https://doi.org/10.52973/rcfcv-e34300
Received: 31/07/2023 Accepted: 25/09/2023 Published: 01/01/2024
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Revista Científica, FCV-LUZ / Vol. XXXIV, rcfcv-e34300
ABSTRACT
Patellar luxation is one of the important orthopedic problem in dogs.
Patellar luxation, which has been accepted as a developmental
disorder in recent years, usually occurs medially in small breeds and
laterally in large breeds. The aim of this study was to evaluate surgical
treatment (femoral trochleoplasty, tibial tuberosity transpositions and
imbrication techniques together), postoperative complications, early
and late results in dogs with patellar luxation. Thirty–two dogs with
grade 3 and grade 4 patella luxation were used in this study. While
patellar luxation was treated in all cases, tibia fracture was seen in
one dog as the most important complication. During tibial tuberosity
transpositions technique, attention should be paid to the cutting
process and the tibia should not be weakened. In conclusion, the
combined use of femoral trochleoplasty, tibial tuberosity transposition
and imbrication techniques can be used for patellar luxation. Complete
recovery may not be possible in grade 4 patellar luxations.
Key words: Dogs with patellar luxation; femoral trochleoplasty;
imbrication; tibial tuberosity transpositions;
postoperative complications
RESUMEN
La luxación rotuliana es uno de los problemas ortopédicos
importantes en los perros. La luxación rotuliana, que se ha aceptado
como un trastorno del desarrollo en los últimos años, suele ocurrir
en la parte media en las razas pequeñas y en la parte lateral en las
razas grandes. El objetivo de este estudio fue evaluar el tratamiento
quirúrgico (trocleoplastia femoral, transposiciones de tuberosidad
tibial y técnicas de imbricación en conjunto), complicaciones
postoperatorias, resultados tempranos y tardíos en perros con
luxación rotuliana. En este estudio se utilizaron 32 perros con luxación
rotuliana de grado 3 y grado 4. Si bien la luxación rotuliana se trató en
todos los casos, la fractura de tibia se observó en un perro como la
complicación más importante. Durante la técnica de transposición
de la tuberosidad tibial, se debe prestar atención al proceso de corte
y no se debe debilitar la tibia. En conclusión, el uso combinado de la
trocleoplastia femoral, la transposición de la tuberosidad tibial y las
técnicas de imbricación pueden utilizarse para la luxación rotuliana.
La recuperación completa puede no ser posible en las luxaciones
rotulianas de grado 4.
Palabras clave: Perros con luxación rotuliana; trocleoplastia femoral;
imbricación; transposiciones de tuberosidad tibial;
complicaciones postoperatorias
Clinical evaluation of complications after surgical treatment of patella
dislocations in dogs: A retrospective study
Evaluación clínica de las complicaciones tras el tratamiento quirúrgico de
las luxaciones de rótula en perros: Un estudio retrospectivo
Emine Çatalkaya
1
* , Sadık Yayla
1
, Semih Altan
2
, Berna Ersöz–Kanay
1
1
Dicle University, Faculty of Veterinary Medicine, Department of Surgery. Diyarbakir, Türkiye.
2
Dokuz Eylul University, Faculty of Veterinary Medicine, Department of Surgery. Izmir, Türkiye.
*
Corresponding author: eminecatalkaya21@gmail.com
Treatment of Patella Luxations in Dogs / Çatalkaya et al. ____________________________________________________________________________
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INTRODUCTION
Patellar luxation has an important place among hind leg lameness
in dogs (Canis lupus familiaris). It is possible to encounter both large
and small breed dogs [1, 2, 3, 4, 5, 6, 7]. The luxation may be medial
or lateral. While medial luxation is seen in small breed dogs, lateral
luxation is more common in large breed dogs [4, 6, 8, 9, 10]. The
incidence of medial patellar luxation in small breed dogs is 12 times
higher than in large breed dogs [4, 6, 9].
disorder in recent years [6, 7, 11, 12, 13], but it can also occur as a
result of a traumatic accident that causes rupture or stretching of
the joint capsule and fascia leading to femoropatellar instability [6,
11, 12]. Although the cause of patellar luxation is not fully understood,
malalignment in the quadriceps mechanism are important in the
development of this disease. Parts of the extensor mechanism of
the knee joint are the quadriceps muscle group, the patella, the
trochlear groove, the patellar ligament and the tibial tuberosity. Any
irregularity in this mechanism leads to some anatomical changes in
the distal femur and proximal tibia during the growth period, followed
by patellar instability [6, 12, 14, 15]. Additionally, causes such as distal
femoral varus or valgus, external or internal torsion of the distal femur,
proximal tibial varus or valgus, internal or external tibial torsion and
shallow trochlear sulcus structure also cause patellar luxation [6].
