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).

Radiological measures of patellofemoral alignment in healthy small-breed dogs: reference values and sex variability

Background: The evaluation of vertical kneecap position within the trochlear groove is essential for understanding the anatomical changes that may lead to canine patellar luxation. Unlike other important diagnostic imaging measurements (e.g. measures of pelvic limb alignment), no data on patellofemoral congruence parameters of canine stifles (congruence angle, linear axial patellar displacement, lateral patellofemoral angle, patellar tilt angle) are reported. The aim of this study was to present metric values of these parameters in healthy dogs from small breeds from both sexes in order to use them for identification of animals with increased risk for medial patellar luxation. Materials, Methods & Results: The study was performed on 44 stifle joints from 22 healthy dogs of both sexes from 4 small breeds (Pinscher, Pomeranian, Chihuahua and Yorkshire terrier). Inclusion criteria were negative patellar displacement and dancing patella tests after orthopaedic examination, lack of femoral and gluteal muscles asymmetry after palpation, lack of signs of long-term proprioceptive dysfunction, normal patellar and withdrawal reflexes after neurological examination. The translation of the patella in the axial plane was evaluated by means of congruence angle and axial linear patellar displacement. The rotation of the patella in the axial plane was evaluated through measurement of lateral patellofemoral angle and patellar tilt angle. Reference ranges of parameters were analysed in agreement with the guidelines of the American College of Veterinary Pathologists for the determination of reference intervals in veterinary species for sample sizes of 40-120 with non-Gaussian distribution - robust method, 95% confidence interval (CI) with 90 % CI for upper and lower reference limits. All measured patellofemoral congruence angles were negative. Their reference range was from -8.06o to -0.58o (median value -3o ). The axial patellar displacement was negligible, with values ranging from 0.1 to 0.8 mm. Lateral patellofemoral angles in all dogs were open to the lateral side (positive); the computed reference interval was from 21.61o to 41.80o (median 31.5o ). Patellar tilt angles ranged from 2o to 8o (median 5o ). A statistically significant difference between sexes was demonstrated for angles describing the rotation of the patella in the axial plane: the lateral patellofemoral angle (P = 0.0248) and the patellar tilt angle (P = 0.0004) were greater in stifles of male dogs. Discussion: This is the first study presenting reference values of parameters describing patellofemoral alignment in healthy dogs from small breeds on tangential radiographs. The values of one of most commonly measured parameters on tangential radiographs (the lateral patellofemoral angle) in stifles of small breed dogs were higher than values in humans, supposedly due to the specific joint anatomy. The patellar tilt angle is considered as more objective and not influenced by limb rotation. For the detection of patellar misalignment, the tilt angle was reported to be almost as specific as the congruence angle but more sensitive and more accurate. It is the most specific and sensitive parameter determining the direction of patellar luxation. In male dogs, the median lateral patellofemoral angle was greater than in females (P = 0.0248). Similar tendency was shown for patellar tilt angle that was also greater in male stifles (P = 0.0004). The reported statistically significant between-sex differences in lateral patellofemoral angle and patellar tilt angle with higher values of both angles in stifles of male dogs could be attributed to the better developed femoral muscles, in particular m. vastus medialis and m. sartorius, and to differences in trochlear groove and kneecap morphology. The presented reference intervals may be useful for early detection of subjects with increased risk to medial patellar luxation.

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)

Femoral corrective osteotomy associated with trochlear prosthetics and tibial tuberosity transposition with a tool for treatment of canine patellar dislocation / Osteotomia corretiva de fêmur associada à prótese troclear do joelho e transposição da tuberosidade tibial por dispositivo para tratamento da luxação de patela canina

