Tendon and LIgament Dz Flashcards Preview

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Flashcards in Tendon and LIgament Dz Deck (44):

How can tendon be damaged? LOOK UP

> trauma
- lacerations
> strains
- breaking/dehiscnece of fibres
- mechanically induced or weakening d/t degeneration


How can muscles be damaged?

> less commonly specifically dx
- injuries similar to tendon


How can tendon/lig dz present?

> Lameness
- acute with trauma
- chronic
> swelling
- diffuse, painful, oedema if acute
- organised and established in chronic cases
> specific functional disability


Is laeration always traumatic?

- no can be chronic


Dxx for tendon and liggament dz?

> clinical signs
- dysfunction
> radiography
- swelling, gap
> ultrasound
- gap, loss of linear orientation of fibres


Outline pathophysiology of tendon injury repair. Which tendons will heal faster? Eg?

- fibroblasts and collage fibres line up along line of actio
- SHEATHED tendons less vascular so hal slower (eg. digital extensors) cf. vascular (eg. common calcaneal Achilles)


Time to heal tendon injuries?

- 6 weeks to regain 50% normal strength (repair must be supported for 6 weeks)
- 1 year to regain average 80% normal strengt h


Tx tendon injury?

> Rest
> specific support to protect tendon from loading
- dressings/casts
- trans-articular fixator
> 1* surgical repair for lacerations
- tendon sutures to manage load
- direc contact of healthy edges (debride if necessary)
- suture of epitendon to promote healing
> ultrasound monitoring healing (@6/8 weeks etc.)


How long should ESF be left on for tendon repair?

- 6 weeks
- then bandage for 2 weeks


HOw big a gap will interfere with tendon healing?



What ar ethe 2 most common tendon repair sutures?

- locking loop
- 3 loop pulley


What is a sprain?

Ligamentous damage
- can be mild/moderate/severe
- 1*/2*/3* degree (stretch, rupture, total laceration)
- ^ level of soft tissue damage, swelling, pain and instability


What suture material should be used for TENDON repair?

- non-absorbable eg. Prolene
- sheath simple interrupted absorbable


Presentation of strains ? PE?

- acute and chronic presentation
> PE:
- especially ROM
- palaptoin
> Dxx:
- radiography + stressed views (to demonstrate strains, pull limbs in direction of strains etc.)
- ultrasound (not very useful fr ligament)
- manipulation under GA
> always check for ancillary damage


Tx sprains?

- rest, reduce swelling (drugs, cooling)
- external coaptation (suppot)
- ligament repair
- internal ligament splintage
- attention to oher structures
- arthrodesis (salvage)
- degree of tx depedns on instability, pain and healing potential


LIkely damage associated with ddrop from a height? Tx?

- palmar carpal ligaments sprained
- need arhrodesis, will not heal conservatively


Surgical repair of ligament?

- screws at insertion of the ligament, figure of 8 suture between the 2


How long do ligament injuries take to heal?

slow healing ~ 6-8 weeks
- not always acceptable function (reevaluate)
- extra chronic capsular tisue formed
- 2* OA
> may require arthrodesis at a later stage


What angle is normal for stress radiographs of the carpus?



How is an arthrodesis carreid out? Which joints is this always required in (first line ?

- remove articular cartilage
- bone graft to stimulate bone healing
- stabilise joint
> TMT (tarsal luxation??)
> Carpal ligaments (carpal hyperextension)


Is ligament dz common in smallies?

NO except for cranial cruciate in dogs!


Which direction does cranial and caudal cruciate run?

Cranial = cranial tibia, caudal femur (proximal and lateral to distal and medial)
Caudal = caudal tibia, cranial femur


Pathophysiology of cruciate disease?

- normally related to degeneratin
- can be acute (trauma/degenerative ligament gicing way)
- assocated with MPL (medial patella luxation) which is seen in young growing animals so even if only found incidentally in older animals check the cruciates!
- causes a debilitating cranio-caudal instability in the stifle
- 60% cases involve medial meniscus


Does meniscal injury occour spontaneously in animals?

