DOCSLIB.ORG

SURGICAL TREATMENT of PATELLAR LUXATION in DOGS Retrospective Findings After Wedge Recession Sulcoplasty And/Or Tibial Tuberosity Transposition

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
SURGICAL TREATMENT of PATELLAR LUXATION in DOGS Retrospective Findings After Wedge Recession Sulcoplasty And/Or Tibial Tuberosity Transposition SURGICAL TREATMENT OF PATELLAR LUXATION IN DOGS Retrospective findings after wedge recession sulcoplasty and/or tibial tuberosity transposition A dissertation presented to the Faculty of Veterinaiy Medicine Glasgow University for the Degree of Master of Veterinary Medicine September 1994 Hilde de Rooster © Copyright ProQuest Number: 13818550 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 13818550 Published by ProQuest LLC(2018). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 GLASGOW university library Table of Contents Summary .....................................................................................................................................iii List of Chapters ........................................................................................................................... iv List of Tables .............................................................................................................................. vi List of Figures............................................................................................................................. vii List of Pictures............................................................................................................................ viii Dedication....................................................................................................................................ix Declaration......................................................................................................................... x Acknowledgements......................................................................................................................xi Summary The study opens with a review of literature on canine patellar luxation. Detailed reference is made to the occurrence, aetiology and pathogenesis, pathomechanics and classification of the range of patellar luxation in dogs. Diagnostic means are discussed. In the chapter on treatment, a survey is made of the majority of existing surgical and non surgical treatments available. Brief comments on prognosis conclude the search of existing literature. A clinical follow-up was carried out on fifty cases of medial patellar luxation which had been treated by recession wedge sulcoplasty (group A: 23), tibial tuberosity transposition (group B: 10) or a combination of both procedures (group C: 17) at Glasgow University Veterinary Hospital during the five-year period from June 1988 till December 1993. All post-operative information was gained via a client questionnaire. The hypothesis was that deepening the trochlear groove slows down the rate of recovery from surgery, as opposed to the more accepted practice of simply correcting the quadriceps axis by transposition of the tibial tuberosity. Ninety six per cent of dog owners across the three groups reported that they were pleased with the final outcome of the surgery performed. Only eight per cent of patients failed to become completely sound on the leg that was operated on. In a further ten per cent of cases, occasional stiffiiess was recorded. The availability of suitable dogs was limited, thus rendering group size relatively small. Another consequence of availability was that the distribution across the three groups was unavoidably unbalanced. These conditions combined to render the sample too small to reject the null hypothesis that no difference in outcome of surgery exists between the various groups of dogs. List of Chapters 1. Literature review..................................................................................................................1 1.1. Introduction...........................................................................................................1 1.2. Normal anatomy and biomechanicsof the femoropatellar joint.............................3 1.2.1. Regional structural and functional anatomy of interest in patellar luxations ........................................................................................................... 3 1.2.1.1. Structural anatomy................................................................3 1.2.1.2. Functional anatomy...............................................................4 1.2.2. Biomechanical basis ...............................................................................4 1.3. Occurrence, aetiology and pathological changes associated with patellar luxation ...........................................................................................................................7 1.3.1. Occurrence of patellar instability ...........................................................7 1.3.2. Aetiology and pathogenesis ................................................................... 10 1.3.3. Pathomechanics and resulting anatomic abnormalities .......................... 12 1.3.3.1. Medial patellar luxation.........................................................12 1.3.3.2. Lateral patellar luxation ........................................................15 1.4. Classification of patellar luxation......................................................................... 17 1.4.1. Classes ...................................................................................................17 1.4.2. Clinical syndromes .................................................................................17 1.4.3. Grading system ...................................................................................... 18 1.5. Associated injuries................................................................................................20 1.6. Diagnosis ............................................................................................................. 21 1.6.1. History .................................................................................................. 21 1.6.2. Clinical examination ............................................................................. 21 1.6.3. Radiographic examination ........................... 23 1.7. Treatment............................................................................................................. 