Short-term outcomes of trochlear recession surgery combined with "Watermelon" autograft for treatment of canine medial patellar luxation: a case series / Resultados a curto prazo da cirurgia de recessão trocolear combinada com o auto-enxerto "Melancia" para tratamento da luxação patelar medial canina: uma série de casos

The aim of this study was to present a novel surgical method for correction of medial patellar luxation in small-breed dogs with trochlear dysplasia and marked hypoplasia of the medial femoral condyle. The "Watermelon" approach was applied together with trochlear wedge recession or trochlear block recession and consisted in increasing the height of the medial condyle with an osteochondral autograft resembling a watermelon slice, placed into an additional slot in the medial femoral condyle to prevent the postoperative reluxation of the patella. The study cohort included 19 dogs (25 joints) from small breeds (Pinscher, Pomeranian, and Chihuahua) with second-grade medial patellar luxation. Fourteen joints were submitted to wedge recession surgery combined with "Watermelon" grafting, and 11 joints: to block recession surgery with "Watermelon" grafting. The sulcus-deepening trochleoplasty combined with "Watermelon" grafting was clinically successful and with low percentage of minor postoperative complications. The mean duration of anesthesia was significantly longer for block recession combined with "Watermelon" (P<0.001), but the recovery period was shorter (P<0.05).

O objetivo deste estudo foi apresentar um novo método cirúrgico para correção da luxação patelar medial em cães de raça pequena com displasia troquelar e hipoplasia marcada do côndilo femoral medial. A abordagem "Melancia" foi aplicada juntamente com a recessão da cunha trocolear ou recessão do bloco trocolear e consistiu em aumentar a altura do côndilo medial com um auto-enxerto osteocondral parecido com uma fatia de melancia, colocado em uma fenda adicional no côndilo femoral medial para evitar o relaxamento pós-operatório da patela. A coorte do estudo incluiu 19 cães (25 juntas) de raças pequenas (Pinscher, Pomeranian, e Chihuahua) com luxação patelar medial de segundo grau. Catorze juntas foram submetidas à cirurgia de recessão em cunha combinada com enxerto de "melancia", e 11 juntas: para bloquear a cirurgia de recessão com enxerto de "melancia". A trocleoplastia de "melancia" combinada com o enxerto de "melancia" foi clinicamente bem sucedida e com baixo percentual de pequenas complicações pós-operatórias. A duração média da anestesia foi significativamente maior para a recessão em bloco combinada com "Melancia" (P<0,001), mas o período de recuperação foi mais curto (P<0,05).

Lateral patellar luxation and Ehlers Danlos Syndrome (EDS) in a dog

Background: Ehlers Danlos Syndrome (EDS) is a rare genetic disease characterized by a deficiency in collagen synthesis,which can result in joint laxity. Patellar luxation is one of the main orthopedic conditions that affect the canine knee joint,with limited descriptions of its association with EDS in dogs. The purpose of this report is to describe the surgical management and postoperative evolution of a 1-year-old Chow Chow dog with grade II patellar luxation, tibial valgus and EDS.Case: A 1-year-old Chow Chow dog was referred to the University Veterinary Hospital due to lameness of the left pelvicfor 3 months. At the orthopedic examination were verified severe lameness and lateral deviation of the left stifle joint during the ambulation of the animal. Additionally, it was verified bilateral hyperextension of the tibiotarsal joint and grade IIpatellar luxation of both pelvic limbs with painful hyperextension of the left stifle joint. Radiographic evaluation showedlateral displacement of the patella from both femoral trochlear groove, and a valgus deviation of the proximal left tibialshaft. In addition, it was verified cutaneous hyperextensibility and an extensibility index suggestive of EDS. The animalwas submitted to trochlear block resection technique and medial imbrication, followed by corrective tibial osteotomy.Furthermore, skin biopsies of the scapular and lumbar folds were performed during the corrective tibial osteotomy. Thesamples were sent for histopathological examination, which revealed fragmented and unorganized collagen fibers in thedermis. Histopathological findings were compatible with EDS. The absence of lameness and correct positioning of thepatella in the trochlear sulcus were verified in the post-surgical follow-up. Complete bone consolidation of the closingwedge osteotomy to correct the tibial...