NO rarely, always affected d/t cruciate dz


How do human and animal cruciate injuries differ?

- human traumatic
- animals gradual degneration n


What is MPL?

- medial patella luxation


What caues the clinical signs seen with cruciate dz? LOOK UP

> forces
- as dog ,oves forwards, weight thrust forwards, must resist reactive forces acting caudally
- stifle is vulnerable to this caudal force (d/t round profile of the femur slipping accross the tibial plataeu)
- cranial cruciate resists this force so if ruptured, joint becomes unstable when loaded
-> if femur can move across tibia, mensci can be damaged stuff


Presentation and predisposed animals of cruciate rupture?

- middle aged (2-10 yrs)
- overweight, neutered
- medium/large breed (lab, rotty, spanial, bull breeds, NOT sighthounds)
> Hx: insiduous onset pelvic limb lameness
- may be bilateral
- acute onset can occour


Main Ddx for pelvic limb lamensss seen with cruciate dz?

- hip and LS disease
> cruciate usually more unilateral


FIndings on PE with cruciate rupture?

> muscle atrophy (quads and hamstrings)
> stifle effusion
> medial buttress
- soft tissue thicking medial aspect of joint
> craniocaudal stifle instability (cranial drawer and tibial thrust)
> pain on manipulation
- sit test (sit with leg to the side)


When may PE tibial thrust/cranial drawer be unhelpful? How cna these be ID?

- partial degeneration (not complete)
> Radiograph
- effusion
- OA


Most common reason for OA In the stifle?

> cranial cruciate MOST COMMON
- paella luxation
- articular fx


Conservative tx of cruciate dz? When is this indicated?

> appropriate if:
- lameness liinal
- low pain
- small dogs slow return to function, stimulation of OA change, no control of meniscal damage (so cant tell if recovery slow d/t crusiate or menisci)


Advantages of surgical tx? Problems?

- improve joint stability
- speed up recovery
- tx meniscal lesions (always necesary)
> joint still never be 100% stable, DJD sill present though less (residual lameness)


Surgical tx options of cranial cruciate repair? LOOK UP

> implant in a position analgous to cranial cruciate (CCL)
- temporarily restores joint stability
- allows fibrous tissue to stabilise stifle
> changing mechanics of stifle
- negates the need for CCL support
*Any surgery should involve inspection and debridement of menisci*


Outline lateral suture technique. What suture material is used? How long does it need to remain for before brekaing down?

- lateral tibio-fabella suture placed
- extracapsular but same line as the CCL
- meniscus inspected via arthrotomy


OUtline TPLO

= tibial plateau levelling osteotomy
- changes angle tibia meets the femur, allows articular surfaces to bear more of caudal shear force from tibial thrust
- will start bearing weight straight after sx


Outline TTA

= tibial tuberosity advancement
- line of patella tendon advanced
- makes it parallel to line of force transfer across joint
- tension in tendon cancels out compression across the joint
- prevents caudal movement of the femur


Outline CWTO

= closed wedge tibial ostectomy
- similar to TPLO but displacement of tibial tuberosity
- tendinitis possible d/t strain on patella tendon
- wedge rather than circular osteotomy to collapse bone


Outline TTO

= triple tibial osteotomy
- mixture TTA/CWTO
- decreases displacmeent
- tendinitis
- more complex surgery
- specialist equipement needed


How long do most cruciate surgeries take to heal? Post op care?

> lead walks for 6-8weeks (rest)
- ^ 5min/2w
> coldp ack 48hrs
> warm packs and PROM BID/TID
> rads @ 6-8weeks (not lateral suture)
> NO hydrotherapy initially


Rehabilitation after cruciate surgery?

- physio and gradual increase in lead excercise


Which tendon is prone to damage? ECHO

common calcaneal tendon?? achilles (extends and flexxes the ???


Which procedures have the best outcome @ 12 weeks?

All have similar!! Despite numerous claims for advantages of new procedures