Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs

R. G. Cashmore; M. Havlicek; N. R. Perkins; D. R. James; S. M. Fearnside; A. M. Marchevsky; A. P. Black

doi:10.3415/VCOT-13-08-0100

Veterinary and Comparative Orthopaedics and Traumatology, Inhaltsverzeichnis

Vet Comp Orthop Traumatol 2014; 27(04): 263-270
DOI: 10.3415/VCOT-13-08-0100

Original Research

Schattauer GmbH

Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs

R. G. Cashmore

¹Small Animal Specialist Hospital, Surgical Department, North Ryde, Sydney, NSW, Australia

²Veterinary Specialist Centre, Surgical Department, North Ryde, Sydney, NSW, Australia

,

M. Havlicek

¹Small Animal Specialist Hospital, Surgical Department, North Ryde, Sydney, NSW, Australia

²Veterinary Specialist Centre, Surgical Department, North Ryde, Sydney, NSW, Australia

,

N. R. Perkins

³AusVet, Animal Health Services, Toowoomba, Qld, Australia

,

D. R. James

¹Small Animal Specialist Hospital, Surgical Department, North Ryde, Sydney, NSW, Australia

²Veterinary Specialist Centre, Surgical Department, North Ryde, Sydney, NSW, Australia

,

S. M. Fearnside

¹Small Animal Specialist Hospital, Surgical Department, North Ryde, Sydney, NSW, Australia

²Veterinary Specialist Centre, Surgical Department, North Ryde, Sydney, NSW, Australia

⁴Northern Sydney Veterinary Specialist Centre, Surgical Department, North Turrarmurra, Sydney, NSW, Australia

,

A. M. Marchevsky

¹Small Animal Specialist Hospital, Surgical Department, North Ryde, Sydney, NSW, Australia

,

A. P. Black

¹Small Animal Specialist Hospital, Surgical Department, North Ryde, Sydney, NSW, Australia

²Veterinary Specialist Centre, Surgical Department, North Ryde, Sydney, NSW, Australia

⁴Northern Sydney Veterinary Specialist Centre, Surgical Department, North Turrarmurra, Sydney, NSW, Australia

› Institutsangaben

Abstract

Summary

Dogs treated for congenital medial patellar luxation were reviewed for the purpose of determining the incidence of postoperative major complications requiring surgical revision and the risk factors for their occurrence. Major complications occurred in 18.5% of the patellar luxation stabilization procedures with implant associated complications being the most frequent, patellar reluxation the second, and tibial tuberosity avulsion the third most common major complication. Other complications included patellar ligament rupture and trochlear wedge displacement. When recession trochleoplasty was performed in addition to tibial tuberosity transposition, a 5.1-fold reduction in the rate of patellar reluxation was observed. Release of the cranial belly of the sartorius muscle further reduced the incidence of patellar reluxation, while patella alta (pre- or postoperative) and patellar luxation grade were not found to influence the rate of reluxation. Tibial tuberosity avulsion was 11.1-times more likely when using a single Kirschner wire to stabilize a transposition, compared with two Kirschner wires. Independent to the number of Kirschner wires used, the more caudodistally the Kirschner wires were directed, the higher the risk for tibial tuberosity avulsion. Tension bands were used in 24.4% of the transpositions with no tuberosity avulsion occurring in stifles stabilized with a tension band. Overall, grade 1 luxations had a significantly lower incidence of major complications than other grades, while body weight, age, sex, and bilateral patellar stabilization were not associated with risk of major complication development.