24 1.7.1. Conservative treatment.......................................................................... 24 1.7.2. Surgical treatment................................................................................. 25 1.7.2.1. Soft-tissue reconstructive procedures................................... 25 Desmotomy/Release ............................................................... 26 Capsular imbrication and retinacular overlap........................ 26 Fascia lata overlap ................................................................ .27 Tension procedures and antirotational sutures....................... 28 Myoplasty ...............................................................................29 1.7.2.2. Bone reconstructive procedures.......................................... 31 Trochlear groove arthroplasty.................................................31 Tibial tuberosity transposition ................................................36 Fibular head transposition .......................................................40 Corrective osteotomy.............................................................. 40 Implants.................................................................................. 42 Epiphysiodesis .........................................................................43 Patellectomy ............................................................................45 Arthrodesis of the stifle joint ...................................................45 1.7.3. Post-operative care................................................................................ 46 1.7.4. Treatment of bilateral patellar luxation.................................................47 1.8. Prognosis after treatment ........................................................................................48 1.8.1. Prognosis after conservative treatment..................................................48 1.8.2. Prognosis after surgical treatment......................................................... 48 2. Retrospective study...............................................................................................................50 2.1. Materials and methods ............................................................................................50 2.1.1. Patients.................................................................................................. 50 2.1.2. Pre-operative examination.....................................................................54 2.1.3. Surgical procedures ...............................................................................57 2.1.4. Post-operative evaluation...................................................................... 59 2.2. Results...................................................................................................................61 2.3. Discussion..............................................................................................................68
Load more

Recommended publications
  • Luxating Patella
    LUXATING PATELLA What is a luxating patella? The patella, or kneecap, is normally located in the center of the knee joint. The term luxating means, “out of place” or “dislocated”. Therefore, a luxating patella is a kneecap that moves out of its normal location. What causes this? The muscles of the thigh attach to the top of the kneecap. There is a ligament, the patellar ligament, running from the bottom of the kneecap to a point on the tibia just below the knee joint. When the thigh muscles contract, force is transmitted through the patella and patellar ligament to a point on the top of the tibia. This results in extension or straightening of the knee. The patella stays in the center of the leg because the point of attachment of the patellar ligament is on the midline and because the patella slides in a groove on the lower end of the femur (the bone between the knee and the hip). The patella luxates because the point of attachment of the patellar ligament is not on the midline of the tibia. It is almost always located too far medial (toward the middle of the body). As the thigh muscles contract, the force is pulled medial. After several months or years of this abnormal movement, the inner side of the groove in the femur wears down. Once the side of the groove wears down, the patella is then free to dislocate. When this occurs, the dog has difficulty bearing weight on the leg. It may learn how to kick the leg and snap the patella back into its normal location.
    [Show full text]
  • Lexique Des Pathologie Du Cheval
    Lexique du cheval, termes Vétérinaires : 1- Pathologies équines - termes de médecine vétérinaire A-C , Equine pathologies, veterinarian terms A-C Français - French - English - Anglais Deutsch - German - Französisch Allemand à vif raw une zone à vif, une plaie à vif a raw spot, a raw wound abattement exhaustion Niedergeschlagenheit abcédation abscessation abcès ; abscess ; die Eiterbeule, die abcès chaud (aigu), abcès froid ; hot (acute) abscess, cold abscess ; Eitergeschwulst l'abcès se collecte ("murit") the abscess matures. abcès de formation lente a slow forming abscess l'abcès s'est rompu the abscess has opened die Eiterbeule hat geöffnet abcès du sabot ; certains les hoof abscess ; hoof abscesses are classent en 4 types : abcès du doigt, of four types : Toe, Sole, Bar and de la sole, des barres et des talons. Heel abscess. abdomen abdoment abdomen aigu acute abdomen abdominal abdominal Bauch- des signes de douleurs abdominales signs of abdominal discomfort des symptômes abdominaux aigus acute abdominal symptoms abondant copious, profuse reichlich des sécrétions abondantes (plur) a copious secretion (sing) abrasion des dents : usure dental abrasion die Zahnabnutzung anormale des dents due à des see : dental wearing away ; dental facteurs mécaniques externes . A attrition différencier de l'usure dentaire ou attrition (cf). Voir auss nivellement acarien mite acide hyaluronique . Certains hyaluronate : some specialists vétérinaires traitent des lésions prone the intralesional hyaluronate tendineuses au stade chronique injection in tendons lesions (lésions persistant après deux mois remaining after 2 months of rest de repos et de traitement and conservative therapy. conservateur) par des injections Hyaluronate would act as an anti- locales d'acide hyaluronique, soit à inflammatory agent and would l'aveugle, soit sous guidage have a direct stimulatory effect on échographique.
