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Multiple Ligamentous Injuries of the Canine Stifle Joint: a Literature Review and Clinical Case Study

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Multiple Ligamentous Injuries of the Canine Stifle Joint: a Literature Review and Clinical Case Study MULTIPLE LIGAMENTOUS INJURIES OF THE CANINE STIFLE JOINT: A LITERATURE REVIEW AND CLINICAL CASE STUDY by Warrick John Bruce BVSc (Massey) Cert SAO MRCVS A thesis presented to the Faculty of Veterinary Clinical Studies University of Glasgow for the Degree of Master of Veterinary Medicine September 1995 © Warrick John Bruce ProQuest Number: 13834040 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 13834040 Published by ProQuest LLC(2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 'fLr-i 10111 S um m ary The aim of this thesis is to detail the clinical, ancillary, surgical and postoperative findings in eleven cases of multiple ligamentous injuries of the canine stifle joint. All cases were presented to the University of Glasgow Veterinary School during the period October 1992 to August 1995. Severe trauma was required to produced multiple ligamentous injury of the stifle joint in nine of the dogs in this series. This resulted from an injury occurring when running at speed, catching the limb in a fence or gate, or from a road traffic accident. In the remaining two dogs, injury occurred without obvious trauma and in these cases there was evidence of chronic stifle joint infection. Multiple ligamentous stifle joint injuries occurred most frequently in adult, male, working or sporting dogs and resulted in a non-weight bearing lameness and stifle joint subluxation. Complete dislocation of the joint occurred in two cases. The cranial cruciate ligament was always injured and ten of the cases involved the caudal cruciate ligament, as well as one, or both, of the collateral ligaments. The most frequent combination was injury to the cranial and caudal cruciate ligaments and the lateral collateral ligament and this injury occurred most often after catching the limb in a fence or gate. Injury to the menisci was a common finding. The surgical method employed produced good to excellent results for long-term limb function in ten cases. There was no significant decrease in thigh muscle mass or reduction in stifle joint range of motion in nine of the cases at long-term follow- up. Radiographic changes such as osteophytic development, joint effusion and soft tissue swelling occurred in all cases postoperatively. These findings are discussed in light of a broad review of the literature pertaining to multiple ligamentous injuries of the stifle joint in dogs and the relevant comparative aspects in man. I DECLARATION I, Warrick John Bruce, do hereby declare that the work carried out in this thesis is original, was carried out by myself or with due acknowledgement, and has not been presented for the award of a degree at any other University. signed: date: II In loving memory of my grandmother Grace Isobel Bruce who always supported me in my quest to enter veterinary science. “The awareness of the ambiguity of one’s highest achievements (as well as one’s deepest failures) is a definite symptom of maturity.” Paul Tillich, Time, 1963. Ill T able O f C ontents SUMMARY................................................................................................................ ......I DECLARATION.............................................................................................................II DEDICATION................................................................................................................. Ill TABLE OF CONTENTS............................................................................................... IV TABLE OF FIGURES................................................................................................... IX TABLE OF TABLES......................................................................................................XII ACKNOWLEDGEMENTS...........................................................................................XIII INTRODUCTION...........................................................................................................XIV SECTION 1: BASIC SCIENCE................................................... 1 PART 1: THE STABILISING STRUCTURES OF THE CANINE STIFLE.............................................................................................................................. 2 Introduction ........................................................................................................2 Primary Joint Restraints .................................................................................3 The Cranial and Caudal Cruciate Ligaments ............................. 3 Anatomy..............................................................................3 Cruciate Ligament Dynamics ............................................4 The Medial and Lateral Collateral Ligaments ............................ 9 Anatomy..............................................................................9 Collateral Ligament Dynamics......................................... 9 Secondary Joint Restraints ............................................................................13 The Lateral and Medial Menisci .................................................. 13 Anatomy..............................................................................13 Meniscal Dynamics............................................................15 The Patella and Patellar Ligament ................................................15 Anatomy..............................................................................15 Patella and Patellar Ligament Dynamics ......................... 16 The Joint Capsule...........................................................................16 Anatomy..............................................................................16 O ther Supporting Structures ........................................................................ 18 Muscles and Tendons of the Stifle Joint.....................................18 PART 2: MOVEMENT AND STABILISING MECHANISMS OF THE STIFLE JOINT .......................................................................................................20 Stifle K inesiology ....................................................................................... 20 The Cruciate Ligam ents ...................................................................................23 The Collateral Ligaments ............................................................................. 24 The Men isc i ........................................................................................................... 24 The Patella A nd Patellar Ligament ...........................................................26 The Joint Capsule ............................................................................................... 26 Muscles A nd Tendons .......................................................................................26 IV PART 3: PATHOPHYSIOLOGICAL CONSIDERATIONS................................ 27 Ligament Properties.......................................................................................... 27 Classification O f Ligament In ju r y .............................................................. 27 Sprain.................................................................................................27 First-degree Sprain .......................................................................... 27 Physical and Radiographic Findings ................................. 27 Second-degree Sprain ......................................................................27 Physical and Radiographic Findings ................................. 28 Third-degree Sprain .........................................................................28 Physical and Radiographic Findings ................................. 28 Mechanisms O f Ligament Failure ................................................................. 28 Mechanical Properties.....................................................................28 Ligament Failure Modes ................................................................ 30 Injury To The Menisci ........................................................................................31 Surface F ibrillation ...................................................32 Peripheral Avulsion................................................. 32 Compression Injury................................................. 32 Axial Fringe Tear.....................................................32 Transverse (Radial) Tear .........................................32 Full Thickness Longitudinal Tear ..........................32 Atrophied, Proliferative, and Discoid M enisci......................................................................32 PART 4: LIGAMENT HEALING AND TREATMENT OF LIGAMENT INJURIES..................................................................................................33 The Reparative Process....................................................................................33 The Substrate Phase ......................................................................... 33 The Repair Phase............................................................................
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