Angels presenting chronic patellar luxation in cattle.by pavul

PATELLAR LUXATION
Prepared by
Dr.Pavulraj.S
M.V.Sc., (Veterinary Pathologist)
Research fellow
National Research Centre of
Equines, India
2/15/2015
Dr. Pavulraj. S, M.V.Sc., Veterinary
Pathologist, Research fellow, NRCE, India

Definition
Impaired patellar function characterized by
jerky movements during flexion to complete
immobilization of the joints.
• Animal fixes its ‘limb in extension’ while the
patella glides up over the trochlea to its
maximum height on the articular surface.
• Recurrent or permanent upward fixation of the
patella.
• More common in draught purpose animals.
Patellarluxationincattle
2/15/2015

• It is non-inflammatory functional disorders of
the femoropatellar articulation in cattle.
• When one limb involved, animal moved
forward by swinging the rigid affected limb
outward and forward.
2/15/2015

• Patella – large sesamoid bone.
• Connected to femur by collateral ligaments
and to the cranial tibial tuberosity by patellar
ligaments.
• Patellar ligaments are medial, middle and
lateral.
Patella
2/15/2015

• Laxity of the patellar ligaments predisposed
the animal to upward fixation of the patella.
• Relaxed ligaments allow the patella to glide
freely on the articular surface of the trochlea.
• If limb is over extended, the patellar apex may
get jammed between the trochlear ridges by
hooking the medial fibrocartilage over the
medial trochlear ridge
2/15/2015

Clinical signs
• Posture of the animal is normal at rest but,
every attempt to move the animal backwards
is resisted.
• Animal shows jerky flexion during movements
or drags the affected limbs with flexed
pastern.
• Affected limb is brought forward with a jerky
flexion on every step.
• Sitting - affected limb stretched.
2/15/2015

2/15/2015

A, Craniocaudal view; note lateral position of the
patella (arrow). B, Lateral view; patella (arrow) is not seen dorsal to the
trochlea groove but overlaps the trochlea because of its lateral position.
2/15/2015

• The subcutaneous division of the medial patellar
ligament is the common surgical treatment to
correct upward fixation of the patella.
• Bassi’s method
Open method
tab method
Clinicians prefer the surgery in the standing
animal, In lactating animal a lateral recumbency
is preferred.
Treatment
2/15/2015

Objective
• The patella gets fixed above the trochlea of
femur and the medial straight ligament is
tightly overstretched behind the medial
trochlear ridge, which prevents the downward
return of the patella.
• The object of the operation is to mechanically
bring down the patella by cutting the tensed
medial ligament.
2/15/2015

• The animal is cast with the affected limb lower
most and the other three limbs are tied
together. The affected limb is drawn slightly
backward in such a way that the stifle joint is
flexed completely.
• The site is prepared for aseptic surgery and
infiltrated with local anesthetic solution .
Casting
2/15/2015

• The index finger is moved upward along the
cranial border of the tibia till the cranial tibial
tuberosity is reached
• The cranial ligament is traced as a broadest
and thickest among the three partellar
ligaments .
• The finger is then moved over the medial
ligament which is felt as a prominent cord .
Locating the medial patellar ligament
2/15/2015

• A small incision is made in the skin directly
over the medial ligament. The index finger is
passed into the wound and the skin separated
from the fascia all around the site.
• The fascia is dissected to expose white
glistening medial patellar ligament . The
ligament is exteriorized by passing a curved
scissors.
Open method
2/15/2015

• The ligament is then sectioned near its
insertion using a knife . The cutaneous wound
is sutured with one or two interrupted
sutures which are removed on seventh or
eighth postoperative day.
• Cessation of crunching sound and immediate
relief of the characteristic jerky flexions during
progression are indications of a successful
medial patellar desmotomy.
2/15/2015

