Clean Run Magazine - April 2010 - 34

Once the groove has been addressed, the alignment of the tibia and femur are assessed. Femoral angulation correction (via a wedge osteotomy) is uncommon and generally reserved for cases with greater than 10°-12° of medial to lateral deviation of the femur. On the other hand, tibial correction is commonly performed and involves cutting the tibial tuberosity and moving (transposing) it either medially or laterally, depending on the nature of the abnormality. The tibial tuberosity is held in the new anatomic location with k-wires (pins). In large breed dogs, a figure-eight wire band is also placed to prevent avulsion (traction) on the tibial tuberosity. Following correction of the groove and alignment, the knee should be able to be placed through a full range of motion without the patella luxating. If the patella dislocates with internal rotation of the knee, then an anti-rotational suture (placed around the lateral fabella or sesamoid bone through the tibial tuberosity) may be necessary. The final step of the procedure is to tighten the medial or lateral retinaculum (band within the joint capsule that helps to hold the kneecap in place). This can be performed by either imbricating (over sewing) the joint capsule or via a capsulectomy (removal of a portion of the joint capsule). In some cases, the side of the joint capsule in which the luxation has occurred needs to be “released” to allow for proper orientation of the kneecap. In these cases, the release site is left open to heal on its own, because surgically closing it may cause too much tension and cause reluxation. Postoperatively, our patients are sent home on 10-14 days of an anti-inflammatory medication and a pain medication. We typically do not bandage the operated limb, as we want to encourage early limb usage. We also recommend a course of treatment with Adequan (a polysulfated glycosaminoglycan that may aid in cartilage healing), which is given intramuscularly every four days for the first month following surgery.

X-ray following surgical correction, showing a block recession and tibial tuberosity transposition.

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The patella is well seated within the surgically deepened groove

Prognosis
The most common complication reported is reluxation of the patella and is often associated with failure to correct all affected components of the condition at the time of the initial surgery. In my opinion, an increase incidence of reluxation is also seen in severe cases of patella luxation (grade 4, significant angulation of the femur) or in cases with concurrent cruciate ligament tears (which should also be addressed at the time of initial surgery or as a staged procedure). However, the reluxation is usually a grade 1-2 and non-clinical, thus often does not need to be surgically addressed. Migration or loosening of k-wires can also occur (typically happens once the bone has healed). While implant removal is required in these cases, this is a minor procedure and has little to no affect on the long-term success of the procedure. Infection is always a risk with orthopedic surgery and is usually related to the patient licking the incision. This is best avoided with use of an Elizabethan or cone collar for 10-14 days following the procedure.

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Rehabilitation Therapy
In our practice, we attribute our high rate of success not only to the surgical procedure performed but also to the frequency with which we re-evaluate our postoperative patients
Clean Run | April 10

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Clean Run Magazine - April 2010

Table of Contents for the Digital Edition of Clean Run Magazine - April 2010