Radiographic and clinical changes of the patellar tendon after tibial plateau leveling osteotomy

K. Carey; S. W. Aiken; G. R. DiResta; L. G. Herr; S. Monette

doi:10.1055/s-0038-1632960

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2005; 18(04): 235-242
DOI: 10.1055/s-0038-1632960

Clinical Communication

Schattauer GmbH

Radiographic and clinical changes of the patellar tendon after tibial plateau leveling osteotomy

94 cases (2001 – 2003)

Authors

K. Carey

¹Dept. of Surgery, The Animal Medical Centre, New York, NY, USA
S. W. Aiken

¹Dept. of Surgery, The Animal Medical Centre, New York, NY, USA
G. R. DiResta

²Memorial Sloan Kettering Cancer Centre, Dept. of Surgery/Orthopaedic Service, New York, NY, USA
L. G. Herr

³Epidemiology Consulting Associates, Exton, Pennsylvania, USA
S. Monette

⁴Dept. of Pathology, The Animal Medical Centre, New York, NY, USA

Abstract

Summary

Patellar tendon thickening (PTT) and patellar tendinosis (PTS) have been discussed in the veterinary literature as a post-operative complication of tibial plateau leveling osteotomy (TPLO). The purpose of this study was to define radiographic PTT, determine the frequency of and risk factors for PTT and PTS, and describe the clinical and histopathological findings of PTS after TPLO. We hypothesized that the location of the osteotomy alters forces placed on the patellar tendon resulting in PTT or PTS. Radiographs and medical records from 83 dogs undergoing 94 TPLO procedures were retrospectively evaluated. Two months post-operatively, 19 dogs (20.2%) had a normal patellar tendon or mild PTT, 51 (54.3%) had moderate PTT, and 24 (25.5%) had severe PTT. Seven of the 24 dogs (7.4%) with severe PTT had clinical signs consistent with PTS. Only dogs with severe PTT developed PTS (p < 0.0001). The risk factors for the development of PTT include: a cranial osteotomy, a partially intact cranial cruciate ligament (CCL) in conjunction with a cranial osteotomy, and post-operative tibial tuberosity fracture. The only risk factor identified for the development of PTS was a partially intact CCL. Four dogs with PTS improved with conservative therapy and one improved with surgical treatment. Two dogs had tendon biopsies with histopathological review that showed tendon degeneration with lack of inflammation. As only the dogs with severe PTT develop PTS, a caudal osteotomy for the prevention of PTT and subsequent PTS is recommended.