The diagnosis of patellar luxation is easy with clinical examination
as well as radiological examination [6, 15, 16, 17, 18]. Among the
surgical treatment methods, besides soft tissue techniques, bone
correction operations such as block recession sulcoplasty, wedge
recession sulcoplasty, and tibial tuberosity transposition have also
5, 6, 19]. Various complications can be encountered
in many of these operative techniques. These complications include
seroma, and osteoarthritis. Among the implant–related complications,
recurrence and fracture of the tibial crest are the most common
complications [6, 20]. Excess body weight has been associated
with a greater incidence of complications after operations of the
patellar luxation [20, 21]. In a study [4] conducted in dogs with patellar
luxation (medial luxation, lateral luxation, or both) weighing > 15 kg,
postoperative complications were reported in 29% of dogs, and it
was stated that there may be a relationship between body weight
and the development of complications. In another study [19] with
a similarly mixed population of 109 dogs with patellar luxation, the
prevalence of dogs with complications and major complications
and the frequency of relapses were greater among dogs weighing
> 20 kg. Lateral patella luxation is more common in larger dogs.
Therefore, dogs with a higher body weight may be at greater risk
for postoperative complications [21]. It has also been reported that
there may be a relationship between the simultaneous single session
in cases with bilateral patella luxation and the risk of complications
[6, 21]. It has been stated that this situation may cause excessive
stress on the implants and healing tissues in dogs undergoing bilateral
surgical repair in a single session, and recurrences may develop [21].
The purpose of this study was to report the history, clinical features
and outcome in dogs treated surgically for patellar luxation. In this
study postoperative complications and early and late outcomes were
evaluated.
MATERIALS AND METHODS
The clinical records of 32 dogs who applied to Dicle University
Veterinary Faculty Surgery Clinic between August 2019 and December
2022 with patellar luxation were analyzed. Gender, age, body weight,
breed, etiology (developmental or traumatic), unilateral or bilateral
luxation, duration of lameness, degree of luxation, direction of luxation
(medial or lateral), degree of lameness at presentation, presence of
concomitant cranial cruciate ligament rupture, treatment method
and complications were evaluated.
Grade of patellar luxation and lameness score
Degree of patellar luxation and lameness, Gibbons et al. [4] were
categorized as described. According to this;
TABLE I
The degrees of patellar luxation and lameness described by Gibbons et al. [4]
Degree of patellar
luxation
Grade 1
The patella was easily luxated with manual
pressure and returned to the femoral trochlea
when released
Grade 2
Patellar luxation occurred with rotation and
stie exion of the paw and returned to the
femoral trochlea
Grade 3
The patella was permanently luxated but could
be reduced with manual pressure
Grade 4
The patella can be permanently luxated and
manually reduced
Lameness scores
0 No lameness
1 Mild or intermittent lameness
2 Moderate lameness
3 Severe lameness
4 Non–weight bearing lameness
Examination and evaluation of the patient
Among the dogs diagnosed with patellar luxation according to
with grade 3 and grade 4 were included in the study.
Surgery
Routine preparations such as shaving asepsis and antisepsis of the
knee joint area of each dog with patellar luxation or patellar instability
included in the study were made and limited to sterile covers.
Dogs with patellar luxation, induction with 1–3 mg·kg
-1
IM xylazine HCl
(Rompun 2%, Bayer, Turkiye), 15–20 mg·kg
-1
IM ketamine HCl (Ketasol
(Sevorane 100%, AbbVie, Turkiye) was anesthetized.
parapetellar incision in all cases. The femoral trochlea, cranial cruciate
ligament, and menisci were evaluated. If there were partial injuries or
growths, they were removed. Femoral trochleoplasty was performed
3]. Tibial
tuberosity transpositions were performed manually using a bone
FIGURE 1. Radiographic images of dierent cases. A: A case of bilateral medial luxation of the patella and unilateral coxofemoral luxation in the ventrodorsal position.
B: A case of patellar luxation in the mediolateral view. C: A case of medial luxation of the patella in the tangential radiographic position
FIGURE 2. Radiograms of the case with complication with K wire and tension
band. A. Radiogram of patella luxation after K wire and tension band application
in operative surgery. B. Radiogram of plate osteosynthesis treatment of tibia
fracture after patellar luxation surgery. In tuberositas tibia transposition
technique, it is important not to weaken the proximal tibia
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saw. In some cases, it was stabilized with one or two K–wires, using
a tension band wire. In some cases, it was stabilized with two cortical
screws. The compatibility of the patella within the femoral trochlea
was evaluated. To increase the tension, a piece of medial or lateral
soft tissues (deep fascia, retinaculum, joint capsule) was excised
and closed by suturing at an appropriate tension.
Dogs with bilateral patellar luxation were treated by surgery in a
single session.
