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CC BY 4.0 · VCOT Open 2023; 06(02): e102-e106
DOI: 10.1055/s-0043-1771232
Case Report

Unilateral Repair of an Avulsion Fracture of the Caudal Cruciate Ligament Origin Combined with a Ruptured Cranial Cruciate Ligament in a Dog

A.A. Pike
1   Surgery Department, Animal Specialty and Emergency Services, Los Angeles, California, United States
,
R.J. Balfour
1   Surgery Department, Animal Specialty and Emergency Services, Los Angeles, California, United States
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Abstract

Caudal cruciate ligament (CaCL) femoral avulsion fractures are rarely documented, and a true incidence is unclear. A literature search revealed very few cases of a CaCL avulsion fracture or rupture combined with a cranial cruciate ligament (CrCL) rupture. Only a single case report described surgical treatment of this combination by fragment removal and stifle stabilization with an extracapsular suture. A 1-year-old female spayed Labrador Retriever presented with a hindlimb lameness. Examination revealed cranial drawer of the stifle, consistent with CrCL rupture. Stifle effusion, as well as a bone opacity seen in the trochlear groove, was evident on radiographs. At surgery, arthrotomy revealed a torn CrCL as well as an avulsion fracture of the CaCL origin from the medial femoral condyle. The avulsion fracture was reduced, and three 0.035-inch Kirschner's wires (K-wires) were placed in a divergent fashion through the fragment into the medial femoral condyle. A tibial plateau leveling osteotomy (TPLO) was then performed. Six-week recheck radiographs showed good healing of the TPLO as well as the repaired avulsion fracture, despite breakage of one of the K-wires. The dog was mildly lame at the 6-week follow-up and subsequently improved to clinically normal on the limb at 8-month follow-up with optimal bone healing on radiographs. To the authors' knowledge, this is the first case report to describe a CaCL avulsion fracture repair with K-wires combined with a TPLO for a torn CrCL, with an excellent clinical outcome.