Lateral patellar luxation and Ehlers Danlos Syndrome (EDS) in a dog

Background: Ehlers Danlos Syndrome (EDS) is a rare genetic disease characterized by a deficiency in collagen synthesis,which can result in joint laxity. Patellar luxation is one of the main orthopedic conditions that affect the canine knee joint,with limited descriptions of its association with EDS in dogs. The purpose of this report is to describe the surgical management and postoperative evolution of a 1-year-old Chow Chow dog with grade II patellar luxation, tibial valgus and EDS.Case: A 1-year-old Chow Chow dog was referred to the University Veterinary Hospital due to lameness of the left pelvicfor 3 months. At the orthopedic examination were verified severe lameness and lateral deviation of the left stifle joint during the ambulation of the animal. Additionally, it was verified bilateral hyperextension of the tibiotarsal joint and grade IIpatellar luxation of both pelvic limbs with painful hyperextension of the left stifle joint. Radiographic evaluation showedlateral displacement of the patella from both femoral trochlear groove, and a valgus deviation of the proximal left tibialshaft. In addition, it was verified cutaneous hyperextensibility and an extensibility index suggestive of EDS. The animalwas submitted to trochlear block resection technique and medial imbrication, followed by corrective tibial osteotomy.Furthermore, skin biopsies of the scapular and lumbar folds were performed during the corrective tibial osteotomy. Thesamples were sent for histopathological examination, which revealed fragmented and unorganized collagen fibers in thedermis. Histopathological findings were compatible with EDS. The absence of lameness and correct positioning of thepatella in the trochlear sulcus were verified in the post-surgical follow-up. Complete bone consolidation of the closingwedge osteotomy to correct the tibial...(AU)

Avaliação radiográfica da profundidade do sulco troclear e diâmetro patelar em cães / Radiographic assessment of the depth of the troclear groove and patellar diameter in dogs

Background: Patellar luxation is an alteration of bone development for which the indicated treatment is surgery. Failure to correct it may result in clinical worsening. The most commonly used surgical approach is the transposition of the tibial crest with trochleoplasty, which aims to accommodate 50% of the patella in the trochlea. The femoral groove and trochlea can be evaluated radiographically by tangential projection, tomography, or ultrasonography; however, all these methodologies have limitations. The objective of this study was to evaluate the depth of the trochlear groove in three regions and to compare it with the patellar diameter on simple mediolateral radiographic images. Materials, Methods & Results: Fifty non-paired pelvic limbs of adult dogs of a specific breed, weighing less than 40 kg and without orthopedic changes, were used. In the mediolateral radiographic projection, three evaluators measured the femoral trochlear sulcus at three different points and the patellar diameter. After imaging examinations, all limbs were skeletonized, and the trochlea and patella were measured with a digital caliper in the same regions as that of the radiographic measurements. All post-skeletonization calculations were performed by an evaluator. The highest mean radiographic and ex vivo trochlear depth was 3.4 ± 1.2 mm and 2.7 ± 0.8 mm, respectively. The lowest mean radiographic and ex vivo patellar diameter was 7.7 ± 1.7 mm and 7.9 ± 1.6 mm, respectively. The average relationship between the trochlear depth and patellar diameter was less than 50% in all animals, with the highest radiographically determined ratio being 44.15% and that determined ex vivo as 34.17%. The mean patellar diameter calculated radiographically was similar among the animals. Discussion: Radiographic images made it possible to assess the patella and bone surface regions of the femoral condyles. A wide arthrotomy...

Técnica de avanço e transposição da tuberosidade tibial (TTTA) com uso de espaçador único de TTA-Maquet em cão / Technique of tibial tuberosity transposition and advancement (TTTA) with use of TTA-Maquet cage-only in dog

Background: The most common conditions that compromise the stifle joint in dogs are medial patellar luxation (MPL) and cranial cruciate ligament (CCL) rupture. Surgical procedures are usually indicated for the treatment of these diseases. One ordinarytechnique for the treatment of MPL is the tibial tuberosity transposition, and one prominent technique for CCL rupture is the tibialtuberosity advancement. These techniques can be associated in one surgical procedure called tibial tuberosity transposition andadvancement (TTTA) for the simultaneous treatment of both stifle diseases. The aim of this study is to report the surgical treatmentof a dog with MPL and CCL rupture affecting the same joint by the TTTA technique with the use of a TTA-Maquet cage-only.Case: A 3-year-old Pitbull dog weighing 39 kg was attended at Veterinary Hospital with a history of marked lameness in theleft pelvic limb. The orthopedic examination showed positive results for cranial drawer motion and tibial compression tests,and a complete CCL rupture was diagnosed. The presence of patellar luxation was evaluated by manual pressure on the patella, and grade 3 of MPL was diagnosed. Both conditions were affecting the same stifle joint. In addition, survey radiographsof the affected joint were performed. Surgical treatment was indicated by the TTTA technique. Radiographic measurementswere taken to calculate the cranial tibial tuberosity advancement by the tibial plateau and the common tangent methods, and atitanium TTA-Maquet cage-only of 10.5 x 20.0 mm was selected. Linear osteotomy was performed on the tibial tuberosity withthe aid of an oscillating saw, based on the Maquet hole technique. The tibial tuberosity was carefully displaced cranially and thecage was inserted at the site of osteotomy. The cage ears were molded on the tibial surface and fixed with 2.4 mm self-tappingcortical screws...

