Solutions to "What's Your Diagnosis?"
Solution to Challenge #1:
Hip dysplasia and cruciate disease would probably be the two most likely problems for this patient. Other diseases such as patella luxation, primary bone neoplasia, tick borne disease, immune mediated arthropathies, and osteoarthritis from other causes would also be possibilities.
Challenge #2:
Based on these findings of the physical exam, what diagnostic tests, if any, would you perform?
PHYSICAL EXAM:
- General appearance: overweight, BCS IV/V; otherwise normal
- EENT: normal
- Cardiovascular system: normal
- Neurologic exam: normal
- Integument: normal
- Orthopedic exam: mild weight-bearing left hind lameness noted; stifle effusion and medial buttress palpated; mild cranial drawer in flexion of the stifle; the hip has a normal range of motion and the patella cannot be luxated.
Solution to Challenge #2:
Although stifle radiographs are not absolutely necessary in every cranial cruciate tear diagnosed on physical exam, in the older patient, we routinely perform them to rule out other disease processes such as primary bone neoplasia near the stifle. A current CBC and chemistry panel would also be indicated prior to surgery.
Radiographs (Pre-op): A lateral view of the stifle was taken to confirm the presence of stifle effusion and to rule out the possibility of other disease processes surrounding the joint. Minor osteoarthirits is notes at the tibial plateau.
Diagnosis: A partial cranial cruciate tear.
Treatment: After discussing the surgical options with the owner, a TTA (tibial tuberosity advancement) stabilization was elected and performed. A 6-hole TTA plate and a 9 mm spacer were used.
Follow-up: At eight weeks, Cassie was walking very well with virtually no lameness noted. Her osteotomy site was completely healed (see post-op rads).