Keywords

TPLO - patellar - tendonitis - thickening

Full Text

References

References
1 Arnoczky S. The cruciate ligaments: the enigma of the canine stifle. J Small Anim Pract 1988; 29: 71-90.
2 Vasseur PB. Stifle joint. In: Textbook of Small Animal Surgery. Slatter DH, ed. Philadelphia: WB. Saunders Co.; 2003: 2090-133.
3 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small AnimPract 1993; 23: 777-95.
4 Mattern K, Berry C. Radiographic and ultrasonographic evaluation of the patellar ligament following tibial plateau leveling osteotomy. In: Annu Met Am Coll Vet Surg. 2004. Denver, CO: E14.
5 Pacchiana PD, Morris E, Gillings SL. et al. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc 2003; 222: 184-93.
6 Kowaleski M, McCarthy RJ. Geometric analysis evaluating the effect of tibial plateau leveling osteotomy position on postoperative tibial plateau slope. Vet Comp Orthop Traumatol 2004; 17: 30-4.
7 Basso O, Amis AA, Race A. et al. Patellar tendon fiber strains: their differential responses to quadriceps tension. Clin Orthop 2002; 400: 246-53.
8 Bodne D, Quinn SF, Murray WT. et al. Magnetic resonance images of chronic patellar tendinitis. Skeletal Radiol 1988; 17: 24-8.
9 Popp JE, Yu JS, Kaeding CC. Recalcitrantpatellar tendinitis. Magnetic resonance imaging, histologic evaluation, and surgical treatment. Am J Sports Med 1997; 25: 218-22.
10 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for cranial cruciate ligament rupture. In: Current Techniques in Small Animal Surgery. Bojrab MJ. ed Philadelphia: The Williams and WilkinsCo; 1998. 1197.
11 Carr JC, Hanly S, Griffin J. et al. Sonography of the patellar tendon and adjacent structures in pediatric and adult patients. Am J Roentgenol 2001; 176: 1535-9.
12 Rosenberg ZS, Kawelblum M, Cheung YY. et al. Osgood-Schlatter lesion: fracture or tendinitis? Scintigraphic, CT, and MR imaging features. Radiology 1992; 185: 853-8.
13 Hirano A, Fukubayashi T, Ishii T. et al. Magnetic resonance imaging of Osgood-Schlatter disease: the course of the disease. Skeletal Radiol 2002; 31: 334-42.
14 Dunn JF. Osgood-Schlatter disease. Am Fam Physician 1990; 41: 173-6.
15 Fornage BD, Rifkin MD, Touche DH, Segal PM. Sonography of the patellar tendon: preliminary observations. Am J Roentgenol 1984; 143: 179-82.
16 Fredberg U, Bolvig L. Significance of ultrasono-graphically detected asymptomatic tendinosis in the patellar and achilles tendons of elite soccer players: a longitudinal study. Am J Sports Med 2002; 30: 488-91.
17 Reiff DB, Heenan SD, Heron CW. MRI appearances of the asymptomatic patellar tendon on gradient echo imaging. Skeletal Radiol 1995; 24: 123-6.
18 Shalaby M, Almekinders LC. Patellar tendinitis: the significance of magnetic resonance imaging findings. Am J Sports Med 1999; 27: 345-9.
19 Gigante A, Bevilacqua C, Bonetti MG. et al. Increased external tibial torsion in Osgood-Schlatter disease. Acta Orthop Scand 2003; 74: 431-6.
20 Shim SS, Leung G. Blood supplyofthe knee joint. A microangiography study in children and adults. Clin Orthop 1986; 208: 119-25.
21 Wheeler JL, Cross AR, Gingrich W. In vitro effects of osteotomy angle and osteotomy reduction on tibial angulation and rotation during the tibial plateau-leveling osteotomy procedure. Vet Surg 2003; 32: 371-7.
22 Slocum B, Slocum TD. Tibial Plateau Leveling Osteotomy Course. Slocum Enterprises Inc. October 2003. Eugene, OR, USA.:
23 Piermattei DL. Approach to the stifle joint through a lateral incision. In: An Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. Philadelphia: WB Saunders Co.; 1993: 276-7.
24 Kergosien DH, Barnhart MD, Kees CE. et al. Radiographic and clinical changes of the tibial tuberosity after tibial plateau leveling osteotomy. Vet Surg 2004; 33: 468-74.
25 Warden SJ, Brukner P. Patellartendinopathy. Clin Sports Med 2003; 22: 743-59.
26 Witvrouw E, Bellemans J, Lysens R. et al. Intrinsic risk factors for the development of patellar tendinitis in an athletic population. A two-year prospective study. Am J Sports Med 2001; 29: 190-5.
27 Baroni E, Matthias RR, Marcellin-Little DJ. et al. Comparison of radiographic assessments of the tibial plateau slope in dogs. Am J VetRes 2003; 64: 586-9.
28 Slocum B, Devine T. Cranial tibial thrust: a primary force in the canine stifle. J Am Vet Med Assoc 1983; 183: 456-9.
29 Aiken S, Kass P, Toombs J. Intercondylar notch width in dogs with and without cranial cruciate ligament injuries. Vet Comp Orthop Traumatol 1995; 8: 128-32.
30 Fitch R, Hathcock J, Montgomery R. Radiographic and computed tomographic evaluation of the canine intercondylar fossa in normal stifles and after notchplasty in stable and unstable stifles. Vet Radiol Ultrasound 1996; 37: 266-74.
31 Narvekar A, Gajjar S. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy 2004; 20: 141-6.
32 Khan KM, Bonar F, Desmond PM. et al. Patellar tendinosis (jumper's knee): findings at histopathological examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group. Radiology 1996; 200: 821-7.
33 Khan K, Cook J. The painful nonruptured tendon: clinical aspects. Clin Sports Med 2003; 22: 711-25.
34 Yu JS, Popp JE, Kaeding CC. et al. Correlation of MR imaging and pathologic findings in athletes undergoing surgery for chronic patellar tendinitis. Am J Roentgenol 1995; 165: 115-8.
35 Fu SC, Wang W, Pau HM. et al. Increased expression of transforming growth factor-beta1 in patellar tendinosis. Clin Orthop 2002; 400: 174-83.
36 Coleman BD, Khan KM, Kiss ZS. et al. Open and arthroscopic patellar tenotomy for chronic patellar tendinopathy. A retrospective outcome study. Victorian Institute of Sport Tendon Study Group. Am J Sports Med 2000; 28: 183-90.