Cruciate Ligament Injury; What Can We Do ?

CRUCIATE LIGAMENT INJURY; WHAT CAN WE DO?

Cruciate ligament injury is the most common cause of hind limb lameness in the dog. The injury typically occurs as a chronic degeneration of the cranial cruciate ligament with progressive instability and osteoarthritis. Hence injury of the cranial cruciate is referred to as cranial cruciate ligament disease (CCLD). The disease is characterized by chronic synovitis and progressive degeneration of the cranial cruciate ligament, which leads to instability of the stifle joint with caudocranial shift and internal rotation of the tibial plateau. The instability can cause overloading of the medial meniscus which typically results in a crushing injury of the caudal horn of the medial meniscus. The clinical diagnosis is based on a positive drawer test in which the tibial plateau is manually displaced cranially with a fixed distal femur. The drawer test can be best performed with the stifle in a 135 degree standing angle in which instability can be assessed at its optimum. In early CCLD pain during the drawer test and pain on extension of the stifle with a still stable joint can be telltale signs. As CCLD is a chronic progressive syndrome most of the dogs present with clear signs of osteoarthritis even if lamenss symptoms seem to be acute. Osteophyte formation can be appreciated by manually assessing the trochlear ridges of the patella and the region of the medial collateral ligament. Effusion of the joint can be determined by palpating the joint space medial and lateral of the patellar tendon. Radiography of the stifle joint can give additional information on joint effusion, and osteophyte and enthesophyte formation. Rupture of the caudal horn of the medial meniscus will exacerbate the clinical signs of lameness but cannot be appreciated radiographically. The integrity of the menisci can be assessed using ultrasonography of MR imaging. Cranial cruciate ligament disease usually affects both stifle joints. […]