    [Show full text]
  • Pelvic Limb Alignment in Small Breed Dogs: a Comparison Between Affected and Free Subjects from Medial Patellar Luxation
    Pelvic limb alignment in small breed dogs: a comparison between affected and free subjects from medial patellar luxation Matteo Olimpo*, Lisa Adele Piras & Bruno Peirone Struttura Didattica Speciale Veterinaria, L.go P. Braccini, 10095 Grugliasco (TO), Italy. * Corresponding author at: Struttura Didattica Speciale Veterinaria, L.go P. Braccini, 10095 Grugliasco (TO), Italy. Tel.: +39 011 6709061, e‑mail: [email protected]. Veterinaria Italiana 2015, 52 (1), 45-50. doi: 10.12834/VetIt.71.206.3 Accepted: 05.08.2015 | Available on line: 17.12.2015 LXVII Meeting of the Italian Society for Veterinary Sciences (SISVet) - Selected papers Keywords Summary Medial patellar luxation, Small breed dogs are 12 times more likely to develop medial patellar luxation (MPL) than Pelvic limb alignment, large breed dogs and breed predisposition has been reported. Many surgical techniques are Small breed dogs. available for correction of patellar luxation in dogs. However, recent studies reported an 8% incidence of reluxation when traditional techniques are used. The relatively high frequency of major complications and patellar reluxation may be partially caused by inadequate appreciation of the underlying skeletal deformity and subsequent incorrect selection and application of traditional techniques. The aims of this study were to report the normal values of the anatomic and mechanical joint angles of the femur and tibia in small breed dogs and to compare these data to a population of small breed dogs affected by different degrees of MPL. Normal values of the anatomic and mechanical angles of the femur are similar to the ones reported in literature in Pomeranian dogs. Normal values of the anatomic and mechanical angles of the tibia have been described for the first time.
    [Show full text]
  • Learning Outcomes Orthopaedics Spring 2013 the Course In
    Learning outcomes Orthopaedics and Hand Surgery Page1 Learning outcomes Orthopaedics Spring 2013 The course in orthopaedics provides students with the fundamental principles for diagnosis and treatment of the diseases and injuries of the musculoskeletal system. The subjects treated in lectures, seminars and group exercises may be prioritised areas for review. The general learning outcomes of the course in orthopaedics are that students shall be able to approach patients in a professional manner obtain a relevant medical history of the patient’s complaint perform an appropriate examination of the musculoskeletal system have knowledge of common diagnostic tools draw up a plan of investigation for the most common diseases of the musculoskeletal system draw up a treatment plan in dialogue with the patient identify disorders that must be treated acutely to avoid a life-long disability On completion of the course, students shall be able to obtain the medical history and perform examination of diseases and injuries of the musculoskeletal system perform primary management, manual repositioning and immobilisation of the injured limb perform an appropriate distal examination make assessments for possible compartmental syndrome make assessments for possible cauda equina syndrome perform infiltration anaesthesia and skin sutures perform joint puncture identify obvious fractures or luxations without X-ray images On completion of the course, students shall demonstrate knowledge of the management principles for patients with multiple injuries the management
    [Show full text]
  • Diseases of the Goat
    Free ebooks ==> www.Ebook777.com www.Ebook777.com k Free ebooks ==> www.Ebook777.com k k www.Ebook777.com k k Diseases of the goat k k k k k k k k Free ebooks ==> www.Ebook777.com Diseases of the goat John Matthews BSc BVMS MRCVS Chalk Street Services Ltd, The Limes Chelmsford, Essex, UK 4TH EDITION k k www.Ebook777.com k k This edition first published 2016 © 2016 by John Wiley & Sons Limited Third edition first published 2009 © 2009 Blackwell Publishing Ltd Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. Designations used by companies to distinguish their products are often claimed as trademarks.