Patellar luxation is one of the main osteoarticular diseases described in the surgical routine of companion animals, whose treatment differs according to the degree of luxation based on the clinical alterations presented by each patient. The present report aims to describe the association of the femoral corrective osteotomy technique, total trochlear replacement of the knee by prosthesis and transposition of tibial tuberosity with device for correction of degree IV patella luxation in a 1.5 year old German Spitz canine with varus femoral deviation and external torsion of the tibia. The treatment allowed the correction of femoral bone deformation, realignment of the extensor mechanism of the quadriceps and permanent maintenance of the patella on the trochlear folds with early functional limb return, absence of pain and claudication.(AU)

luxação de patela é uma das principais enfermidades osteoarticulares descrita na rotina cirúrgica de animais de companhia, cujo tratamento difere de acordo com a graduação da luxação baseando-se nas alterações clínicas apresentadas por cada paciente. O presente relato tem como objetivo descrever a associação da técnica de osteotomia corretiva femoral, subs-tituição troclear total do joelho por prótese e transposição da tuberosidade tibial com dispositivo para correção de luxação de patela grau IV em uma canina da raça Spitz Alemão de 1,5 anos com desvio femoral varus e torção externa da tíbia. O trata-mento permitiu a correção da deformação óssea femoral, realinhamento do mecanismo extensor do quadríceps e manutenção permanente da patela sobre o sulco troclear protético com retorno funcional precoce do membro, ausência de dor e claudicação(AU)

Femoral corrective osteotomy associated with trochlear prosthetics and tibial tuberosity transposition with a tool for treatment of canine patellar dislocation / Osteotomia corretiva de fêmur associada à prótese troclear do joelho e transposição da tuberosidade tibial por dispositivo para tratamento da luxação de patela canina

Patellar luxation is one of the main osteoarticular diseases described in the surgical routine of companion animals, whose treatment differs according to the degree of luxation based on the clinical alterations presented by each patient. The present report aims to describe the association of the femoral corrective osteotomy technique, total trochlear replacement of the knee by prosthesis and transposition of tibial tuberosity with device for correction of degree IV patella luxation in a 1.5 year old German Spitz canine with varus femoral deviation and external torsion of the tibia. The treatment allowed the correction of femoral bone deformation, realignment of the extensor mechanism of the quadriceps and permanent maintenance of the patella on the trochlear folds with early functional limb return, absence of pain and claudication.

luxação de patela é uma das principais enfermidades osteoarticulares descrita na rotina cirúrgica de animais de companhia, cujo tratamento difere de acordo com a graduação da luxação baseando-se nas alterações clínicas apresentadas por cada paciente. O presente relato tem como objetivo descrever a associação da técnica de osteotomia corretiva femoral, subs-tituição troclear total do joelho por prótese e transposição da tuberosidade tibial com dispositivo para correção de luxação de patela grau IV em uma canina da raça Spitz Alemão de 1,5 anos com desvio femoral varus e torção externa da tíbia. O trata-mento permitiu a correção da deformação óssea femoral, realinhamento do mecanismo extensor do quadríceps e manutenção permanente da patela sobre o sulco troclear protético com retorno funcional precoce do membro, ausência de dor e claudicação

Evaluation of trochlear dysplasia in dogs with medial patellar luxation: comparative studies

