2. DISEASES OF THE MUSCULOSKELETAL SYSTEM
PART 2
Chapter 7
Pg: 126

3. TRAUMA: Ligament Injury – Anterior/Posterior Cruciate Ligament Rupture
Anterior Cruciate Ligament (cranial cruciate ligament) and Posterior Cruciate Ligament
--stabilize knee joint
Ruptured CCL – most common stifle injury and leads to Degenerative Joint Disease (DJD)
May be complete rupture or partial tear => unstable joint => DJD
CCL is similar to a human that tore their ACL
Degenerative joint disease: cartilage deteriorates, mainly in knees, hips, and spine. Any bone really.
Approximately 50% of dogs with a torn CCL also experience a meniscal or meniscus injury.
The meniscus is a c-shaped pad of cartilage in the knee that acts as a shock absorber
Meniscal injury: Torn tissue in the knee. Remove the torn meniscus because it can be painful.
MOST COMMON KNEE ISSUE SEEN.
Degenerative joint disease: Also known as osteoarthritis (A type of arthritis that occurs when flexible tissue at the ends of bones wears down)

4. TRAUMA: CRUCIATE LIGAMENT INJURY/RUPTURE

5. CLINICAL SIGNS OF CRANIAL CRUCIATE LIGAMENT INJURY/RUPTURE
Highly active, athletic animals
Middle-aged obese dog

6. CLINICAL SIGNS OF CRANIAL CRUCIATE LIGAMENT INJURY/RUPTURE
Joint effusion: excess synovial fluid in and around the knee.
If recent tear, they can have effusion(swelling in the knee).
Normally, it is an acute onset.
Hyperextending: over extend leg.
Animal is acutely non wt. bearing
on the rear leg after hyperextending
the stifle joint
Joint effusion

7. TRAUMA: CRANIAL CRUCIATE LIGAMENT RUPTURE
Cranial drawer: tibial slides forward.
Tibial compression: tibia moves forward when the hock if flexed.
Cranial drawer test
Tibial compression test

8. Same as the tibial compression test: tibia moves forward when hock is flexed.

9. CRANIAL CRUCIATE LIGAMENT RUPTURE REPAIR
Extraarticular: outside the joint
Most successful in small patients (less than 30 lbs).
Suture material is placed around the caudal fabellae ( behind femoral condyles) and through a tunnel in the tibial crest to stabilize the joint (front portion on this image).
The tibial crest is the insertion point for the patellar tendon.
Extraarticular Stabilization
*Most successful in patients less than 15kg

10. CRANIAL CRUCIATE LIGAMENT RUPTURE REPAIR
Intraarticular: within the joint
Over-the-top patellar tendon graft: uses a strip of patellar tendon to replace the cranial cruciate ligament
The patellar tendon attaches the bottom of the patella to the top of the tibia
(Ligaments connect bone to bone) (Tendon connects muscle to bone)
Intraarticular stabilization:
Over-the-top patellar tendon graft

11. CRANIAL CRUCIATE LIGAMENT RUPTURE REPAIR
This prevents the tibial from moving forward away from the femur. The surgeon actually cuts the tibia and rotates it backwards. This makes the tibia fit in place at a level where it does not rub the femur and then uses a plate and screws to hold it in the level position. When the cruciate ligament is ruptured, the knee feels unstable for the dog and causes them to become lame. This is done by having radiographs prior and the surgeon actually goes and measures the angle that she needs to cut the bone.
Intraarticular stabilization technique
TPLO – Tibial Plateau Leveling Osteotomy

12. TPLO, or tibial-plateau-leveling osteotomy, is a surgery performed on dogs to stabilize the stifle joint after ruptures of the cranial cruciate ligament 

13. The tibia is pushed further back to prevent the tibia from slipping forward.

15. TPLO surgery (DOVE) 11 mins
Medial buttress( tissue that has thickened or scarred due to trying heal itself)

16. CRANIAL CRUCIATE LIGAMENT RUPTURE – CLIENT INFO
Restrict activity 3-4 weeks post surgery
Cage rest
Leash walk only to urinate and defecate
Gradually increase exercise 4-8 wks post sx
Full activity 8-12 weeks
Opposite cruciate often tears within 1 yr
Weight loss helps
DJD of stifle joint is likely
If no surgery, joint thickens from new fibrous tissue formation in an attempt to stabilize itself
Can use Adequan injections to help with process.
DJD (osteoarthritis) is likely because it is caused by inflammation and break down of cartilage and joints.
Adequan helps relieve the pain of arthritis by soothing and lubricating the inflamed joint in addition to stimulating joint cartilage repair (will never be the same though)

18. LUXATING PATELLA
These occur frequently in dogs and occasionally in cats.
Medial luxation (most common) – mainly in small breeds (Both knees are affected, but surgeon will usually do surgery on the worst one)
Lateral luxation (not common, usually do not do surgery for this)- in both small and large breeds (They will do surgery if it is bad enough)

19. LUXATING PATELLA
Medial patella luxation is most common. Medial is usually congenital (anatomical deformities). Can lead to a CCL tear.

