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areas are visible in the same area in 54% of the patients. Bucket-handle tears in the medial meniscus are mostly associated with CCLR and can be detected with a sensitivity of 90% and a specificity of 93% using ultrasound.
In case the conventional examinations are inconclusive to demonstrate a CCLR, more sophisticated imaging procedures (computed tomography (CT) or MRI) can be performed before going to surgery. The aims of these examinations are to exclude another (non-CCL) origin of the lameness and to demonstrate a partial CCLR without joint instability.
The technique for CT-arthrography of the canine stifle has been described, resulting in easy identification of normal ligamentous structures by use of reconstructions. CT-arthrography has been shown useful for identifying abnormalities of the CCL but of questionable value
for assessing the menisci with single-detector CT- arthrography.
High-field MRI is a reliable method (sensitivity of 100% and specificity of 94% in one study) for the diagnosis
of meniscal tears pre-operatively in dogs with CCLR. High-field MRI also seems accurate for the diagnosis of late meniscal tears, as the artefacts associated with TTA implants don’t prevent the evaluation of critical intra- articular structures. There is more controversy about the value of low-field MRI, although the diagnostic accuracy for the detection of meniscal lesions seems quite a bit lower than for high-field MRI.
Arthroscopy and arthrotomy remain the gold standard for the final evaluation of dogs suspected of a CCL lesion with a stable joint. An incipient rupture of the CCL is often associated with fraying of the ligament during arthroscopic examination.
References
Blond L, Thrall DE, Roe SC, et al. Diagnostic accuracy of magnetic resonance imaging for meniscal tears in dogs affected with naturally occurring cranial cruciate ligament rupture. Vet Radiol Ultrasound 2008;49:425-431.
Böttcher P, Brühschwein A, Winkels P, et al. Value of low-field magnetic resonance imaging in diagnosing meniscal tears in the canine stifle: a prospective study evaluating sensitivity and specificity in naturally occurring cranial cruciate ligament deficiency with arthroscopy as the gold standard. Vet Surg 2010;39:296- 305.
de Rooster H, van Bree H. Popliteal sesamoid displacement associated with cruciate rupture in the dog. J Small Anim Pract 1999b;40:316-318.
de Rooster H, van Bree H. Use of compression stress radiography for the detection of partial tears of the canine cranial cruciate ligament. J Small Anim Pract 1999a;40:573-576.
de Rooster H, van Bree H. Radiographic measurement of craniocaudal instability in stifle joints of clinically normal dogs and dogs with injury of a cranial cruciate ligament. J Small Anim Pract 1999c;60:1567-1570.
de Rooster H, Van Ryssen B, van Bree H. Diagnosis of cranial cruciate ligament injuries in dogs by tibial compression radiography. Vet Rec 1998;142:366-368.
Samii VF, Dyce J. Computed tomographic arthrography of the normal canine stifle. Vet Radiol Ultrasound 2004;45:402-406.
Samii VF, Dyce J, Pozzi A, et al. Computed tomographic arthrography of the stifle for detectionof cranial and caudal cruciate ligament and meniscal tears in dogs. Vet Radiol Ultrasound 2009;50:144-150.
Taylor-Brown F, Lamb CR, Tuvers MS, et al. Magnetic resonance imaging for detection of late meniscal tears in dogs following tibial tuberosity advancement for treatment of cranial cruciate ligament injury. vet Comp Orthop Traumatol 2014;27:141-146.
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