Three Legged Cat with Cruciate rupture

Re: Three Legged Cat with Cruciate rupture

Virginia Campbell — Wed, 31 Jul 2013 16:43:54 GMT

[quote user="Linda Filshie"]any update on the cat?![/quote]Meanwhile, back at the ranch...

Re: Three Legged Cat with Cruciate rupture

Linda Filshie — Tue, 30 Jul 2013 20:29:35 GMT

BTW any update on the cat?!

Re: Three Legged Cat with Cruciate rupture

Linda Filshie — Tue, 30 Jul 2013 20:28:26 GMT

I think I prefer being a member of the Royal College of Veterinary Surgeons, to the Royal College of Veterinarians nevertheless. Apparently 'aluminum' is correct too, but you'll never catch me saying it. I suppose it's like the rules of grammar - you can ignore and subvert them once you know what the correct form should be!

Re: Three Legged Cat with Cruciate rupture

Christina Smith — Tue, 30 Jul 2013 18:58:24 GMT

[quote user="Braden Collins"]

I agree with draw. Possibly the best way to sort it is work out how the Americans spell it, and go for the opposite. I still hate seeing hematology, color, etc written with the American spelling!

[/quote]Apparently veterinarian is more correct than veterinary surgeon. So they have got that one right or is it gotten!

Re: Three Legged Cat with Cruciate rupture

Braden Collins — Mon, 29 Jul 2013 06:50:03 GMT

I agree with draw. Possibly the best way to sort it is work out how the Americans spell it, and go for the opposite. I still hate seeing hematology, color, etc written with the American spelling!

Re: Three Legged Cat with Cruciate rupture

Luciano Nebiante PGCertSAS — Fri, 26 Jul 2013 10:21:19 GMT

In Italian: "Test del cassetto". So drawer for me

Re: Three Legged Cat with Cruciate rupture

Lucy Fleming — Wed, 24 Jul 2013 12:00:49 GMT

I've always thought it should be 'draw' - because you are able to draw the tibia cranially... I try to avoid writing it if possible!

Re: Three Legged Cat with Cruciate rupture

Laurence Webb — Wed, 24 Jul 2013 10:11:18 GMT

[quote user="Malcolm Ness"]Not even IKEA!![/quote]

No the Ikea drawer sign is when the cruciate is fine - it looks a bit dodgy but, try as you might, it doesn't budge.

Re: Three Legged Cat with Cruciate rupture

Evelyn Barbour-Hill — Wed, 24 Jul 2013 00:16:14 GMT

[quote user="Chris Geddes"]On many human medical websites they describe the cranial-caudal movement as being like "pulling a drawer in and out".[/quote]

Bloomin' funny drawers they have in the medical world!

Re: Three Legged Cat with Cruciate rupture

Malcolm Ness — Tue, 23 Jul 2013 22:33:23 GMT

[quote user="Chris Geddes"]It's always seemed obvious to me that "drawer" is correct as the motion is like opening and closing a drawer[/quote]

Not even IKEA!!

Re: Three Legged Cat with Cruciate rupture

Chris Geddes — Tue, 23 Jul 2013 21:02:02 GMT

On many human medical websites they describe the cranial-caudal movement as being like "pulling a drawer in and out".

I suppose language is fluid, both are used commonly, so both are currently correct.

Re: Three Legged Cat with Cruciate rupture

Chris Geddes — Tue, 23 Jul 2013 20:58:57 GMT

It's always seemed obvious to me that "drawer" is correct as the motion is like opening and closing a drawer

Re: Three Legged Cat with Cruciate rupture

John Flynn — Tue, 23 Jul 2013 20:41:33 GMT

[quote user="Evelyn Barbour-Hill"]early on in the history of canine cranial cruciate ligament science[/quote]

I think it just comes from the human phrase with "cranial" added on the front?

