Concepts in managing canine medial patellar luxation cases
|
|
- Marsha Walker
- 5 years ago
- Views:
Transcription
1 Vet Times The website for the veterinary profession Concepts in managing canine medial patellar luxation cases Author : Toby Gemmill, Bill Oxley Categories : Companion animal, Vets Date : May 30, 2016 Medial patellar luxation (MPL) is a commonly encountered condition in small animal practice and can cause lameness, pain and secondary osteoarthritis. Table 1. Clinical grading scheme for assessing medial patellar luxation. Historically, the condition was seen more commonly in small breed dogs; however, increasing reports have existed of patellar luxation in larger breeds. Yorkshire terriers, miniature poodles and cavalier King Charles spaniels are over-represented and, among large breeds, Labrador retrievers and mastiffs appear to be especially predisposed. MPL is recognised more commonly than lateral patellar luxation. Although MPL has been described as a congenital condition, it is thought, in most cases, affected dogs are born with normal stifles and problems develop as they grow. Clinical signs associated with MPL vary depending on the severity of the patellar instability, which can be quantified using a four point grading scheme (Table 1). In most cases, grade one results in minimal clinical signs and can be treated conservatively; however, owners should be warned deterioration can occur, usually in association with other problems, such as cranial cruciate ligament deficiency or trauma to the stifle joint. 1 / 26
2 Dogs with a grade two are often presented with a history of an intermittent lameness. This can be relatively severe, although affected dogs can usually recover rapidly and walk normally once the patella is reduced. Grade three will often lead to a more persistent lameness. It is important to differentiate this clinically from grade four, since this can affect prognosis following treatment. In most cases, dogs with grade two to grade four are surgical candidates. On occasions, however, some small breed dogs can cope surprisingly well without surgery and may be treated conservatively. Medial patellar subluxation, where the patella rides on the medial trochlear ridge, is also occasionally encountered, especially in bulldogs and bull terriers, leading to the rapid development of femoropatellar osteoarthritis, and can be extremely debilitating. Aetiopathogenesis Figure 1. Determining axial alignment of the femur from a caudocranial radiograph. The proximal anatomic axis of the femur (a) and the distal joint reference line (b) are identified. At the intersection of these lines, the resultant angle on the lateral aspect of the femur, is the anatomic distal lateral femoral angle. Although MPL is often considered a disease of the patella, it has been recognised the pathogenesis relates to underlying deformities of the limb, leading to malalignment of the quadriceps mechanism with respect to the trochlear groove and consequential maltracking of the patella. Therefore, the patellar instability is effectively a clinical sign of the underlying deformity. 2 / 26
3 These deformities can vary in severity and complexity. Distal femoral varus deviation, external torsion of the femur and hypoplasia of the trochlear groove are common. Valgus deviation and torsional deformities of the tibia are also encountered concurrently in some cases, although tibial deformities are not thought to cause MPL per se. Tibial deformities are often compensatory for femoral deformities. Although medial deviation of the tibial tuberosity is often described, it is thought, in most cases, this results from internal rotation of the tibia with respect to the femur rather than any bony deformity of the tibial crest. Aims of treatment The aim of MPL surgery is to stabilise the patella in the trochlear groove by restoration of quadricep alignment and appropriate patellar tracking, as well as deepening the trochlear groove, where appropriate. In addition, tension in regional soft tissues medial or lateral to the patella should be balanced, generally by medial desmotomy and lateral capsular and fascial imbrication. Although the presence of underlying limb deformities has been recognised for many years, restoration of quadriceps alignment and patellar tracking has, historically, been achieved by surgery on the stifle itself, usually by means of tibial crest transposition. While this is an effective means of treatment and remains very useful in cases with internal tibial rotation, recurrence of patellar instability following tibial crest transposition is not uncommon, especially in cases with severe grade four MPL. It has been suggested this relatively high recurrence rate could be due to a failure to recognise and directly address the underlying deformity of the limb. Indeed, in dogs where underlying femoral deformities were treated, the prognosis appeared to be improved, even in severely affected cases (Swiderski and Palmer, 2007; Roch and Gemmill, 2008). Case assessment These concerns have led to a reappraisal of the assessment and treatment of dogs with MPL. Careful assessment of radiographs can allow identification and quantification of underlying deformities, particularly those involving the femur. This can allow correction of deformities using corrective osteotomies, where appropriate. Unfortunately, because of the morphology of the femur, reliable quantification of femoral alignment can be challenging as minor errors in positioning can lead to significant errors in measurements. Therefore, perfectly positioned orthogonal projections of the femur are required. From the caudocranial radiograph, the proximal anatomic femoral axis and distal joint reference line can be identified, and the anatomic lateral distal femoral angle (aldfa) determined (Figure 1). 3 / 26
