pathology than cruciate damage, although fragmentation of the medial (or
lateral) intercondylar eminence is occasionally (but not always) associated
with cruciate ligament injury. Careful assessment of other soft tissue
structures of the stifle is important to rule out other concurrent pathology.
Treatment consists of arthroscopic debridement and rest. Arthroscopic
assessment and debridement can be facilitated by removal of the median
septum. Debridement using motorized resectors is recommended for some
grade 2 and for grade 3 tears, followed by a prolonged period of rest and
controlled exercise (up to 6 months). Selected results suggest that this may
lead to favourable outcome in some cases. Some contained injuries have
been treated with arthroscopically guided intra-ligamentous injections with
mesenchymal stem cells.
Fractures of the medial intercondylar eminence have long been regarded as
avulsion injuries of the cranial cruciate ligament. Arthroscopic exploration of
such injuries however has shown that they may occur without significant
ligament disruption. Arthroscopic removal of fracture fragments or internal
fixation with a lag screw may result in good functional outcome.
VII Meniscal and meniscal ligament injuries
The meniscus cannot be comprehensively evaluated with any one imaging
technique only and the best evaluation is achieved by a combination of
radiography, ultrasonography, and arthroscopy (Schramme et al. 2006).
Arthroscopy will enable the cranial and caudal poles of the menisci to be
evaluated while ultrasonography allows the identification of pathology within
the medial or lateral portion of the body of the meniscus, not visible
arthroscopically.
Ultrasonography of the menisci is relatively easily
performed. The transducer should be aligned vertically along the longitudinal
axis of the limb and moved in a craniocaudal direction. The menisci and the
collateral ligaments can be identified (as well as the popliteal tendon lying
between the lateral meniscus and the collateral ligament on the lateral
aspect).
Injury is invariably associated with moderate to severe lameness and
frequently (but not always) with distension of the femorotibial (and sometimes
also the femoropatellar) joint. Medial meniscal injuries are more common
than lateral and based on recent biomechanical studies, are believed to occur
because the cranial horn of medial meniscus is compressed and minimally
mobile when the stifle is extended (Fowlie et al. 2012). This also explains
why most tears arise in the cranial aspect of the menisci and extend variably
caudally.
Chronic meniscal pathology often results in osteoarthritis of the femorotbial
joints identified by osteophytes on the medial intercondylar eminence of the
tibia and on the perimeter of the tibial plateau. Pathognomonic for tearing of
the cranial ligament of the meniscus is the presence of entheseous new bone
on the cranial surface of the medial intercondylar eminence of the tibia, as
seen most easily on flexed lateromedial views of the stifle.
15-‐18
February
2016
East
London
Convention
Centre,
East
London,
South
Africa
66