Medial patellar luxation (MPL) is one of the commonest orthopaedic diseases in small dog breeds. Although the bone deformities associated with canine medial patellar luxation are described in numerous studies, the pathogenesis of the condition is still disputable. What is more, there is no categorical evidence that luxation of the patella is associated to a shallow trochlear groove as no objective method for determination of trochlear depth and shape has been proposed. The aim of the present study was to evaluate the depth and shape of femoral trochlear groove on radiographs obtained from healthy dogs and dogs affected with grade II and grade III MPL. A total of 45 dogs (33 with MPL and 12 healthy) from 4 small breeds (Mini-Pinscher, Pomeranian, Chihuahua and Yorkshire terrier) were included in the study. After deep sedation, stifle radiographs were obtained in tangential projection (skyline view). The dogs were positioned in ventral recumbency, the examined stifle bent as much as possible, and the central beam focused on the patella between femoral condyles. Six morphometric parameters associated with the onset of trochlear dysplasia similar to those used in human medicine were measured: trochlear sulcus angle (SA), lateral and medial trochlear inclination angles (LTI; MTI), trochlear groove depth (TD), patellar thickness (PaT) and the ratio between trochlear depth and patellar thickness (PaT/TD). The non-parametric Mann-Whitney test was used for evaluation of differences between healthy joints and those affected with grade II and III MPL. The association between measured variables was evaluated via the Spearman's rank-order correlation. TD was greater in healthy joints as compared to those affected with MPL grade II and III (P < 0.001). In healthy stifles, PaT value exceeded significantly (P < 0.01) that in joints with grade III MPL. The TD/PaT ratio was significantly greater in healthy joints vs both those with grade II (P < 0.01) and grade III MPL (P < 0.001). In healthy joints, there was a significant negative relationship (rho­0.508; P = 0.0113) between SA and TD: smaller sulcus angles corresponded to deeper trochleas. This correlation was even stronger in joints with patellar luxation (rho ­0.723; P < 0.0001). The LTI and MTI showed a very strong positive correlation in healthy joints (rho 0.854; P < 0.0001) and at the same time, lack of significant association in joints affected with MPL (rho -0.163; P = 0.327 for grade II MPL and rho 0.175; P = 0.448 for grade III MPL) was demonstrated. The altered trochlear shape and depth were more pronounced in joints with grade III MPL. As MPL grade increased, the SA became statistically significantly greater. In grade III MPL it was accompanied with considerably reduced trochlear depth, medial trochlear inclination angle and trochlear depth/patellar thickness ratio. Five of the measured morphometric parameters for radiographic detection of trochlear dysplasia in dogs were found to be important in the evaluation of trochlear morphology in dogs. The obtained results indicated the presence of trochlear dysplasia in dogs with MPL. A 3-stage classification system for assessment of abnormal trochlear development in small dog breeds: mild; moderate and severe trochlear dysplasia, was proposed. The occurrence of shallow trochlear groove and medial femoral condyle's hypoplasia could be accepted as signs of mild and moderate trochlear dysplasia. The pre-operative measurements of these parameters could improve surgical planning and decisions-making.

Dimensões da patela relacionadas à massa corporal do cão para emprego na confecção de prótese: estudo em cadáver / Patellar dimensions related to canine body mass for use in the manufacture of prosthesis: cadaver study

O objetivo deste trabalho foi mensurar as dimensões da patela de cadáveres caninos e avaliar sua relação com a massa corporal. Para a realização das medidas patelares, foram utilizados 70 cadáveres de cães adultos, com massa corpórea de 1 a 50kg, sem evidência clínica de afecção na articulação femorotibiopatelar. Com auxílio de um paquímetro, foram mensurados os comprimentos externo e interno, a largura externa no terço médio, a largura e a espessura internas nos terços proximal, médio e distal das patelas. Também foram mensuradas a largura nos terços proximal, médio e distal, a profundidade nos terços proximal, médio e distal do sulco troclear; essas medidas foram exclusivamente internas. Observou-se, de forma geral, forte correlação entre as medidas patelares e a massa corporal de cadáveres de cães. Nas condições deste estudo, pode-se concluir que o tamanho da patela varia segundo a massa corporal do cão e que essas medidas devem ser consideradas ao se planejar uma substituição protética.(AU)

The aim of this study was to measure the canine cadaver patellar dimensions and evaluate its relationship with body mass. 70 cadavers of adult dogs were used, with a body mass between 1 and 50kg, without clinical evidence of affection in the stifle joint. The external and internal lengths, external width in the middle third, width and thickness of the proximal, middle and distal thirds were measured using a pachymeter. The width was also measured in the proximal third, middle third and distal third, depth in the proximal third, middle third and distal third of the trochlear groove; these measurements were exclusively internal. A strong correlation was observed between the patellar dimension and body mass of canine cadavers. Under this study conditions, it is possible to conclude that the patellar size varies according to the canine body mass and these measures should be considered when planning a prosthetic replacement.(AU)

Dimensões da patela relacionadas à massa corporal do cão para emprego na confecção de prótese: estudo em cadáver / Patellar dimensions related to canine body mass for use in the manufacture of prosthesis: cadaver study

