Surgical management of avulsion fragments of the caudal cruciate ligament

With surgical intervention, the prognosis was surprisingly good.
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Computed tomographic imaging and surgical management of distal insertional avulsion fragments of the caudal cruciate ligament in four horses
Vet Surg. 2023 Sep 13. doi: 10.1111/vsu.14025.
Authors
Nico Michael Bolz 1 , Anna Ehrle 1 , Kathrin Mählmann 1 , Christophorus Johannes Lischer 1
Affiliation

1 Equine Clinic, Surgery and Radiology, Freie Universität Berlin, Berlin, Germany.

PMID: 37702039
DOI: 10.1111/vsu.14025

Abstract

Objective: To describe cases with caudal cruciate ligament (CdCL) avulsion fragments diagnosed based on computed tomography (CT) examination and report on arthroscopic fragment removal.

Animals: Four Warmblood horses with hindlimb lameness and osseous fragments located in the caudal medial femorotibial joint (mFTJ).

Study design: Short case series.

Methods: CT and arthroscopic evaluation of the caudal mFTJ were performed. The caudal mFTJ and the insertion of the CdCL on the tibia were assessed and removal of the avulsion fragments was attempted in three horses using a cranial intercondylar approach.

Results: The fragment was not accessible via caudomedial approaches in one horse. A cranial intercondylar approach was used in three horses, allowing removal of the intra-articular fragment in two horses, and removal of two-thirds of the proximal fragment in the last horse. Acute, profuse, arterial bleeding occurred in this horse during surgery with transient postoperative soft tissue swelling. Comorbidities included medial femoral condyle cartilage defects (3), cranial cruciate ligament lesions (2), and medial collateral ligament lesions (2). Horses were followed up for 16 months (median, range 11-28 months), at which point all were back in ridden exercise; owners’ satisfaction was good.

Conclusion: CT examination confirmed the diagnosis and allowed evaluation of the stifle joint for comorbidities. A cranial intercondylar arthroscopic approach facilitated the removal of CdCL insertional avulsion fragments, although not always complete.

Clinical significance: A cranial intercondylar approach can allow access to CdCL avulsion fragments, but complications and incomplete removal remain possible.

© 2023 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.