Keywords

MPL - patellar luxation - avulsion - trochleoplasty

Volltext

Referenzen

References
1 Ness MN, Abercromby RH, May C. et al. A survey of orthopaedic conditions in small animal veterinary practice in Britain. Vet Comp Orthop Traumatol 1996; 9: 43-52.
2 Johnson JA, Austin C, Breur GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 7: 56-69.
3 LaFond E, Breur GJ, Austin CC. Breed susceptibility for developmental orthopaedic diseases in dogs. J Am Anim Hosp Assoc 2002; 38: 467-477.
4 Ruble RP, Hird DW. Congenital abnormalities in immature dogs from a pet store: 253 cases (1987-1988). J Am Vet Med Assoc 1993; 202: 633-636.
5 Roush JK. Canine patella luxation. Vet Clin North Am Small Anim Pract 1993; 23: 855-868.
6 Tomlinson J, Constantinescu GM. Repair of medial patella luxation. Vet Med 1994; 48-56.
7 Brinker WO, Pierrmattei DL, Flo GL. Diagnosis and treatment of orthopaedic conditions of the hindlimb. In: Brinker, Piermattei and Flo’s Handbook of Small Animal Orthopaedics and Fracture Treatment. Philidelphia, PA: Saunders; 1990. pg. 1990-377.
8 Kowaleski MP, Boudrieau RJ, Pozzi A. Stifle Joint. In: Tobias KM, Johnston SA. editor Veterinary Surgery Small Animal. St Louis, MO: Elsevier Saunders; 2012. pg. 2012-973.
9 Swiderski JK, Palmer RH. Long-term outcome of distal femoral osteotomy for treatment of combined distal femoral varus and medial patella luxation: 12 cases (1999-2004). J Am Vet Med Assoc 2007; 231: 1070-1075.
10 Peruski AM, Kowaleski MP, Pozzi A. et al. Treatment of medial patellar luxation and distal femoral varus by femoral wedge osteotomy in dogs: 30 cases (2000-2005). Proceedings of the 2nd World Veterinary Orthopedic Congress. 2006. February 25-March 4 Keystone, CO, USA: pg. 240.
11 Slocum B, Devine T. Knee. In: Bojrab JM, Slocum B, Ellison GW. editors. Current Techniques in Small Animal Surgery. Philidelphia, USA: Lea Febiger; 1998. pg. 1998-1232.
12 Robins GM. The canine stifle joint. In: Whittick WG. editor. Canine Orthopaedics. Philidelphia, USA: Lei Febiger; 1990. pg. 1990-707.
13 Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patella luxation in 109 dogs. Vet Surg 2006; 35: 559-566.
14 Gibbons SE, Macias C, Tonzing MA. et al. Patella luxation in 70 large breed dogs. J Small Anim Pract 2006; 47: 3-9.
15 Willauer CC, Vasseur PB. Clinical results of surgical correction of medial luxation of the patella in dogs. Vet Surg 1987; 16: 31-36.
16 Yeadon R, Fitzpatrick Kowaleski M. Tibial tuberosity transposition-advancement for treatment of medial patella luxation and concomitant cranial cruciate ligament disease in the dog. Vet Comp Orthop Traumatol 2011; 24: 18-26.
17 Alam MR, Lee JI, Kang KS. et al. Frequency and distribution of patella luxation in dogs. Vet Comp Orthop Traumatol 2007; 20: 59-64.
18 Slocum B, Devine T. Trochlear recession for correction of luxating patella in the dog. J Am Vet Med Assoc 1985; 186: 365-369.
19 Chase D, Farrell M. Fracture of the lateral trochlear ridge after surgical stabilisation of medial patella luxation. Vet Comp Orthop Traumatol 2010; 23: 203-208.
20 Remedios AM, Basher AW, Runyon CL. Medial patella luxation in 16 large breed dogs. A retrospective study. Vet Surg 1992; 21: 5-9.
21 Boone EG, Hohn RB, Weisbrode SE. Trochlear recession wedge technique for patella luxation: An experimental Study. J Am Anim Hosp Assoc 1983; 19: 735-742.