O objetivo deste trabalho foi mensurar as dimensões da patela de cadáveres caninos e avaliar sua relação com a massa corporal. Para a realização das medidas patelares, foram utilizados 70 cadáveres de cães adultos, com massa corpórea de 1 a 50kg, sem evidência clínica de afecção na articulação femorotibiopatelar. Com auxílio de um paquímetro, foram mensurados os comprimentos externo e interno, a largura externa no terço médio, a largura e a espessura internas nos terços proximal, médio e distal das patelas. Também foram mensuradas a largura nos terços proximal, médio e distal, a profundidade nos terços proximal, médio e distal do sulco troclear; essas medidas foram exclusivamente internas. Observou-se, de forma geral, forte correlação entre as medidas patelares e a massa corporal de cadáveres de cães. Nas condições deste estudo, pode-se concluir que o tamanho da patela varia segundo a massa corporal do cão e que essas medidas devem ser consideradas ao se planejar uma substituição protética.(AU)

The aim of this study was to measure the canine cadaver patellar dimensions and evaluate its relationship with body mass. 70 cadavers of adult dogs were used, with a body mass between 1 and 50kg, without clinical evidence of affection in the stifle joint. The external and internal lengths, external width in the middle third, width and thickness of the proximal, middle and distal thirds were measured using a pachymeter. The width was also measured in the proximal third, middle third and distal third, depth in the proximal third, middle third and distal third of the trochlear groove; these measurements were exclusively internal. A strong correlation was observed between the patellar dimension and body mass of canine cadavers. Under this study conditions, it is possible to conclude that the patellar size varies according to the canine body mass and these measures should be considered when planning a prosthetic replacement.(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 patelar medial em canino / Canine medial patellar dislocation

A luxação patelar é uma das condições mais comuns da articulação do joelho em cães e pode evoluir para doença articular degenerativa. A luxação pode ocorrer medial ou lateralmente, sendo unilateral ou bilateral, onde a ocorrência medial é mais frequente em animais de raças pequenas e a lateral é mais comum em animais de raças grandes. A classificação da luxação patelar compreende quatro graus, de acordo com a posição patelar, sinais clínicos e gravidade das deformidades ósseas encontradas. O diagnóstico é feito com base na avaliação clínica, associada a uma radiografia. O presente estudo apresenta uma fêmea de 10 meses de idade, na qual o tutor relatou que o animal já havia sido submetido à cirurgia para corrigir o deslocamento medular da patela e ainda apresentava claudicação e dor. Após a radiografia, foi encontrado o diagnóstico de luxação patelar medial do membro em que a cirurgia havia sido realizada.(AU)

Patellar dislocation is one of the most common knee joint conditions in dogs and may progress to degenerative joint disease. The dislocation can run medially or laterally, being unilateral or bilateral, where the medial occurrence is more frequent in small breed animals and the lateral one is more common in large breed animals. The classification of patellar luxation comprises four grades, according to the patellar position, clinical signs and seriousness of the bone deformities found. The diagnosis is made based on the clinical evaluation, associated with a radiograph. The present study presents a 10-month-oldfemale canine in which the tutor reported that the animal had already undergone surgery to correct medial patellar dislocation and still had lameness and pain. After x-ray the diagnosis of medial patellar dislocation of the limb in which surgery had been performed was found.(AU)

Luxação patelar medial em canino / Canine medial patellar dislocation

A luxação patelar é uma das condições mais comuns da articulação do joelho em cães e pode evoluir para doença articular degenerativa. A luxação pode ocorrer medial ou lateralmente, sendo unilateral ou bilateral, onde a ocorrência medial é mais frequente em animais de raças pequenas e a lateral é mais comum em animais de raças grandes. A classificação da luxação patelar compreende quatro graus, de acordo com a posição patelar, sinais clínicos e gravidade das deformidades ósseas encontradas. O diagnóstico é feito com base na avaliação clínica, associada a uma radiografia. O presente estudo apresenta uma fêmea de 10 meses de idade, na qual o tutor relatou que o animal já havia sido submetido à cirurgia para corrigir o deslocamento medular da patela e ainda apresentava claudicação e dor. Após a radiografia, foi encontrado o diagnóstico de luxação patelar medial do membro em que a cirurgia havia sido realizada.

