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1.
Partial rupture of the cranial cruciate ligament was diagnosed in 25 dogs. In all dogs, the primary problem at the time of physical examination was hind limb lameness. The mean time from initial onset of lameness to diagnosis at exploratory surgery was 17 weeks. A cranial drawer sign was detected in 13 of the 25 dogs; in 9, the cranial drawer sign was evident only when the stifle was positioned in flexion. Of the 25 dogs, 12 had no detectable cranial drawer sign in response to manipulation of the involved stifle. In all dogs, lateral stifle arthrotomy was performed in routine manner, and the cranial cruciate ligament was found to be incompletely torn. Lesions identified during arthrotomy were rupture of the craniomedial band (n = 20 dogs), interstitial tear (n = 4 dogs), and rupture of the caudolateral band (n = 1 dog).  相似文献   

2.
Twenty-three cases of partial rupture of the cranial cruciate ligament (CCL) were reviewed. All of these patients were evaluated for clinical and radiographic signs of instability. Nine cases showed a negative drawer sign on manual assessment. A positive radiographic tibial compression test was obtained for all stifle joints with a partially ruptured cruciate. In 13 cases, the site of injury and the appearance of the torn ends were evaluated. The final diagnosis of partial CCL rupture was made by direct visualisation and probing of the CCL during arthrotomy (22 cases) or arthroscopy (one case).  相似文献   

3.
Cranial cruciate ligament (CCL) disease in the dog is a multifactorial complex problem that requires a thorough understanding of the biomechanics of the stifle joint to be understood. Successful treatment of rupture of the CCL should be based on managing underlying anatomical and conformational abnormalities rather than attempting to eliminate the tibial cranial drawer sign. The cranial and caudal cruciate ligaments, the patella ligament and quadriceps mechanism, the medial and lateral collateral ligaments, the medial and lateral menisci and the joint capsule provide stability of the joint and load-sharing. The function of the stifle is also significantly influenced by the musculature of the pelvic limb. An active model of biomechanics of the stifle has been described that incorporates not only the ligamentous structures of the stifle but also the forces created by weight-bearing and the musculature of the pelvic limb. This model recognises a force called cranial tibial thrust, which occurs during weight-bearing, and causes compression of the femoral condyles against the tibial plateau. In middle-aged, large-breed dogs, forces acting on the CCL together with conformation-related mild hyperextension of the stifle and slightly increased tibial plateau slopes are suspected to cause progressive degeneration of the ligament. Palpation of craniolateral stifle laxity has become pathognomonic for CCL rupture; however, chronic periarticular fibrosis, a partial CCL rupture, and a tense patient, may make evaluation of instability of the stifle difficult. Surgical treatment is broadly separated into three groups: intracapsular, extracapsular, and tibial osteotomy techniques. Tibial osteotomy techniques do not serve to provide stability of the stifle but rather alter the geometry of the joint to eliminate cranial tibial thrust such that functional joint stability is achieved during weight-bearing. Visualisation of both menisci is a critical aspect of CCL surgery, irrespective of the technique being performed. Regardless of the surgical technique employed, approximately 85% of dogs show clinical improvement. However, many of these dogs will demonstrate intermittent pain or lameness. Post-operative management is an integral part of the treatment of CCL rupture, and significant benefits in limb function occur when formalised post-operative physiotherapy is performed.  相似文献   

4.
Fourteen dogs were presented with caudal cruciate ligament (CaCL) rupture without concurrent cranial cruciate ligament (CrCL) rupture. The history usually included moderate to severe trauma. Presenting signs included lameness, positive drawer sign, and additional orthopedic injuries. A final diagnosis of CaCL rupture was made during surgical exploration of the joint in 12 of the dogs. In nine of the dogs, this diagnosis was not included in the preoperative differential diagnoses, and seven of the dogs were misdiagnosed as sustaining CrCL rupture. Methods of treatment included intracapsular and extracapsular stabilization. Follow-up time ranged from 3 weeks to 7 years. Function of the limbs was good regardless of surgical procedure chosen and did not appear to depend upon stifle stability.  相似文献   

