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Small Ani. Sx- Ortho- Cranial cruciate ligament rupture

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wilsbach's version from 2015-11-28 21:30

oh hey this sucks yo

Question Answer
name which is the cr and which is the ca cruciate lig (haha do you remember? I never do..) it's the position on the TIBIA, so A: cranial cruciate ligament and B: caudal cruciate ligament
what is the fxn of the cr cru lig? (what movements does it prevent)Stability of the stifle joint-- prevents Cranial translation of the Tibia, Internal rotation of the stifle, and Hyperextension of the stifle
what is the main reason there is cr cru rupture in dogs?Degenerative (in humans its trauma) (left to right is normal to degenerative)
what are two Conformational abnormalities which might lead to crcru rupture?Proximal tibia, Straight legs
how is there a hormonal influence on crcru rupture?neutered more prone to rupture
what are some causes/contributing factors to crcru rupture?Conformational abnormalities, Hormonal (neutered more prone to rupture), Autoimmune, age, body weight, unknown
which meniscus is more likely to get damaged with a crcru rupture?puts weight with no crcru, stifle luxates, !medial meniscus gets damaged
is there medical management of crcru rupture?NO! dogs cannot compensate for this loss of support. must be SX TX
what is the signalment of a crcru rupture animal?All dog breeds and all ages!! Usually if its in a cat, they are obese (said in class: large breeds <5yo usually seem predisposed)
what 4 things can you do on your Orthopedic examination to determine if there is a crcru rupture?Gait analysis, Inspection, Palpation, Manipulation, Cranial drawer test, Tibial compression test
what does the sit test show/tell you?when they sit, they wont flex the affected stifle as much as they would normally. hocks SHOULD touch pelvis and dogs SHOULD sit symmetrically.
orthopedic exam--> will you find pain upon stile flexion or extension with a cr cru rupture?extension
orthopedic exam--> what 4 thing might you see during ortho exam which would make you think crcru rupture?(1) Pain during stifle extension (2) Joint effusion (3) Muscular atrophy (4) Medial buttress
what on earth is a Medial buttress?This is Thickening of the medial joint capsule.....it is a physiological response to instability-- lay down fibrous tissue. (if you dont go to sx, meniscus will suffer and eventually be resorbed)
what three things are you looking for during Recumbent examination? What two tests do you do in Recumbent examination?look for Joint effusion, ROM, Crepitus and you can do a **Cranial drawer test and a **Tibial compression test
what's up with/ how do you do the Cranial drawer test?basically testing if you can subluxate the tibia cranially- dog laying on side- hold tibia, femur, and patella. Make sure to grab the bones and not the mm (or you wont feel anything).
whats up with/how do you do the tibial compression test?dog laying on side, flex the hock and if cr cu torn, the prox tibia will slide cr. you can put your finger in the tibial tuberosity to feel this better.
whats this test?Tibial compression test
what 4 things might you see on rads which might indicate a ruptured cr cru?Joint effusion (fat pad sign), Osteophytes, Medial buttress (seen in crca view) (fibrotic thickening on the medial aspect of the stifle joint), Subchondral Sclerosis
whats this all about?This is the fat pad sign- when filled with synovial fluid itll become whiteish
Differential Diagnosis for cr cru rupture? (5)Osteochondrosis dissecans, patellar luxation, Caudal cruciate rupture, Meniscal damage (2* to crcru rupture), Septic arthritis
Meniscal damage--> how common is it to see this with cru cru rupture?80 % of dogs with complete CrCLR will have this too
memorize