Patellar dislocation is one of the most common knee joint conditions in dogs and may progress to degenerative joint disease. The dislocation can run medially or laterally, being unilateral or bilateral, where the medial occurrence is more frequent in small breed animals and the lateral one is more common in large breed animals. The classification of patellar luxation comprises four grades, according to the patellar position, clinical signs and seriousness of the bone deformities found. The diagnosis is made based on the clinical evaluation, associated with a radiograph. The present study presents a 10-month-old female canine in which the tutor reported that the animal had already undergone surgery to correct medial patellar dislocation and still had lameness and pain. After x-ray the diagnosis of medial patellar dislocation of the limb in which surgery had been performed was found.

Patellar luxation and articular lesions in dogs: a retrospective: study research article / Luxação de patela e lesões articulares em cães: estudo retrospectivo

This study describes lesions that occur in the stifle joints of dogs with patellar luxation. These lesions are associated with the animal's age, body weight, and degree of luxation. The rate of redislocation was also evaluated. The patellar lesions found include articular cartilage erosion, subchondral bone exposure, a flattened or concave patellar surface, and enthesophytes. Extra-patellar lesions included synovitis, osteophytes, blunting of the trochlear groove, an absent trochlea, erosion of the condylar margins, capsule thickening, a long digital extensor tendon injury, cranial cruciate ligament rupture, and meniscal prolapse. Such lesions were frequently found in animals with Grade II or III luxation who were aged 24 months or more, and they were more severe in dogs weighing more than 15 kg. Patellar luxation causes changes that favor articular degeneration and should be treated surgically. Conservative treatment relieves pain, but does not address tissue alterations.(AU)

O estudo descreve as lesões articulares em cães com luxação de patela. Elas foram associadas com a idade do animal, massa corporal e grau de luxação. Foi avaliada também a porcentagem de casos com recidiva. As lesões patelares observadas foram erosão da cartilagem articular, exposição óssea subcondral, superfície patelar achatada ou côncava e entesófitos. As lesões extra patelares incluíram sinovite, osteófitos, ausência do sulco troclear, erosão das bordas condilares, espessamento da cápsula, lesão do tendão do músculo extensor digital, ruptura do ligamento cruzado cranial e prolapso de menisco. As lesões foram encontradas com maior frequência em animais com luxação de Grau II ou III e idade de 24 meses ou mais, sendo mais graves em cães com massa corporal superior a 15 kg. A luxação patelar ocasiona alterações que favorecem a degeneração articular e devem ser tratadas cirurgicamente. O tratamento conservativo alivia a dor, mas não corrige as alterações teciduais.(AU)

Patellar luxation and articular lesions in dogs: a retrospective: study research article / Luxação de patela e lesões articulares em cães: estudo retrospectivo

This study describes lesions that occur in the stifle joints of dogs with patellar luxation. These lesions are associated with the animal's age, body weight, and degree of luxation. The rate of redislocation was also evaluated. The patellar lesions found include articular cartilage erosion, subchondral bone exposure, a flattened or concave patellar surface, and enthesophytes. Extra-patellar lesions included synovitis, osteophytes, blunting of the trochlear groove, an absent trochlea, erosion of the condylar margins, capsule thickening, a long digital extensor tendon injury, cranial cruciate ligament rupture, and meniscal prolapse. Such lesions were frequently found in animals with Grade II or III luxation who were aged 24 months or more, and they were more severe in dogs weighing more than 15 kg. Patellar luxation causes changes that favor articular degeneration and should be treated surgically. Conservative treatment relieves pain, but does not address tissue alterations.(AU)

