Case Study

ORTHO – Degenerative joint disease (DJD) with complete and partial cranial cruciate ligament (CCL) ruptures in both stifles in a 10 year old FS Poodle/ Shih Txu mix dog

This 10 year old FS Poodle/Shih Tzu mix had CCL surgery left stifle in 2010. Fober wire and bone anchors. Presented today with acute onset right hind lameness.

Physical exam: left stifle crepitus, thickened joint, clicks with flexion/extension, slight cranial drawer. Right stifle positive cranial drawer and CTT.

This 10 year old FS Poodle/Shih Tzu mix had CCL surgery left stifle in 2010. Fober wire and bone anchors. Presented today with acute onset right hind lameness.

Physical exam: left stifle crepitus, thickened joint, clicks with flexion/extension, slight cranial drawer. Right stifle positive cranial drawer and CTT.

DX

The ultrasonographic examination of the left stifle joint is compatible with a moderate chronic degenerative joint disease and a chronic full rupture of the cranial cruciate ligament. Moreover the findings are suggestive for a medial meniscal injury. The ultrasonographic examination of the right stifle joint is compatible with a moderate chronic degenerative joint disease and a partial rupture of the cranial cruciate ligament with biomechanical failure. A medial meniscal pathology was not seen.

Image Interpretation

Ultrasound of the left and right stifle joints – Left:
Mild to moderate anechoic effusion is noted within the suprapatellar and infrapatellar recess of the left stifle joint. The synovium & joint capsule reveal marked thickening.
A moderate amount of osteophytes is seen at the periarticular margins of the femoropatellar and a mild amount at the margins of the femorotibial joint. Mild subchondral bone irregularity is noted.
The cranial cruciate ligament presents as a short & smoothly delineated echogenic stump at the intercondylar eminence of the tibia. Scant periligamentous effusion is seen.
The caudal horn of the medial meniscus is not directly seen. The visible portion of the medial meniscus is in situ, but reveals non-uniform echogenicity and uneven outline with a possible hypoechoic interruption. The lateral meniscus is in situ and within normal limits except for a mild overall increase in echogenicity.
Right:
Moderate anechoic effusion is noted within the suprapatellar recess and infrapatellar recess of the right stifle joint. The synovial membranes are moderately thickened.
A moderate amount of osteophytes is seen at the periarticular margins of the femoropatellar and a mild amount at the margins of the femorotibial joint.
A small portion of the cranial cruciate ligament is continuous but reveals uneven surface and width with irregular echogenicity. Echogenic tissue is seen next to the tibial eminence. There is a mild amount of periligamentous effusion.
The caudal horn of the medial meniscus is not directly seen. The visible portion of the medial meniscus is in situ, uniform in echogenicity and smooth in outline. The lateral meniscus is in situ, uniform in echogenicity and smooth in outline.