Re: Three Legged Cat with Cruciate rupture

Evelyn Barbour-Hill — Tue, 23 Jul 2013 20:23:15 GMT

[quote user="Malcolm Ness"]As an aside: the use of the word "drawer" in this context is widespread, near universal but it has always seemed incorrect to me. A drawer is either a piece of furniture or, alternatively, a person who draws. I think the phrase should be "cranial draw" as in draw water [from a well] or draw forwards [when parking a car]. Vetsurgeon has plenty pedants and people with an impressive command of our language - what do you think?[/quote]

It seems so obvious to me that "cranial draw" is correct. It makes perfect sense. "Cranial drawer" makes no sense, for two reasons: firstly, because the action is nothing like sliding a drawer in and out; secondly, because if the action did resemble that of a drawer the description would have to be "drawer-slide" or "drawer-pull".

It's my opinion that early on in the history of canine cranial cruciate ligament science, somebody who may have been a fine surgeon but was poorly read and poorly educated in English spelled the word as "drawer" and every veterinary school clinician since then has aped it, inventing the furnitureal (I made that up) justification to suppress their own unease and to pre-empt any challenge by literate students.

Re: Three Legged Cat with Cruciate rupture

John Flynn — Tue, 23 Jul 2013 20:03:03 GMT

There may be a "correct" etymological answer out there, but the version I was given was that it was a "cranial drawer sign", i.e. it felt like moving a drawer in and out, and the commonly used "cranial draw" made no sense.

Of course, I am Irish and "cranial drawer" and "cranial draw" sound identical when I pronounce them so this one doesn't matter too much for me!

(Unlike when I went through a phase of using the term "anal sacs" after reading that this was the correct term - I soon reverted back to "anal glands" after I got a few strange looks to comments and realised what this sounded like...

Client: "He's been dragging his bum along the ground, I think its sore"

Vet: "Ahh... it's probably anal sacs have caused this, do you know much about anal sacs?"

Client: *dumbstruck*

Vet: "Well, you and I don't have anal sacs, but dogs do and sometimes we get problems as a result."

etc.)

Re: Three Legged Cat with Cruciate rupture

Chris Geddes — Tue, 23 Jul 2013 19:23:04 GMT

Agree with Sammy!

Re: Three Legged Cat with Cruciate rupture

Sammy82 — Tue, 23 Jul 2013 18:49:01 GMT

hmmm, in german it's "Schublade"= drawer too, always thought it's because you can draw the tibia forwards/backwards like a drawer, so I'll stick with that.

Re: Three Legged Cat with Cruciate rupture

Clive Ansell — Tue, 23 Jul 2013 18:37:17 GMT

I've always used the term cranial draw too

Re: Three Legged Cat with Cruciate rupture

Will McMullan — Tue, 23 Jul 2013 18:27:38 GMT

I had always used the term 'draw' since I was at college, for the same reasons you give, but then made myself switch to 'drawer' as I saw it so often and even in some very modern textbooks. I should have backed myself, dammit. Switching back...

Re: Three Legged Cat with Cruciate rupture

Malcolm Ness — Tue, 23 Jul 2013 16:54:58 GMT

[quote user="robloxley"] the bony changes suggest chronic disease[/quote]

Agree - the cat is tripod so that is enough to produce what we see but there may well be more.

[quote user="robloxley"]s the cranial drawer a recent development[/quote]

Can't tell - but it is a good question to ask. Many small dogs and cats live with a cruciate deficient stifle without obvious problems.

[quote user="robloxley"]do we have an acute flareup of underlying chronic pathology that will settle with NSAIDs[/quote]

Almost certainly, hence my advice above. An aggressive surgeon could slip in an operation and then (provided they haven't done too much harm with their surgery) they could sit back and claim a surgical success.

[quote user="robloxley"]If the radio-opaque piece is mineralised ligament or meniscus, do we have any good rationale to remove it?[/quote]

No. At best it is abnormal, there is no evidence that it is problematic and consequently there can be no advantage to be gained by removing it.

[quote user="robloxley"]cranial drawer[/quote]

As an aside: the use of the word "drawer" in this context is widespread, near universal but it has always seemed incorrect to me. A drawer is either a piece of furniture or, alternatively, a person who draws. I think the phrase should be "cranial draw" as in draw water [from a well] or draw forwards [when parking a car]. Vetsurgeon has plenty pedants and people with an impressive command of our language - what do you think?