5.
A reappraisal of anterior cruciate ligament disease in the dog   总被引：3，自引：0，他引：3  
A study of 111 cases of cranial cruciate ligament disease, seen over a three year period has been made. Fifty-five of these dogs were under four years of age (average age 21.4 months) and most were of the larger breeds, particularly the rottweiler (25 per cent). The onset of clinical signs was sudden in 53 per cent and gradual in 47 per cent of these cases; bilateral disease was present in 31 per cent. The severity of the lameness was variable. The pathogenesis of the disease appears to involve a gradual stretching, partial rupture and eventually a complete rupture of the cranial cruciate ligament. The term cruciate disease has been used to cover this spectrum of ligament pathology and the clinical signs can appear at any stage during this ligament degeneration. Slight anterior drawer movement can often be detected during the earlier stages of stretching and partial rupture but this can only be appreciated under general anaesthesia. Osteoarthritis is initiated during the early stages and may be well established by the time the cruciate completely tears. The predisposition to cruciate disease in these young dogs of the larger breeds is difficult to explain but may be related to inadequate exercise during puppyhood.  相似文献   

6.
This study describes the distribution of CD4+ and CD8alpha+ T lymphocytes, B lymphocytes, macrophages, MHC class II antigens, immunoglobulin (IgG, IgM, IgA)-containing cells and of adhesion molecules belonging to the CD11/CD18 family in synovial membrane biopsies from 28 dogs with spontaneous rupture of the cranial cruciate ligament (CCL). Synovial membranes from 11 dogs without evidence of joint lesions were used as control tissues. The main cell types in synovial membranes from dogs with CCL rupture were B lymphocytes and plasma cells belonging to the IgG isotype. The severity of inflammatory cell infiltration in CCL cases was positively correlated with the expression of adhesion molecules. Double immunofluorescence labelling of frozen sections revealed that in the inflamed synovium of dogs with CCL rupture numerous dendritic cells expressing MHC class II antigen and canine CD1c were present. The findings further support the view that in the synovium of dogs with CCL rupture an immunologic response is going on in which dendritic cells are possibly involved by presenting hitherto unknown antigens to T lymphocytes.  相似文献   

7.
Computed tomographic arthrography (CTA) of four cadaveric canine stifles was performed before and after partial cranial cruciate ligament rupture in order to verify the usefulness of CTA examination for the diagnosis of partial cranial cruciate ligament rupture. To obtain the sequential true transverse image of a cranial cruciate ligament, the computed tomography gantry was angled such that the scanning plane was parallel to the fibula. True transverse images of cranial cruciate ligaments were identified on every sequential image, beginning just proximal to the origin of the cranial cruciate ligament distal to the tibial attachment, after the administration of iodinated contrast medium. A significant decrease in the area of the cranial cruciate ligament was identified on CTA imaging after partial surgical rupture of the cranial cruciate ligament. This finding implies that CTA can be used for assessing partial cranial cruciate ligament ruptures in dogs.  相似文献   

8.
O bjective : To estimate specificity, sensitivity, positive predictive value and negative predictive value of tests and signs used for the diagnosis of cranial cruciate ligament failure in dogs.
M ethods : One stifle in each of 42 dogs was examined: 25 "affected" and 17 "control" dogs. All dogs were subjected to the following tests when conscious: cranial drawer, tibial compression, patellar tendon palpation and palpation of the medial aspect of the joint. Under general anaesthesia, cranial drawer and tibial compression tests were repeated and a lateral stifle radiograph was taken to evaluate changes of the infrapatellar fat pad. The results were analysed using a 2×2 table method. Sensitivity, specificity, positive predictive value and negative predictive value were estimated.
R esults : The sensitivity of the cranial drawer and tibial compression tests was surprisingly low when performed on conscious patients but significantly better when performed under anaesthesia. Similarly, palpation of the medial aspect of the stifle joint cannot be considered a reliable indicator of cranial cruciate ligament injury. Patellar palpation and radiographic assessment showed excellent sensitivity, specificity, positive predictive value and negative predictive value.
C linical S ignificance : In the diagnosis of cranial cruciate ligament, it is essential that the clinician is aware of each test's features and limitations to reduce the risk of misdiagnosis.  相似文献   