4 Normal ranges for the aldfa have been determined for some breeds (Tomlinson et al, 2007); for normal Labrador retrievers this angle ranges from 94 to 100. In most breeds, an osteotomy to realign the femur is considered when the aldfa exceeds 100 to 102, corresponding to a distal femoral varus deviation of greater than 10 to 12. It should be borne in mind if compensatory tibial deformities are also present, it may be necessary to correct these in some dogs. In addition to standard orthogonal radiographs, an axial proximodistal projection of the femur can be obtained to give an indication of femoral torsion (Figure 2). The angle of anteversion (AA) can be determined from the intersection between a line drawn along the femoral neck and another drawn along the caudal aspect of the femoral condyles. Assuming the hip joint and proximal femoral anatomy are normal, the AA should range from approximately 20 to 30, although breed variations in this angle are poorly documented. MPL is often associated with a low AA, corresponding to external femoral torsion. Where present, this can be corrected by femoral osteotomy. Because of the challenge of obtaining perfectly positioned radiographs, CT is often used to assess femoral alignment. Following a standard CT scan of the pelvic limbs, 3D images can be created, which can be manipulated to produce perfect mediolateral, caudocranial and axial views of the femur to allow accurate assessment of femoral alignment. Measurements obtained from semitransparent images (Figure 3) have been shown to be repeatable and highly precise (Oxley et al, 2013). Surface rendered images (Figure 4) can be useful to assist in surgical planning. Images of the tibia can also be easily created, allowing assessment of any concurrent tibial deformities. In addition, CT scans using modern systems can be acquired very rapidly, reducing the sedation or anaesthetic time required to obtain a complete series of high quality radiographs. Careful assessment of limb alignment prior to surgery allows detailed planning of surgical treatment in each case. Because the nature and severity of the deformities is highly variable, different surgical options are required in different cases. Selection of the most appropriate surgical options can be daunting; it can be helpful to make a list of all the deformities present and consider the need to correct each of these individually. It is also important to bear in mind more complex procedures are often more expensive and carry a potentially greater risk of postoperative complications. In general terms, the simplest surgical options should be selected, provided appropriate quadriceps alignment and patellar tracking are restored. 4 / 26
5 Figure 2. Estimation of femoral torsion from an axial radiograph of the femur. The axis of the femoral neck (a) and the distal joint reference line (b) are identified. The intersection between the femoral neck axis and a line parallel to the distal joint reference line (b1) represents the angle of anteversion (AA). Assuming normal hip and proximal femoral morphology, the AA gives an estimation of femoral torsion. 5 / 26
6 6 / 26
7 7 / 26
8 Figure 3a. The femur, mediolateral. These semi-transparent CT images can be manipulated on a computer to achieve perfect positioning, improving the accuracy of preoperative assessment of femoral alignment. 8 / 26
9 9 / 26
10 Figure 3b. The femur, caudocranial. These semi-transparent CT images can be manipulated on a computer to achieve perfect positioning, improving the accuracy of preoperative assessment of femoral alignment. 10 / 26
11 11 / 26
12 Figure 4. Surface-rendered CT image of the femur. 12 / 26
13 13 / 26
14 Figure 5a. A femoral osteotomy stabilised with bone plates mediolateral. A tibial crest transposition has also been performed. 14 / 26
15 Figure 5b. A femoral osteotomy stabilised with bone plates caudocranial. A tibial crest transposition has also been performed. 15 / 26
16 Surgical technique The surgical technique for femoral osteotomy has evolved. In most cases, a lateral approach is made to the stifle joint and the distal femur. A jig is applied to the cranial aspect of the bone and either an opening or closing wedge osteotomy is performed using an oscillating saw, to allow correction of angular deformities. Torsional deformities can also be addressed. Performing femoral osteotomy without the use of a jig is discouraged, since this can result in inadvertent torsional malalignment. Following reduction, the osteotomy is stabilised using one or two bone plates and screws. Locking systems are preferred, if available (Figure 5). In more complex cases, 3D printing of affected bones can greatly assist surgical planning. In addition, using computer modelling, osteotomies can be performed electronically allowing printing of a second post-correction bone model. This allows bone plates to be precontoured to the shape of the bone prior to surgery, which facilitates accurate osteotomy reduction and decreases surgical time. 3D printing can also be used to create custom osteotomy and reduction guides (Figure 6). The osteotomy guide is applied to the bone using pins; this facilitates creation of an accurate osteotomy. The osteotomy guide is removed, but the pins are left in place. The reduction guide is slid on to the pins, reducing the osteotomy and restoring bone alignment. The device also maintains reduction of the osteotomy while precontoured plates are applied. As well as restoring quadriceps alignment and patellar tracking by correction of underlying deformities or performance of a tibial crest transposition, it is necessary to deepen the trochlear groove in many cases. The decision to perform a trochleoplasty is subjective, but should be considered if the depth of trochlear groove is less than 30% to 50% the craniocaudal height of the patella, as measured from a mediolateral radiograph of the stifle. V-recession sulcoplasty has been performed for several years and allows preservation of the articular surface of the trochlear groove, at least in its central region. Rectangular block recession sulcoplasty starts at the apex of the trochlear ridges, slightly converging osteotomies are performed in a craniolateral to caudomedial direction. An osteotome is used to remove an osteochondral block from the trochlear groove. Additional bone is removed from the resultant femoral defect before the block is replaced in a recessed position (Johnson et al, 2001; Figure 7). 16 / 26