O estudo descreve as lesões articulares em cães com luxação de patela. Elas foram associadas com a idade do animal, massa corporal e grau de luxação. Foi avaliada também a porcentagem de casos com recidiva. As lesões patelares observadas foram erosão da cartilagem articular, exposição óssea subcondral, superfície patelar achatada ou côncava e entesófitos. As lesões extra patelares incluíram sinovite, osteófitos, ausência do sulco troclear, erosão das bordas condilares, espessamento da cápsula, lesão do tendão do músculo extensor digital, ruptura do ligamento cruzado cranial e prolapso de menisco. As lesões foram encontradas com maior frequência em animais com luxação de Grau II ou III e idade de 24 meses ou mais, sendo mais graves em cães com massa corporal superior a 15 kg. A luxação patelar ocasiona alterações que favorecem a degeneração articular e devem ser tratadas cirurgicamente. O tratamento conservativo alivia a dor, mas não corrige as alterações teciduais.(AU)

Comparação da TTTT® (Tibial Tuberosity Transposition Tool) com a técnica tradicional de transposição e fixação da tuberosidade tibial em cães com luxação patelar: revisão bibliográfica / Comparison of TTTT® (Tibial Tuberosity Transposition Tool) with the traditional technique for tibial tuberosity transposition and fixation in dogs with patellar luxation: literature review

A luxação de patela representa casuística importante entre as afecções ortopédicas que acometem o membro pélvico dos cães. É consenso que a luxação de patela é sinal clínico e não doença, sendo causada por deformidades musculoesqueléticas, como a torção externa ou interna da tíbia proximal. A transposição da tuberosidade tibial (TTT) é técnica frequentemente empregada para correção desses desvios torcionais, consistindo no deslocamento lateral ou medial da tuberosidade tibial (TT), permitindo o reestabelecimento da posição da patela no sulco troclear do fêmur. Esta técnica é considerada indispensável por muitos autores, mesmo nos casos mais graves. A TTTT® (Tibial Tuberosity Transposition Tool) é técnica que permite o deslocamento da TT após osteotomia parcial e que não necessita de fixação da TT deslocada com banda de tensão. O presente trabalho tem por objetivo comparar os aspectos relacionados à execução, condições de aplicabilidade e incidência de complicações pós-operatórias da técnica tradicional de transposição e fixação da tuberosidade tibial, em relação à TTTT®.

The patellar dislocation is a important casuistry among the orthopedic disorders affecting the dog’s hindlimb. There’s a consensus that patellar luxation is a clinical sign and not the disease, caused by underlying musculoskeletal deformities, which we can highlight the external or internal torsion of the proximal tibia. Tibial tuberosity Transposition (TTT) is the technique commonly performed to correct these torsional deviations, consisting on lateral or medial displacement of the tibial tuberosity (TT), allowing the restoration of the patella neutral path in the femoral trochlear groove. This technique is considered indispensable by many authors, even in the most severe cases. The TTTT® (Tibial Tuberosity Transposition Tool) provides a method that allows the displacement of tibial tuberosity, after partial osteotomy, that doesn’t require fixation of the transposed tuberosity with tension band wire. The present paper aims to compare the aspects related to performance, applicability and incidence of postoperative complications of the established technique of transposition and attachment of tibial tuberosity in relation to TTTT®.

Comparação da TTTT® (Tibial Tuberosity Transposition Tool) com a técnica tradicional de transposição e fixação da tuberosidade tibial em cães com luxação patelar: revisão bibliográfica / Comparison of TTTT® (Tibial Tuberosity Transposition Tool) with the traditional technique for tibial tuberosity transposition and fixation in dogs with patellar luxation: literature review

