Surgical repair of congenital lateral luxation of the patella in an Arabian foal using a polypropylene mesh

Abstract

Summary A 3‐h‐old, 40‐kg Arabian filly was referred to the Veterinary Teaching Hospital, due to inability to stand and nurse after birth. The left stifle was oedematous and warm, and the patella was palpated lateral to the distal end of the femur. Radiographs of the left stifle confirmed the patella to be positioned laterally. The trochlear groove of the femur appeared of normal depth, and no other radiographic abnormalities were observed. The filly was leucopenic (white blood cell count 3.0 x 109/L; reference range 6.9–17.0 x 109/L) and had a normal packed cell volume [40% (RR 37–50%)] and low concentration of total serum protein [44 g/L (RR 51–78 g/L)] suggesting the filly likely suffered from failure of passive transfer. The filly was surgically treated for lateral patellar luxation by transecting the lateral parapatellar fascia, imbricating the medial parapatellar fascia and suturing a polypropylene mesh to the imbricated fascia. Post‐operative complications included dehiscence of the lateral incision, a subcutaneous abscess on the medial aspect of the stifle and synovial sepsis of the femoropatellar joint. The filly was sound at the walk 10 months after surgery, and no osseous abnormalities were noted on examination of radiographs of the left stifle at that time.

Patellar instability/patellar luxation in horses: Potential risk factors and treatment options

“…In larger foals, lateral release and medial imbrication is less successful (Leitch and Kotlikoff 1980), and reinforcement of the medial imbrication is recommended. A mesh can be used as reinforcement as performed in the case report by Gustafsson et al (2022), but in larger foals and weanlings placement of an artificial implant mimicking the function of the femoropatellar ligaments could be considered (Busschers 2009). The implant used needs to be strong (high molecular weight polyethylene cable or similar) and correct placement through the patella and fixation on the femoral epicondyle is extremely important.…”

“…Patellar instability/luxation in horses is an uncommon condition and a good understanding of the mechanism behind the condition and the potential risk factors is lacking as is highlighted in the report by Pagliara et al (2022). A variety of treatment options are available and some of these have been described in the report by Abu-Seida and Shamaa (2022) in a donkey foal and in a larger Arabian foal by Gustafsson et al (2022). The aim of this commentary is to describe the clinical signs, potential risk factors and a variety of treatment options, including surgical options for larger foals, associated with patellar instability/luxation.…”

Luxation of the patella in foals: A treatment challenge

“…It is usually seen in the miniature breeds, particularly in ponies. The article in this issue by Gustafsson et al (2022) illustrates the successful diagnosis and surgical treatment of a congenital lateral luxation of the patella in an Arabian filly. The authors report on the success of treatment after transecting the lateral parapatellar fascia, imbricating the medial parapatellar fascia and suturing a polypropylene mesh to the imbricated fascia.…”

“…The case reports by Gustafsson et al (2022) and Abu-Seida and Shamaa (2022) describe the diagnosis and surgical repair of congenital lateral luxation of the patella in foals.…”

“…Surgical treatment of lateral patellar luxation through lateral release and medial imbrication has reportedly produced good results in miniature horses (Engelbert et al 1993); however, in larger breeds, the same technique was reported to be less successful (Leitch and Kotlikoff 1980). Therefore, the report of Gustafsson et al (2022) is important because the authors used a polypropylene mesh in the repair of patella luxation in large-breed horses that has not been previously described. This modification has the potential of improving the success rate in this group of horses.…”