    [Show full text]
  • Vi STEP by STEP
    Issue 6 t +44 (0)114 258 8530 [email protected] www.vetinst.com Academy Step by Step Patellar Luxation - A Step By Step Guide Patellar luxation is the condition where the patella luxates out of the femoral trochlear sulcus instead of tracking up and down within it. Most commonly the patella luxates medially but lateral luxation also occurs. It can occur in any size or breed of dog but is more common in small breed dogs. Cats have a broad and flat patella and the femoral trochlear sulcus is shallow; therefore the normal cat patella is much more mobile medial to lateral and relatively unstable compared to dogs. Patellar subluxation is common in cats but, clinically significant patellar luxation is uncommon. Patellar luxation is usually a diagnosis made from Grade 3: The patella is always luxated but the patient history and signalment, and by stifle can be returned to the normal position in the manipulation and palpation, rather than from trochlear sulcus by digital manipulation. Once radiographs. This is because the luxating patella such manipulation stops, patellar luxation recurs. is mobile and can change position which can be This causes an abnormality of stifle function i.e. easily palpated but not necessarily appreciated on a inability to extend the stifle and associated hindlimb radiograph. lameness. Surgical correction is beneficial to the Patellar luxation is graded depending on its severity patient as it restores normal stifle function including and there are many ways of doing this. The most the quadriceps ability to extend the stifle. commonly used grading system is the Putnam/ Grade 4: The patella is permanently luxated and Singleton system which can be described as: cannot be reduced to a normal position despite Grade 1: The patella tracks normally but luxates manipulation.
    [Show full text]
  • Alpaca Breed Standard
    British Alpaca Society - ALPACA BREED STANDARD Overview This breed standard has been developed to encourage the objective assessment of the form and function of the alpaca. It is intended as a guide for breeding selection, to promote the pursuit of the alpaca exhibiting high quality fleece traits on a correct frame. The ideal alpaca should not only be fit for function, but be seen as the embodiment of the very best conformational and fleece traits of the breed. An ideal alpaca is one that produces high quality fibre over a long, healthy and productive lifetime. Whilst the breed standard places traits into ‘ideal’ and ‘negative/undesirable traits’, most alpacas will fall somewhere between the two on the continuum of the different characteristics. However, the standard promotes the goal of reaching the ideal through selective breeding, resulting in genetic gain and phenotypical improvement. Consideration should be given to the longevity of the ideal traits and thus the commercial benefits that this brings. Note: Traits are not listed in any particular order - It is acknowledged that some traits, especially those of fleece, will continually improve over time and that this standard is not intended to be static, but to evolve alongside alpaca breeding in the UK. Ideal Negative/Undesirable traits Conformation Phenotype • Alpacas should have a balanced, • Obvious lack of balance proportioned frame, free moving, with a • Light substance of bone strong substance of bone and an alert • Narrow head stance • The head should be carried high Side Profile
    [Show full text]
  • Canine Patellar Luxation Part 2: Treatments and Outcomes
    Vet Times The website for the veterinary profession https://www.vettimes.co.uk Canine patellar luxation part 2: treatments and outcomes Author : Albane Fauron, Karen Perry Categories : Companion animal, Vets Date : April 18, 2016 ABSTRACT The most important decision in cases of canine patellar luxation is whether surgical stabilisation is required. Surgical treatment is generally not recommended for asymptomatic cases. For clinically affected cases, conservative management is unlikely to result in significant improvement and surgical therapy is indicated. Corrective surgical techniques focus on realignment of the quadriceps mechanism and stabilisation of the patella in the trochlea. Cases treated with tibial tuberosity transposition and femoral trochleoplasty have been associated with lower risks of patellar reluxation and major complications, and