oh hey this sucks yo

Question Answer
name which is the cr and which is the ca cruciate lig (haha do you remember? I never do..) it's the position on the TIBIA, so A: cranial cruciate ligament and B: caudal cruciate ligament
what is the fxn of the cr cru lig? (what movements does it prevent)Stability of the stifle joint-- prevents Cranial translation of the Tibia, Internal rotation of the stifle, and Hyperextension of the stifle
what is the main reason there is cr cru rupture in dogs?Degenerative (in humans its trauma) (left to right is normal to degenerative)
what are two Conformational abnormalities which might lead to crcru rupture?Proximal tibia, Straight legs
how is there a hormonal influence on crcru rupture?neutered more prone to rupture
what are some causes/contributing factors to crcru rupture?Conformational abnormalities, Hormonal (neutered more prone to rupture), Autoimmune, age, body weight, unknown
which meniscus is more likely to get damaged with a crcru rupture?puts weight with no crcru, stifle luxates, !medial meniscus gets damaged
is there medical management of crcru rupture?NO! dogs cannot compensate for this loss of support. must be SX TX
what is the signalment of a crcru rupture animal?All dog breeds and all ages!! Usually if its in a cat, they are obese (said in class: large breeds <5yo usually seem predisposed)
what 4 things can you do on your Orthopedic examination to determine if there is a crcru rupture?Gait analysis, Inspection, Palpation, Manipulation, Cranial drawer test, Tibial compression test
what does the sit test show/tell you?when they sit, they wont flex the affected stifle as much as they would normally. hocks SHOULD touch pelvis and dogs SHOULD sit symmetrically.
orthopedic exam--> will you find pain upon stile flexion or extension with a cr cru rupture?extension
orthopedic exam--> what 4 thing might you see during ortho exam which would make you think crcru rupture?(1) Pain during stifle extension (2) Joint effusion (3) Muscular atrophy (4) Medial buttress
what on earth is a Medial buttress?This is Thickening of the medial joint capsule.....it is a physiological response to instability-- lay down fibrous tissue. (if you dont go to sx, meniscus will suffer and eventually be resorbed)
what three things are you looking for during Recumbent examination? What two tests do you do in Recumbent examination?look for Joint effusion, ROM, Crepitus and you can do a **Cranial drawer test and a **Tibial compression test
what's up with/ how do you do the Cranial drawer test?basically testing if you can subluxate the tibia cranially- dog laying on side- hold tibia, femur, and patella. Make sure to grab the bones and not the mm (or you wont feel anything).
whats up with/how do you do the tibial compression test?dog laying on side, flex the hock and if cr cu torn, the prox tibia will slide cr. you can put your finger in the tibial tuberosity to feel this better.
whats this test?Tibial compression test
what 4 things might you see on rads which might indicate a ruptured cr cru?Joint effusion (fat pad sign), Osteophytes, Medial buttress (seen in crca view) (fibrotic thickening on the medial aspect of the stifle joint), Subchondral Sclerosis
whats this all about?This is the fat pad sign- when filled with synovial fluid itll become whiteish
Differential Diagnosis for cr cru rupture? (5)Osteochondrosis dissecans, patellar luxation, Caudal cruciate rupture, Meniscal damage (2* to crcru rupture), Septic arthritis
Meniscal damage--> how common is it to see this with cru cru rupture?80 % of dogs with complete CrCLR will have this too
Meniscal damage--> which meniscus is more likely to be damaged with cr cru rupture?MEDIAL
if there is meniscal damage 2* to crcru rupture, what are you gonna have to prolly do sx-lyPartial or complete Meniscectomy...cannot reattach! super painful! (meniscus is well innervated so it is a super painful condition to have a damaged meniscus)
if there conservative/medical tx for crcru rupture?yes, and sx. Usually conservative if sx not possible
what is conservative tx for crcru rupture? WHO can you do this for? what risks are there? (how long?)for Small dog breeds and cats you can try Close confinement 4- 8 Weeks. There is the big risk of instability --> OA & Meniscal damage (why he says this is usually a sx dz)
what are examples of sx tx for crcru rupture? (3 main categories)More than 250 techniques!! no perfect technique. There are Extracapsular Techniques, Intracapsular Techniques, and Dynamic Techniques
3 ex of Extracapsular techniques for sx repair?Lateral Retinacular stabilization, Tightrope CCL, Fibular head transposition
explain Lateral Retinacular Stabilization technique for sx repair. WHO do you usually do this in? (intracapsular, extracapsular, or dynamic?)(extracapsular) put Suture around fabella /bone anchor, and through a tunnel in prox tibia. keep in min isometric points (should be same length when flexed and extended and be as close as possible to he joint). Good for cats and small dogs- it will break in large dogs :(. this technique depends on the fibrosis to form to stabilize- usually use multifilament sutures to provoke this. Since causing rection for fibrosis, MUST WORK ASEPTICALLY. (if around fabella) (if around bone anchor ie screw)
if doing Lateral Retinacular Stabilization technique for sx repair...what should you keep in mind which is unique to cats?ONLY ONE FABELLA!
Fibula head transposition- what are you doing here? (intracapsular, extracapsular, or dynamic?)(extracapsular) more the fibula head forward, bc the lateral collateral lig attaches to the head of it, so if it moves forward is more cr and can kinda work like a cr cru instead of just a lat.
"Over the top" technique- what should you know about it? how do you do it/ how useful is it? (intracapsular, extracapsular, or dynamic?)(intracapsular) DOESNT WORK IN DOGS. overstretches too fast. dogs crcru is under more stress than a humans. Basically take a piece of piece of patellar tendon, cut it, put it through tunnel, pass between condyles of femur, attach to lateral condyle.
what are the two Dynamic techniques? why are they called "dynamic"? pros and cons?(1) Tibial plateau leveling osteotomy (TPLO) (2) Tibial tuberosity advancement (TTA). Called dynamic bc provide Dynamic stability-- Cranial drawer present, but stifle stable during weight bearing. there are no ROM restrictions (bc no suture in there)...but do expect some Osteotomy related complications
explain how the Tibia Plateau Leveling Osteotomy works (intracapsular, extracapsular, or dynamic?)(dynamic) usually tibial plateau slants backwards. In this, cut the plateau so its level and femur kind sits in it, then the forces acting on the leg go more up and down so it doesnt slide forward (for smaller diagrams- more you flex the stile, less the slanty-back angle will be, which is why straight legged dogs are more prone)
explain how the Tibial Tuberosity Advancement works (intracapsular, extracapsular, or dynamic?)(dynamic) cut the tibial tuberosity and advance it. advance the tibial tuberosity, which changes the angle of the patellar ligament to neutralize the tibiofemoral shear force during weight bearing
CrCruLR causes lameness how often?Most common cause of lameness in the dog-- all breeds and all ages.
summary: unlike humans, CrCruLR is usually due to...degeneration
how likely is uni vs bilateria CrCruLR?even if start uni, bilateral after less than 2yr
memorize