17 17 / 26
18 18 / 26
19 Figure 6a. The use of customised cutting and reduction guides to assist femoral osteotomy in a complex case. Preoperative CT scan showing a femoral deformity following malunion of a diaphyseal femoral fracture. Medial patellar luxation can be appreciated. 19 / 26
20 20 / 26
21 Figure 6b. The use of customised cutting and reduction guides to assist femoral osteotomy in a complex case. Intraoperative image showing the cutting guide attached to the cranial aspect of the femur with pins. The saw blade is positioned using the slot in the guide. Figure 6c. The use of customised cutting and reduction guides to assist femoral osteotomy in a complex case. Intraoperative image showing the completed osteotomy. 21 / 26
22 Figure 6d. The use of customised cutting and reduction guides to assist femoral osteotomy in a complex case. Replacement of the cutting guide with the reduction guide, using the same pins. 22 / 26
23 23 / 26
24 Figure 6e. The use of customised cutting and reduction guides to assist femoral osteotomy in a complex case. Postoperative reconstructed CT image showing restoration of femoral alignment and stabilisation of the osteotomy with orthogonal bone plates. Figure 7. Intraoperative image showing a rectangular block recession trochleoplasty. Compared to a V-recession, the block achieves improved recession proximally and distally, and better preserves the articular surface. These advantages must be balanced against the technical challenge of creating and stabilising the block, especially in smaller patients. Another possibility developed is augmentation of the trochlear ridges using a polyethylene insert. However, peer-reviewed evidence of efficacy is lacking. Complete replacement of the trochlear groove has also been described. This is useful for cases with complete absence of the trochlear groove or severe derangement of the femoropatellar joint, often seen with chronic medial patellar subluxation. 24 / 26
25 Figure 8. Postoperative mediolateral radiograph of the stifle showing a patellar groove replacement. A frontal plane osteotomy is performed and the entire cranial aspect of the distal femur resected. A base plate is secured to the femur using screws and the patellar groove replacement (PGR) clipped into place (Figure 8). The PGR is highly polished with a diamond-like coating, giving a very low coefficient of friction. This device has been shown to be successful in the management of challenging MPL cases (Dokic et al, 2015). It is also possible to change the orientation of the frontal plane femoral osteotomy or the precise position of the PGR to address certain femoral angular or torsional deformities and improve quadriceps alignment. While PGR is a promising development and postoperative complications appear to be low, the advantages must be weighed against the possibility for catastrophic complications. These developments have led to improved outcomes following surgery to treat MPL; in particular, the risk of recurrence of patellar instability appears to be reduced. However, decision-making in individual cases can be challenging. It is recommended full assessment of limb alignment and bony anatomy, using high-quality radiography or CT, is performed in all cases. Surgery should be planned on an individual basis, aiming to restore quadriceps alignment and patellar tracking in all cases, as well as ensuring adequate depth of the trochlear groove and balancing the soft tissues. To minimise the potential risk of postoperative complications, the simplest surgical techniques allowing these aims to be achieved are selected. 25 / 26
26 Powered by TCPDF ( In many dogs, conventional tibial crest transposition can be performed; however, femoral and occasionally concurrent tibial corrective osteotomies should be considered for more complex cases. Case assessment and novel techniques for management of medial patellar luxation will be covered in detail in the forthcoming AOVET course on Advanced pelvic limb osteotomy, chaired by one of the authors, planned for 17 to 19 May 2017 at the Royal College of Surgeons in Edinburgh. References Dokic Z, Lorinson D, Weigel JP and Vezzoni A (2015). Patellar groove replacement in patellar luxation with severe femoro-patellar osteoarthritis, Vet Comp Orthop Traumatol 28(2): Johnson AL, Probst CW, Decamp CE, Rosenstein DS, Hauptman JG, Weaver BT and Kern TL (2001). Comparison of trochlear block recession and trochlear wedge recession for canine patellar luxation using a cadaver model, Vet Surg 30(2): Oxley B, Gemmill TJ, Pink J, Clarke S, Parry A, Baines S and Malcolm McKee W (2013). Precision of a novel computed tomographic method for quantification of femoral varus in dogs and an assessment of the effect of femoral malpositioning, Vet Surg 42(6): Roch SP and Gemmill TJ (2008). Treatment of medial patellar luxation by femoral closing wedge ostectomy using a distal femoral plate in four dogs, J Small Anim Pract 49(3): Swiderski JK and Palmer RH (2007). Long-term outcome of distal femoral osteotomy for treatment of combined distal femoral varus and medial patellar luxation: 12 cases ( ), J Am Vet Med Assoc 231(7): 1,070-1,075. Tomlinson J, Fox D, Cook JL and Keller GG (2007). Measurement of femoral angles in four dog breeds, Vet Surg 36(6): / 26
Medial Patella Luxation
Medial Patella Luxation Anatomy The Patella is the large sesamoid bone (Kneecap) in the stifle joint. It forms part of the quadriceps muscle mechanism which is the main muscle group responsible for extension
More informationPlease answer the following questions by responding with a score of 0 to 10. Please answer for how your dog is doing NOW.
Online Supplementary Material to: Distal femoral lateral closing wedge osteotomy as a component of comprehensive treatment of medial patellar luxation and distal femoral varus in dogs Barry E. Brower;
More informationPatellar Ligament Disease.