Técnica de avanço e transposição da tuberosidade tibial (TTTA) com uso de espaçador único de TTA-Maquet em cão / Technique of tibial tuberosity transposition and advancement (TTTA) with use of TTA-Maquet cage-only in dog

Background: The most common conditions that compromise the stifle joint in dogs are medial patellar luxation (MPL) and cranial cruciate ligament (CCL) rupture. Surgical procedures are usually indicated for the treatment of these diseases. One ordinarytechnique for the treatment of MPL is the tibial tuberosity transposition, and one prominent technique for CCL rupture is the tibialtuberosity advancement. These techniques can be associated in one surgical procedure called tibial tuberosity transposition andadvancement (TTTA) for the simultaneous treatment of both stifle diseases. The aim of this study is to report the surgical treatmentof a dog with MPL and CCL rupture affecting the same joint by the TTTA technique with the use of a TTA-Maquet cage-only.Case: A 3-year-old Pitbull dog weighing 39 kg was attended at Veterinary Hospital with a history of marked lameness in theleft pelvic limb. The orthopedic examination showed positive results for cranial drawer motion and tibial compression tests,and a complete CCL rupture was diagnosed. The presence of patellar luxation was evaluated by manual pressure on the patella, and grade 3 of MPL was diagnosed. Both conditions were affecting the same stifle joint. In addition, survey radiographsof the affected joint were performed. Surgical treatment was indicated by the TTTA technique. Radiographic measurementswere taken to calculate the cranial tibial tuberosity advancement by the tibial plateau and the common tangent methods, and atitanium TTA-Maquet cage-only of 10.5 x 20.0 mm was selected. Linear osteotomy was performed on the tibial tuberosity withthe aid of an oscillating saw, based on the Maquet hole technique. The tibial tuberosity was carefully displaced cranially and thecage was inserted at the site of osteotomy. The cage ears were molded on the tibial surface and fixed with 2.4 mm self-tappingcortical screws...(AU)

Luxação medial de patela grau IV traumática em gato / Medial patellar luxation grade IV traumatic in cat / Luxación medial de patela grado IV traumática en gato

A luxação patelar é o deslocamento medial ou lateral da patela a partir de sua posição anatômica normal no sulco troclear. Ela normalmente é causada por uma má formação congênita ou por trauma e pode ser classificada em 4 graus, sendo uma condição rara o grau IV de causa traumática em felinos. Diagnosticamos a luxação patelar a partir do exame físico, o tratamento pode ser cirúrgico ou conservativo, dependendo do grau da luxação. Foi atendido um felino, macho, de 5 meses, com histórico de trauma e após apresentou claudicação que persistia há 20 dias. Ao exame físico, foi observada presença de luxação patelar medial grau IV, do membro pélvico esquerdo. O raio X evidenciou luxação patelar medial esquerda e ausência de deformidade angular. O tratamento preconizado foi a correção cirúrgica e o paciente apresentou uma ótima recuperação. O objetivo deste relato é evidenciar esse tipo de afecção pouco diagnosticada e investigada nos felinos.(AU)

The patellar luxation is a medial or lateral patella displacement from your normal anatomical position in the trochlear groove. It is usually caused by poor congenital formation or by trauma and can be classified in 4 degrees, being a rare condition the 4th degree of traumatic cause in felines. We diagnose the patellar luxation from the physical examination. The treatment can be surgical or conservative, depending on the degree of the luxation. It was attended a feline, male, 5 months old, with a history of trauma and after showing lameness that persisted for 20 days. At physical examination, the presence of medial patellar luxation grade IV, of the left pelvic limb was observed. The x-ray showed left medial patellar dislocation and absence of angular deformity. The recommended treatment was surgical correction and the patient presented an excellent recovery. The purpose of this report is to high light this type of condition that is little diagnosed and investigated in felines.(AU)