20. LUXATING PATELLA Grade 1: moves out of groove slightly and goes back
Grade 2: Moves completely out of groove and goes back
Grade 3: sits outside of groove naturally but can be pushed back in
Grade 4: sits outside of groove and will not go back in
The patella rests in a groove on top of the femur called the trochlear groove

21. POOR CONFORMATION: LUXATING PATELLA
PATELLA IN
GROOVE
PATELLA
OUT OF
GROOVE
With this image, you have to rotate limbs inwards to get a straight shot of the patella.

22. TREATMENT OF PATELLAR LUXATION
Surgery to place patella back in place. Also known as a Trochleoplasty.
(trochlear groove is reshaped to improve patellar stability)
Cerclage wire is then used to strap the patella into place
TROCHLEAR WEDGE RESECTION

23. TROCHLEAR WEDGE RESECTION
Deepens the trochlear groove due to them cutting it.

24. Recovery will be similar to a Cranial cruciate ligament

25. HIP DYSPLASIA YOUNG DOGS 5-8m AND MATURE ANIMALS WITH CHRONIC DISEASE
Rarely seen in dogs less than 30lb.
YOUNG DOGS 5-8m AND MATURE
ANIMALS WITH CHRONIC DISEASE

26. HIP YSPLASIA

27. HIP DYSPLASIA
Can be genetic or trauma. It can be popped back into place by closed reduction (Reduction means putting bone back in place), but can pop back out. If that happens, surgery would be best.
Poor conformation combined with genetic, environmental and nutritional factors

28. HIP DYSPLASIA PHYSICAL EXAM FINDINGS Pain on palpation of hips
Joint laxity – subluxation of hip
Crepitus
Decreased range of motion of hip joints
Atrophy of thigh muscles
Crepitus: bone rubbing against bone. Atrophy due to limb not being used as much. Leg looks smaller and withered away.

29. Hip Dysplasia DIAGNOSTICS: Radiographic view
ventrodorsal view of the pelvis with rear limbs extended symmetrically and rotated inward to center the patellae over the trochlear grooves
Moving the hips inwards. This puts a lot on the patients hips, so it is best to take these images while under sedation.
OFA- They also have to be 2 years of age.
The obturator foramen is the large opening created by the ischium and pubis bones of the pelvis through which nerves and blood vessels pass
For standard Orthopedic Foundation for Animals–type radiographs to evaluate hip conformation, extend the hips and internally rotate the tibias until the patella lies directly over the trochlear grooves. Be sure the pelvis is straight, with symmetric obturator foramina.

30. POOR CONFORMATION: HIP DYSPLASIA and OFA CERTIFICATION
You want it to sit in the socket.

31. POOR CONFORMATION: HIP DYSPLASIA and OFA CERTIFICATION

32. HIP DYSPLASIA and OFA CERTIFICATION
Dysplastic hips are categorized as mild, moderate, or severe

33. HIP DYSPLASIA TREATMENT: medical management
NSAIDs
Adequan helps relieve the pain of arthritis by soothing and lubricating the inflamed joint in addition to stimulating joint cartilage repair (will never be the same though)
NEUTRICEUTICALS/CHONDROPROTECTIVE AGENTS

34. HIP DYSPLASIA TREATMENT: MEDICAL MANAGEMENT
Polysulfated glycosaminoglycan (Adequan):
Polysulfated glycosaminoglycans prevent cartilage breakdown by inhibiting the enzymes of cartilage degradation during inflammation.
Cosequin:
Cosequin is a brand name for glucosamine HCL combined with chondroitin sulfate which may stimulate synthesis of synovial fluid, inhibit degradation, and improve healing of articular cartilage.
Can use Adequan injections for management.
Cosequin stimulates synthesis of synovial fluid

35. Hip Dysplasia Treatment: surgical correction
Total hip replacement
Salvage procedure in mature dogs with severed DJD unresponsive to medical Tx
Pain free and near normal limb function in 95% of cases
Femoral Head Ostectomy
Forms “false” joint
Removal of femoral head to prevent joint pain
Salvage procedure when medical treatment not working and other sx too expensive
Best - < 20#; good musculature
Abnormal gait
Triple Pelvic Osteotomy
Allows rotation of dorsal acetabular rim to increase coverage of femoral head
Good return of function with minimal arthritic changes
Total hips are a new procedure. If do it incorrect the femur can be split. Femoral head ostectomy most common. TPO: cuts into the pelvis so the socket (acetabulum) can be rotated over the femoral head. Used on larger breeds.
“False joint” forms from scar/fibrous tissue

36. HIP DYSPLASIA TREATMENT: surgical correction
TRIPLE PELVIC OSTEOTOMY
It is stabilized by a bone plate.

37. HIP DYSPLASIA TREATMENT: SURGICAL CORRECTION
FEMORAL HEAD OSTECTOMY
“False joint” forms from scar/fibrous tissue

38. HIP DYSPLASIA TREATMENT: SURGICAL CORRECTION
TOTAL HIP REPLACEMENT

39. Hip Dysplasia – Client Info
Weight control important to decrease load on painful joint
Swimming excellent activity
Lameness may occur due to surgical shortening of the affected limb
Physiotherapy – decreases joint stiffness, helps maintain muscle integrity
Joint degeneration progressive
May be heritable – do not breed
Special diets designed for fast growing dogs may decrease severity