Patellar Ligament Disease. The patellar ligament disease is a condition of the stifle where the cartilage keeping the patella in place over knee joint is weakened or damaged. The patella is held in place
More informationBen 5 year old M mixed breed dog. Dr. Norman Ackerman Memorial Radiography Case Challenge
February 2014 Dr. Norman Ackerman served the University of Florida, College of Veterinary Medicine with distinction as Professor of Radiology from 1979 to 1994. A concerned teacher of veterinary students
More informationComplex angular and torsional deformities (distal femoral malunions)
Online Supplementary Material to: Complex angular and torsional deformities (distal femoral malunions) Preoperative planning using stereolithography and surgical correction with locking plate fixation
More informationFinancial Support: This study was funded via a grant from the Canine Health Fund. Schattauer 2017 Vet Comp Orthop Traumatol 3/2017
Original Research 191 Computed tomographic evaluation of femoral and tibial conformation in English Staffordshire Bull Terriers with and without congenital medial patellar luxation Mark Newman 1,2 ; Katja
More informationProceedings of the World Small Animal Veterinary Association Sydney, Australia 2007
Proceedings of the World Small Animal Sydney, Australia 2007 Hosted by: Next WSAVA Congress CRANIAL CRUCIATE LIGAMENT INJURIES SURGICAL MANAGEMENT Warrick J. Bruce BVSc(dist), MVM, DSAS(orthopaedics),
More informationCORRECTIVE OSTEOTOMY BRINGING THE PLAN TO THE BONE (TRIGONOMETERY, GUIDE WIRES, SLA MODELING AND ART)
CORRECTIVE OSTEOTOMY BRINGING THE PLAN TO THE BONE (TRIGONOMETERY, GUIDE WIRES, SLA MODELING AND ART) Randy J. Boudrieau, DVM, DACVS, DECVS Cummings School of Veterinary Medicine at Tufts University, North
More informationPhyseal fractures in immature cats and dogs: part 1 forelimbs
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Physeal fractures in immature cats and dogs: part 1 forelimbs Author : Lee Meakin, Sorrel Langley-Hobbs Categories : Canine,
More informationPatellofemoral Joint Allison Mourad December 20, 2013
Patellofemoral Joint Allison Mourad December 20, 2013 The patellofemoral joint is located in the hind leg of a canine and plays a key role in dynamic mobility. This joint enables the dog to sit, walk,
More informationLuxation of the Patella
Luxation of the Patella The patella or knee cap is the small bone that connects the thigh muscles to the bones that comprise the shin, namely the tibia and fibula. The term luxation refers to the dislocation
More informationCranial cruciate ligament rupture and tibial tuberosity advancement
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Cranial cruciate ligament rupture and tibial tuberosity advancement Author : Nick Wiliams Categories : Vets Date : September
More informationPatellar Luxation. The Patella. Dr. PJ Rocheleau, DVM and Associates 138 Tudhope St, Espanola ON, P5E 1S6
Patellar Luxation The Patella The patella (equivalent to the knee cap ) is one of several structures in the stifle (equivalent to our knee) that provide joint stability and allow normal function. The stifle
More informationRobert Botte, DVM, Diplomate ACVS Veterinary Surgical Service San Diego, California. Kyon Symposium 2010 Zurich
Robert Botte, DVM, Diplomate ACVS Veterinary Surgical Service San Diego, California Kyon Symposium 2010 Zurich ! Special Considerations " Anatomic variation " Precise implant placement " Factors affecting
More informationSupplementary Material to this article is available online at
Clinical Communication 536 Combined tibial plateau levelling osteotomy and tibial tuberosity transposition for treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation
More informationArthrex Open Wedge Osteotomy Technique Designed in conjunction with:
Arthrex Open Wedge Osteotomy Technique Designed in conjunction with: Dr. Giancarlo Puddu, M.D. Dr. Peter Fowler, M.D. Dr. Ned Amendola, M.D. To treat pain and instability associated with lower extremity
More informationPatellar Luxation. Anatomy, Function, and Dysfunction
6910 Carpenter Fire Station Road, Cary NC 27519 Phone (919) 545-1001 Patellar Luxation This information is provided to help you understand the condition that has been diagnosed in your pet. We find that
More informationFeasibility of utilizing the patellar ligament angle for assessing cranial cruciate ligament rupture in dogs
pissn 1229-845X, eissn 1976-555X J. Vet. Sci. (2014), 15(4), 563-568 http://dx.doi.org/10.4142/jvs.2014.15.4.563 Received: 6 Jan. 2014, Revised: 17 Jun. 2014, Accepted: 19 Jun. 2014 Original Article JOURNAL
More informationCranial Cruciate Ligament Disease
24- hour Emergency Service 01635 47170 The Tibial Tuberosity Advancement (TTA) procedure is one of the advanced procedures for the treatment of cranial cruciate ligament disease in dogs. TTA is now available
More informationHOW DO WE DIAGNOSE LAMENESS IN YOUR HORSE?
HOW DO WE DIAGNOSE LAMENESS IN YOUR HORSE? To help horse owners better understand the tools we routinely use at VetweRx to evaluate their horse s soundness, the following section of this website reviews
More informationCranial Cruciate disease
Cranial Cruciate disease Anatomy The Cranial cruciate ligament is located in the stifle joint (or knee). It is a thick fibrous band that runs from the distal femur to the proximal tibia. It is designed
More informationPre-operative evaluation
Pre-operative evaluation Andrea Meyer-Lindenberg Clinic of Small Animal Surgery and eproduction Ludwig-Maximilians-University Munich Importance of pre-operative planning Evaluate patient before selecting
More informationTTA Wedge System INSTRUCTIONS FOR USE
TTA Wedge System INSTRUCTIONS FOR USE 1 INSTRUCTIONS FOR USE The OssAbility TTA Wedge System consists of the following products: Wedge Implants Osteotomy Guide Advancement Levers Osteotomy Planning Overlay
More informationSIMITRI STABLE IN STRIDE SURGICAL PROCEDURE
Copyright 2016 NGD. All rights reserved Neil Embleton, B.Sc., DVM and Veronica Barkowski, DVM Helivet Mobile Surgical Services, Sundre, AB, Canada July 2016 SIMITRI STABLE IN STRIDE SURGICAL PROCEDURE
More informationConsiderations around total and partial joint replacement surgery
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Considerations around total and partial joint replacement surgery Author : MALCOLM MCKEE, GARETH ARTHURS Categories : Vets
More informationANATOMIC. Navigated Surgical Technique 4 in 1 TO.G.GB.016/1.0
ANATOMIC Navigated Surgical Technique 4 in 1 TO.G.GB.016/1.0 SCREEN LAYOUT Take screenshot Surgical step Dynamic navigation zone Information area and buttons 2 SCREEN LAYOUT Indicates action when yellow
More informationWhere to Draw the Line:
Where to Draw the Line: Anatomical Measurements Used to Evaluate Patellofemoral Instability Murray Grissom, MD 1 Bao Do, MD 2 Kathryn Stevens, MD 2 1 Santa Clara Valley Medical Center, San Jose, CA 2 Stanford
More information2017 Resident Advanced Trauma Techniques Course COMPLICATIONS / CHALLENGES MALUNIONS/DEFORMITY
2017 Resident Advanced Trauma Techniques Course COMPLICATIONS / CHALLENGES MALUNIONS/DEFORMITY What is a Malunion? Definition: a fracture that has healed in a nonanatomic (i.e. deformed) position Must
More informationMultiapical Deformities p. 97 Osteotomy Concepts and Frontal Plane Realignment p. 99 Angulation Correction Axis (ACA) p. 99 Bisector Lines p.
