Diagnosis of cranial cruciate ligament injury in dogs by tibial compression radiography

Correlation of spontaneous radiographic cranial tibial translation with complete cranial cruciate ligament rupture and medial meniscal tears in dogs

The primary objective of our study was to determine the prevalence of cranial tibial translation on a single unstressed, standing angle, mediolateral radiograph of the stifle and the accuracy of diagnosing complete cranial cruciate ligament rupture in dogs with this finding using a previously published method. The secondary objective was to determine if there was a higher incidence of meniscal injuries associated with spontaneous radiographic cranial tibial translation as previously proposed. Medical records were reviewed for client owned dogs with cranial cruciate ligament rupture that underwent surgical stabilization with intra-operative evaluation of the stifle joint via arthrotomy between June 2013 to January 2022 and had pre-operative radiographs performed within 60 days prior to surgery. Pre-operative radiographs were evaluated for cranial tibial translation via the previously published method. Three hundred twenty-three dogs met the inclusion criteria for the study. Intra-operative findings and radiographic assessments were evaluated for correlations. Cranial tibial translation on pre-operative standing angle radiographs detected cranial cruciate ligament tears in 24.8% of cases but had a positive predictive value of 97.5% for diagnosing complete cranial cruciate ligament rupture with a specificity of 95.4% and an overall accuracy of 36.8%. Meniscal tears were present in 58.75% of cases with radiographic cranial tibial translation and 41.25% of cases without. There was no significant increase in the incidence of meniscal tears between the two groups. The presence of radiographic cranial tibial translation in dogs on an unstressed, standing angle, mediolateral radiograph of the stifle is diagnostic for cranial cruciate ligament rupture, but cannot be used to determine the presence of a meniscal tear.

The Role of Tibial Plateau Angle in Canine Cruciate Ligament Rupture-A Review of the Literature

Cranial cruciate ligament disease is a common pathological condition in dogs that is often presented in daily clinical practice. Different risk factors for the development of this condition include breed, sex, age, bodyweight and neuter status, as well as different biological and biomechanical mechanisms. In the literature, special attention has been paid to the role of the tibial plateau angle in damage to the cranial cruciate ligament. Although the disease was first described at the beginning of last century, and since then different surgical methods have been developed to treat it, its aetiology remains unclear. In this review, contemporary literature data related to the role of tibial plateau angle in canine cranial cruciate ligament rupture are presented.

Evaluation of cranial tibial translation in dogs: Diagnostic accuracy of radiographic method using a simple device

A hand-made, radiolucent, custom-designed device having a mobile and a non-mobile platforms was used to objectively quantify the in vivo cranial tibial translation, in order to assess the functional status of cranial-cruciate-ligament (CrCL) in dogs. The hypothesis was that changes in CrCL integrity would result in detectable changes in tibial translation. To validate the diagnostic method, data from injured (PA, n = 32), contralateral (CO, n = 32) and healthy stifles (HE, n = 32) were compared. Normalized tibial translation (Δ_N) of each stifle was measured in medio-lateral radiographic projection obtained before and during standard thrust force application, in PA (43.59±12.97%), CO (20.32±6.69%) and HE (12.22±3.77%). Comparing PA with HE and CO (Δ_N cut-off value: 29.73%), diagnosis could be issued with very high probability. Comparing HE with CO (Δ_N cut-off value: 14.80%), high performance was obtained. The translator device could be a useful tool to objectively quantify the in vivo tibial translation in dogs with CrCL rupture, before surgery and during post-operatory follow-up.

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

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.

Clinical and Radiological Evaluation of the Treatment of Cranial Cruciate Ligament Rupture in Cats with the Musculus Biceps Femoris Transposition Technique

The aim of this study was to clinically and radiologically evaluate the technique of biceps femoris muscle transposition as a new extracapsular treatment technique for cranial cruciate ligament ruptures, which are often encountered in cats. In this study, eight cats diagnosed with cranial cruciate ligament rupture were treated with the biceps femoris muscle transposition technique. The postoperative standard clinical examination procedures were applied to each cat for 90 days. In the preoperative clinical and radiological examinations of the eight cats in the study, cranial cruciate ligament rupture alone was diagnosed in seven of them. Both, the cranial cruciate ligament rupture and meniscal lesions in the same stifle joint were determined in one cat. The biceps femoris muscle transposition technique operation took approximately 20 mins in each case.

The postoperative radiographs were taken on days 10, 30, 60 and 90. No complications were seen in any case during the postoperative follow-up. The Illinois University Evaluation Scale was used for a more objective evaluation. At 90 days postoperatively, there was no lameness in seven out of eight cats, and mild limping was determined in one of them due to concomitant meniscal lesion.

According to the study results, the biceps femoris muscle transposition technique was found to be extremely useful as an easily applicable technique in the treatment of cranial cruciate ligament rupture in cats.

