Latero-distal transposition of the tibial crest in cases of medial patellar luxation with patella alta

Abstract

Medial patellar luxation is defined as medial displacement of the patella from the trochlear groove. In dogs, medial luxations account for 75% of all patellar luxation cases, and are frequently associated with patella alta. Common surgical treatments for medial luxation are trochleoplasty and lateral transposition of the crest to drive the patella into the correct anatomical alignment. Postoperative complications for this procedure are estimated to be between 18-29% of cases, with up to 48% of complications involving reluxation. It was previously hypothesized that in cases of medial luxation involving patella alta, the addition of a distal component to the lateral tibial crest transposition will result in repositioning of the patella into its proper position in the trochlear groove, thus reducing the recurrence of luxation. We performed this modified procedure on 14 dogs (17 limbs) that were suffering from medial luxation combined with patella alta, and our results led to favourable clinical outcomes. This modified surgical procedure places the patella into a more normal proximo-distal anatomical position, is simple to perform, and may become common practice for surgical treatment of medial patellar luxation with an alta component.

Combined transverse femoral ostectomy and tibial tuberosity distalisation for correction of medial patella luxation and patella alta in dogs

“…However, a recent ex vivo study found stifle extensor mechanism load increased significantly following tibial tuberosity distalisation . Increased stifle extensor mechanism load may explain the reduced stifle range of movement and patellar ligament thickening commonly observed postoperatively in these case series . Clinically, we have also observed tibial tuberosity avulsion and tibial implant failure when tibial tuberosity distalisation is performed alone.…”

“…Tibial tuberosity distalisation without transverse femoral ostectomy has been previously recommended for managing dogs with patella luxation and patella alta . However, a recent ex vivo study found stifle extensor mechanism load increased significantly following tibial tuberosity distalisation .…”

“…Distalisation of the tibial tuberosity, typically performed in addition to trochleoplasty and/or translation of the tibial tuberosity, has been recommended to establish proximodistal alignment of the stifle extensor mechanism with the underlying femur in dogs affected by patella alta . However, a recent canine ex vivo study found stifle extensor mechanism load increased significantly following tibial tuberosity distalisation .…”

Comparison of short‐term complications between unilateral and single‐session bilateral surgery for medial patellar luxation in small/medium breed dogs

“…Medial patellar luxation (MPL) is one of the most common orthopaedic conditions in veterinary medicine and frequently affects toy or small breed dogs (Priester 1972, Willauer & Vasseur 1987, Remedios et al 1992, Hayes et al 1994, LaFond et al 2002, Arthurs & Langley-Hobbs 2006, Johnson et al 2006, Mortari et al 2009, Campbell et al 2010, Linney et al 2011, Segal et al 2012, Fujii et al 2013, Wangdee et al 2013, Cashmore et al 2014, Bosio et al 2017. Surgical correction of MPL is recommended for the treatment of lameness associated with MPL, with multiple studies reporting minimal to no lameness after surgical correction in 77 to 92% of the dogs (DeAngelis & Hohn 1970, Willauer & Vasseur 1987, Remedios et al 1992, Roy et al 1992, Vasseur 2003, Piermattei et al 2006, Linney et al 2011, Segal et al 2012, Clerfond et al 2014, Stanke et al 2014.…”

The effect of polydioxanone hemicerclage suture on the occurrence of fracture during tibial tuberosity advancement with an elongated bi‐directional hinged osteotomy

“…In addition to the risk of fracture, the incomplete tibial osteotomy reduces the ability to perform multi‐directional translation of the tibial tuberosity. Complete tibial crest osteotomy with TTA fixation for the treatment of patella baja, patella alta, and patella luxation in the dog has been described . Although flexibility of the cortical hinge may permit limited medial or lateral translation of the tibial tuberosity to correct malalignment associated with patella luxation, translation in a proximal or distal direction to address patella baja/alta is not possible.…”