Normal Lower Limb Alignment and Joint Orientation p. 1 Mechanical and Anatomic Bone Axes p. 1 Joint Center Points p. 5 Joint Orientation Lines p. 5 Ankle p. 5 Knee p. 5 Hip p. 8 Joint Orientation Angles
More informationTRUMATCH PERSONALIZED SOLUTIONS with the SIGMA High Performance Instruments
TRUMATCH PERSONALIZED SOLUTIONS with the SIGMA High Performance Instruments Resection Guide System SURGICAL TECHNIQUE RESECTION GUIDE SURGICAL TECHNIQUE The following steps are an addendum to the SIGMA
More informationMINI TIBIAL PLATEAU LEVELING OSTEOTOMY (TPLO) SYSTEM
MINI TIBIAL PLATEAU LEVELING OSTEOTOMY (TPLO) SYSTEM For stabilizing osteotomies of the canine and feline proximal tibia SURGICAL TECHNIQUE TABLE OF CONTENTS INTRODUCTION Mini Tibial Plateau Leveling
More informationOsteotomy of the Femur and Tibia ( 1-Jan-1985 )
In: Textbook of Small Animal Orthopaedics, C. D. Newton and D. M. Nunamaker (Eds.) Publisher: International Veterinary Information Service (www.ivis.org), Ithaca, New York, USA. Osteotomy of the Femur
More informationRevolution. Unicompartmental Knee System
Revolution Unicompartmental Knee System While Total Knee Arthroplasty (TKA) is one of the most predictable procedures in orthopedic surgery, many patients undergoing TKA are in fact excellent candidates
More informationJOINT RULER. Surgical Technique For Knee Joint JRReplacement
JR JOINT RULER Surgical Technique For Knee Joint JRReplacement INTRODUCTION The Joint Ruler * is designed to help reduce the incidence of flexion, extension, and patellofemoral joint problems by allowing
More informationTriple Tibial Osteotomy (TTO)
Triple Tibial Osteotomy (TTO) Objective: This operation is based on the biomechanical analysis performed by Dr Slobodan Tepic, which revealed that in order to remove the shear strain from the cranial cruciate
More informationTTA. Common Tangent Method
TTA Common Tangent Method This document is derived from a presentation by Dr. Randy Boudrieau DVM, Dipl. ACVS, ECVS, Prof. of Surgery, Cummings School of Veterinary Medicine, Tufts University IVET DESIG
More informationSmall Animal radiography Stifle Joint and CruS
Peer reviewed ImagIng EssEnTIals Small Animal radiography Stifle Joint and CruS Danielle Mauragis, CVT, and Clifford R. erry, DVM, Diplomate ACVR This is the fourth article in our Imaging Essentials series,
More informationPeriarticular knee osteotomy
Periarticular knee osteotomy Turnberg Building Orthopaedics 0161 206 4803 All Rights Reserved 2018. Document for issue as handout. Knee joint The knee consists of two joints which allow flexion (bending)
More informationPatellofemoral Instability Jacqueline Munch, MD April 23, 2016
Patellofemoral Instability Jacqueline Munch, MD April 23, 2016 With many thanks to Beth Shubin Stein, MD What is the Problem??? THIS IS THE PROBLEM Patella Stability Factors contributing to stability Articular
More informationSpecialist Referral Service Willows Information Sheets. Limb deformity
Specialist Referral Service Willows Information Sheets Limb deformity Limb deformity Why do limbs become deformed? The limbs of dogs and cats, like the legs of people, are meant to be relatively straight.