Evaluation of the radiographic infrapatellar fat pad sign of the contralateral stifle joint as a risk factor for subsequent contralateral cranial cruciate ligament rupture in dogs with unilateral rupture: 96 cases (2006-2007)

OBJECTIVE

To determine prevalence of the contralateral radiographic infrapatellar fat pad sign and contralateral radiographic degenerative sign (degenerative changes) and evaluate both signs as risk factors for subsequent contralateral cranial cruciate ligament (CrCL) rupture in dogs with unilateral CrCL rupture.

DESIGN

Retrospective cohort study.

ANIMALS

96 dogs with unilateral CrCL rupture and 22 dogs with bilateral CrCL rupture.

PROCEDURES

Dogs with unilateral CrCL rupture were classified as having normal (n = 84) or abnormal (12) contralateral stifle joints on the basis of joint palpation. Associations between potential predictive variables and rates of subsequent contralateral CrCL rupture were evaluated.

RESULTS

Of the 84 dogs with unilateral CrCL rupture in which the contralateral stifle joint was palpably normal, 29 (34.5%) had a contralateral fat pad sign and 31 (36.9%) had a degenerative sign. All dogs with unilateral CrCL rupture in which the contralateral stifle joint was palpably abnormal had a contralateral fat pad sign and degenerative sign. The contralateral fat pad sign was the most important risk factor for subsequent rupture of the contralateral CrCL. For dogs with unilateral CrCL rupture and palpably normal contralateral stifle joint with and without a contralateral fat pad sign, median time to subsequent rupture was 421 and 1,688 days, respectively, and the 3-year probability of subsequent rupture was 85.3% and 24.9%, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Bilateral stifle joint radiography should be performed for all dogs with CrCL rupture. Bilateral stifle joint arthroscopy should be considered for dogs with a contralateral fat pad sign.

Feasibility of utilizing the patellar ligament angle for assessing cranial cruciate ligament rupture in dogs

The patellar ligament angle (PLA) was assessed in 105 normal stifle joints of 79 dogs and 33 stifle joints of 26 dogs with a ruptured cranial cruciate ligament (CrCL). The PLA of stifles with complete CrCL rupture was significantly lower than that of normal stifles, particularly at a flexion angle of 60~80° in both plain and stress views. If the PLA was <90.55° on the stress view with a 60~80° flexion angle, the dog was diagnosed with a complete rupture of the CrCL with a sensitivity of 83.9% and specificity of 100%. In conclusion, measuring the PLA is a quantitative method for diagnosing complete CrCL rupture in canines.

Radiographic landmarks for measurement of cranial tibial subluxation in the canine cruciate ligament deficient stifle

OBJECTIVES

The primary objective was to develop a repeatable radiographic technique for assessment of cranial tibial subluxation (CTS) and test the intra-observer and inter-observer repeatability of the chosen landmarks. A secondary objective was to determine the effects of digital radiographic magnification on CTS measurement repeatability.

METHODS

Twenty-three normal canine pelvic limbs were used to determine the magnitude of CTS before and after transection of the cranial cruciate ligament. Mediolateral radiographs were taken with and without fiduciary markers in place. Three investigators measured the CTS using radiographically visible anatomic landmarks at two different magnifications. The total observed variabilities were assessed by inter-observer and intra-observer differences. Paired t-tests were used to determine the effect of magnification and marker presence on CTS measures.

RESULTS

Measurement of the CTS from the caudal margin of the intercondylar fossa on the femur to the intercondylar eminence was the most repeatable. Poor correlation between the anatomic landmarks and the fiduciary bone markers was observed. We found no effect of magnification or presence or absence of bone markers on measurement of CTS.

CLINICAL SIGNIFICANCE

Cranial tibial subluxation can be detected with the most repeatability by measuring between the caudal margin of the intercondylar fossa and the intercondylar eminence. Magnification of the digitized radiographic image had minimal effect on repeatability. This technique can be used for in vivo analysis of the canine cruciate ligament deficient stifle joint.

Advanced imaging: use and misuse

SUMMARY

The primary purpose of diagnostic imaging is to enable clinicians to make correct decisions about a patient's diagnosis and severity of its condition and, thereby, to contribute to effective and efficient treatment. Advanced imaging modalities are inherently better detectors of morphological lesions than radiography; hence, they offer the possibility of more accurate diagnosis and staging, with correspondingly better patient outcomes. However, there is a lack of evidence that better outcomes are being realised for veterinary patients. Furthermore, increased use of advanced imaging carries the possibility of increased misuse, primarily through unnecessary studies that contribute little to patient management other than increased costs.

SCOPE

This article is intended to be relevant to all veterinary species. Advanced imaging of cats is not sufficiently developed as a specific discipline that a balanced review could be based purely on feline examples or references.

Synovitis in dogs with stable stifle joints and incipient cranial cruciate ligament rupture: a cross-sectional study

OBJECTIVE

To evaluate stifle joints of dogs for synovitis, before development of joint instability and cranial cruciate ligament rupture (CrCLR).

STUDY DESIGN

Cross-sectional study.

ANIMALS

Dogs (n = 16) with CrCLR and stable contralateral stifles; 10 control dogs with intact CrCL.

METHODS

Arthritis and tibial translation were graded radiographically. Synovitis severity and cruciate pathology were assessed arthroscopically. Presence of inflammatory cells in synovial membrane biopsies was scored histologically. CrCLR stifle pairs and control stifles were compared.

