Diagnosing cranial cruciate ligament pathology - Veterinary Medicine
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Diagnosing cranial cruciate ligament pathology
Not all dogs with cranial cruciate ligament pathology have palpable stifle instability. Here are a few examination skills and diagnostic tools to help you make an early diagnosis.


VETERINARY MEDICINE


MRI

Unlike radiography, MRI allows visualization of the cruciate ligaments and menisci, so it may be used to detect more subtle pathology.18,19 However, because MRI accessibility is limited, it has not been an integral part of the diagnosis for most patients with cranial cruciate ligament pathology.

Arthroscopy

Arthroscopic assessment and treatment of the intra-articular structures of the stifle are performed at many specialty practices. The illumination and magnification allow direct visualization of the cranial cruciate ligament and surrounding structures.20 Arthroscopic techniques for cranial cruciate ligament and medial meniscal tear débridement, medial meniscal release, and meniscectomy have been developed.

TREATMENT

Surgically stabilizing the stifle is indicated in most patients with cranial cruciate ligament pathology. Combinations of small patient size, adequate locomotor function and comfort, the presence of concurrent disease, and advanced age may preclude surgical stabilization in isolated instances. Traditionally, surgical treatments have sought to passively constrain the stifle joint by substituting the cranial cruciate ligament with autologous tissues or synthetic materials. These techniques have been exhaustively described elsewhere. More recently, the tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement procedures have been described, which render the cranial cruciate ligament unnecessary by altering the mechanical forces acting on the stifle. The TPLO procedure is described in the next article.

Ross H. Palmer, DVM, MS, DACVS
Department of Clinical Sciences
College of Veterinary Medicine and Biomedical Science
Colorado State University
Fort Collins, CO 80523

REFERENCES

1. Vasseur PB. Stifle joint. In: Slatter D, ed. Textbook of small animal surgery. 2nd ed. Philadelphia, Pa: WB Saunders, 1993;1817-1865.

2. Evans HE, Christensen GC. Joints and ligaments of the pelvic limb. In: Evans HE, Christensen GC, eds. Miller's anatomy of the dog. 2nd ed. Philadelphia, Pa: WB Saunders, 1979;254-268.

3. Arnoczky SP, Marshall JL. The cruciate ligaments of the canine stifle: an anatomical and functional analysis. Am J Vet Res 1977;38:1807-1814.

4. Vasseur PB, Arnoczky SP. Collateral ligaments of the canine stifle joint: anatomic and functional analysis. Am J Vet Res 1981;42:1133-1137.

5. Briggs KK. The canine meniscus: injury and treatment. Compend Contin Educ Pract Vet 2004;26:687-697.

6. Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993;23:777-795.

7. Arnoczky SP. Surgery of the stifle—the cruciate ligaments (part I). Compend Contin Educ Pract Vet 1980;2:106-115.

8. Vasseur PB, Pool RR, Arnoczky SP, et al. Correlative biomechanical and histologic study of the cranial cruciate ligament in dogs. Am J Vet Res 1985;46:1842-1854.

9. Paatsama S. Ligament injuries in the canine stifle joint. J Small Anim Med 1953;1:329-334.

10. Lampman TJ, Lund EM, Lipowitz AJ. Cranial cruciate disease: current status of diagnosis, surgery and risk for disease. Vet Comp Orthop Traumatol 2003;16:122-126.

11. Smith GK, Torg JS. Fibular head transposition for repair of cruciate-deficient stifle in the dog. J Am Vet Med Assoc 1985;187:375-383.

12. Duval JM, Budsberg SC, Flo GL, et al. Breed, sex, and body weight as risk factors for rupture of the cranial cruciate ligament in young dogs. J Am Vet Med Assoc 1999;215:811-814.

13. Whitehair JG, Vasseur PB, Willits NH. Epidemiology of cranial cruciate ligament rupture in dogs. J Am Vet Med Assoc 1993;203:1016-1019.


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