Page 352 - Canine Lameness

324 19 Stifle Region

Figure 19.8 The cranial tibial compression test is
performed by placing one hand over the cranial distal
thigh with the index finger placed on the tibial
tuberosity. The other hand is used to flex the tarsus,
while the upper hand maintains the knee in extension
(i.e. not allowing any flexion of the joint). Cranial tibial
movement indicates CCLD deficiency and may be
observed or detected with the index finger on the
tibial tuberosity.

STIFLE REGION

palpation. This is accomplished by internal rotation of the lower limb while performing the tibial
compression test. This test can be performed before surgery to determine appropriate treatment
strategies and after TPLO surgery, since pivot shift after this procedure may cause residual lame-
ness. A significant additional rotational instability may require therapeutic intervention (Knight
et al. 2017), most commonly with an anti-rotational suture. This rotation may be significant enough
to also induce a low-grade medial patellar luxation (MPL) in predisposed patients.

Video 19.4

Pivot shift.

19.4.3 Diagnostics
While exam findings (such as positive cranial drawer) have shown a high specificity to detect
CCLD, they are not pathognomonic for CCLD. Rare differential diagnoses (e.g. neoplasia such as
synovial cell sarcoma and osteosarcoma, immune-mediated arthritis) need to be considered when
establishing the diagnosis. Additional diagnostics, most often radiographs, are generally performed
to rule out these differential diagnoses and to further confirm the tentative diagnosis. Surgical
inspection (either via arthroscopy or arthrotomy) is most commonly used to confirm the diagnosis
and further characterize the sequelae of osteoarthritis and meniscal degeneration seen with this
disease. In case surgery is not performed, ultrasound or MRI can also be used to confirm the
diagnosis and to evaluate the meniscal status.