Postoperative radiographs were obtained in all dogs and they
were followed for 2 months. Short– and long–term outcomes of dogs
were graded as very good (no lameness), good (mild or intermittent
lameness), moderate (moderate lameness), or poor (severe lameness
or non–weight–bearing lameness). In addition, the development of
surgical complications was followed up.
RESULTS AND DISCUSSION
Of the 32 dogs included in the study, 18 were female and 14 were
male. Dogs evaluated in the study were of various breeds (Miniature
Pinscher (n=3), Pomerian (n=3), Terrier (n=5), Pekingese (n=3), Poodle
(n=3), Pug (n=2), Spaniel Cocker (n=2), Chihuahua (n=3), Golden
Retriever (n=1), Labrador Retriever (n=1), Rottweiler (n=2), Chow Chow
(n=1), Belgian Malinous (n=2), German shepherd (n=1)). Their ages
ranged from 8 to 22 months and their body weights ranged from 6 to
56 kg. Five of these cases had lateral patellar luxation and they were
other four had bilateral luxation. In cases with medial patellar luxation,
27 dogs were bilateral and 3 dogs were unilateral. Patellar luxation was
considered to be developmental in all cases in this study. Especially
in the radiological examination, the deformation of the tibia in the
medial dislocations was remarkable.
Patellar luxation type, degree and lameness scores are summarized
in TABLE II.
There was no cranial cruciate ligament rupture in any of the patients.
However, there was a meniscus laceration in one case. In another
case, there were osteophytic growths in the femoral lateral trochlea.
Surgically, femoral trochleaplasty (trochlear block recession) was
performed by a single surgeon with the same procedure in all cases.
For tibial tuberosity transposition, K wire and tension band (FIG. 2)
were used in 14 cases (43.75%), while two cortical screws (FIG. 3)
were used in all other 18 cases (56.25%).
TABLE II
Patellar luxation type, degree and lameness scores of the cases
Type of patellar
luxation
Degree of
luxation
Scores of
lameness
BW
(mean, kg)
Gender
Grade
3
Grade
4
0 1 2 3 4 F M
Medial
n=27
Unilateral
n=3
–
3
(2R,1L)
– – – – 3 9.33 3 –
Bilateral
n=24
22 2 – – – 19 5 19.54 15 9
Lateral
n=5
Unilateral
n=1
–
1
(R)
– – – – 1 56.00 – 1
Bilateral
n=4
– 4 – – – – 4 50.50 0 4
R: Right, L: Left, F: Female, M: Male
In all dogs with medial patellar luxation weighing less than 25 kg,
lameness disappeared at the end of the 4th postoperative week. In
a 28 kg dog (3.12%) with medial patellar luxation and a K–wire and
tension band, healing at the incision site was delayed, the site was
opened, and treatment took longer than expected. In a 35 kg dog with
bilateral medial patellar luxation (3.12%), the tibia was fractured on
the 3rd postoperative day (FIG. 2).
FIGURE 3. A radiogram of one of the cases in which two cortical screws were
used for tibial tuberosity transposition in patella luxation
Treatment of Patella Luxations in Dogs / Çatalkaya et al. ____________________________________________________________________________
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Those with grade 4 patellar luxation (5 medial, 5 lateral) could not
fully recover in the long term, these dogs (31.25%) had moderate
lameness despite using their legs. No recurrence was observed in
terms of patellar instability in any of the cases.
A population of dogs with patellar luxation was not looked at in
this study. Only dogs with 3rd and 4th degree patellar luxation were
included in the study. The technique applied in all of these patients
was performed by the same team. Postoperative complications were
evaluated in the follow–up phase of the study after the operations.
ABLE II).
It has been reported that the prognosis of medial patellar luxation
is more favorable than that of lateral patellar luxation, but it has not
body weight and the presence of postoperative complications [21]. It is
already known that lateral dislocations are more common in large breed
dogs [4]. Many studies have reported an association between cranial
cruciate ligament (CCL) rupture [20] and postoperative complications,
depending on excess body weight (>20) and the degree of patellar
luxation [6, 21, 23].
Shaver et al. [21] reported that lateral patella luxation is more common
in large dogs with a large body weight and that high body weight in
these dogs poses a greater risk for postoperative complications. In
this study, CCL rupture was not encountered, complications were
seen in only one case. A tibial fracture was encountered in this 35 kg
patient with bilateral medial luxation. This may be attributed to the
weakening of the tibia with the load on the tibia or when transposition
of the tuberositas tibia.
It has been reported by some authors that patellar dislocation
is more common in male dogs in general [1, 2] However, different
authors have reported that it is more common in males among large
dogs and in females among small breed dogs [4]. The data obtained
in this study support the opinion of the authors in the second group
in terms of gender. The age of the dogs in this study was not different
from previous studies [1, 2, 4]. The ages of the dogs with patella
dislocation were 8–22 months.