the use of these techniques should be considered in all developmental cases. In cases where significant skeletal deformities have been identified preoperatively, or in cases that fail to respond to conventional surgical techniques, more advanced imaging and surgery may be required. As discussed in part one (VT46.09), while patellar luxation (PL) is a common condition, not all cases require surgical intervention. Of those needing stabilisation, deciding which deformities require correction to achieve a comfortable and functional outcome is not always straightforward. Corrective surgical techniques used in the management of clinically affected cases focus on realignment of the quadriceps mechanism and stabilisation of the patella in the trochlea. The results of surgical correction vary with the severity of the anatomic abnormalities present, but if appropriate decision-making is employed, for the majority of cases, the outcome should be favourable. 1 / 12 Treatment Decision-making Figure 1.
    [Show full text]
  • Patella Luxation in Dogs and Cats
    Patella Luxation in Dogs and Cats The knee is a complex structure consisting of muscles, ligaments, tendons, cartilage, and bones. These components must align properly and interact harmoniously in order to function properly. Three bones are included in the knee: the femur, the tibia, and the patella (kneecap). Normal Knee Joint of a Dog The patella or kneecap moves up and down in the lower part of the femur called the trochlear groove. In patella luxations, the trochlear groove is usually shallow, causing the kneecap to displace or luxate. Normal Knee Joint of a Dog Showing Muscles, Tendons and Ligaments Normal Exposed Knee Joint of a Dog Symptoms of Patella Luxation Patella luxation (dislocation) is a condition where the kneecap does not align properly with the femur and tibia. The condition can be temporary or permanent and range from complete dislocation to mild patellar instability. The dislocation can occur laterally (toward the outside of the knee joint), medially (toward the inside), or in both directions. There are 4 types of patella luxations. Grade 1 – The patella is positioned normally but can be luxated with slight manual pressure. Grade 2 – Spontaneous luxation occurs; however, it can reduce spontaneously or can be replaced manually. Grade 3 – The patella is luxated most of the time; however it can be replaced manually. Grade 4 – The patella cannot be reduced manually. Most commonly, the disease is a medial luxation and occurs as a result of a congenital (existing at birth) condition in toy and miniature breeds of dogs. Dog breeds most commonly affected by this condition are poodles, Yorkshire terriers, Maltese and bichon frise.
    [Show full text]
  • Luxating Patella Or Kneecap in Dogs
    to Veter n cy H in o en os a r g p r Toronto Veterinary Emergency Hospital er it o a y m l T E 21 Rolark Dr, Toronto, ON, M1R3B1 Phone: 416 247 8387 Fax: 4162873642 Email: [email protected] 24 Hour Emergency & Website: www.tveh.ca Referral Hospital Luxating Patella or Kneecap in Dogs What is a luxating patella? The patella, or "kneecap," is normally located in a groove on the end of the femur, or thigh bone. "Term luxating means 'out of place'." The term luxating means "out of place" or "dislocated". Therefore, a luxating patella is a kneecap that moves out of its normal location. It generally resumes its normal anatomical orientation after only a brief period of luxation in most dogs. What causes a patellar luxation? The large muscles of the thigh (quadriceps) attach to the top of the kneecap. A ligament, known as the patellar ligament, attaches the quadriceps muscle to a point on the center front of tibia (the bone in the lower leg) just below the knee joint. The kneecap sits on the undersurface of this ligament. When the thigh muscles contract, the force is transmitted through the patellar ligament, pulling on the tibia,. This results in extension or straightening of the knee. The patella slides up and down in its groove (the trochlear groove) and helps keep the patellar ligament in place during this movement. "Many toy or small breed dogs...have a genetic predisposition..." Many toy or small breed dogs, including Maltese, Yorkshire terriers, French poodles, and Bichon frise dogs, have a genetic predisposition for a luxating patella due to a congenitally shallow trochlear groove.
