Case Study

ORTHO – Degenerative joint disease (DJD), arthritis and full CCL rupture with likely meniscal tear in a 9 year old MN Labrador Retriever

This 9 year old MN Labrador Retriever dog has a history of CCL surgery right stifle 3 months prior. Now lame right hind.

DX

The findings of the left stifle joint are compatible with mild generalized chronic degenerative joint disease (DJD) with synovitis, joint effusion and emerging osteophytosis. The findings are further compatible with edema of the cranial cruciate ligament. Biomechanical failure is not likely at this point. There is no evidence of meniscal injury. The findings of the right stifle joint are compatible with moderate generalized chronic degenerative joint disease (DJD) with activated arthritis and marked capsular fibrosis. The findings are further compatible full rupture of the cranial cruciate ligament and suggestive for a medial meniscal injury.

Image Interpretation

ultrasound of the left and right stifles-
LEFT STIFLE: A mild amount of anechoic effusion is noted within the suprapatellar recess of the left
stifle joint as well as moderate synovial proliferation.
Emerging osteophytes is seen at the periarticular margins of the femoropatellar joint.
The cartilage within the patellar sulcus is even in thickness and anechoic.
The cranial cruciate ligament (CCL) is continuous and well delineated with mild
swelling and a focal increase in echogenicity.
The infrapatellar fat pad is of normal echotexture.
The cranial and mid portion of the medial meniscus are well visible and in situ with
even surface and uniform echogenicity. The visible portion of the lateral meniscus is
within normal limits.
RIGHT STIFLE: Both the supra- and infrapatellar recess of the right stifle joint reveal marked capsular
thickening as well as moderate anechoic effusion. Marked thickening and irregularity
of the joint capsule is noted associated with the former surgery site. Multiple saddle stitch knots are seen here. A large amount of osteophytes with unsharp surface is seen at the periarticular margins
of the femoropatellar and femorotibial joint. The cartilage within the patellar sulcus is
uneven in thickness and increased in echogenicity.
The cranial cruciate ligament (CCL) presents as an echogenic stump of fibres at the
intercondylar eminence of the tibia which is surrounded by anechoic periligamentous
effusion.
The infrapatellar fat body presents moderate heterogeneity as found commonly in
degenerative joint disease (DJD). The assessment of the medial meniscus is limited as large amounts of reactive soft
tissue and osteophytes interfere with the medial aspect of the femorotibial joint. A
small portion of the medial meniscus is accessible for inspection and reveals a
hypoechoic line intersecting the meniscal tissue and extending to the medial surface of
the meniscus.
The visible portion of the lateral meniscus reveals multifocal increase in echogenicity
consistent with degeneration. A tear is not seen.

Outcome

Reactive tissue inflammation and capsular fibrosis is seen associated with the former
surgery site with no evidence of infection.
However, biomechanical instability has to be considered as potential underlying cause
of the possible meniscal tear. Should the ultrasonographic findings be complemented by clinical instability of the
stifle joint stabilizing surgery including arthrotomic/arthroscopic revision of the joint is
indicated to address the assumed biomechanical failure and fully evaluate the medial
meniscus.