Latero-distal transposition of the tibial crest in cases of medial patellar luxation with patella alta

Summary

Medial patellar luxation is defined as medial displacement of the patella from the trochlear groove. In dogs, medial luxations account for 75% of all patellar luxation cases, and are frequently associated with patella alta. Common surgical treatments for medial luxation are trochleoplasty and lateral transposition of the crest to drive the patella into the correct anatomical alignment. Postoperative complications for this procedure are estimated to be between 18–29% of cases, with up to 48% of complications involving reluxation. It was previously hypothesized that in cases of medial luxation involving patella alta, the addition of a distal component to the lateral tibial crest transposition will result in repositioning of the patella into its proper position in the trochlear groove, thus reducing the recurrence of luxation. We performed this modified procedure on 14 dogs (17 limbs) that were suffering from medial luxation combined with patella alta, and our results led to favourable clinical outcomes. This modified surgical procedure places the patella into a more normal proximodistal anatomical position, is simple to perform, and may become common practice for surgical treatment of medial patellar luxation with an alta component.

Keywords

Medial patellar luxation - patella alta - tibial crest transposition

• References

• 1 Gibbons SE, Macias C, Tonzing MA. et al. Patellar luxation in 70 large breed dogs. J Small Anim Pract 2006; 47: 3-9.
• 2 Hulse DA. Pathophysiology and management of medial patellar luxation in the dog. Vet Med Small Anim Clin 1981; 76: 43-51.
• 3 Johnson AL, Probst CW, Decamp CE. et al. Comparison of trochlear block recession and trochlear wedge recession for canine patellar luxation using a cadaver model. Vet Surg 2001; 30: 140-150.
• 4 Ness MG, 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.
• 5 Hulse DA. Medial patellar luxation in the dog. In: Bojrab EMJ. editor. Disease Mechanisms in Small Animal Surgery. Philadelphia, PA, USA: Lippincott Williams & Wilkins; 1993. pg. 2122-2136.
• 6 Towle HA, Griffon DJ, Thomas MW. et al. Pre- and postoperative radiographic and computed tomographic evaluation of dogs with medial patellar luxation. Vet Surg 2005; 34: 265-272.
• 7 Hayes AG, Boudrieau RJ, Hungerford LL. Frequency and distribution of medial and lateral patellar luxation in dogs: 124 cases (1982-1992). J Am Vet Med Assoc 1994; 205: 716-720.
• 8 Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patellar luxation in 109 dogs. Vet Surg 2006; 35: 559-566.
• 9 Johnson AL, Probst CW, DeCamp CE. et al. Vertical position of the patella in the stifle joint of clinically normal large-breed dogs. Am J Vet Res 2002; 63: 42-46.
• 10 Piermattei DL, Flo GL, DeCamp CE. The Stifle Joint. In: Piermattei DL, Flo GL, DeCamp CE. editors. Handbook of Small Animal Orthopedics and Fracture Repair. Philadelphia: Saunders Elsevier; 2006. pg. 562-632.
• 11 Johnson AL, Broaddus KD, Hauptman JG. et al. Vertical patellar position in large-breed dogs with clinically normal stifles and large-breed dogs with medial patellar luxation. Vet Surg 2006; 35: 78-81.
• 12 Mostafa AA, Griffon DJ, Thomas MW. et al. Proximodistal alignment of the canine patella: radiographic evaluation and association with medial and lateral patellar luxation. Vet Surg 2008; 37: 201-211.
• 13 Impellizeri JA, Tetrick MA, Muir P. Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis. J Am Vet Med Assoc 2000; 216: 1089-1091.
• 14 DeAngelis M. Patellar luxation in dogs. Vet Clin North Am 1971; 1: 403-415.
• 15 Singleton WB. The surgical correction of stifle deformities in the dog. J Small Anim Pract 1969; 10: 59-69.
• 16 Al-Sayyad MJ, Cameron JC. Functional outcome after tibial tubercle transfer for the painful patella alta. Clin Orthop Relat Res 2002; 152-162.