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Specific orthopaedic disease - hind limb > Patella luxation > Flashcards

Patella luxation Flashcards

1
Q

Cause of patella luxation?

A

Usually secondary to pelvic limb deformity

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2
Q

presentation?

A

6-12 months, or older due to OA or CCL

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3
Q

What type of disease is patella lux?

A

developmental, as is not present at birth

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4
Q

What is the extensor mechanism of the stifle?

A
  • quadriceps muscle
  • patella
  • trochlea
  • patellar ligament
  • tibial tuberosity

Misalignement of this mechanism gives patella lux, lack of pressure on groove -> hypoplastic

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5
Q

Bilateral in?

A

60%

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6
Q

Breed predisposition?

A

Spaniels
Yorkshire Terrier
Poodles
Staffordshire Bullterrier
Labrador
Flatcoat retriever

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7
Q

Patella stability is evaluated?

A

When extended and flexed, best when not sedated

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8
Q

What can indicate cartilage erosion on clinical exam?

A

Pain on retropatellar pressure

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9
Q

Grading of patella lux?

A

Grade 1 - the patella can be luxated manually when the stifle is extended, but returns to normal position when released
Grade 2 - the patella luxates and reduces spontaneously during motion
Grade 3 - The patella is permanently luxated but can be manually reduced
Grade 4 - Permanent, irreducible luxation of the patella

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10
Q

Indications for conservative treatment?

A

Small dogs (or cats) with no or mild clinical signs
Grade 1-2 without clinical signs
sedentary dogs -> can manage with conservative treatment

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11
Q

Indications for surgery?

A

Puppies grade 3-4 -> 2 step surgery (as TTA cannot be done in growing animals)
All grade 3+4, and grade 2 with symptoms

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12
Q

What is the reluxation rate and complication rate?

A

48% reluxation
18% complication

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13
Q

What are the options for surgical alignement?

A
  • tibial tuberosity transposition
  • distal femoral corrective osteotomy (closed wedge, open wedge or de-rotational osteotomy)
  • proximal tibial corrective osteotomy
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14
Q

What are the adjunct procedures of patella lux?

A
  • Trochleoplasty (block, wedge, trochlear chondroplasty, abrasion)
  • Soft tissue release
  • Imbrication
  • rectus femoris muscle release
  • antirotational suture
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15
Q

What is the salvage procedure?

A

Patellectomy

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16
Q

What is the difference between the block and wedge sucoplasty?

A

Block ensures a deeper groove especially proximally, increasing cartilage contact and decreasing proximal patella luxaiton

17
Q

What are the anatomical landmarks for block sulcoplasty?

A

From intercondylar notch to ostechondral junction

18
Q

What size tension band should you choose for TTT in animals below and above 20kg?

A

Tension band wire
<20kg = 0,8mm
>20kg = 1 mm

19
Q

Complications of TTT?

A
  • implant failure
  • loss of reduction of TT
  • non-union, mal-union, delayed union
  • implant associated infection
  • fracture (of tibial tuberosity or tibia)
20
Q

Complications of sulcoplasty?

A
  • recurrent luxation
  • recurrent pain
  • loss of reduction of autograf
  • septic arthritis
  • fracture of trochlear ridges
  • reurrent patella luxation
  • OA
21
Q

What is the reluxation rate?

A

6-28%

22
Q

Patella luxation in the cat?

A

Uncommon, usually medially
Often associated with HD
Surgery recommended if symptomatic
As dogs

23
Q

Other treatment options for patella luxation?

A
  • antirotational suture (historic)
  • corrective femoral osteotomy (if distal femoral varus)
  • patellar groove replacement (salvage)
  • medial trochlear ridge elevation (can give erosion)
  • partial patellectomy (discoid patella, cats)
24
Q

What is the key for patella luxation with concomitant cranial cruciate ligament disease?

A

Signalement! Was the patella lux a problem prior to CCL -> if yes, you must adress it! If not -> focus on CCL

25
Q

What treatment options are available if you need to treat CCL and patella lux at the same time?

A
  • Lateral suture + TTT
  • TPLO with medialisation of fragment (TTT in practice)
  • CCWO + TTT
  • Combined tibial osteotomy and distal femoral corrective osteotomy
26
Q

What are the degrees of ligament injury?

A

1st: Mild stretching, minimal instability
2nd: Moderate strecthing, some tearing
3rd: complete rupture or avulsion of ligament, significant instability

27
Q

Treatment options for different degrees?

A

1st+2nd -> conservative
3rd -> surgical

28
Q

What are the stabilizing role of collateral lig?

A

stabilize knee from valgus, varus, rotational and translational instability

29
Q

What is the cause of collateral ligament injury?

A

usually trauma, usually concomittant injuries

30
Q

Stifle luxation - treatment?

A

Debride, resect, primary repair, replacement or fuctional augmentation
-exfix or transarticular pin

31
Q

What is the salvage surgery for stifle luxation?

A

Arthrodesis
Amputation

Specific orthopaedic disease - hind limb (10 decks)

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