    [Show full text]
  • THE LUXATING PATELLA: One Size Does NOT Fit All
    THE LUXATING PATELLA: One size does NOT fit all Synopsis-- Anatomy and the Disease The quadriceps mechanism is the unit of interest when talking about a luxating patella. The condition is a dynamic one, created by predisposing genetics and the resultant development, or by a predisposing anatomy exacerbated by low impact trauma. The patella is supported or encouraged to ride in its groove by several structures. 1) The alignment of the quadriceps muscle/patellar tendon/patella/patellar ligament/tibial tubercle (quadriceps “mechanism”) with the groove; 2) medial and lateral retinacular/joint capsular tension; and 3) depth of groove—probably in that order of importance. IN BREEDS WITH PREDISPOSING GENETICS, we see either a) the mismatch of quadriceps mechanism growth/elongation with bone growth/elongation or b) a wayward tibial tubercle physis that “moves” medially or laterally as it develops as the developmental cause of this condition. When this abnormality is pronounced early in puppyhood, a patella that jumps its track even just a little promotes a vicious cycle of malalignment by the quadriceps mechanism pulling the tibial tubercle physis medially or laterally. In other breeds/mixed breeds, a subtle abnormal anatomy of the quadriceps mechanism can be suddenly turned into a painful luxation with vigorous play, turning, landing, and is best categorized as a catastrophic sprain. The resultant looseness is poorly contained conservatively, and repeated luxations perpetuate the tissue damage preventing healing. PAIN OR DISABILITY associated with a loose patella manifests from several situations. Ongoing pain and consistent lameness is seen when cartilage wear results in subchondral bone exposure, grinding and joint inflammation.
    [Show full text]
  • Tipler, a – Medial Patella Luxation Treatment
    Medial patella luxation treatment Dr Abbie Tipler ATCL BVSc MANZCVS (Surgery) Veterinary Specialist Services 1-15 Lexington Road, Underwood, QLD 4119 Aetiology For a patella to function correctly it needs a proper alignment to the quadriceps muscle group that meets and converges on the patella. With correct alignment, the patella sits in the trochlear groove and this groove develops normally over time. The entire mechanism from pelvis to quadriceps to patella to tibial tuberosity should sit in a relatively straight line. This mechanism is called the extensor apparatus and when aligned with the patella it works to effectively and painlessly extend the knee via contraction of the quadriceps. There can be several facts that can contribute to the abnormal development that is seen in dogs with medial patella luxation (MPL). Puppies are born with normal stifles, however medial malalignment of the quadriceps mechanism leads to abnormal forces on the growth plates during growth and conformational abnormalities result. The conformational abnormalities can typically involve varying degrees of torsion of the tibia with internal rotation, distal femoral varus, hypoplasia of the medial condyle, patella alta and underdevelopment of the trochlear groove. Signalment This is primarily a disease of small breeds such as Chihuahuas, Toy Poodles, Yorkies, Silky Terriers, Papillons and Pomeranians but is also seen in larger breeds such as Labradors, Staffordshires and Bull Terriers. Females tend to be over-represented and it is heritable. Around 50%-60% of the time it is bilateral. Around 80% of luxations are either a grade 2 or a grade 3. Around 10-40% of dogs have a concurrent cruciate ligament rupture.
    [Show full text]