Re: Three Legged Cat with Cruciate rupture

Rob Loxley — Tue, 23 Jul 2013 13:37:05 GMT

[quote user="Luciano Nebiante"] I was expecting different opinions. I also had different opinions from different Orthopaedic Specialists[/quote]

Because nobody really knows!

Some thoughts - the bony changes suggest chronic disease; is the cranial drawer a recent development?; do we have an acute flareup of underlying chronic pathology that will settle with NSAIDs/rest or an acute worsening e.g. the cruciate finally rupturing? If the radio-opaque piece is mineralised ligament or meniscus, do we have any good rationale to remove it?

Re: Three Legged Cat with Cruciate rupture

Malcolm Ness — Tue, 23 Jul 2013 13:30:16 GMT

[quote user="Luciano Nebiante"] But don't you feel that the long-term outcome for this case would be better if having surgery[/quote]

No. Unless it fails to respond adequately to the passage of time + NSAIDs.

[quote user="Luciano Nebiante"]What do you think of the radiopaque piece in the joint?[/quote]

It looks like meniscal calcification which is a relatively common and usually incidental finding.

[quote user="Luciano Nebiante"]In regards to scale to assess lameness[/quote]

Ben Walton at Liverpool who pops up here from time to time is doing some work on lameness/outcome measurements - he will have something useful and interesting to say on this subject.

Re: Three Legged Cat with Cruciate rupture

Luciano Nebiante PGCertSAS — Tue, 23 Jul 2013 10:01:47 GMT

Many thanks for all the replies.

The knee cap was not dislocating on clinical exam, and rest of orthopaedic examination was normal.

This case is not easy, and I was expecting different opinions. I also had different opinions from different Orthopaedic Specialists.

Malcolm, I agree there is not enough evidence out there regarding cruciate disease in cats, therefore the clinical decision in these cases is not well supported and mostly based on personal experience. But don't you feel that the long-term outcome for this case would be better if having surgery? What do you think of the radiopaque piece in the joint?

In regards to scale to assess lameness, I believe there was a paper published about assessment of lameness in dogs, with a grading scale of 10. But I don't remember in which Journal. I did a little research yesterday and I couldn't find it, I'm afraid.

Re: Three Legged Cat with Cruciate rupture

Malcolm Ness — Tue, 23 Jul 2013 09:25:51 GMT

I would wait and see. NSAIDs and time - six weeks or so to give this a chance to settle down itself which I think it probably will.

I am not at all convinced about cruciate surgery in cats - the oft repeated adage that cats are not just small dogs is pertinent and the extrapolation of techniques and experience from dogs to cats is not something that I think should be done. There is remarkably little written about cranial cruciate surgery in cats and much of what is out there is of remarkably poor quality to the extent that it is impossible to discern whether the cat got better because of the the surgery described or in spite of it. It is impossible to place an extracapsular suture in a cat that affords anything like functional stability while retaining an acceptable range of motion and the femoro-fabellar ligament in cats seems relatively feeble compared to that in even small dogs and consequently I have serious reservations about the genuine benefit of such surgery.

In summary, faced with this case, I would try and avoid surgery but if the cat remains significantly disabled (I am not at all interested or worried about passive stifle instability) then I would probably go for a TTA procedure as that can be fixed robustly and have a short convalescence allowing the cat to get up and about again as quickly as possible. Like all cruciate surgery in cats, TTA is not adequately researched.

Re: Three Legged Cat with Cruciate rupture

David Mills — Mon, 22 Jul 2013 19:20:40 GMT

I'd operate. Unstable stifle. Quickest route to functional recovery. Post-op pain likely no worse - with hospitalisation and opiods - than conservative tx - and in 2 weeks the cat should be just as sound post-op as you could hope to wish for with conservative tx, and a soundness that should be permanent in terms of cruciate (OA inevitable).

Assume its not a massively fat cat - which may change my opinion, but probably not, more likely just put in a thicker suture.

At college, we regularly used to get descriptors from clinicians - mainly horsey types - such as 8.5/10 lame - which at the time and still now strikes me as saying far more about the ego of the describer than the lameness. Personally I use a 5 point grading scale - partly because I'm cynical about there being objective difference between, say, 3 or 4/10, and partly because if there is I wouldn't trust myself to see it...