More informationPatellofemoral Joint. Question? ANATOMY
Doug Elenz is a paid Consultant/Advisor for the Biomet Manufacturing Corporation. Doug Elenz, MD Team Orthopaedic Surgeon The University of Texas Men s Athletic Department Question? Patellofemoral Joint
More informationHigh Tibial Osteotomy
High Tibial Osteotomy With each step, forces equal to three to eight times your body weight travel between the thigh bone (femur) and shin bone (tibia) in your knee. These forces are dampened by a meniscus
More informationFINAL DECISION OF THE COMPLAINTS ASSESSMENT COMMITTEE. Dr B and Dr C CAC (Complaint by A Re D)
FINAL DECISION OF THE COMPLAINTS ASSESSMENT COMMITTEE Dr B and Dr C CAC2-12-10 (Complaint by A Re D) Ms A Dr B Dr C D E F Dr G H Dr I Complainant First veterinarian complained against Second veterinarian
More informationZoran Lončar. CONGRESS AMVAC/RoSAVA September, 2014
Zoran Lončar Veterinary Clinic www.vetnovak.com loncarzor@yahoo.co.uk Belgrade, Serbia CONGRESS AMVAC/RoSAVA 11-13 September, 2014 ALL ABOUT THE KNEEE To become familiar with the EXAM To recognize most
More informationVARIABILITY OF THE POSTERIOR CONDYLAR ANGLE
VARIABILITY OF THE POSTERIOR CONDYLAR ANGLE Łukasz Cieliński, Damian Kusz, Michał Wójcik Department of Orthopedics Medical University of Silesia in Katowice Introduction Correct positioning of implants
More informationCase Report. Antegrade Femur Lengthening with the PRECICE Limb Lengthening Technology
Case Report Antegrade Femur Lengthening with the PRECICE Limb Lengthening Technology S. Robert Rozbruch, MD Hospital for Special Surgery New York, NY, USA ABSTRACT This is a case illustrating a 4.5 cm
More informationPREVALENCE OF MEDIAL MENISCAL TEARS WITH ARTHROSCOPIC ASSISTED TIBIAL
1 2 PREVALENCE OF MEDIAL MENISCAL TEARS WITH ARTHROSCOPIC ASSISTED TIBIAL PLATEAU LEVELING OSTEOTOMY 3 4 5 6 7 Stephen Kalff 1 BVSc MACVSc, Sarah Meachem 2 BSc PhD, Christopher Preston 1 BVSc DipACVS FACVSc
More informationCorrection of Traumatic Ankle Valgus and Procurvatum using the Taylor Spatial Frame: A Case Report
The Foot and Ankle Online Journal Official publication of the International Foot & Ankle Foundation Correction of Traumatic Ankle Valgus and Procurvatum using the Taylor Spatial Frame: A Case Report by
More informationCT Evaluation of Patellar Instability
CT Evaluation of Patellar Instability Poster No.: C-2157 Congress: ECR 2014 Type: Educational Exhibit Authors: R. Ruef, C. Edgar, C. Lebedis, A. Guermazi, A. Kompel, A. Murakami; Boston, MA/US Keywords:
More informationTTA Rapid with Patellar Luxation
TTA Rapid with Patellar Luxation The dog is placed in a dorsal recumbency with the affected limb suspended from a stand. Make sure that the dog s paws are not fixed too tightly, since the affected limb
More informationANATOMIC SURGICAL TECHNIQUE. 5 in 1. Conventional instrumentation 07/11/2013
ANATOMIC SURGICAL TECHNIQUE 5 in 1 Conventional instrumentation PRO.GB.933/1.0 Octobre 2013 2 Tibial step 3 Intramedullary technique - Based on the preoperative plan, drill the medullary canal with the
More informationRuptured cranial cruciate ligament (CCL) Ruptured cruciate, Ruptured ligament, Ruptured anterior cruciate ligament (ACL), Torn ACL, Torn ligament
1333 Plaza Blvd, Suite E, Central Point, OR 97502 * www.mountainviewvet.net Category: Canine Ruptured cranial cruciate ligament (CCL) Ruptured cruciate, Ruptured ligament, Ruptured anterior cruciate ligament
More informationANTERIOR REFERENCE NEXGEN COMPLETE KNEE SOLUTION. Multi-Reference 4-in-1 Femoral Instrumentation Anterior Reference Surgical Technique
ANTERIOR REFERENCE NEXGEN COMPLETE KNEE SOLUTION Multi-Reference 4-in-1 Femoral Instrumentation Anterior Reference Surgical Technique For NexGen Cruciate Retaining & Legacy Posterior Stabilized Knees INTRODUCTION
More informationTRK REVISION KNEE Surgical Technique
1 TRK REVISION KNEE Surgical Technique 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. INTERCONDYLAR RESECTION...... page FEMORAL STEM...... page NON CEMENTED FEMORAL STEM...... page TRIAL FEMORAL COMPONENTS...... page
More informationTibial & Femoral Opening Wedge Osteotomy System. Surgical Technique
Tibial & Femoral Opening Wedge Osteotomy System Surgical Technique Opening Wedge Osteotomy Tibial & Femoral Opening Wedge Osteotomy 2 Prior to the osteotomy, a diagnostic arthroscopy is performed to verify
More informationSurgical Technique Final Trial Reduction and Component Implantation of
Surgical Technique Final Trial Reduction and Component Implantation of TC *smith&nephew TC-PLUS PRIMARY Mobile Bearing TC-PLUS PRIMARY Mobile Bearing Final Trial Reduction and Component Implantation of
More informationPOSTERIOR REFERENCE NEXGEN COMPLETE KNEE SOLUTION. Multi-Reference 4-in-1 Femoral Instrumentation Posterior Reference Surgical Technique
POSTERIOR REFERENCE NEXGEN COMPLETE KNEE SOLUTION Multi-Reference 4-in-1 Femoral Instrumentation Posterior Reference Surgical Technique For NexGen Cruciate Retaining & Legacy Posterior Stabilized Knees
More informationRESECTION GUIDE SYSTEM. TRUMATCH Personalized Solutions Surgical Technique with ATTUNE Knee INTUITION Instruments
RESECTION GUIDE SYSTEM TRUMATCH Personalized Solutions Surgical Technique with ATTUNE Knee INTUITION Instruments RESECTION GUIDE SURGICAL TECHNIQUE The following steps are an addendum to the ATTUNE Knee
More informationAs for the forelimb, treatment of condition of the hindlimb may be treated by both localised therapy, applying the laser
MLS Master Class - Veterinary Imaging Presented by CelticSMR Ltd Free Phone (UK): 0800 279 9050 International: +44 (0) 1646 603150 AUTHOR DETAILS Carl Gorman BVSc MRCVS PUBLISHER DETAILS Mike Howe B Vet
More informationJoop Hopmans, Small animal orthopedic surgeon. Wednesday, April 24, 13
Joop Hopmans, Small animal orthopedic surgeon 1 Cranial Cruciate Trauma What to do????? TightRope OTT TPLO MMT FHT MRIT TTA TCC TTO TTArap TTA-2 2 The biggest ones TPLO TTA TTO TCC 3 Why changing/modifying?
