High-frequency ultrasound, computed tomography and computed tomography arthrography of the cranial cruciate ligament, menisci and cranial meniscotibial ligaments in 10 radiographically normal canine cadaver stifles

Abstract

Background Bilateral non-traumatic cranial cruciate disease is frequently seen in originally unilateral cruciate pathology. Untreated cranial cruciate ligament disease and concurrent meniscal lesions cause progressive osteoarthritis and pain of the stifle joint. Early presurgical diagnosis is important, but remains difficult. The purpose of this ex vivo study was (1) to describe the ultrasonographic appearance of the canine cranial cruciate ligament (CrCrL), menisci and meniscal ligaments using a high-frequency linear transducer, (2) to determine the length of the CrCrL seen on ultrasonography (US) and (3) to describe and compare the appearance of the CrCrL, menisci and meniscal ligaments on US, computed tomography (CT) and computed tomography arthrography (CTA). Results US and CT examinations were performed on 10 radiographically normal cadaveric stifles of adult dogs weighing more than 15 kg, followed by macroscopic and histologic evaluations. The CrCrL had a parallel hyperechoic fibrillar pattern at the insertion on the tibia and a hypoechoic structure more proximally in all stifles. This pattern was visible over 35% (median) of the total length of the ligament, with 50% (median) of the total length CrCrL that could be outlined. All medial menisci and 8 out of 10 of the lateral menisci showed hypoechoic lines within their bodies oriented obliquely to the direction of the ultrasound beam. Fifteen of the 20 cranial meniscotibial ligaments were detected, showing a hyperechoic fibrillar pattern. Normal macro- and microscopic appearance was observed in all menisci, with the radial bundles of collagen fibers at the level of and with similar orientation as the intrameniscal hypoechoic lines on US. The CrCrL, menisci and meniscal ligaments were of intermediate density on CT, but marked improvement of the border detection was obtained using CTA. Contrast within the CrCrL was observed in 4/10 stifles using CT and confirmed in 3/4 stifles on histology. One of these ligaments had a partial tear (5–10%) on macroscopic evaluation. None of the menisci showed any abnormalities on CTA. Conclusions Normal canine menisci are heterogeneous on high-frequency US and a fibrillar pattern may be observed in the cranial meniscotibial ligaments and the distal portion of the CrCrL. Linear areas of contrast may be detected within the cranial cruciate ligament of radiographically normal stifles.

Prevalence and Risk Factors for Bilateral Meniscal Tears Identified during Treatment for Cranial Cruciate Ligament Disease Via Tibial Plateau Levelling Osteotomy in Dogs

“…Of the study population, 25% underwent bilateral TPLO, consistent with previous studies that reported a range of 17 to 61%. 1,2,7 The signalment of our study population was consistent with other studies on cranial cruciate ligament disease and medial meniscal tears. 2,13,23 Sex and neuter status were not identified as risk factors for bilateral meniscal tears in this study; however, breed and age were significant.…”

“…1 Bilateral cranial cruciate ligament rupture, identified during single or staged surgeries, shows a reported occurrence of 17 to 54%. 1,2,6,7 The menisci contribute to joint stabilization by aiding in shock absorption, load transmission, prevention of synovial membrane impingement between the femur and tibia, joint proprioception and joint lubrication. [2][3][4][8][9][10] In full extension, the menisci transmit $50 to 70% of the body weight, which increases to 85 to 90% in flexion.…”

“…11 Researchers have speculated that the medial meniscus is less mobile than the lateral meniscus, and is therefore more prone to damage during cranial drawer motion in cranial cruciate ligamentdeficient stifles. 7,8,12 However, recent research has revealed moderate motion of the medial meniscus during different weight-bearing angles. 11 Thus, the underlying aetiologies for meniscal tears in cranial cruciate ligament-deficit stifles remain unclear.…”

“…12,13 Concurrent medial meniscal injury is a common finding in naturally occurring partial or complete cranial cruciate ligament rupture, with a reported prevalence of 5 to 83%. 5,7,9,10,12,14,15 Cranial cruciate ligament rupture with concurrent meniscal tear has been well-documented; however, the prevalence of bilateral meniscal damage in dogs with bilateral cranial cruciate ligament rupture remains undetermined. This study aimed to report the prevalence and risk factors associated with bilateral meniscal tears with concurrent bilateral cranial cruciate ligament rupture identified during tibial plateau levelling osteotomy (TPLO) procedures performed in a staged or simultaneous manner.…”

Meniscusletsels bij de hond

“…Magnetische resonantie (MR) is een uitstekende niet-invasieve beeldvormingstechniek voor het diagnosticeren van subtiele letsels van de menisci bij de hond (Martig et al, 2006;Böttcher et al, 2010;Przeworski et al, 2016;Franklin et al, 2017;Van der Vekens et al, 2019). De gevoeligheid en specificiteit van MR voor de diagnose van mediale meniscusletsels zijn respectievelijk 68% (of 75%, afhankelijk van de referentiestandaard) en 100% (Franklin et al, 2017).…”