Abstract
BackgroundBilateral non-traumatic cranial cruciate disease is frequently seen in originally unilateral cruciate pathology. Untreated cranial cruciate ligament disease and concurrent meniscal lesions cause progressive osteoarthritis and pain of the stifle joint. Early presurgical diagnosis is important, but remains difficult.The purpose of this ex vivo study was (1) to describe the ultrasonographic appearance of the canine cranial cruciate ligament (CrCrL), menisci and meniscal ligaments using a high-frequency linear transducer, (2) to determine the length of the CrCrL seen on ultrasonography (US) and (3) to describe and compare the appearance of the CrCrL, menisci and meniscal ligaments on US, computed tomography (CT) and computed tomography arthrography (CTA).ResultsUS and CT examinations were performed on 10 radiographically normal cadaveric stifles of adult dogs weighing more than 15 kg, followed by macroscopic and histologic evaluations. The CrCrL had a parallel hyperechoic fibrillar pattern at the insertion on the tibia and a hypoechoic structure more proximally in all stifles. This pattern was visible over 35% (median) of the total length of the ligament, with 50% (median) of the total length CrCrL that could be outlined. All medial menisci and 8 out of 10 of the lateral menisci showed hypoechoic lines within their bodies oriented obliquely to the direction of the ultrasound beam. Fifteen of the 20 cranial meniscotibial ligaments were detected, showing a hyperechoic fibrillar pattern. Normal macro- and microscopic appearance was observed in all menisci, with the radial bundles of collagen fibers at the level of and with similar orientation as the intrameniscal hypoechoic lines on US.The CrCrL, menisci and meniscal ligaments were of intermediate density on CT, but marked improvement of the border detection was obtained using CTA. Contrast within the CrCrL was observed in 4/10 stifles using CT and confirmed in 3/4 stifles on histology. One of these ligaments had a partial tear (5–10%) on macroscopic evaluation. None of the menisci showed any abnormalities on CTA.ConclusionsNormal canine menisci are heterogeneous on high-frequency US and a fibrillar pattern may be observed in the cranial meniscotibial ligaments and the distal portion of the CrCrL. Linear areas of contrast may be detected within the cranial cruciate ligament of radiographically normal stifles.
Highlights
Bilateral non-traumatic cranial cruciate disease is frequently seen in originally unilateral cruciate pathology
Normal canine menisci are heterogeneous on high-frequency US and a fibrillar pattern may be observed in the cranial meniscotibial ligaments and the distal portion of the cranial cruciate ligament (CrCrL)
Linear areas of contrast may be detected within the cranial cruciate ligament of radiographically normal stifles
Summary
Bilateral non-traumatic cranial cruciate disease is frequently seen in originally unilateral cruciate pathology. Untreated cranial cruciate ligament disease and concurrent meniscal lesions cause progressive osteoarthritis and pain of the stifle joint. Non-traumatic or degenerative cranial cruciate disease, frequently occurring bilateral, is seen in 17 to 54% of dogs with originally unilateral disease. This and the fact that some of the dogs that developed contralateral CrCrL rupture had initially normal stifle radiographs, makes early diagnosis important for treatment and prognosis [3,4,5,6]. Meniscal lesions contribute to the progression of osteoarthritis and should be treated [1, 2, 8,9,10]
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