La luxación patelar es el desplazamiento medial o lateral de la patela a partir de suposición anatómica normal en el surco troclear. Por lo general es causada por una mala formación congénita o por trauma y puede ser clasificada en 4 grados, siendo una condición rara el grado IV de causa traumática en felinos. Diagnosticamos la luxación patelar a partir del examen físico, el tratamiento puede ser quirúrgico o conservador, dependiendo del grado de la luxación. Fue atendido un felino, macho, de 5 meses, con historial de trauma y después, presentó claudicación que persistió hace 20 días. En el examen físico, se observó presencia de luxación patelar medial grado IV, del miembro pélvico izquierdo. El rayo x evidenció luxación patelar medial izquierda y ausencia de deformidad angular. El tratamiento preconizado fue la corrección quirúrgica y el paciente presentó una óptima recuperación. El objetivo de este relato es evidenciar este tipo de afección poco diagnosticada e investigada en los felinos.(AU)

Luxação medial de patela grau IV traumática em gato / Medial patellar luxation grade IV traumatic in cat / Luxación medial de patela grado IV traumática en gato

A luxação patelar é o deslocamento medial ou lateral da patela a partir de sua posição anatômica normal no sulco troclear. Ela normalmente é causada por uma má formação congênita ou por trauma e pode ser classificada em 4 graus, sendo uma condição rara o grau IV de causa traumática em felinos. Diagnosticamos a luxação patelar a partir do exame físico, o tratamento pode ser cirúrgico ou conservativo, dependendo do grau da luxação. Foi atendido um felino, macho, de 5 meses, com histórico de trauma e após apresentou claudicação que persistia há 20 dias. Ao exame físico, foi observada presença de luxação patelar medial grau IV, do membro pélvico esquerdo. O raio X evidenciou luxação patelar medial esquerda e ausência de deformidade angular. O tratamento preconizado foi a correção cirúrgica e o paciente apresentou uma ótima recuperação. O objetivo deste relato é evidenciar esse tipo de afecção pouco diagnosticada e investigada nos felinos.

The patellar luxation is a medial or lateral patella displacement from your normal anatomical position in the trochlear groove. It is usually caused by poor congenital formation or by trauma and can be classified in 4 degrees, being a rare condition the 4th degree of traumatic cause in felines. We diagnose the patellar luxation from the physical examination. The treatment can be surgical or conservative, depending on the degree of the luxation. It was attended a feline, male, 5 months old, with a history of trauma and after showing lameness that persisted for 20 days. At physical examination, the presence of medial patellar luxation grade IV, of the left pelvic limb was observed. The x-ray showed left medial patellar dislocation and absence of angular deformity. The recommended treatment was surgical correction and the patient presented an excellent recovery. The purpose of this report is to high light this type of condition that is little diagnosed and investigated in felines.

La luxación patelar es el desplazamiento medial o lateral de la patela a partir de suposición anatómica normal en el surco troclear. Por lo general es causada por una mala formación congénita o por trauma y puede ser clasificada en 4 grados, siendo una condición rara el grado IV de causa traumática en felinos. Diagnosticamos la luxación patelar a partir del examen físico, el tratamiento puede ser quirúrgico o conservador, dependiendo del grado de la luxación. Fue atendido un felino, macho, de 5 meses, con historial de trauma y después, presentó claudicación que persistió hace 20 días. En el examen físico, se observó presencia de luxación patelar medial grado IV, del miembro pélvico izquierdo. El rayo x evidenció luxación patelar medial izquierda y ausencia de deformidad angular. El tratamiento preconizado fue la corrección quirúrgica y el paciente presentó una óptima recuperación. El objetivo de este relato es evidenciar este tipo de afección poco diagnosticada e investigada en los felinos.

