Correlation between orthopaedic and radiographic examination findings and arthroscopic ligament fibre damage in dogs with cruciate ligament rupture

Abstract

Objective The objective is to study the correlations between physical examination and stifle radiography findings and severity of arthroscopic cranial cruciate ligament (CrCL) fibre damage in dogs with cruciate rupture (CR).Design Design Prospective clinical study.Methods Twenty-nine client-owned dogs with CR underwent physical examination, stifle radiography and arthroscopy, and the findings were recorded. Initial examination was repeated after sedation and after general anaesthesia. The Spearman rank correlations of examination variables with diagnostic imaging were examined.Results Overall, cranial tibial translation assessed by the tibial compression test in extension showed correlation with arthroscopic CrCL fibre damage (P < 0.05). Correlations between severity of cranial drawer laxity and arthroscopic CrCL fibre damage were not significant. Under general anaesthesia, stifle laxity tests were positively correlated with lameness severity grade (S R ≥ 0.41, P < 0.05). Meniscal damage was correlated with pain on the internal rotation of the tibia (S R = 0.42, P < 0.05) and severity of radiographic osteophytosis (S R = 0.53, P = 0.01).Conclusion Detection and estimation of severity of cranial tibial translation enable the diagnosis of CR and also the inference of the severity of CrCL fibre rupture, particularly with the tibial compression test in extension. Severity of joint laxity is best assessed under general anaesthesia. Such knowledge should reduce the risk of misdiagnosis and may enhance early diagnosis and treatment of dogs with CR over time.

Use of Blumensaat's line for assessment of cranial tibial subluxation in dogs with cranial cruciate ligament deficiency

“…27 nial translation of the tibia has been demonstrated radiographically previously by showing the tibial eminences and the caudal margin of the fibula displaced cranially relative to the normal neutral position. 28 It has also been shown that the degree of cranial translation that can be demonstrated radiographically is greater in cruciate deficient stifles compared to those with partially deficient cruciate ligaments and intact cruciate ligaments. 29 In human patients, passive anterior tibial subluxation of over 3.5 mm, detected via MRI, has been used as a highly specific and sensitive diagnostic marker for complete anterior cruciate ligament tears.…”

“…Radiographically detectable signs of cranial tibial translation are useful in the diagnosis of CCL failure because the manual assessments through cranial drawer and tibial compression tests have limitations, especially when these are performed in the conscious patient 27 . Cranial translation of the tibia has been demonstrated radiographically previously by showing the tibial eminences and the caudal margin of the fibula displaced cranially relative to the normal neutral position 28 . It has also been shown that the degree of cranial translation that can be demonstrated radiographically is greater in cruciate deficient stifles compared to those with partially deficient cruciate ligaments and intact cruciate ligaments 29 .…”

Degree of osteophyte formation seen on radiographs provides useful prognostic information for dogs with cruciate ligament disease

“…Dogs with CCLD generally develop progressive OA, which has a substantial impact on the welfare of the affected dogs 9,14,22–24 . The relationship between radiographic evidence of stifle joint OA and pain/function in dogs has been evaluated in several studies, but there are still knowledge gaps and there is no consensus regarding the best method for pain evaluation in dogs with OA 10,25,26 . Gordon et al 26 .…”

“…Osteoarthritis (OA) is generally present in the stifle at the time of CCLD diagnosis and progresses in the affected joint regardless of treatment method 8–10 . OA involves degradation of the articular cartilage and ligaments, and formation of osteophytes and is associated with a varying degree of inflammation, lameness and pain 11–13 .…”

Update on the management of canine cruciate disease

“…Meniscal tears are 9.6 to 12.9 times more common in stifles with complete v partial CCL rupture, and risk also increases with duration of lameness, bodyweight, being older, being a smaller dog, or a rottweiler (Hayes and others 2010, Laube and Kerstetter 2020). Detection of a meniscal ‘click’, pain on stifle flexion, and/or pain on internal rotation of the tibia are significantly correlated with the presence of meniscal damage (Dillon and others 2014, Ashour and others 2019). A meniscal ‘click’ is most likely to be elicited using the modified tibial compression test, and where a bucket‐handle tear exists (Neal and others 2015, Valen and others 2017).…”