• A stab incision is made into the skin with a
B.P. blade immediately in front of the medial
tibial tuberosity .
• Though this incision,the abscess knife, curved
probe pointed knife or Hey groove knife is
passed flat wise between the middle and
medial patellar ligaments and the sharp edge
of the instrument is directed towards the
ligaments.
Closed method
2/15/2015

• The ligament is then transected by
withdrawing the knife towards the operator.
• A small quantity of tincture iodine is instilled
into the wound which is left unsutured.
• A piece of the ligaments is removed to prevent
the reunion of cut ends of the ligaments.
• Cessation of crunching sound and immediate
relief of the characteristic jerky flexions during
progression are indications of a successful
medial patellar desmotomy.
2/15/2015

Patellar luxation in dogs
• Displacement of patellar from the trochlear
sulcus
• Slipped knee cap
• Smaller, toy- breeds affected
• Intermittent weight bearing lameness. Hold
the leg in a flexed position for one to two step.
Medial patellar Luxation
2/15/2015

Grading
• Grade1. Spontaneous luxation of the patellar during normal
joint, flexion and extension other wise normal
• Grade 2. Patella luxate with flexion of the stifle joint. It
remain luxated
• Grade 3. Patella remain luxated, but manually reduced with
stifle extension, there will be medial displacement of
quadriceps muscle
• Grade 4. Patella in permanently luxated. Cannot manually
repositioned. Medial displacement of quadriceps muscle.
2/15/2015

Physical examination
• Skipping while walking
• Non – weight being limping
• Walk with near quarter in a crouched position
Radiograph
Cranio-caudal and medial – to – lateral
radiograph. Patella displaced medially.
2/15/2015

Surgical treatment
• Positioning: lateral or dorsal recumbency
• Place polyester suture through femoral fabellar
ligament and lateral parapateller fibrocartilage.
Next place series of imbrication suture though
the fibrous joint capsule and lateral edge of the
patella tendon.
• Tie the femoral – fabellar suture and imbrication
suture.
Lateral reinforcement
2/15/2015

Deepening of the trochlear groove
• It deepens the trochlear groove to restrain the
patella and maintain the integrity of patella
femoral articulation.
• Fine-toothed hand-held saw used to cut the
trochlea. Cut in to the articular cartilage of the
trochlea, making a diamond shaped out line.
• The width of the cut is sufficient at its midpoint
to accommodate the width of the patella. Close
the arthrotomy as lateral approach to stifle joint.
Trochlear wedge recession
2/15/2015

Trochlear resection
• Is a method of deepening the trochlear
groove through removal of articular cartilage
and subchondral cancellous bone.
2/15/2015

Lateral patellar luxation
• It is an intermittent or permanent displacement
of the patella from the trochlear sulcus.
• More in large breeds of dog
• Intermittent, weight – bearing lameness
• Animal holds the leg in a flexed position for one
or two step.
Diagnosis
2/15/2015

• Skipping when walking
• Walk with the near quarters in crouched
position (due to inability to extent the stifle
joints fully )
Craniocaudal and medial to lateral radiograph –
patella displaced laterally.
Physical examination
Radiograph
2/15/2015

Surgical treatment
Positioning
Animal in lateral recumbency with affected leg
up.
Methods
• Lateral reinforcement
• Trochlear wedge resection
• Trochlear resection.
Prognosis – fair – 52%
2/15/2015

References
• Small Animal Surgery- Theresa Welch Fossum
• Bovine Surgery and Lameness, Second Edition-
A. David Weaver
• Ruminant Surgery - R.P.S.Tyagi.Jit Singh,
Fourth edition
2/15/2015

TARA
JESSY
2/15/2015

Angels presenting chronic patellar luxation in cattle.by pavul

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Semelhante a Angels presenting chronic patellar luxation in cattle.by pavul

Semelhante a Angels presenting chronic patellar luxation in cattle.by pavul (20)

Mais de Pavulraj Selvaraj

Mais de Pavulraj Selvaraj (9)

Último

Último (20)

Angels presenting chronic patellar luxation in cattle.by pavul