Explore the value of musculoskeletal ultrasound in detecting cruciate ligament pathology
Partial tears of the cranial cruciate ligament (CCL) can be difficult to diagnose due to the lack of instability present on orthopedic examination. Advanced diagnostics would be required for further evaluation. While a common tool in human medicine, MRI is of limited use in canines due to cost and the need for general anesthesia. Musculoskeletal ultrasound (MSK-US) can be performed without anesthesia but there are no current studies to date evaluating its usefulness in detecting partial tears of the cruciate ligaments
This is a retrospective case series (n=32) of dogs that underwent diagnostic MSK-US of the stifle who later had a surgical procedure (stifle arthroscopy/arthrotomy) to evaluate the intra-articular space.
Medical records were evaluated between May 2014 - April 2020 for canines with clinically stable stifles that underwent both an MSK-US of the stifle followed by stifle surgery. Ultrasound findings of the CCL were compared to surgical findings (considered gold standard).
Compared to arthroscopy, ultrasound was a very sensitive test in detecting CCL pathology however it is less specific. Its sensitivity (SN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were 100%, 58.3%, 81.5%, and 100% respectively.
MSK-US is a non-invasive test that can be performed with little to no sedation. Using a high frequency 18-5MHz linear transducer, MSK-US is a sensitive test for detecting partial CCL injuries in dogs and may aid in its diagnosis for canines without stifle instability and be useful in guiding treatment. As it is less specific, arthroscopy would be necessary to further confirm the intra-articular pathology.
Diagnostic MSK-US is a non-invasive tool that can be used to detect CCL pathology in the stifle. Its application can help guide treatment recommendations prior to a more invasive diagnostic/therapeutic procedure such as surgery or arthroscopy.
Arnault, F., Cauvin, E., Viguier, E., Kraft, E., Sonet, J. & Carozzo, C. (2009). Diagnostic value of ultra-sonography to assess stifle lesions in dogs after cranial cruciate ligament rupture: 13 cases. Veterinary and Comparative Orthopaedics and Traumatology. 22(6), 479–485. DOI: https://doi.org/10.3415/vcot-08-10-0103
Atarod, M., Frank, C.B. & Shrive, N.G. (2014). Decreased posterior cruciate ligament and altered collateral ligament loading following ACL transection: A longitudinal study in the ovine model. Journal of Orthopaedic Research. 32(3), 431–438. DOI: https://doi.org/10.1002/jor.22529
Barger, B., Piazza, A. & Muir, P. (2016). Treatment of stable partial cruciate rupture (Grade 1 sprain) in five dogs with tibial plateau leveling osteotomy. Vet Record Case Reports. 4(1), e000315. DOI: https://doi.org/10.1136/vetreccr-2016-000315
Bertocci, G.E., Brown, N.P. & Mich, P.M. (2017). Biomechanics of an orthosis-managed cranial cruciate ligament-deficient canine stifle joint predicted by use of a computer model. American Journal of Veterinary Research. 78(1), 27–35. DOI: https://doi.org/10.2460/ajvr.78.1.27
Breukers, M., Haase, D., Konijnenberg, S., Klos, T.V.S., Dinant, G.J. & Ottenheijm, R.P.G. (2019). Diagnostic accuracy of dynamic ultrasound imaging in partial and complete anterior cruciate ligament tears: a retrospective study in 247 patients. BMJ Open Sport & Exercise Medicine. 5(1), e000605. DOI: https://doi.org/10.1136/bmjsem-2019-000605
Brown, N.P., Bertocci, G.E. & Marcellin-Little, D.J. (2014). Canine stifle joint biomechanics associated with tibial plateau leveling osteotomy predicted by use of a computer model. American Journal of Veterinary Research. 75(7), 626–632. DOI: https://doi.org/10.2460/ajvr.75.7.626
Canapp Jr., S.O., Leasure, C.S., Cox, C., Ibrahim, V. & Carr, B.J. (2016). Partial Cranial Cruciate Ligament Tears Treated with Stem Cell and Platelet-Rich-Plasma Combination Therapy in 36 Dogs: A Retrospective Study. Frontiers in Veterinary Science. 3, 112. DOI: https://doi.org/10.3389/fvets.2016.00112
Cauvin, E.R.J. & Smith, R.K.W. (2019). Ultrasonography of the stifle. UK-Vet Equine. 3(3), 86–92. DOI: https://doi.org/10.12968/ukve.2019.3.3.86
Coss, P. (2019). The Use of Ultrasonography for Detection of Meniscal Damage in Dogs. Veterinary Evidence. 4(2). DOI: https://doi.org/10.18849/ve.v4i2.207
De Rooster, H., van Ryssen, B. & van Bree, H. (1998). Diagnosis of cranial cruciate ligament injury in dogs by tibial compression radiography. Veterinary Record. 142(14), 366–368. DOI: https://doi.org/10.1136/vr.142.14.366
Din Dar, M.U., Patil, D.B., Parikh, P.V., Joy, N., Jhala, S.K., Tiwari, D.K. & Pitroda, A.H. (2010). Ultrasonographic anatomy of the stifle joint in dogs. Indian Journal of Veterinary Surgery. 31(2), 141–142. [online]. Available from: http://www.indianjournals.com/ijor.Aspx?target=ijor:ijvs&volume=31&issue=2&article=019 [Accessed April 2023].
