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Stifle: cranial cruciate ligament disease

ffelis

Synonym(s): CCL rupture (CCLR), CCL insufficiency, cranial cruciate ligament disease (CCLD)


Introduction

  • Common cause of hindlimb lameness Lameness: overview.
  • Traumatic or degenerative.
  • Can occur with caudal cruciate rupture and medial and lateral collateral ligament rupture  - the deranged or luxated stifle. Important to differentiate between this more serious disease and an isolated CCLR.
  • Signs: acute hindlimb lameness or acute deterioration of a more chronic problem or chronic low grade hindlimb lameness.
  • Diagnosis: cranial instability of stifle (cranial draw test Stifle: cranial draw test/cranial tibial thrust).
  • Treatment: in some cats conservative treatment may suffice, surgical repair will usually give a quicker return to function.
  • Prognosis: good.

Pathogenesis

Etiology

  • Traumatic - other injuries may be concurrent.
  • Senile degeneration (aging)/normal wear/tear. Mineralization of the fat pad, joint capsule and meniscus may be concurrent - meniscal mineralization Stifle: meniscal mineralization.

Predisposing factors

General

  • Obesity Obesity.
  • Steep tibial plateau angle (TPA). Cats with no CCLR had a mean TPA of 21.6°, cats with CCLR had a mean angle of 24.7°.
  • Increasing age.

Specific

  • Athletic event or fall - traumatic rupture.

Pathophysiology

  • Rupture is often complete.
  • Check that there are not multiple ligament ruptures - deranged stifle.
  • Partial rupture involves one of the bands making up the ligament - usually craniomedial band - may be bilateral.

Timecourse

  • Variable, but progressive, weeks → months unless traumatic.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Wessely M, Reese S, Schnabl-Feichter E (2017) Aetiology and pathogenesis of cranial cruciate ligament rupture in cats by histological examination. J Feline Med Surg 19 (6), 631-637 PubMed.
  • Mindner J K, Bielecki M J, Scharvogel S et al (2016) Tibial plateau leveling osteotomy in eleven cats with cranial cruciate ligament rupture. Vet Comp Orthop Traumatol 29 (6), 528-535 PubMed.
  • Retournard M, Bilmont A, Asimus E et al (2016) Effect of tibial tuberosity advancement on cranial tibial subluxation in the feline cranial cruciate deficient stifle joint: An ex vivo experimental study. Res Vet Sci 107, 240-245 PubMed.
  • Ruthrauff C M, Glerum L E, Gottfried S D (2011) Incidence of meniscal injury in cats with cranial cruciate ligament ruptures. Can Vet J 52 (10), 1106-1110 PubMed.
  • Schnabl E, Reese S, Lorinson K et al (2009) Measurement of the tibial plateau angle in cats with and without cranial cruciate ligament rupture. Vet Comp Orthop Traumatol 22 (2), 83-86 PubMed.
  • Harasen G L (2005) Feline cranial cruciate rupture: 17 cases and a review of the
    literature.
    Vet Comp Orthop Traumatol 18 (4), 254-257 PubMed.

Other sources of information

  • Montavon P, Voss K, Langley-Hobbs S J (2009) Feline Orthopedic Surgery and Musculoskeletal Disease. Elsevier Saunders.

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