A luxação de patela representa casuística importante entre as afecções ortopédicas que acometem o membro pélvico dos cães. É consenso que a luxação de patela é sinal clínico e não doença, sendo causada por deformidades musculoesqueléticas, como a torção externa ou interna da tíbia proximal. A transposição da tuberosidade tibial (TTT) é técnica frequentemente empregada para correção desses desvios torcionais, consistindo no deslocamento lateral ou medial da tuberosidade tibial (TT), permitindo o reestabelecimento da posição da patela no sulco troclear do fêmur. Esta técnica é considerada indispensável por muitos autores, mesmo nos casos mais graves. A TTTT® (Tibial Tuberosity Transposition Tool) é técnica que permite o deslocamento da TT após osteotomia parcial e que não necessita de fixação da TT deslocada com banda de tensão. O presente trabalho tem por objetivo comparar os aspectos relacionados à execução, condições de aplicabilidade e incidência de complicações pós-operatórias da técnica tradicional de transposição e fixação da tuberosidade tibial, em relação à TTTT®.(AU)

The patellar dislocation is a important casuistry among the orthopedic disorders affecting the dogs hindlimb. Theres a consensus that patellar luxation is a clinical sign and not the disease, caused by underlying musculoskeletal deformities, which we can highlight the external or internal torsion of the proximal tibia. Tibial tuberosity Transposition (TTT) is the technique commonly performed to correct these torsional deviations, consisting on lateral or medial displacement of the tibial tuberosity (TT), allowing the restoration of the patella neutral path in the femoral trochlear groove. This technique is considered indispensable by many authors, even in the most severe cases. The TTTT® (Tibial Tuberosity Transposition Tool) provides a method that allows the displacement of tibial tuberosity, after partial osteotomy, that doesnt require fixation of the transposed tuberosity with tension band wire. The present paper aims to compare the aspects related to performance, applicability and incidence of postoperative complications of the established technique of transposition and attachment of tibial tuberosity in relation to TTTT®.(AU)

ESTUDO CLÍNICO E RADIOGRÁFICO DA LUXAÇÃO DE PATELA E SUA CORRELAÇÃO COM A VELOCIDADE DE HEMOSSEDIMENTAÇÃO EM CÃES

A luxação patelar é uma das afecções do joelho mais comuns em cães, podendo ser congênita ou traumática, lateral ou medial, uni ou bilateral. Essa alteração articular varia desde instabilidade sem sinais clínicos evidentes, até uma luxação completa e irredutível da patela e claudicação grave. A luxação patelar pode evoluir para uma osteoartrose (OA). Deste modo, é importante pesquisar sobre o processo inflamatório desta afecção. Foram utilizados no estudo um total de 14 cães diagnosticados com luxação de patela provenientes de uma Clínica Veterinária particular da cidade de Umuarama - PR. Todos os animais foram avaliados e passaram por exame físico e ortopédico, classificação quanto ao grau de luxação patelar, grau de claudicação, grau de OA, radiografia, HG e VHS. Com base em nossos resultados podemos concluir que existe uma forte correlação entre o grau de Luxação Patelar e o grau de Claudicação. Não houve correlação significativa entre o grau de OA com o grau de Luxação Patelar ou grau de Claudicação. A VHS mostrou uma correlação desprezível em relação ao grau de Luxação Patelar, grau de Claudicação e grau de OA. Apenas um animal teve a VHS acima do padrão de referência pelo aumento da concentração plasmática de PFA.

Patellar luxation is one of the most common knee disorders in dogs, it may be congenital or traumatic, lateral or medial, uni or bilateral. This joint alteration can present instability without clinically evident signs, or complete and irreducible patella dislocation and severe lameness. Patellar luxation can evolve to osteoarthrosis. Therefore, it is important to research the inflammatory process of this condition. A total of 14 dogs diagnosed with patellar dislocation from a private Veterinary Clinic in the city of Umuarama - PR were used in the study. All animals were evaluated and underwent physical and orthopedic examination, classification as to degree of patellar luxation, degree of lameness, degree of OA, radiography, HG e ESR. Based on our results we can conclude that there is a strong correlation between the degree of Patellar luxation and the degree of lameness. There was no significant correlation between the degree of OA with the degree of Patellar luxation or degree of lameness. ERS showed a negligible correlation in relation to the degree of Patellar luxation, degree of lameness and degree of OA. Only one animal had ERS above reference pattern by increasing the plasma concentration of APP.

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)