9.
OBJECTIVE: To review the gross, microscopic, and functional anatomy of the cranial cruciate ligament (CCL) in dogs. STUDY DESIGN: Literature review. METHODS: Reports of the anatomy and function of the cruciate ligaments in dogs were retrieved by search of the 1975-2005 PubMed database. RESULTS: The CCL has an important biomechanical function resisting cranial drawer, hyperextension, and internal rotation and acts to fine tune and guide the stifle through its rolling and sliding motion. It has a complex architecture, and distinct geographic regions within the ligament have different functional roles depending on the angle and loading conditions. Collagen type I is the main component of the extracellular matrix; the fibrils have a crimped structure. The cruciate ligaments are almost completely covered by synovium, protecting them from synovial fluid. Cruciate blood supply is mainly of soft tissue origin. The intraligamentous network is relatively limited whereas the core of the middle third of the CCL is even less well vascularized. Neurohistologic studies are very limited in the dog. Various mechanoreceptors and proprioceptive receptors have been identified within the substance of the cruciate ligaments. CONCLUSIONS: CCL structural characteristics play an important part in its complex behaviour with the crimped pattern of the collagen fibrils being an important determinant of its biomechanical properties. In contrast to reports of managing CCL rupture, there are few reports describing the microanatomy and neurovascular morphology of the cruciate ligaments. CLINICAL RELEVANCE: Cruciate disease is likely multi-factorial. Improved understanding of CCL degradation leading to CCL rupture is critical to development of new diagnostic tests for cruciate disease in dogs. Appropriate intervention during the early stages of disease process might preserve CCL structural properties by preventing further collagen degradation. Accurate knowledge of functional and fiber bundle anatomy is imperative for reconstruction and restoration of normal stifle joint physiology. Reconstructive goals should alleviate existing instability and mimic normal kinematics. Knowledge of the exact function of the CCL in the neuromuscular control around the stifle joint could possibly explain osteoarthritis progression after CCL damage.  相似文献   

10.
OBJECTIVE: To measure and compare synovial fluid antibody titers to type-I and -II collagen in stifle joints with instability caused by complete or partial cranial cruciate ligament (CCL) rupture and joints with osteoarthrosis secondary to other pathologic changes in dogs. ANIMALS: 82 dogs with diseased stifle joints. PROCEDURE: Synovial fluid samples were collected from 7 dogs with clinically normal stifles (control group) and 82 dogs with diseased joints (50 stifle joints with complete rupture of the CCL, 20 with partial damage of the CCL, and 12 joints with radiographic signs of osteoarthritis secondary to other arthropathies). Synovial fluid samples were tested for autoantibodies to type-I and -II collagen by an ELISA. RESULTS: In dogs with complete and partial CCL rupture, synovial fluid antibody titers to type-I and -II collagen were significantly increased, compared with control dogs. Forty-eight percent (24/50) of samples from dogs with complete CCL rupture and 35% (7/20) of samples from dogs with partial CCL rupture had antibody titers to type-I collagen that were greater than the mean plus 2 standard deviations of the control group titers. Synovial fluid antibody titers to type-II collagen were high in 40% of the dogs with partial or (8/20) complete (20/50) CCL rupture. Dogs with osteoarthrosis secondary to other pathologic changes had significantly increased synovial fluid antibodies to type-I and -II collagen, compared with control dogs. CONCLUSION: Increases in autoantibodies to collagen in synovial fluid are not specific for the type of joint disorder. It is unlikely that the anticollagen antibodies play an active role in the initiation of weakening of the CCL.  相似文献   