More informationTechnique Guide. TomoFix Osteotomy System. A comprehensive plating system for stable fixation of osteotomies around the knee.
Technique Guide TomoFix Osteotomy System. A comprehensive plating system for stable fixation of osteotomies around the knee. Table of Contents Introduction TomoFix Osteotomy System 2 AO Principles 4 Indications
More informationNEXGEN COMPLETE KNEE SOLUTION S A. Tibial Stem Extension & Augmentation Surgical. ATechnique
NEXGEN COMPLETE KNEE SOLUTION ATechnique Tibial Stem Extension & Augmentation Surgical INTRODUCTION The NexGen Complete Knee Solution Intramedullary Tibial Instruments have been designed to provide an
More informationOver 20 Years of Proven Clinical Success. Zimmer Natural-Knee II System
Over 20 Years of Proven Clinical Success Zimmer Natural-Knee II System CSTi Porous Coating Structurally similar to human bone CSTi porous coating combines the excellent biocompatibility of titanium with
More informationKinematic vs. mechanical alignment: What is the difference?
Kinematic vs. mechanical alignment: What is the difference? In this 4 Questions interview, Stephen M. Howell, MD, explains the potential benefits of 3D alignment during total knee replacement. Introduction
More informationPatellofemoral Instability
Disclaimer This movie is an educational resource only and should not be used to manage Patellofemoral Instability. All decisions about the management of Patellofemoral Instability must be made in conjunction
More informationPRE & POST OPERATIVE RADIOLOGICAL ASSESSMENT IN TOTAL KNEE REPLACEMENT. Dr. Divya Rani K 2 nd Year Resident Dept. of Radiology
PRE & POST OPERATIVE RADIOLOGICAL ASSESSMENT IN TOTAL KNEE REPLACEMENT Dr. Divya Rani K 2 nd Year Resident Dept. of Radiology PRE OPERATIVE ASSESSMENT RADIOGRAPHS Radiographs are used for assessment and
More informationImaging assessment of Unicomp candidates!
7th Advanced Course on Knee Surgery - 2018: Imaging assessment of Unicomp candidates! Presenter: Anders Troelsen, MD, ph.d., dr.med., Professor Distribution of the basic primary OA patterns Medial FT:
More informationTechnique Guide. LCP Proximal Femoral Hook Plate 4.5/5.0. Part of the LCP Periarticular Plating System.
Technique Guide LCP Proximal Femoral Hook Plate 4.5/5.0. Part of the LCP Periarticular Plating System. Table of Contents Introduction Features and Benefits 2 AO ASIF Principles 4 Indications 5 Surgical
More informationChronic patellar dislocation in adults
CASE STUDY 11 Chronic patellar dislocation in adults What are the reasons for chronic dislocation? Which is the best imaging modality for documentation? How can we treat it? Table CS11 Patellofemoral joint
More informationFlexitsystem. - Description Flexitsystem solution - Ancillaries, instruments. Surgical technique for HTO lateral external closing wedge
Surgical technique for HTO lateral external closing wedge - Description solution - Ancillaries, instruments Solution for closing high tibial osteotomy Genu varum: pathology Genu varum is a deformation
More informationMULTIPLE SURGICAL techniques have been
Effect of Tibial Plateau Leveling on Stability of the Canine Cranial Cruciate Deficient Stifle Joint: An In Vitro Study Veterinary Surgery 31:147-154, 2002 ULLRICH REIF, DVM, DONALD A. HULSE, DVM, Diplomate
More informationTotal Knee Original System Primary Surgical Technique
Surgical Procedure Total Knee Original System Primary Surgical Technique Where as a total hip replacement is primarily a bony operation, a total knee replacement is primarily a soft tissue operation. Excellent
More informationTOTAL KNEE ARTHROPLASTY (TKA)
TOTAL KNEE ARTHROPLASTY (TKA) 1 Anatomy, Biomechanics, and Design 2 Femur Medial and lateral condyles Convex, asymmetric Medial larger than lateral 3 Tibia Tibial plateau Medial tibial condyle: concave
More informationComputational Evaluation of Predisposing Factors to Patellar Dislocation
Computational Evaluation of Predisposing Factors to Patellar Dislocation Clare K. Fitzpatrick 1, Robert Steensen, MD 2, Jared Bentley, MD 2, Thai Trinh 2, Paul Rullkoetter 1. 1 University of Denver, Denver,
More information10/30/18. Disclosures. Recurrent Patellar Instability. Management of Recurrent Patellar Instability
Management of Recurrent Patellar Instability Miho J. Tanaka, MD Associate Professor Director, Women s Sports Medicine Program ORTHOPAEDIC SURGERY Disclosures None Recurrent Patellar Instability Lack of
More informationSurgical Technique. VISIONAIRE FastPak Instruments for the LEGION Total Knee System
Surgical Technique VISIONAIRE FastPak Instruments for the LEGION Total Knee System VISIONAIRE FastPak for LEGION Instrument Technique* Nota Bene The technique description herein is made available to the
More informationTriple Tibial Osteotomy (TTO)
