Case Study

ORTHO – Left Stifle degenerative joint disease (DJD) with partial cranial cruciate (CCL) rupture in a 2 year old MN mixed dog

History of injury to left stifle dating back about 1 year, on and off favoring. Jumped log recently and a lot worse.

Physical Exam: Positive Cr drawer, positive CTT, pain left stifle, med buttress.

CBC/chem: wnl

Reason for Ultrasound Exam: Pre surgical evaluation of left stifle.

History of injury to left stifle dating back about 1 year, on and off favoring. Jumped log recently and a lot worse.

Physical Exam: Positive Cr drawer, positive CTT, pain left stifle, med buttress.

CBC/chem: wnl

Reason for Ultrasound Exam: Pre surgical evaluation of left stifle.

DX

Left stifle DJD with partial CCL rupture and intact medial meniscal and lateral meniscal degeneration

Image Interpretation

Left stifle joint:
Both the supra- and infrapatellar recess of the left stifle joint contain a moderate and mild amount of anechoic effusion respectively. The joint capsule reveals moderate thickening. Moderate synovial proliferations are noted.
The cartilage layers as appreciated onto the femoral trochlea is mildly uneven thickness and increased in echogenicity. Especially within the sulcus of the patella the cartilage layer appears to be very thick, but is largely smooth in outline here. The cartilage layer onto the femoral condyles is even and smooth and anechoic as far as seen.
A moderate amount of osteophytes is noted at the periarticular margins of the femoropatellar and femorotibial joints.
The cranial cruciate ligament (CCL) presents with a thin, long and undulating continuous portion and a second portion that is represented by a broad band of echogenic tissue at the intercondylar eminence of the tibia. Mild periligamentous effusion as well as prominent synovial thickening is noted. Soft tissue proliferation is evident here as well.
The infrapatellar fat body presents heterogenous increase in echogenicity as found commonly in chronic degenerative joint disease (DJD).
The view on the medial meniscus is limited in the depth of the image. As far as visible it is in situ with regular echogenicity and outline. The lateral meniscus is in situ with mild multifocal increase in regular echogenicity and smooth outline.

Outcome

The findings of the left stifle joint are compatible with moderate generalized chronic degenerative joint disease with joint effusion, osteophytosis, capsular fibrosis, synovial proliferation and emerging cartilage breakdown at the femoral trochlea.
The findings are suggestive for partial rupture of the cranial cruciate ligament with a part of the band that has completely ruptured and one thin elongated portion of continuous fibres. The changes are compatible with biomechanical failure.
The medial meniscus appears to be within normal limits. Signs of lateral meniscal degeneration are evident.
Surgical therapy is indicated to address the biomechanical failure and prevent progression of the DJD & further damage.