Computed tomographic imaging and surgical management of distal insertional avulsion fragments of the caudal cruciate ligament in four horses.
Authors: Bolz Nico Michael, Ehrle Anna, Mählmann Kathrin, Lischer Christophorus Johannes
Journal: Veterinary surgery : VS
Summary
# Caudal Cruciate Ligament Avulsion Fragments: CT-Guided Arthroscopic Management in Horses Distal avulsion fragments of the caudal cruciate ligament (CdCL) at its tibial insertion represent a poorly described cause of hindlimb stifle lameness in horses; this case series examined how computed tomography imaging could refine diagnosis and guide arthroscopic removal in four Warmblood horses presenting with osseous fragments in the caudal medial femorotibial joint. Using CT to map fragment location and size, the authors attempted arthroscopic removal via a cranial intercondylar approach—a less common surgical pathway than traditional caudomedial access—successfully removing intra-articular debris in two horses and achieving partial removal (two-thirds) in a third, though one horse's fragment remained inaccessible even with this approach. All four horses returned to ridden work within a 16-month follow-up period with owner satisfaction rated as good, despite one case being complicated by acute arterial bleeding and transient postoperative swelling, and despite most horses harbouring concurrent cartilage or ligamentous lesions (medial femoral condyle defects, cranial cruciate ligament damage, and medial collateral ligament injury in three, two, and two horses respectively). The cranial intercondylar approach expands the arthroscopic toolkit for managing these fragments, yet clinicians should recognise that complete removal is not guaranteed and vascular complications are possible, making careful CT pre-operative planning and intra-operative awareness essential. For practitioners managing obscure hindlimb lameness localised to the stifle, CT examination offers both diagnostic confirmation and a realistic assessment of fragment accessibility before committing to surgery.
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Practical Takeaways
- •CT imaging should be used to confirm diagnosis and assess for concurrent stifle pathology before surgical planning for suspected caudal cruciate ligament injuries
- •The cranial intercondylar arthroscopic approach is a viable surgical option but may not always allow complete fragment removal; surgeons should be prepared for potential arterial bleeding complications
- •Most horses achieve good functional outcomes and return to work even when complete fragment removal is not achieved, though long-term follow-up data remains limited
Key Findings
- •CT imaging successfully identified and characterized caudal cruciate ligament avulsion fragments in the medial femorotibial joint
- •Cranial intercondylar arthroscopic approach enabled fragment removal in 3 horses, with complete removal achieved in 2 horses
- •All 4 horses returned to ridden exercise within median 16 months (range 11-28 months) with good owner satisfaction
- •Comorbidities were present in 75% of cases, with medial femoral condyle cartilage defects most common (3/4 horses)