Keywords

TPLO - fracture fixation - traumatic cruciate disease


Publication History

Received: 02 November 2022

Accepted: 12 May 2023

Article published online:
29 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Johnston SA, Tobias KM. Stifle joint. In: Veterinary Surgery: Small Animal. St. Louis, MO: Elsevier; 2018: 1071-1168
    Google Scholar
  • 2 Soderstrom MJ, Rochat MC, Drost WTOD. Radiographic diagnosis: avulsion fracture of the caudal cruciate ligament. Vet Radiol Ultrasound 1998; 39 (06) 536-538
    CrossrefPubMedGoogle Scholar
  • 3 Reif U, Hulse DA, Hauptman JG. Effect of tibial plateau leveling on stability of the canine cranial cruciate-deficient stifle joint: an in vitro study. Vet Surg 2002; 31 (02) 147-154
    CrossrefPubMedGoogle Scholar
  • 4 Krystalli AA, Prassinos NN, Mantis P. Caudal cruciate ligament avulsion at its origin in a dog. J Hell Vet Med Soc 2019; 70 (03) 1733
    CrossrefPubMedGoogle Scholar
  • 5 Johnson AL, Olmstead ML. Caudal cruciate ligament rupture. A retrospective analysis of 14 dogs. Vet Surg 1987; 16 (03) 202-206
    CrossrefPubMedGoogle Scholar
  • 6 Theresa MW, Kyle WM, Colleen GD, Angela JM, Felix MD. Evaluation of pacing as an indicator of musculoskeletal pathology in dogs. J Vet Med Anim Health 2016; 8 (12) 207-213
    CrossrefPubMedGoogle Scholar
  • 7 Monotti IC, Davies SE, Lidbetter DA. What is your diagnosis? Caudal cruciate avulsion fracture. J Am Vet Med Assoc 2015; 246 (05) 507-509
    CrossrefPubMedGoogle Scholar
  • 8 Katsman A, Strauss EJ, Campbell KA, Alaia MJ. Posterior cruciate ligament avulsion fractures. Curr Rev Musculoskelet Med 2018; 11 (03) 503-509
    CrossrefPubMedGoogle Scholar
  • 9 Servant CTJ, Ramos JP, Thomas NP. The accuracy of magnetic resonance imaging in diagnosing chronic posterior cruciate ligament injury. Knee 2004; 11 (04) 265-270
    CrossrefPubMedGoogle Scholar
  • 10 Kocher MS, Shore B, Nasreddine AY, Heyworth BE. Treatment of posterior cruciate ligament injuries in pediatric and adolescent patients. J Pediatr Orthop 2012; 32 (06) 553-560
    CrossrefPubMedGoogle Scholar
  • 11 Veltri DM, Deng X-H, Torzilli PA, Warren RF, Maynard MJ. The role of the cruciate and posterolateral ligaments in stability of the knee. A biomechanical study. Am J Sports Med 1995; 23 (04) 436-443
    CrossrefPubMedGoogle Scholar
  • 12 Accadbled F, Knörr J, Sales de Gauzy J. All inside transtibial arthroscopic posterior cruciate ligament reconstruction in skeletally immature: surgical technique and a case report. Orthop Traumatol Surg Res 2013; 99 (03) 361-365
    CrossrefPubMedGoogle Scholar
  • 13 Harari J. Caudal cruciate ligament injury. Vet Clin North Am Small Anim Pract 1993; 23 (04) 821-829
    CrossrefPubMedGoogle Scholar
  • 14 Jerram RM, Walker AM. Cranial cruciate ligament injury in the dog: pathophysiology, diagnosis and treatment. N Z Vet J 2003; 51 (04) 149-158
    CrossrefPubMedGoogle Scholar
  • 15 Decamp CE, Johnston SA, Dejardin LM. The stifle joint. In: Brinker, Piermattei and Flo's Handbook of Small Animal Orthopedics and Fracture Repair. St Louis, MO: Elsevier Health Sciences; 2015: 597-669
    Google Scholar
  • 16 Bourbos A, Cinti F, Baroni M, Piola V, Pisani G. Long-term outcome of a combined surgical approach for repair of femoral avulsion fracture of the caudal cruciate ligament in a dog. Vet Rec Case Rep 2020;8(02):
    PubMedGoogle Scholar
  • 17 Wong WT. Caudal cruciate ligament avulsion fracture in a dog. Aust Vet J 1994; 71 (03) 82-83
    CrossrefPubMedGoogle Scholar
  • 18 Plaga BR, Royster RM, Donigian AM, Wright GB, Caskey PM. Fixation of osteochondral fractures in rabbit knees. A comparison of Kirschner wires, fibrin sealant, and polydioxanone pins. J Bone Joint Surg Br 1992; 74 (02) 292-296
    CrossrefPubMedGoogle Scholar
  • 19 Harari J, Johnson AL, Stein LE, Kneller SK, Pijanowski G. Evaluation of experimental transection and partial excision of the caudal cruciate ligament in dogs. Vet Surg 1987; 16 (02) 151-154
    CrossrefPubMedGoogle Scholar
  • 20 Frost-Christensen LN, Mastbergen SC, Vianen ME. et al. Degeneration, inflammation, regeneration, and pain/disability in dogs following destabilization or articular cartilage grooving of the stifle joint. Osteoarthritis Cartilage 2008; 16 (11) 1327-1335
    CrossrefPubMedGoogle Scholar
  • 21 Guerrero TG, Koch D, Montavon PM. Fixation of a proximal femoral physeal fracture in a dog using a ventral approach and two Kirschner wires. Vet Comp Orthop Traumatol 2005; 18 (02) 110-114
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Monk ML, Preston CA, McGowan CM. Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament. Am J Vet Res 2006; 67 (03) 529-536
    CrossrefPubMedGoogle Scholar
  • 23 Sharma AK, Kumar A, Joshi GR, John JT. Retrospective study of implant failure in orthopaedic surgery. Med J Armed Forces India 2006; 62 (01) 70-72
    CrossrefPubMedGoogle Scholar