Doring, A.K., Junginger, J. & Hewicker-Trautwein, M. (2018). Cruciate ligament degeneration and stifle joint synovitis in 56 dogs with intact cranial cruciate ligaments: Correlation of histological findings and numbers and phenotypes of inflammatory cells with age, body weight, and breed. Veterinary Immunology and Immunopathology. 196, 5–13. DOI: https://doi.org/10.1016/j.vetimm.2017.12.006
Fazio, C.G., Muir, P., Schaefer, S.L. & Waller III, K.R. (2018). Accuracy of 3 Tesla magnetic resonance imaging using detection of fiber loss and a visual analog scale for diagnosing partial and complete cranial cruciate ligament ruptures in dogs. Veterinary Radiology & Ultrasound. 59(1), 64–78. DOI: https://doi.org/10.1111/vru.12567
Fossum, T.W. (2012). Small Animal Surgery (4th). Missouri: Elsevier.
Fuchs, S. & Chylarecki, C. (2002). Sonographic evaluation of ACL rupture signs compared to arthroscopic findings in acutely injured knees. Ultrasound in Medicine Biology. 28(2), 149–154. DOI: https://doi.org/10.1016/s0301-5629(01)00507-5
Gnudi, G. & Bertoni, G. (2001). ECHOGRAPHIC EXAMINATION OF THE STIFLE JOINT AFFECTED BY CRANIAL CRUCIATE LIGAMENT RUPTURE IN THE DOG. Veterinary Radiology & Ultrasound. 42(3), 266–270. DOI: https://doi.org/10.1111/j.1740-8261.2001.tb00938.x
Grzelak, P., Tomasz, M.T., Stefanczyk, L. & Domzalski, M. (2015). Ultrasonographic test for complete anterior cruciate ligament injury. Indian Journal of Orthopaedics. 49, 143–149. DOI: https://doi.org/10.4103/0019-5413.152432
Han, S., Cheon, H., Cho, H., Kim, J., Kang, J., Yang, M., Lee, Y., Lee, H. & Chang, D. (2008). Evaluation of partial cranial cruciate ligament rupture with positive contrast computed tomographic arthrography in dogs. Journal of Veterinary Science. 9(4), 395–400. DOI: https://doi.org/10.4142/jvs.2008.9.4.395
Hayashi, K., Frank, J.D., Dubinsky, C., Hao, Z., Markel, M.D., Manley, P.A. & Muir, P. (2003). Histologic Changes in Ruptured Canine Cranial Cruciate Ligament. Veterinary Surgery. 32(3), 269–277. DOI: https://doi.org/10.1053/jvet.2003.50023
Henderson, R.E.A., Walker, B.F. & Young, K.J. (2015). The accuracy of diagnostic ultrasound imaging for musculoskeletal soft tissue pathology of the extremitis: a comprehensive review of the literature. Chiropractic & Manual Therapies. 23, 31. DOI: https://doi.org/10.1186/s12998-015-0076-5
Jerram, R.M. & Walker, A.M. (2003). Cranial cruciate ligament injury in the dog: pathophysiology, diagnosis, and treatment. New Zealand Veterinary Journal. 51(4), 149–158. DOI: https://doi.org/10.1080/00480169.2003.36357
Johnson, J. & Radasch, R. (1988). Stifle Injuries in the Canine. Iowa State University Veterinarian. 50(1), 16–22. [online]. Available from: https://lib.dr.iastate.edu/iowastate_veterinarian/vol50/iss1/7 [Accessed April 2023].
