How I manage. Combined CCL rupture and patella luxation. in small dogs and cats 1/27/2017 NOVOS FORUM 28 JANUARY

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1 How I manage Combined CCL rupture and patella luxation in small dogs and cats SUNE JERRE DVM,SPECIALIST IN SURGERY FOR DOGS AND CATS 1/27/2017 NOVOS FORUM 28 JANUARY

2 Clinicl examination of dogs with hind leg lameness Most important to get your patient as early as possible for examination and treatment A good history is very important Lamnessexamination Palpation of the stiffle both before and after sedation Sedation for radiografs or CT 1/27/2017 NOVOS FORUM 28 JANUARY

3 Clincal examination of cats with lameness History important Cats have either patella luxation or CCL Let the cat move free in the room Palpation both whitout and under sedation Radiology and CT under sedation 1/27/2017 NOVOS FORUM 28 JANUARY

4 Diagnostic Imaging of stiffleproblems 1/27/2017 NOVOS FORUM 28 JANUARY

5 Stiffle disease offen involves a combination of problems that always have to be solved at operation Clinical examination should find out where the problem is and give you a clue what the problem is Preoperativ diagnostic imaging will give you the bone formation and angulation between bones Artroscopy or exploration of the joint: look for jointcartilage, meniscus and cruciate disease Patellar grow and tibial creast. 1/27/2017 NOVOS FORUM 28 JANUARY

6 Be careful so that you dont create patellar luxation with your CCl surgery TPLO : correct for obvios tibial rotation and look for femur valgus or varus deformitis TTA: prepare to change tibial creast. Look for femur valgus or varus deformitis LATERAL SUTUR: Lateral rotion a common problem 1/27/2017 NOVOS FORUM 28 JANUARY

7 Patellarluxation is a complex disease and all cases are unik but 90% I handle easy Checking patellar grow. Most cases dont need deepening but if they do I prefer wedge osteotomy in the realy small dogs less than 5 kg and blockresektion in larger dogs. Transposition of the tibial crest i cut with a hoby saw I awoyed to cut the hole way thrue I try to awoyed to pin the tibial creast instead I put a scruw beside in the bone that push the creast in the right direction. When the creast breaks I have to fix it with pin and tension band wire Always fabella to patellasutur that holds the patella in the right position during healing CCl rupture in small dogs and cats I still do one monofil nylonsuture around both fabellas and thrue a hole in the tibial creast 1/27/2017 NOVOS FORUM 28 JANUARY

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9 Aftercare of stiffle surgery, leach walks rehab each week with massage and Laser Early treatment of stiffle problems is the key to success Small dogs normaly patella surgery transposition of crista tibia and stabilizing surgery with suture technics Controlled rehab each week after surgery Walk in leach with the dog pulling Mussle massage, K-laser. Most commen problem is myositis of m.rectus femoris. 1/27/2017 NOVOS FORUM 28 JANUARY

10 Cats are not small dogs patellar luxation in cats Broad patella in cats Often the patellar grow are shallow Cats do not have coxa vara, bowing of the distal femur or tibial rotation that is tipycal of dogs with patellar luxation. Tretment is trimming of patella, deepening of the patellar grow and antirotional suturtechnics. 1/27/2017 NOVOS FORUM 28 JANUARY

11 Patellaluxation with femur bowing and tibial rotation in a german sheephard dog 1/27/2017 NOVOS FORUM 28 JANUARY

12 In dogs especialy larger dogs, you should take in femur bowing and tibial rotation in your treatment of patellar luxation. 1/27/2017 NOVOS FORUM 28 JANUARY

13 How i manage combined cranial ccl and medial patellar luxation in small dogs and cats In small dogs often have CCl rupture combined with medial patella luxation. Propper diagnosis preoperativt with good radiografs Keep treatment simple, tibial tuberosity transposition lateraly and combined suturtechnics. If nessesary meniscektomy, patellar grow surgery. Patellar luxation in cats a problem of patella and patellar grow. Antirotional suturs effectiv CCL rupture in cats often traumatic and nearly never in assosiation with patellar luxation. CCl rupture in cats in my hands are best treated with fabella to crista tibia sutures both lateral and medial. 1/27/2017 NOVOS FORUM 28 JANUARY