11.
Cranial tibial thrust: a primary force in the canine stifle   总被引：5，自引：0，他引：5  
A cranially directed force identified within the canine stifle joint was termed cranial tibial thrust. It was generated during weight bearing by tibial compression, of which the tarsal tendon of the biceps femoris is a major contributor, and by the slope of the tibial plateau, found to have a mean cranially directed inclination of 22.6 degrees. This force may be an important factor in cranial cruciate ligament rupture and in generation of cranial drawer sign.  相似文献   

12.
A prosthetic replacement for the cranial cruciate ligament was successfully implanted under arthroscopic guidance in four canine cadavers and seven normal dogs. Several strands of size 2 braided polyester were implanted in the cadavers and one normal dog, and a copolymer coated tow of 10,000 carbon fibers was implanted in six normal dogs. The average time required to surgically implant the carbon fiber prosthetic ligaments was 60 minutes. All of the dogs had slight to no drawer sign postoperatively. Five of the dogs were bearing more weight 3 weeks postoperatively than after transection of the cranial cruciate ligament. The surgical technique for implantation was successful for elimination of the cranial drawer sign, but carbon fibers were broken prematurely and instability reoccurred.  相似文献   

13.
OBJECTIVE: To measure concentrations of nitric oxide metabolites (nitrite-nitrate [NOt]) in cartilage, synovial membrane, and cranial cruciate ligament (CCL) in dogs and evaluate associations with osteoarthritis in dogs with CCL rupture. ANIMALS: 46 dogs with CCL rupture and 54 control dogs without joint disease. PROCEDURE: Tissue specimens for histologic examination and explant culture were harvested during surgery in the CCL group or immediately after euthanasia in the control group; NOt concentrations were measured in supernatant of explant cultures and compared among dogs with various degrees of osteoarthritis and between dogs with and without CCL rupture. RESULTS: Osteoarthritic cartilage had significantly higher NOt concentration (1,171.6 nmol/g) than did healthy cartilage (491.0 nmol/g); NOt concentration was associated with severity of macroscopic and microscopic lesions. Synovial membrane NOt concentration did not differ between dogs with and without CCL rupture. Ruptured CCL produced less NOt than did intact ligaments. In control dogs, NOt concentrations were similar for intact ligaments (568.1 nmol/g) and articular cartilage (491.0 nmol/g). Synthesis of NOt was inhibited substantially by coincubation with inhibitors. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that NOt in canine joint tissues originates from the inducible nitric oxide synthase pathway. Nitric oxide metabolite production in cartilage was greater in dogs with osteoarthritis than in healthy dogs and was associated with lesion severity, suggesting that nitric oxide inhibitors may be considered as a treatment for osteoarthritis. The CCL produces substantial concentrations of NOt; the importance of this finding is unknown.  相似文献   

14.
OBJECTIVE: To compare tibial plateau angle (TPA) in dogs with unilateral versus bilateral cranial cruciate ligament (CCL) rupture, to compare right versus left TPA in dogs with bilateral CCL rupture, and to determine whether TPA can be used to predict whether a dog with unilateral CCL rupture would subsequently rupture the contralateral CCL. DESIGN: Retrospective case series. ANIMALS: 150 dogs with unilateral (n=58) or bilateral (92) CCL rupture. PROCEDURES: Medical records were reviewed and TPA was recorded. Dogs with unilateral CCL rupture that were not known to have ruptured the contralateral ligament were followed up for a minimum of 2 years. RESULTS: Dogs with unilateral CCL rupture were significantly older (median, 7.0 years) than dogs with bilateral CCL rupture (median, 4.5 years). Median TPA for dogs with unilateral CCL rupture (26 degrees) was not significantly different from median TPA for dogs with bilateral rupture (27 degrees in both the right and left limbs), and right and left TPAs were not significantly different in dogs with bilateral CCL rupture. There was no correlation between TPA and the time interval between diagnosis of the initial and subsequent CCL ruptures in dogs with bilateral CCL rupture. CONCLUSION AND CLINICAL RELEVANCE: Results suggested that TPA in the range studied (mostly<35 degrees) was not a useful predictor of contralateral CCL rupture among dogs with unilateral CCL rupture, although age may be a risk factor for development of bilateral CCL rupture. The incidence of bilateral CCL rupture may be higher than previously reported.  相似文献   