RESULTS

Radiographic evidence of arthritis, cranial tibial translation, and arthroscopic synovitis were increased in unstable stifles, when compared with stable contralateral stifles in CrCLR dogs (P < .05). Arthroscopic synovitis in both joints of CrCLR dogs was increased compared with controls, was correlated with radiographic arthritis (S(R) = 0.71, P < .05), and was present in all stable contralateral stifles. Arthroscopically, 75% of stable stifle joints had CrCL fiber disruption, which correlated with severity of synovitis (S(R) = 0.56, P < .05). Histologic evidence of synovitis was identified in all CrCLR dogs, but was only significantly correlated with arthroscopic observations in stable stifles (r(2) = 0.57, P < .005).

CONCLUSION

Synovitis is an early feature of the CrCLR arthropathy in dogs before development of joint instability clinically. Severity of synovitis is correlated with radiographic arthritis in joints with minimal to no clinically detectable CrCL damage.

Diagnostic imaging of the canine stifle: a review

The stifle joint, a common location for lameness in dogs, is a complex arrangement of osseous, articular, fibrocartilaginous, and ligamentous structures. The small size of its component structures, restricted joint space, and its intricate composition make successful diagnostic imaging a challenge. Different tissue types and their superimposition limit successful diagnostic imaging with a single modality. Most modalities exploit the complexity of tissue types found in the canine stifle joint. Improved understanding of the principles of each imaging modality and the properties of the tissues being examined will enhance successful diagnostic imaging.

Instrumented measurement of in vivo anterior-posterior translation in the canine knee to assess anterior cruciate integrity

This study was designed to objectively quantify in vivo anterior-posterior canine knee translation relative to anterior cruciate ligament (ACL) integrity. Tibial translation was determined in one knee of 43 crossbreed hounds from radiographs performed while a set anterior and then posterior force was applied to the tibia using a custom designed device. The total (TTT), anterior (ATT), and posterior (PTT) tibial translation were measured (absolute) and normalized to the width of the tibia (normalized). Absolute and normalized TTT was significantly greater in ruptured ACL knees than in partially disrupted (PD) ACL knees, which were significantly greater than in intact ACL knees. ATT and PTT was significantly greater in ruptured ACL knees than in PD or intact ACL knees, which were not significantly different. The sensitivity and specificity of normalized TTT to distinguish knees with intact from PD ACLs were both 100%. Normalized TTT to distinguish knees with PD from ruptured ACLs had a sensitivity and specificity of 100% and 92%, respectively. Intra- and inter-observer intra-class correlation coefficients were 0.84 or higher for all translations. This precise non-invasive technique to assess canine knee translational stability and ACL integrity permits repetitive, objective measurements for diagnostic use and to assess therapeutic intervention efficacy.

Caudal proximal tibial deformity and cranial cruciate ligament rupture in small-breed dogs

Eight dogs presented with chronic hindlimb lameness associated with cranial cruciate ligament rupture. Seven were small terriers. A caudal deformity of the proximal tibial shaft, originating at the proximal tibial physis, and an excessive caudal slope of the tibial plateau were present bilaterally in all dogs. The deformity was thought to be responsible for the cranial cruciate ligament failure and poor response to conservative management. Tibial plateau angles were in excess of 26 degrees in all dogs. The lameness was bilateral in three dogs. There was complete cranial cruciate ligament rupture in seven stifles and partial rupture in four. There were no meniscal injuries. Surgical correction resulted in a significant improvement (P<0.0001) in all dogs, with a mean follow-up of 12 months (range three to 24 months). There were no complications.

Echographic examination of the stifle joint affected by cranial cruciate ligament rupture in the dog

Ultrasound is a useful technique for the study of normal and pathologic stifle joints, in particular for soft tissue examination. The aim of this study was to evaluate sonography for examination of stifle joints affected by cranial cruciate ligament rupture. Forty-two medium to giant breed dogs were studied. Tibial compression radiography was performed. A 7.5 MHz transducer with an incorporated 2 cm thick standoff was employed. Sagittal and midsagittal images were collected. The stifle was positioned in maximum flexion during sonography. Sonographic findings were compared with pathologic findings at surgery. Ultrasound was useful in evaluating the presence of fibrous tissue within the joint due to repair processes. It was observed in 70% of stifles with radiographic evidence of chronic osteoarthritis. In 19.6% of the joints it was possible to identify the ruptured cranial cruciate ligament. Ultrasound was not an accurate test for cruciate rupture evaluation, but was specific for the soft tissue pathologic changes which were observed consequent to joint instability.

Use of compression stress radiography for the detection of partial tears of the canine cranial cruciate ligament

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).

Popliteal sesamoid displacement associated with cruciate rupture in the dog

Distal displacement of the popliteal sesamoid is a useful parameter in the interpretation of tibial compression radiographs in cases of cranial cruciate ligament rupture in the dog. An accuracy of 99 per cent and a specificity of 100 per cent were achieved by assessing the localisation of the sesamoid bone in the diagnosis of cruciate disease.