Name the 2 cruciate ligaments and the

direction they run in

Cranial
Runs in same direction as your hand in your pants
pocket
More cranial in the intercondylar space
Runs cranially & medially as it courses distally to
insert at the cranial intercondyloid area of the
tibia
Caudal
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What are the 3 functions of the CrCL
1. prevent cranial displacement of the tibia
2. limit internal tibial rotation
3. prevent stifle hyperextension
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What are the 2 distinct bands of the
CrCL & their functions
Craniomedial band
Taut during flexion AND extension
I.e. always working
This rupture only drawer in flexion
Caudolateral band
Only taut in extension
Rupture = no cranial drawer
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What causes CrCL rupture
Excess stress on normal ligament
Uncommon in dogs
Normal stress on abnormal lig
Most common form in dogs
Degeneration occurs earlier & is more severe in
larger breeds
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What might you find on PE - acute
rupture
Acute rupture
Lameness
Effusion
Often not super painful
Cranial drawer sign
Complete rupture present in flex & extension
Only craniomedial band = drawer in flex
Only caudolateral = no cranial drawer
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What might you find on PE - chronic
rupture
Lamenss
Muscle atripohy
Periarticular fibrosis
Joint effusion
+/- crepitus
Decreased ROM
+/- cranial drawer
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What is the gold Dx test for cruciate
rupture?
Cranial drawer!

Why is it commonly missed?
Diff to detect in conscious pt
Need good technique
Periarticualr fibrosis may limit cranial drawer
Might only be partially ruptured (i.e. caudolateral
band tear = no drawer)
Absence doesnt rule out cruciate disease!
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What can you see?
Displaced fat
pad because
joint effusion
Osteophyts
on distal
pole of
patella
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What might you see on rads?
- Bone sclerosis
- Osteophytes on , distal pole of patella trochlear ridge, tibial
plateau
- Look for avulsion fractures
- Joint effusion displacement of fat pad
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What are some options for treating
cruciate disease?
Conservative
NO! continued instability worsening!
Sx
Passive joint stabilisation
Extracapsular
Lateral fabello-tibial suture
Intracapsuar not used anymore
Tibial osteotomy sx
TPLO ~4% late meniscal injury
TTO ~4%
TTA 22-42% late meniscal injury!
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Describe skin incision for stifle joint
exploration & cruciate sx
Curvilinear skin incision centred at level of
patella, on lateral aspect of stifle
Extend from distal 1/3- of femurs
Down to a point just distal to tibial tuberosity
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Now what?
Incise SQ tissue along same line of skin
incision
Fascia lata & lateral reticulum are incised
along similar line approx 2-3mm caudal to
patella lig, incise fascia 15mm lateral to patella
lig (leave enough tissue between incison &
patella to place sutures alter
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After incising fascia lata(remember that really
plasticcy kind of tissue that the biceps is attached to)
Fascia lata is undermined & reflected caudally
Beware: the peroneal nerve
Proximally need to dissect the loose fascia
between the biceps & vastus lateralis and the
facial attachment of the vastus to the femur
In this way we can reflect biceps expose and locate
lateral fabella before making capsule incision
To expose the joint capsule
Beware: avoid the caudal femoral a & v in this area
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Once the joint capsule is exposed
Make a stab incision at the level of the patella
Along the same line as the precious incisions
Extend this incision in the capsule distally to
level of the tibia dont damage the long
digital extensor tendon
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So how to we maximise our visibility
into the joint?
Extend the joint, luxate patella medially then
flex joint to hold patella out of the way
Use gelpi retractor in soft tissue to aid
exposure
Retract infrapatella fat pad cranially with
sharp pointed Senn retractor ID sites of
stifle distractors
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ID sites of stifle distractors
Intracondylar fossa of the femur & the
insertion site of the cr cruciate lig of the tibia
When stifle distractors are openend the distal
point will hook on intermeniscal lig behind the
fat pad
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ID origin & insertion of both long digital
extensor tendon (lateral femoral condyle) and
the lateral collateral lig

ID Cr & Cau crucitae lig

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How to visualise the menisci?
Put the stifle in cranial drawer
Use either
Stifle joint distractor
OR Homann retract with a Senn retractor
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Which meniscus is more likely to be
damaged?
Medial because
Firmly attached to tibial plasteau

Lateral meniscus is only loosely attached able to
move out of the way
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How to place LFTS? which muscles
to retract/elevate?
Reflect biceps femoris caudally at level of
patella use sharp/blunt dissection
Need to be able to visualise the lateral fabella
(which is at the same level of the patella, in the origin if the lateral head of
the gastrocnemius)
Elevate the cranial tibial muscle from the
prox lateral tibia
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Where do we drill the hole?
Subperiosteally elevate cr tibial muscle from
prox lateral tibia allow placement of the hole
Transversely through the prox tibia, at the
level of the tibial tuberosity
Use drill bit & Jacob's chuck/power drill
Tunnel needs to be perpendicular to the bone
(lateral to medial)
Mark location of hole using a 18g needle
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Now we have a hole?
Pass cruciate needle around the lateral sesamoid
Beware trapping the peroneal n. immediately caudal to fibula head!!!
Feed the needle cranioprox to caudal distally
Walk needle tip off the bone to stay as close as possible to the fabella
Once placed tugging on suture should feel fabella moving (about 1mm)
Place distal end of suture through the tunnel, then feed suture back
behind the patella lig

Tie/crimp it securely adjacent to the lateral part of femoral condyle
Tied in a neutral standing position
Place knot on laterla aspect of the stifle so you can suture biceps over the top
of it to hide the knot


***use 27 or 36kg nylon leader line
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closing
Close the fascia lata with an interrupted
pattern to achieve imbrication
Caudal edge of fascia should imbricate over the
top of the cranial edge horizontal mattress
sutures


Close SQ and skin
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