Stifle

Question 1

What does TPLO stand for? What is it used for?

Answer 1

Tibial plateau levelling osteotomy

Periarticular technique used to repair crania cruciate ligament rupture

Question 2

What does TTA stand for? What is it used for?

Answer 2

Tibial tuberosity advancement

Periarticular technique used to repair cranial cruciate ligament rupture

Question 3

How can stifle conditions be diagnosed?

Answer 3

History and clinical signs
Radiography and other imaging
Arthrocentesis
Diagnostic analgesia

Question 4

Give examples of developmental conditions of the stifle

Answer 4

Osteochondrosis
Growth disturbances (genu valgum)
Patella luxation

Question 5

What is genu valgum?

Answer 5

Knees angled to touch each other instead of being straight

Question 6

Give examples of acquired conditions of the stifle

Answer 6

Cruciate disease
Osteoarthritis
Immune-mediated arthritis
Neoplasia

Question 7

What are the causes of cranial cruciate ligament (CCL) rupture?

Answer 7

Disease or degeneration in older dogs (+ minor trauma)
Young large breed dogs
Trauma = least common

Question 8

What breeds are predisposed to CCL rupture?

Answer 8

Older dogs = Lab, Terriers

Young large breed dogs = Great Dane, Bull Mastiff

Question 9

What diseases/degenerations can cause cranial cruciate ligament rupture?

Answer 9

Increased collagen metabolism (in predisposed breeds)
Increased joint laxity
Narrowed intercondylar notches
Sloping angle of tibial plateau
Immune mediated disease

Question 10

What are the clinical signs of cranial cruciate ligament (CCL) rupture?

Answer 10

Chronic/acute onset of HL lameness
Leg carried flexed (‘toe touching’
Stifle effusion - patellar ligament
Medial buttress and OA (if chronic)

Question 11

What is a medial buttress?

Answer 11

Firm swelling on medial aspect of proximal tibia

Question 12

What 2 tests can be used to test the integrity of the CCL?

Answer 12

Tibial compression test (if torn CCL, tibial tuberosity with move cranial when hock flexed)
Cranial drawer test (moving joint laterally - should have little movement)

Question 13

How is CCL tear/ruptured diagnosed?

Answer 13

Clinical exam and history - v important
Radiography
Arthrocentesis
MRI

Question 14

What are the treatment options of CCL tears/rupture?

Answer 14

Conservative - restricted exercise and analgesia (if <15kg)

Surgery - intracapsular, extracapsular or periarticular (TPLO or TTA)

Question 15

What is an example of an intracapsular technique to repair the CLL?

Answer 15

Over the top (OTT)

Question 16

What are examples of periarticular techniques used to repair the CLL?

Answer 16

TTA - tibial tuberosity advancement

TPLO - tibial plateau levelling osteotomy

Question 17

After cruciate surgery, when should the patient re-examined?

Answer 17

Re-examine at 4-6 weeks and again at 12 weeks

Progress x-rays for osteotomies at 8 wks

Question 18

What are potential complications of cruciate surgery?

Answer 18

Infection

Menisci tears

Question 19

Are meniscal injuries usually medial or lateral?

Answer 19

Medial
(‘Bucket handle’ caudal pole - most common)
Can be iatrogenic (surgery) or later

Question 20

What are the treatment options for meniscal injuries?

Answer 20

Conservative - 4-6 weeks

Surgical removal of meniscus (if persistently lame)

Question 21

Is patellar luxation more common medially or laterally?

Answer 21

Medial

Question 22

What can cause patellar luxation?

Answer 22

Trauma
Congenital - predisposed breeds
Developmental problems- malalignment of quadriceps

Question 23

Patellar lunation is more common in what size dogs

Answer 23

Toy breeds

Large breeds

Question 24

Can gets get patellar luxation?

Answer 24

Yes - often asymptomatic

Question 25

What are the 4 grades of patellar luxation?

Answer 25

Grade 1 = intermittent patellar luxation, reduction immediate Grade 2 = frequent/spontaneous luxation, reduction not always immediate, skipping Grade 3 = permanent luxation, reduction possible but reluxates Grade 4 = permanent luxation, reduction not possible

Question 26

How is patellar lunation diagnosed?

Answer 26

History Clinical signs Radiography

Question 27

What are the treatment options for patellar lunation?

Answer 27

Conservative (if intermittent clinical signs) - restricted, controlled exercise and NSAIDs Surgery (if recurrent clinical signs) - many techniques

Question 28

What surgery can be done to correct patellar luxation?

Answer 28

Wedge or block trochleoplasty | Many techniques

Question 29

What breed is predisposed to osteochondrosis? Which sex?

Answer 29

Lab retrievers | Males > females

Question 30

How common is osteochondrosis?

Answer 30

Not very common

Question 31

What location in the HL is osteochondrosis most likely to be found?

Answer 31

Lateral or medial femoral condyle | Articular surface

Question 32

What are the clinical signs of osteochondrosis?

Answer 32

Lameness from 5 months old Bilateral crouching gait Joint effusion and discomfort upon palpation

Question 33

How is osteochondrosis diagnosed?

Answer 33

History Clinical signs Radiography

Question 34

How is rupture of the collateral ligaments diagnosed?

Answer 34

``` Abnormal joint movement in medial or lateral direction Stress radiographs (take contralateral limb to check for normality) - widening of joint space ```

Question 35

How is rupture of the collateral ligaments treated?

Answer 35

Parapatellar approach to affected side | Primary repair of ligament with screws and washers

Question 36

Multiple ligament injuries are uncommon, but are usually seen in what type of dogs?

Answer 36

Working dogs

Question 37

How are multiple ligament injuries diagnosed?

Answer 37

Clinical exam | Stress radiography

Question 38

How are multiple ligament injuries treated? What is the prognosis?

Answer 38

Repair of CCL and collateral ligaments Removal of damaged meniscus and joint capsule Prognosis = good

Question 39

Is stifle osteoarthritis common?

Answer 39

Yes | Secondary to CCL rupture

Question 40

Give an example of a neoplasia seen in the stifle of larger breed dogs

Answer 40

Osteosarcoma