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Surgery > tendons/ligs (combo smallies + equine) > Flashcards

tendons/ligs (combo smallies + equine) Flashcards

1
Q

stages of tendon healing

A
  1. Inflammation days 0-3
  2. Early proliferation days 1-7
  3. Late proliferation days 7-21d
  4. Remodelling up to 18months
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2
Q

describe process of inflammatory stage of healing

A
  • blood clot formation stabilises torn tendon edges + scaffold for cells
  • fibroblasts produce type III collagen
  • macrophages remove devitalised tissue
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3
Q

describe process of early proliferation stage of healing

A
  • angiogenesis commences

- tenocytes produce type III collagen

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4
Q

describe process of late proliferation stage of healing

A
  • fibroblasts from epitenon + synovial sheath, intrinsic fibroblasts from endotendon
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5
Q

describe process of remodelling stage of healing

A
  • type III collagen replaced by type I collagen

- rel. strength 56% @ 6wks, 80% at 1 yr

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6
Q

6 principles of tendon repair

A
  1. Clean the wound
  2. Appose tendon ends
  3. Placement of holding and circumferential sutures
  4. Reinforce the repair
  5. Immobilisation
  6. Strict post-op plan
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7
Q

3 parts of the common calcaneal tendon (dogs)

A
  • tendons of gastrocnemius m. (paired)
  • combined tenxons of gracilis, semitendionsus, biceps femoris muscles
  • tendon of SDFT muscle
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8
Q

compare surgical approach to traumatic and atraumatic common calcaneal disruption

A
  • traumatic usu. involves wound cleaning and minimal debridement of tendon (as acute - still viable) + apposition of ends w/ circumferential/holding sutures
  • chronic atraumatic disruption usu. involves considerable debridement/resection resulting in limited tendon volume distally thus sx tx may involve tunnels, polyethylene terephthalate prosthesis
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9
Q

presentation of atraumatic common calcaneal disruption

A

1 Sign:. F>M, medium-large breed, dobermans, labs

  1. Hx: chronic progressive lameness w/ acute deterioration + no hx of trauma
  2. Px: thickened calcaneal tendon esp. at insertion
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10
Q

post-op care of common calcaneal disruption

A

tarsus maintained in extension for 6-8wks (bivalved cast, ESF, calcaneotibial screws)

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11
Q

px of common calcaneal disruption (dogs)

A

excellent (w/ sx) 72-94% success

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12
Q

failure to ID lacerations in the DDF tendon (concurrent to SDFT) may result in…
dogs

A
  • flattened digits, weight bearing or metatarsal/carpal pad
  • pressure sores
  • chronic pain + lameness
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13
Q

bandaging regime for DDFT lacerations (dogs)

A

3 wks w/ foot in flexion followed by 3 wks w/ foot in normal weight bearing position

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14
Q

radiographic findings of biceps tendinopathy (dogs)

A
  • intertubercular groove mineralisation, tendon mineralisations
    req. orthogonal views + skyline
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15
Q

US findings of biceps tendinopathy (dogs)

A
  • enlarged, hypoechoic tendon, fibre pattern disruption, irreg. synovium
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16
Q

why is MRI useful to investigate biceps tendinopathy?

A

concurrent assessment of intra-articular structures, substance tears, impingement ID w/ intra-articular contrast

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17
Q

medical tx of biceps tendinopathy

A
  1. Intra-articular methylprednisolone 1mg/kg 1-2doses 4-6wks apart
  2. Strict rest 4-6wks
18
Q

sx tx of biceps tendinopathy

A
  1. tenodesis: good outcomes reported but implant assoc. complications
  2. tenotomy: preferred - can be arthroscopic
19
Q

common lig/tendon issues in dogs

A
  • common calcaneal disruption
  • DDFT lacerations
  • biceps tendinopathys
  • traumatic lig injuries: collateral lig injury, carpal hyperextension
20
Q

repair options for collateral lig injury (dogs)

A
  1. Primary repair w/ locking loop pattern
  2. Internal splint: augment + mimic action of ligament
    - bone anchors, screws w/ washers
    - bone tunnels, nylon sutures + wire
21
Q

what structures may be damaged by carpal hyperextension in the dog?

A
  • damage to flexor retinaculum, palmar fibrocartilage

- collateral ligs

22
Q

rad dx of carpal hyperextension injuries

A

orthogonal views + stress rads

23
Q

principles of arthrodesis

A
  1. Cartilage removed from all aspects of joints
  2. Cancellous bone graft placed in joints
  3. Apposed jt surfaces
  4. Rigid internal fixation
  5. Post-op immobilisation
  6. Follow-up rads @ 6-12wks
24
Q

indications for arthrodesis in dogs

A
  • implant failures for tendon repairs

- severe joint instability w/ primary repair not a viable option

25
Q

complications of arthrodesis in dogs

A
  • swelling, infection, dehiscence
  • implant/fusion failure
  • fractures
26
Q

common equine tendon/lig issues

A
  1. Bowed tendons: flexor tendonitis
  2. Tendon lacerations: SDFT/DDFT/SL
    3 Suspensory lig. desmitis
  3. Palmar/plantar annular lig. constriction
  4. Tendon sheath injuries
27
Q

predilection sites for bowed tendons

A
  • forelimb (inc. weight bearing)

- mid cannon (narrow cross section)

28
Q

inc. risk for bowed tendons

A
  • wet track
  • > 6yo
  • conformation/shoeing
29
Q

initial tx for bowed tendons

A
  1. Control inflammation (cold therapy, NSAIDs, bandaging)
  2. Limb support (Robert jones bandage, splint, heel elevation- DDFT)
  3. Stall rest
30
Q

intra-lesional medications for tendon injuries (horses)

A
  • IGF-1 (tendotrophine) + other GFs
  • autologous bone marrow implantation
  • stem cell therapy
  • platelet rich plasma
31
Q

potential surgeries for equine flexor tendonitis

A
  • percutaneous tendon stab
  • superior check lig desmotomy
  • palmar/plantar annular lig. desmotomy (fetlock canal syndrome)
32
Q

action of tendon stab/splitting

A

evacuates core lesion haematoma + may promote intrinsic healing

33
Q

action of palmar/plantar annular lig transection

A

used to relieve tension on flexors in PAL constriction

34
Q

action of superior check lig. desmotomy

A

inc. elasticity in muscle tendon unit

35
Q

compare prognosis of flexor vs extensor tendon lacerations (horse)

A 
extensor = excellent
flexors = poor - fair dt inc. load and propulsive movements
36
Q

tx of tendon sheath injuries

A
  • tenoscopy + cont. lavage + regional limb perfusions + intralesional ABs
37
Q

px of PAL post-sx

A

fair to good dependent on adhesions (chronicity) + damage to flexor tendons

38
Q

proximal suspensoty desmitis blocks to what nerve block?

A

high 4 point

39
Q

indications for neurectomy + fasciotomy w/ suspensory lig desmitis

A

chronic HL desmitis only

40
Q

predilection sites for SL desmitis

A

HLs in STBs
FLs in TBs
- proximal

Surgery (22 decks)

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