Johnson, J.A., Austin, C. & Breur, G.J. (1994). Incidence of Canine Appendicular Musculoskeletal Disorders in 16 Veterinary Teaching Hospitals from 1980 through 1989. Veterinary and Comparative Orthopaedics and Traumatology. 7(2), 56–69. DOI: https://doi.org/10.1055/s-0038-1633097
Johnson, J.M. & Johnson, A.L. (1993). Cranial Cruciate Ligament Rupture. Pathogenesis, Diagnosis, and Postoperative Rehabilitation. Veterinary Clinics of North America: Small Animal Practice. 23(4), 717–733. DOI: https://doi.org/10.1016/s0195-5616(93)50078-5
Kramer, M., Stengel, H., Gerwing, M., Schimke, E. & Sheppard, C. (1999). SONOGRAPHY OF THE CANINE STIFLE. Veterinary Radiology & Ultrasound. 40(3), 282–293. DOI: https://doi.org/10.1111/j.1740-8261.1999.tb00363.x
Kumar, S., Kumar, A., Kumar, S. & Kumar, P. (2018). Functional Ultrasonography in Diagnosing Anterior Cruciate Ligament Injury as Compared to Magnetic Resonance Imaging. Indian Journal of Orthopaedics. 52, 638–644. DOI: https://doi.org/10.4103/ortho.ijortho_28_17
Little, J.P., Bleedorn, J.A., Sutherland, B.J., Sullivan, R., Kalscheur, V.L., Ramaker, M.A., Schaefer, S.L., Hao, Z. & Muir, P. (2014). Arthroscopic Assessment of Stifle Synovitis in Dogs with Cranial Cruciate Ligament Rupture. PLoS ONE. 9, e97329. DOI: https://doi.org/10.1371/journal.pone.0097329
Marino, D.J. & Loughin, C.A. (2010). Diagnostic Imaging of the Canine Stifle: A Review. Veterinary Surgery. 39(3), 284–295. DOI: https://doi.org/10.1111/j.1532-950x.2010.00678.x
MedCalc Software Ltd. Diagnostic test evaluation calculator. Version 20.218. [online]. Available from: https://www.medcalc.org/calc/diagnostic_test.php [Accessed April 2023].
Paatsama, S. (1988). LONG-STANDING AND TRAUMATIC LIGAMENT INJURIES AND MENISCAL RUPTURES OF THE CANINE STIFLE. Veterinary Radiology. 29(2), 54–56. DOI: https://doi.org/10.1111/j.1740-8261.1988.tb01747.x
Palm, H.G., Bergenthal, G., Ehry, P., Schwarz, W., Schmidt, R. & Friemert, B. (2009). Functional ultrasonography in the diagnosis of acute anterior cruciate ligament injuries: A field study. The Knee. 16(6), 441–446. DOI: https://doi.org/10.1016/j.knee.2009.04.012
Piermattei, D.L., Flo, G. & DeCamp, C.E. (2006). Handbook of Small Animal Orthopedics and Fracture Repair. Missouri: Elsevier. DOI: https://doi.org/10.1016/B978-0-7216-9214-2.X5001-1
Ptasznik, R., Feller, J., Bartlett, J., Fitt, G., Mitchell, A. & Hennessy, O. (1995). The value of sonography in the diagnosis of traumatic rupture of the anterior cruciate ligament of the knee. American Journal of Roentgenology. 164(6), 1461–1463. DOI: https://doi.org/10.2214/ajr.164.6.7754893
Reed, A.L., Payne, J.T. & Constantinescu, G.M. (1995). ULTRASONOGRAPHIC ANATOMY OF THE NORMAL CANINE STIFLE. Veterinary Radiology & Ultrasound. 36(4), 315–321. DOI: https://doi.org/10.1111/j.1740-8261.1995.tb00268.x
Rubin, R.M., Marshall, J.L. & Wang, J. (1975). Prevention of Knee Instability. Experimental Model for Prosthetic Anterior Cruciate Ligament. Clinical Orthopaedics and Related Research. 113, 212–236. [online]. Available from: https://journals.lww.com/clinorthop/Citation/1975/11000/Prevention_of_Knee_Instability__Experimental_Model.32.aspx [Accessed April 2023].