Reconstituição cirúrgica de luxação patelar em macaco-da-savana (Cercopithecus aithiops Linnaeus, 1758) relato de caso / Surgical reparation of patellar luxation in a savanna monkey (Cercopitheucus aethio´s Linnaeus, 1758) - case report

O artigo relata um caso de reconstituição cirúrgica de luxação patelar por ruptura dos ligamentos colateral lateral e cruzados, cranial e caudal, em um macaco-da-savana (Cercopithecus aethips Linaeus, 1758). Traumas articulares envolvendo luxação patelar ocorrem freqüentemente em pequenos animais com sinal clínico de claudicação aguda e incapacidade de sustentação do peso corporal, porém são raramente descritos em primatas. Uma fêmea de macaco-da-savana, com 10 anos de idade, pertencente ao plantel da Fundação RIOZOO, foi encaminhada ao setor da veterinária apresentando claudicação grave do membro pélvico direito. Foram realizados exames físicos e radiográficos cujos resultados indicaram luxação da patela provavelmente por ruptura de ligamento. O animal foi submetido a procedimento cirúrgico para reconstituição da luxação patelar em que se constataram rupturas de ligamentos colateral lateral e cruzados, cranial e caudal. Sessenta dias após a cirurgia, não se observaram sinais de claudicação, dor ou desconforto. Este relato tem como objetivo ressaltar que é possível a realização de cirurgias ortopédicas de reconstituição de ligamentos, cuja fase pós-operatória é normalmente extensa e nas quais é imprescindível o repouso por longos períodos, em primatas não humanos, desde que haja monitoramento constante do animal na fase de recuperação(AU)

This paper describes a casa of surgical reparation of patellar luxation caused by rupture of lateral collateral, and cranial and cruciate ligaments in savana monkey (Cercopithecus aethiops Linnaeus, 17580. Stifle joints traumas with patellar luxation used to occur in small animals with clinic alteration of active halting and incapacity to support the corporal weight however are rarity describes in primates. A female ten years old savanna monkey, ten years old, belonging of Rio de Janeiro zoo, is guided to veterinary sector with active and serious halting in the posterior member. The results of physics and radiological exams suggested patellar luxation. The animal was submitted to a surgery to repair the patellar luxation where observed of the collateral and cranial and caudal cruciate ligaments. Sixty days after surgery it was not observed changes as halting, pain or uneasiness indicating that surgery reparation of the ligaments be realized with success. This report shows that is possible to surgically repair ligaments in non-human primates, even with extensive recovering periods, since providing a good monitoring of the patients(AU)

Reconstituição cirúrgica de luxação patelar em macaco-da-savana (Cercopithecus aithiops Linnaeus, 1758) – relato de caso / Surgical reparation of patellar luxation in a savanna monkey (Cercopitheucus aethio´s Linnaeus, 1758) - case report

O artigo relata um caso de reconstituição cirúrgica de luxação patelar por ruptura dos ligamentos colateral lateral e cruzados, cranial e caudal, em um macaco-da-savana (Cercopithecus aethips Linaeus, 1758). Traumas articulares envolvendo luxação patelar ocorrem freqüentemente em pequenos animais com sinal clínico de claudicação aguda e incapacidade de sustentação do peso corporal, porém são raramente descritos em primatas. Uma fêmea de macaco-da-savana, com 10 anos de idade, pertencente ao plantel da Fundação RIOZOO, foi encaminhada ao setor da veterinária apresentando claudicação grave do membro pélvico direito. Foram realizados exames físicos e radiográficos cujos resultados indicaram luxação da patela provavelmente por ruptura de ligamento. O animal foi submetido a procedimento cirúrgico para reconstituição da luxação patelar em que se constataram rupturas de ligamentos colateral lateral e cruzados, cranial e caudal. Sessenta dias após a cirurgia, não se observaram sinais de claudicação, dor ou desconforto. Este relato tem como objetivo ressaltar que é possível a realização de cirurgias ortopédicas de reconstituição de ligamentos, cuja fase pós-operatória é normalmente extensa e nas quais é imprescindível o repouso por longos períodos, em primatas não humanos, desde que haja monitoramento constante do animal na fase de recuperação

This paper describes a casa of surgical reparation of patellar luxation caused by rupture of lateral collateral, and cranial and cruciate ligaments in savana monkey (Cercopithecus aethiops Linnaeus, 17580. Stifle joints traumas with patellar luxation used to occur in small animals with clinic alteration of active halting and incapacity to support the corporal weight however are rarity describes in primates. A female ten years old savanna monkey, ten years old, belonging of Rio de Janeiro zoo, is guided to veterinary sector with active and serious halting in the posterior member. The results of physics and radiological exams suggested patellar luxation. The animal was submitted to a surgery to repair the patellar luxation where observed of the collateral and cranial and caudal cruciate ligaments. Sixty days after surgery it was not observed changes as halting, pain or uneasiness indicating that surgery reparation of the ligaments be realized with success. This report shows that is possible to surgically repair ligaments in non-human primates, even with extensive recovering periods, since providing a good monitoring of the patients