There are authors who argue that there is a relationship between
patella luxation and rupture of the cranial cruciate ligament. It is
thought that the risk of cranial cruciate ligament rupture is increased
in dogs with medial patellar luxation due to incorrect alignment of
the extensor mechanism of the knee joint and internal rotation of
the proximal tibia [1, 8, 16]. Contrary to this information, Hayes et al.
[2] reported
cranial cruciate ligament rupture with patellar luxation. Remedios
et al. [1] also argued that dogs with chronic patellar luxation are old
animals and that cranial cruciate ligament lesions develop due to
the increase in age.
In this study, all patients were routinely evaluated for cruciate
ligament rupture during clinical examination. No cruciate ligament
rupture was found in the dogs included in the study, but if it had
been ruptured, the treatment would have changed. In addition to
method or tibial plateau level osteotomy would be required for cruciate
ligament rupture. The reason why cruciate ligament rupture was not
observed in this study may be related to the fact that the age of the
cases was less than 22 months and their etiology was not traumatic.
Although the surgical plan varies according to the degree of patellar
luxation, proximal tibia or distal femur deformities are also effective
on the surgical plan [3, 4, 15, 24, 25]. In this study, only grade 3 and
grade 4 dogs were used among dogs with patellar luxation. Therefore,
a combination of femoral trochleaplasty (trochlear block recession),
tibial tuberosity transposition, and soft tissue surgery (to create tension
without patellar instability) was used in each dog. These techniques
have been described in previous studies [3, 4, 8, 15, 19] and are known
in practice, and are often used in combination depending on the case.
Postoperative complications in these techniques include reluxation,
femoral trochlea and tibia fracture, osteoarthritis, meniscus tear,
pin migration, implant failure, delayed healing or no healing. In
developed. Most importantly, patellar luxation did not recur. Wound
formation was observed in one case in which K wire and stretching
tape were applied. The most serious postoperative complication was
fracture of the tibia in only one case. Therefore, the tuberosity tibia
should not be taken too deep during tibial tuberosity transposition.
Thus, the proximal tibia is not weakened.
In the tibial tuberosity transposition technique, two K wires and a
tension band are also recommended. The compatibility of the patella
is achieved very quickly. It is easy and practical during operation.
This procedure was performed very easily in cases where K wire
and tension band were applied, and no problems were detected in
the intraoperative stage [15, 26]. In this technique, pin migration and
associated seroma formation are among the minor complications
in the postoperative period. Although this pin migration requires a
as a minor complication [6, 22, 27].
Fullagar et al. [20] emphasized that the use of a single K–wire and
screw in the tibial tuberosity transposition technique may result
in fracture of the tibia as a postoperative complication or implant
failure. In this study, two K–wire and tension band techniques were
used in 14 cases. In only one case, a wound occurred on the skin and
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healing was delayed. In addition, in some of the 18 cases, the tibial
tuberosity transposition technique was achieved with two cortical
body weight greater than 50 kg. No complications related to screw use
were observed. Therefore, two screw applications are more practical
than K wire and tension band. With this study, screw application can
be recommended for both small breed dogs and large breed dogs.
It was noteworthy that the hip joint was also affected in the cases
presented in this study. While 6 of these cases had medial luxation of
the patella, 2 had lateral luxation. In lateral or medial patellar luxation,
the involvement of the hind leg changes with the disruption of the
quadriceps mechanism. In other words, the caput femoris is pulled
out of the acetabulum. Therefore, it is thought to cause subluxation
or joint incompatibility.
Dogs with grade 4 patellar luxation (5 medial, 5 lateral) could not fully
recover in the long term. These dogs had moderate lameness despite
better use of their legs. This situation can be associated with the
development of patellar luxation, anatomical deformation of the joints
rthritis.
Di Dona et al. [6] reported in a study they conducted in Pomerians
that there was 100% success in the treatment of dogs with second
degree patellar luxation, 11% reluxation and complications in those
with third degree luxation, high reluxation and complications in fourth
degree cases, and skeletal deformities in 36% of these dogs.
CONCLUSION
In conclusion, femoral trochleoplasty, tibial tuberosity transposition
(extremely practical and easy with cortical screw) and imbrication
techniques can be used in patellar luxation cases (especially in non–
traumatic ones) in terms of postoperative complications. In addition,
of tuberosity tibia transposition, especially in large and small breed
dogs. Since it is not always possible to correct permanent damage in
grade 4 patellar luxations, early detection and time of surgery were
found to be important.
Availability of data and materials
request from the corresponding author (EÇ).
Conict interests statement
interests.
Informed consent
It is declared that this study, whose information is given above, is
among the studies that do not require ethics committee approval,
since it is a retrospective study.
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