Advancement (TTA)

Question 14

What is involved in the aftercare following a patient with a cranial cruciate ligament tear? What are the complications that could arise?

Answer 14

Cage rest at least 8 weeks (varies depending on the surgery performed), controlled rehab, weight management

Question 15

We have a patient that got a extracapsular repair sx done and we can feel cranial drawer after he is all healed up, is this a concern?

Answer 15

Yes, there should be an absent cranial drawer after this sx

Question 16

At my GP, a client said they had a osteotomy procedure done on their patient (TPLO, TTA, other), they did not listen to the referral center at discharge about their patient’s care. What should you remind them?

Answer 16

Cage rest 8-12 weeks, controlled rehab with increasing intensity a 4-6 weeks under direction of DVM, weight management, leash walks, Should have absent tibial thrust when it comes to see me and do rads to recheck its healing

Question 17

What sx procedure is better???

Answer 17

Personal preferences, bias in outcome assessments, no procedure is perfect
Historical studies: no real difference in long-term outcome between procedures. (all have progressive OA, adequate limb function, both have complications…..TPLO has quicker return to normal function compared to extrascapular repair)

Question 18

______ luxation is more common than ____ of the patella

Answer 18

Medial is more common than lateral

Question 19

Most cases of patella luxation are presented as small dogs with congenital patellar luxations involved with abnormal ____ and _____devo causing displaced _____ _____

Answer 19

confirmation and muscle development; displaced quad mechanism*

Question 20

What are the common grades of patellar luxation** on exam and NAVLE

Answer 20

Grade 1- patella in n location, can luxate but returns to n on its own
Grade 2- patella in n location, can luxate and stays luxated
Grade 3- patella luxated, can reduce to n but re-luxates on its own
Grade 4- patella luxated, cannot be reduced
Grades 3 and 4 need sx repair

Question 21

What are the goals of surgery for treatment of patellar luxations?

Answer 21

GOALS of surgery are to:
Realign the quads mechanism
Deepen the femoral trochlea if its shallow
Reinforce soft tissue support

Question 22

When do we rec. sx for patella luxations???

Answer 22

recommend surgery when clinical signs persist regardless of grade, or with huge variation in the gait despite the grade

Question 23

What are the many surgical procedures used for treatment of patellar luxations?

Answer 23

Medial release of soft tissues (to free the quads mechanism until you can luxate patella both ways, done most frequently), lateral imbrication where the jt capsule is tightened on the side where things are stretched laterally, and tracheoplasty (recession, resection, chondroplasty)

Question 24

What is the goal of Tracheoplasty (recession, resection, chondroplasty)

Answer 24

allow 50% of patellar thickness to sit in the groove, block recession is the most common technique

Question 25

What are the indications for Tracheoplasty (recession, resection, chondroplasty)???

Answer 25

Large breed dogs that luxate in full extension, allows patella to stay seated and can also do trochlear wedge recession with a fine tooth saw or oscillating saw, which is easier but does not have as many advantages as a block recession or trochlear resection

Question 26

_____ is only done in animals less than 6 months of age

Answer 26

Chondroplasty

Question 27

Tibial tuberosity transposition is when we cut the bone, move it over and stabilize it with pins. What is the goal?

Answer 27

To realign the quads mechanism by cutting the tibial tuberosity at the end of the quad where the patella inserts and replacing the crest with osteotome, transposition with K wires, check for patella stability

Question 28

Patella luxation is a common complex _____ problem, that may be traumatic, when is tx not required?

Answer 28

developmental; tx not required for asymp. patients with mild luxations.

Question 29

The outcome is usually good for patellar luxations despite progression of ?

Answer 29

Osteoarthritis (OA)

Question 30

T/F, we should always do arthroscopy or arthrotomy for meniscal disease?

Answer 30

true

Question 31

Lateral fabellar to tibial suture is what procedure?

Answer 31

Extracapsular repair (building a prosthetic ligament)

Question 32

What are the sx options for patella luxations (Bone reconstruction):

Answer 32

a. Trochleoplasty (defined as modifying the shape of the trochlear groove) includes Trochlear wedge recession, Trochlear block recession- in large dogs, Trochlear sulcoplasty, Trochlear chondroplasty in dogs younger than 6 months, or medial ridge elevation wedge trochleoplasty
b. Tibial tuberosity transposition

Question 33

What is the sx options for patella luxations (Soft Tissue reconstruction):

Answer 33

Capsulectomy