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Diagnosis | Rupture of the caudal cruciate ligament

Lab Animal volume 38, pages 10–11 (2009)Cite this article

The cranial drawer sign is pathognomonic for rupture of the cranial cruciate ligament (CrCL). In some cases, however, a crisp endpoint to the cranial drawer motion and a sluggish caudal drawer motion with no defined endpoint may be experienced. In these cases, the correct diagnosis is rupture of the caudal cruciate ligament (CaCL). In dogs, the occurrence of CaCL rupture is 1 in every 150 cases of suspected CrCL rupture1. Rupture of the CaCL is not easy to detect, and the positive drawer sign can easily be mistaken for rupture of the CrCL. The caudomedial corner of the tibial plateau will move caudally and laterally in CaCL rupture, whereas the caudolateral aspect of the tibial plateau will move cranially and medially in CrCL rupture. Excessive internal rotation of the knee joint may also be detected with CaCL rupture. In one retrospective survey2 of 14 dogs with CaCL rupture without concurrent CrCL rupture, 9 were misdiagnosed as sustaining CrCL rupture with a positive cranial drawer sign. A final diagnosis of CaCL rupture was made only during surgical exploration of the joint in 12 of the dogs. In another retrospective survey3 of 8 dogs and 4 cats diagnosed with CaCL rupture, a positive drawer sign was seen in all affected knees, and six of these knees (4 dogs and 2 cats) were preoperatively misdiagnosed with CrCL rupture.

The confusion in diagnosing CaCL rupture comes from the initial position of the tibia in comparison with the femur. In a CaCL rupture, the tibia subluxates caudally. This is seen by a disappearance of the tibial tuberosity when the knee is in flexion. The drawer test in this position will give the impression of a cranial drawer sign, because it is possible to displace the tibia cranially. But, in fact, it is not a true cranial drawer sign (i.e., cranial luxation of the tibia relative to femur); it is the return of the tibia into a neutral position4. Diagnosis of a CaCL rupture generally requires performance of the drawer sign test on a very quiet or tranquilized animal. We like to compare the tibial tuberosities of both hind limbs in profile view. Disappearance of the tibial tuberosity is noted in the limb with CaCL rupture. Pressure on the tibia in a caudal direction accentuates the disappearance of the tibial tuberosity4.

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Figure 3: Articulated left stifle joint of the ferret shown in Figure 1.
Figure 4: Tightening of the extra-articular prosthesis (artificial CaCL).

References

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Diagnosis | Rupture of the caudal cruciate ligament. Lab Anim 38, 10–11 (2009). https://doi.org/10.1038/laban0109-10

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