15.
The objective of this study was to investigate if cellular reactivity to collagen type I exists in dogs with unilateral cranial cruciate ligament (CrCL) rupture and if it relates to disease progression. The patient group consisted of 10 dogs with unilateral CrCL rupture. The control dogs consisted of three healthy control dogs, and two healthy dogs with unilateral sham operations of the stifle joint. All dogs were assayed repeatedly every 6 months for 12-24 months. Peripheral blood mononuclear cells were isolated from whole blood and were cultured with human collagen type I at concentrations of 5, 20 and 40 microg/ml for 6 and 7 days. Lymphocyte reactivity to collagen type I occurred not only in dogs with CrCL rupture, but also in sham-operated dogs and healthy dogs. Five of the eight assays (63%) performed at the time of operation or at the time of diagnosis of CrCL rupture had a stimulation index (SI) >or=3.0. This was not significantly different compared to healthy control dogs, not to the sham-operated control dogs. The CrCL rupture was assessed intraoperatively in six cases. Three cases had partial rupture and three had complete rupture. Only one dog with partial rupture, and two dogs with complete rupture had a positive SI. An increase in proliferation to collagen type I was seen in dogs with CrCL rupture, whereas it either remained stable or decreased in the control dogs. No distinct pattern in lymphocyte reactivity to collagen type I could be established from the dogs that sustained a CrCL rupture in the contralateral stifle joint, although most dogs that did not sustain a CrCL rupture in the contralateral stifle joint remained negative during this study with exception of one dog. Further research is required to determine whether cellular reactivity to collagen type I may play an initiating role in cruciate degradation.  相似文献   

16.
OBJECTIVE: To determine hip, stifle, and tarsal joint ranges of motion (ROM) and angular velocities during swimming and walking in healthy dogs and dogs with surgically corrected cranial cruciate ligament (CCL) rupture. DESIGN: Prospective clinical study. ANIMALS: 13 healthy dogs and 7 dogs with CCL rupture. PROCEDURE: Dogs with CCL rupture were enrolled in a postoperative aquatic rehabilitation program and evaluated 21 to 35 days after surgery. Dogs were filmed while swimming in a pool and while walking at a fast (1.3 m/s) or slow (0.9 m/s) pace on a treadmill. Maximal angles of extension and flexion, ROM, and angular velocities were calculated. RESULTS: In healthy dogs, swimming resulted in a significantly greater ROM in the hip joint than did walking, but in dogs with CCL rupture, ROM of the hip joint did not vary with swimming versus walking. For dogs in both groups, swimming resulted in significantly greater ROM of the stifle and tarsal joints than did walking, primarily because of greater joint flexion. Stifle joint ROM was significantly lower in dogs with CCL rupture than in healthy dogs, regardless of whether dogs were swimming or walking. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that following surgical management of a ruptured CCL in dogs, swimming resulted in greater ROM of the stifle and tarsal joints than did walking. This suggests that if ROM is a factor in the rate or extent of return to function in these dogs, then aquatic rehabilitation would likely result in a better overall outcome than walking alone.  相似文献   

17.
One of the possible initiating factors in canine cranial cruciate ligament (CCL) rupture could be an abnormal pattern of ligament cell death. This study compared apoptotic cell death in sections of ruptured CCLs and normal controls, and examined nitric oxide (NO) production in joint tissues and correlated this to apoptosis. CCLs and cartilage from the lateral femoral condyle were harvested from 10 healthy dogs and 15 dogs with CCL rupture and ligaments were further processed to detect cleaved caspase-3 and to determine supernatant NO production in explant cultures. Apoptotic activity was greater in ruptured ligaments compared to controls. NO in ligaments showed a moderate but significant positive correlation with caspase-positive cells. The results suggest that increased apoptosis has a role in CCL rupture and that apoptosis may be influenced by local NO production.  相似文献   