22 Talcott K, Goring R, Haan J. Rectangular recession trochleoplasty for treatment of patella luxation in dogs and cats. Vet Comp Orthop Traumatol 2000; 13: 39-43.
23 Dudley RM, Kowaleski MP, Drost WT. et al. Radiographic and computed tomographic determination of femoral varus and torsion in the dog. Vet Radiol Ultrasound 2006; 47: 546-552.
24 Soporat C, Wangdee C. Chuthatep et al. Radiographic measurement for femoral varus in Pomerranian dogs with and without medial patella luxation. Vet Comp Orthop Traumatol 2012; 25: 197-201.
25 Mostafa A, Griffon D, Thomas M. et al. Proximodistal alignment of the canine patella: Radiographic evaluation and association with medial and lateral patella luxation. Vet Surg 2008; 31: 201-211.
26 Segal U, Or M, Shani J. Latero-distal transposition of the tibial crest in cases of medial patella luxation with patella alta. Vet Comp Orthop Traumatol 2012; 25: 281-285.
27 Linney WR, Hammer DL, Shott S. Surgical treatment of medial patella luxation without femoral trochlear groove deepening procedures in dogs: 91 cases (1998-2009). J Am Vet Med Assoc 2011; 238: 1168-1172.
28 Wangdee C, Theyse LFH, Techakumphu M. et al. Evaluation of surgical treatment of medial patella luxation in Pomeranian dogs. Vet Comp Orthop Traumatol 2013; 26: 435-439.
29 Harari J, Smith C, Quinn M. et al. What is your diagnosis?. J Am Vet Med Assoc 2000; 217: 1797-1798.
30 Hermanson JW, Evans HE. The Muscular System. In: Evans H. Millers Anatomy of the Dog. Philidelphia, USA: Saunders; 1993. pg. 1993-361.
31 Wangdee C, Chuthatep S, Soontornvipart K. et al. The structural study of the sartorius of medial patella luxated dogs. In: Proceedings of the Annual Congress of the Faculty of Veterinary Science, Chulalongkorn University; 2006 April 28; Bangkok, Thailand; 2006; pg. 2006-56.
32 Horne RD. Transplantation of the cranial head of the Sartorius muscle for correction of medial patella luxations. J Am Anim Hosp Assoc 1979; 15: 561-565.
33 Piermattei DL, Flo GL, DeCamp CE. The Stifle Joint. In: Brinker, Piermattei and Flo’s Handbook of Small Animal Orthopaedics and Fracture Treatment. Philidelphia, PA: Saunders; 2006. pg. 2006-377.
34 Johnston SA, von Pfeil DJ, Dejardin LM. et al. Internal fracture fixation. In: Tobias KM, Johnston SA. editor Veterinary Surgery Small Animal. St Louis, MO: Elsevier Saunders; 2012. pg. 2012-973.
35 Cashmore RG, Havlicek M, Dabirrahmani D. et al. Mechanical evaluation of K-wire orientation, alignment and tension band wire fixation in a tibial tuberosity osteotomy model. In: Proceedings of the 4th World Veterinary Orthopedic Congress. 2014. March 1-8 Breckenridge, CO, USA: pg. 59.
36 Johnson A, Broaddus KM, Hauptman J. et al. Vertical patella position in large-breed dogs with clinical normal stifles and large breed dogs with medial patella luxation. Vet Surg 2006; 35: 78-81.
37 DeAngelis M, Hohn RB. Evaluation of surgical correction of canine patella luxation in 142 cases. J Am Vet Med Assoc 1970; 156: 587-594.
38 Hulse DA. Medial patellar luxation in the dog. In: Bojrab J. editor. Disease Mechanisms in Small Animal Surgery. Philidelphia, USA: Lea Febiger; 1994. pg. 1994-808.
39 Hayashi K, Lansdowne J, Dejardin L. Patellar luxation in Dogs. In: Bojrab J, Monnett E. editors Mechanisms of Disease in Small Animal Surgery. Philidelphia, USA: Lea Febiger; 2012. pg. 2012-655.

Zusatzmaterial

Zusatzmaterial