Seong, Y., Eom, K., Lee, H., Lee, J., Park, J., Lee, K., Jang, K., Oh, T. & Yoon, J. (2005). ULTRASONOGRAPHIC EVALUATION OF CRANIAL CRUCIATE LIGAMENT RUPTURE VIA DYNAMIC INTRA-ARTICULAR SALINE INJECTION. Veterinary Radiology & Ultrasound. 46(1), 80–82. DOI: https://doi.org/10.1111/j.1740-8261.2005.00016.x
Slocum, B. & Slocum, T.D. (1993). Tibial Plateau Leveling Osteotomy for Repair of Cranial Cruciate Ligament Rupture in the Canine. Veterinary Clinics of North America: Small Animal Practice. 23(4), 777–795. DOI: https://doi.org/10.1016/s0195-5616(93)50082-7
Strom, H. (1990). Partial rupture of the cranial cruciate ligament in dogs. Journal of Small Animal Practice. 31(3), 137–140. DOI: https://doi.org/10.1111/j.1748-5827.1990.tb00746.x
Tinga, S., Kim, S.E., Banks, S.A., Jones, S.C., Park, B.H., Pozzi, A. & Lewis, D.D. (2018). Femorotibial kinematics in dogs with cranial cruciate ligament insufficiency: a three-dimensional in-vivo fluoroscopic analysis during walking. BMC Veteterinary Research. 14, 85. DOI: https://doi.org/10.1186/s12917-018-1395-2
Van der Vekens, E., de Bakker, E., Bogaerts, E., Broeckx, B.J.G., Ducatella, R., Kromhout, K. & Saunders, J.H. (2019). High-frequency ultrasound, computed tomography and computed tomography arthrography of the cranial cruciate ligament, menisci and cranial meniscotibial ligaments in 10 radiographically normal canine cadaver stifles. BMC Veterinary Research. 15, 146. DOI: https://doi.org/10.1186/s12917-019-1892-y
Vasseur, P.B. (1984). Clinical Results Following Nonoperative Management for Rupture of the Cranial Cruciate Ligament in Dogs. Veterinary Surgery. 13(4), 243–246. DOI: https://doi.org/10.1111/j.1532-950X.1984.tb00801.x
Wang, J., Wu, H., Dong, F., Li, B., Wei, Z., Peng, Q., Dong, D., Li, M. & Xu, J. (2018). The role of ultrasonography in the diagnosis of anterior cruciate ligament injury: A systematic review and meta-analysis. European Journal of Sport Science. 18(4), 579–586. DOI: https://doi.org/10.1080/17461391.2018.1436196
Widmer, W.R., Buckwalter, K.A., Braunstein, E.M., Hill, M.A., O’Connor, B.L. & Visco, D.M. (1994). RADIOGRAPHIC AND MAGNETIC RESONANCE IMAGING OF THE STIFLE JOINT IN EXPERIMENTAL OSTEOARTHRITIS OF DOGS. Veterinary Radiology & Ultrasound. 35(5), 371–383. DOI: https://doi.org/10.1111/j.1740-8261.1994.tb02057.x
Copyright (c) 2023 Helen Tsoi, Sherman Canapp, Debra Canapp
This work is licensed under a Creative Commons Attribution 4.0 International License.
Veterinary Evidence uses the Creative Commons copyright Creative Commons Attribution 4.0 International License. That means users are free to copy and redistribute the material in any medium or format. Remix, transform, and build upon the material for any purpose, even commercially - with the appropriate citation.
Most read articles by the same author(s)
- Robert Cullen, Debra Canapp, David Dycus, Brittany Carr, Victor Ibrahim, Sherman Canapp, Clinical Evaluation of Iliopsoas Strain with Findings from Diagnostic Musculoskeletal Ultrasound in Agility Performance Canines – 73 Cases , Veterinary Evidence: Vol. 2 No. 2 (2017): The second issue of 2017
- Brittany Jean Carr, Sherman Canapp, Julia L Petrovitch, Derrick Campana, Debra Canapp, Christopher S Leasure, Retrospective Study on External Canine Limb Prosthesis used in 24 patients , Veterinary Evidence: Vol. 3 No. 1 (2018): The first issue of 2018