Here is another e-mailed question.
Also, I thought that you had mentioned a maneuver for flipping the meniscus over. Any drawings or a video to go with that? And how can one tell with PE the amount of tear of the CCL- obviously if the entire tibia slides forward, I would give it 100% but where does a 25% fit in vs normal movement?
Thanks for any help you can give.
JM
Meniscal treatment and Cruciate grading
Re: Meniscal treatment and Cruciate grading
Hey J.
Okay… then on to the meniscal treatment. Here’s what’s on Four Leg - it’s a video. Really, you need a video for it.
Video Training
Video Training 09: The Canine Stifle Meniscus
I’ve seen about a 50% chance of improvement with this technique (usually for post-op meniscal tears). I combine it with laser and shockwave - you could use Acup as well. Really, the goal is stimulation for healing of the tissue once it’s in place IF it’s not a ‘floating bit of cartilage’ (which is why it’s not 100% successful). Essentially, it is a distraction of the joint while simultaneously rotating the tibia and flexing and extending the stifle. Easier said than done. I have one dog I’m doing this on right now… and it seems to be working. I usually say, do 3 sessions (mostly so I am confident that I gave it my best try). If no change, then surgical consult.
Ah, and if there is cruciate tear AND meniscal involvement - do surgery. There is too much joint inflammation for any healing to occur and not enough stability to allow the meniscus to stay in place long enough to heal. (Unless the dog is too old / too unwell to go for surgery… then you manage inflammation and pain. But you won’t ‘fix’ it per se.)
Okay, and as for deciding on a degree of cruciate tear. Here are my teaching handouts on that subject. The fill in the blanks for the scenarios below are:
Scenario1- Full tear
Scenario 2 - Grade 2 of the craniomedial band only
Scenario 3 - Grade 1 of the craniomedial band only
Scenario 4 - Full Tear of the craniomedial band, Grade 1 tear of the caudolateral band
Scenario 5 - Full Tear of the craniomedial band, Grade 2 tear of the caudolateral band
Scenario 6 - Chronic cruciate injury.
You can rehab Scenario 2 and 3 (and in some instances scenario 1), Scenario 4 & 5 are the ones that will progress to full tears within a year (even with rehab… 2 years was the longest I saw one go).
Scenario 6 is chronic with OA - as such a ‘stabilization surgery’ (aka any cruciate targeted surgery) isn’t helpful.
•Special Tests – CrCL
–Notes
•The craniomedial band is taut in flexion & extension
•The caudolateral band is taut in extension
•
•The craniomedial band is usually the band that is affected in a partial tear
•Tears can be graded 1 – 3 (1 being microtearing, 2 being macrotearing, 3 being a full tear).
•Grade 2 tears are more painful than 1s or 3s. (and 3’s might not be painful if there is no longer joint inflammation)
•You can rehab a grade 1 tear and some grade 2 tears
•Scenario 1:
–Swelling in stifle, drawer & tibial thrust in flexion & extension, minimal pain to testing.___________________
•Scenario 2:
–Swelling in stifle, no drawer in flexion or extension, moderate – severe pain to test in flexion, mild pain to test in extension.____________________________________
•Scenario 3:
–Mild swelling in stifle, no drawer in flexion or extension, mild pain to test in flexion, okay in extension.___________
•Scenario 4:
–Swelling in the stifle, drawer & tibial thrust in flexion with minimal pain, no drawer or thrust in extension with minimal pain._____________________________________________
•Scenario 5:
–Swelling in the stifle, drawer & tibial thrust in flexion with minimal pain, no drawer or thrust in extension with moderate – severe pain.________________________________________
•Scenario 6:
–Thickening of the stifle, medial buttress present, filling in and tenderness to palpate the posteromedial joint line sulcus. No drawer or thrust on testing in any position. Pain on end ranges of flexion and extension.______________________________
Okay, I hope this helps! Best of luck!
Cheers,
Laurie
Okay… then on to the meniscal treatment. Here’s what’s on Four Leg - it’s a video. Really, you need a video for it.
Video Training
Video Training 09: The Canine Stifle Meniscus
I’ve seen about a 50% chance of improvement with this technique (usually for post-op meniscal tears). I combine it with laser and shockwave - you could use Acup as well. Really, the goal is stimulation for healing of the tissue once it’s in place IF it’s not a ‘floating bit of cartilage’ (which is why it’s not 100% successful). Essentially, it is a distraction of the joint while simultaneously rotating the tibia and flexing and extending the stifle. Easier said than done. I have one dog I’m doing this on right now… and it seems to be working. I usually say, do 3 sessions (mostly so I am confident that I gave it my best try). If no change, then surgical consult.
Ah, and if there is cruciate tear AND meniscal involvement - do surgery. There is too much joint inflammation for any healing to occur and not enough stability to allow the meniscus to stay in place long enough to heal. (Unless the dog is too old / too unwell to go for surgery… then you manage inflammation and pain. But you won’t ‘fix’ it per se.)
Okay, and as for deciding on a degree of cruciate tear. Here are my teaching handouts on that subject. The fill in the blanks for the scenarios below are:
Scenario1- Full tear
Scenario 2 - Grade 2 of the craniomedial band only
Scenario 3 - Grade 1 of the craniomedial band only
Scenario 4 - Full Tear of the craniomedial band, Grade 1 tear of the caudolateral band
Scenario 5 - Full Tear of the craniomedial band, Grade 2 tear of the caudolateral band
Scenario 6 - Chronic cruciate injury.
You can rehab Scenario 2 and 3 (and in some instances scenario 1), Scenario 4 & 5 are the ones that will progress to full tears within a year (even with rehab… 2 years was the longest I saw one go).
Scenario 6 is chronic with OA - as such a ‘stabilization surgery’ (aka any cruciate targeted surgery) isn’t helpful.
•Special Tests – CrCL
–Notes
•The craniomedial band is taut in flexion & extension
•The caudolateral band is taut in extension
•
•The craniomedial band is usually the band that is affected in a partial tear
•Tears can be graded 1 – 3 (1 being microtearing, 2 being macrotearing, 3 being a full tear).
•Grade 2 tears are more painful than 1s or 3s. (and 3’s might not be painful if there is no longer joint inflammation)
•You can rehab a grade 1 tear and some grade 2 tears
•Scenario 1:
–Swelling in stifle, drawer & tibial thrust in flexion & extension, minimal pain to testing.___________________
•Scenario 2:
–Swelling in stifle, no drawer in flexion or extension, moderate – severe pain to test in flexion, mild pain to test in extension.____________________________________
•Scenario 3:
–Mild swelling in stifle, no drawer in flexion or extension, mild pain to test in flexion, okay in extension.___________
•Scenario 4:
–Swelling in the stifle, drawer & tibial thrust in flexion with minimal pain, no drawer or thrust in extension with minimal pain._____________________________________________
•Scenario 5:
–Swelling in the stifle, drawer & tibial thrust in flexion with minimal pain, no drawer or thrust in extension with moderate – severe pain.________________________________________
•Scenario 6:
–Thickening of the stifle, medial buttress present, filling in and tenderness to palpate the posteromedial joint line sulcus. No drawer or thrust on testing in any position. Pain on end ranges of flexion and extension.______________________________
Okay, I hope this helps! Best of luck!
Cheers,
Laurie
LAURIE EDGE-HUGHES