18.
Over a 5-year period, fibular head transposition was performed in 85 stifles in 80 dogs with rupture of a cranial cruciate ligament. The most common complication during surgery was iatrogenic fracture of the fibular head or neck (10 dogs; 12.5%), and the most common postoperative complication was seroma formation at the lateral aspect of the proximal portion of the tibia overlying the pin (6 dogs; 7.5%). Sixty-nine of 80 owners were contacted for follow-up evaluation of lameness 6 months to 5 years after surgery; 51% reported excellent results, 39% good results, and 10% fair results. Fifty-six dogs were available for long-term follow-up examination; all dogs had some degree of medical thickening of the stifle, 27 (48%) had crepitus, 4 (7%) had signs of pain, and 2 (3.5%) had moderate cranial drawer instability on manipulation of the joint. Results were good or excellent in 90% of the dogs.  相似文献   

19.
OBJECTIVE: To determine the prevalence of cranial cruciate ligament rupture (CCLR) in dogs with lameness previously attributed to canine hip dysplasia (CHD). DESIGN: Retrospective study. ANIMALS: 369 client-owned dogs. PROCEDURES: Hospital medical records from 1994 to 2003 were reviewed for dogs in which the referring veterinarian had diagnosed hip dysplasia or hip pain. Dogs were designated as having hind limb lameness because of partial or complete CCLR or CHD. RESULTS: 8% of dogs were sexually intact females, 43% were spayed females, 14% were sexually intact males, and 35% were castrated males. Mean age was 3.8 years (range, 3 months to 15 years). The most common breeds were the Labrador Retriever (21%), German Shepherd Dog (13%), and Golden Retriever (11%). The prevalence of CCLR as the cause of hind limb lameness was 32% (95% confidence interval, 27.2% to 36.8%). The distribution of CCLR among hind limbs was left (29%), right (28%), and bilateral (43%). Of 119 dogs with CCLR, 94% had concurrent radiographic signs of CHD, 92% had stifle joint effusion, and 81% had a cranial drawer sign. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of the high prevalence of CCLR in dogs referred for lameness because of CHD, it is important to exclude other sources of stifle joint disease before making recommendations for treatment of CHD.  相似文献   

20.
OBJECTIVE: To determine whether histopathologic changes are detectable in grossly normal medial menisci from dogs with rupture of the cranial cruciate ligament (CCL). DESIGN: Case series. SAMPLE POPULATION: 40 medial menisci from dogs with rupture of the CCL and 20 medial menisci from control dogs without stifle joint disease. PROCEDURE: Data evaluated included age, duration of clinical signs, and whether rupture of the CCL was complete or incomplete. Three groups (n = 20/group) were also compared on the basis of 5 histologic criteria; group-1 menisci appeared grossly normal and were obtained from dogs with naturally occurring rupture of the CCL, group-2 menisci were grossly abnormal and were also obtained from dogs with naturally occurring CCL ruptures, and group-3 menisci were collected at postmortem from dogs without stifle joint disease that were of similar age and weight as dogs in groups 1 and 2. RESULTS: Group-2 menisci were significantly different from group-1 and -3 menisci in all histologic criteria. Group-1 menisci were significantly different from control menisci in only 1 of the 5 histologic criteria (cartilage differentiation). Dogs that were > or =3 years old had significantly more surface cellularity than did dogs that were < 3 years old. A significant difference was not detected between groups 1 and 2 with regard to completeness of rupture. CONCLUSIONS AND CLINICAL RELEVANCE: Histologic changes in meniscal cartilage correlate with gross appearance of the cartilage at time of surgery for rupture of the CCL. On the basis of minimal histologic changes, routine removal of grossly normal menisci does not appear to be warranted.  相似文献   

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