Objective: This operation is based on the biomechanical analysis performed by Dr Slobodan Tepic, which revealed that in order to remove the shear strain from the cranial cruciate ligament the tibial plateaux
More informationDoron Sher. 160 Belmore Rd, Randwick Burwood Rd, Concord. MBBS, MBiomedE, FRACS FAOrthA
Doron Sher MBBS, MBiomedE, FRACS FAOrthA 160 Belmore Rd, Randwick 47 49 Burwood Rd, Concord www.kneedoctor.com.au www.orthosports.com.au Medial PatelloFemoral (MPFL) And AnteroLateral Ligament (ALL) Reconstruction
More informationBone Preservation Stem
TRI-LOCK Bone Preservation Stem Featuring GRIPTION Coating Surgical Technique Implant Geometry Extending the TRI-LOCK Stem heritage The original TRI-LOCK Stem was introduced in 1981. This implant was
More informationACL Athletic Career. ACL Rupture - Warning Features Intensive pain Immediate swelling Locking Feel a Pop Dead leg Cannot continue to play
FIMS Ambassador Tour to Eastern Europe, 2004 Belgrade, Serbia Montenegro Acute Knee Injuries - Controversies and Challenges Professor KM Chan OBE, JP President of FIMS Belgrade ACL Athletic Career ACL
More informationProceeding of the NAVC North American Veterinary Conference Jan. 8-12, 2005, Orlando, Florida
Proceeding of the NAVC North American Veterinary Conference Jan. 8-12, 2005, Orlando, Florida Reprinted in the IVIS website with the permission of the NAVC http:/// The North American Veterinary Conference
More informationMasterclass. Tips and tricks for a successful outcome. E. Verhaven, M. Thaeter. September 15th, 2012, Brussels
Masterclass Tips and tricks for a successful outcome September 15th, 2012, Brussels E. Verhaven, M. Thaeter Belgium St. Nikolaus-Hospital Orthopaedics & Traumatology Ultimate Goal of TKR Normal alignment
More informationPreoperative Planning. The primary objectives of preoperative planning are to:
Preoperative Planning The primary objectives of preoperative planning are to: - Determine preoperative leg length discrepancy. - Assess acetabular component size and placement. - Determine femoral component
More informationComplications of Total Knee Arthroplasty
Progress in Clinical Medicine Complications of Total Knee Arthroplasty JMAJ 44(5): 235 240, 2001 Shinichi YOSHIYA*, Masahiro KUROSAKA** and Ryosuke KURODA*** *Director, Department of Orthopaedic Surgery,
More informationCanine Juvenile Orthopedic Disease
STEP 1: Comprehensive Overview Canine Juvenile Orthopedic Disease Jonathan Miller, DVM, MS, DACVS Oradell Animal Hospital Paramus, New Jersey Most juvenile orthopedic disease is developmental in nature,
More informationA NEW CONCEPT IN FUNCTIONAL ORTHOSES
A NEW CONCEPT IN FUNCTIONAL ORTHOSES THE KNEE in movement! Climbing stairs, walking and running are everyday actions that we can perform thanks to our knees. The knee joint is one of the most exposed and
More informationCONTRIBUTING SURGEON. Barry Waldman, MD Director, Center for Joint Preservation and Replacement Sinai Hospital of Baltimore Baltimore, MD
CONTRIBUTING SURGEON Barry Waldman, MD Director, Center for Joint Preservation and Replacement Sinai Hospital of Baltimore Baltimore, MD System Overview The EPIK Uni is designed to ease the use of the
More informationA Useful Reference Guide for the Stem Anteversion During Total Hip Arthroplasty in the Dysplastic Femur
A Useful Reference Guide for the Stem Anteversion During Total Hip Arthroplasty in the Dysplastic Femur Tadashi Tsukeoka, Yoshikazu Tsuneizumi, TaeHyun Lee. Chiba Rehabilitation Center, Chiba, Japan. Disclosures:
More informationDiagnosing Forelimb Lameness in Canine Patients
OCTOBER 2018 Diagnosing Forelimb Lameness in Canine Patients DR. SEVIMA AKTAY, VMD, DACVS Diagnosing and treating forelimb lameness in dogs can often be challenging. Our patients rarely demonstrate overt
More informationUniglide. Unicompartmental Knee Replacement Mk III surgical technique
Uniglide Unicompartmental Knee Replacement Mk III surgical technique Uniglide Contents Operative summary 4 Pre-operative assessment 6 Preparation 7 Incision 7 Approach 7 Medial procedure 8 Tibial preparation
More informationZimmer NexGen Tibial Stem Extension & Augmentation. Surgical Technique IMAGE TO COME. Stem Extensions and Augments
Zimmer NexGen Tibial Stem Extension & Augmentation Surgical Technique IMAGE TO COME Stem Extensions and Augments Zimmer NexGen Tibial Stem Extension & Augmentation Surgical Technique 1 Zimmer NexGen Tibial
More informationLateral femoral sliding osteotomy
Lateral femoral sliding osteotomy LATERAL RELEASE IN TOTAL KNEE ARTHROPLASTY FOR A FIXED VALGUS DEFORMITY J. Brilhault, S. Lautman, L. Favard, P. Burdin From Trousseau University Hospital of Tours, France
More informationCranial cruciate ligament rupture in Dogs
Clinical sheet - Surgery Cranial cruciate ligament rupture in Dogs Cranial cruciate ligament rupture is one of the most common orthopedic conditions in dogs. Rupture of the cranial cruciate ligament is
More informationSEVERE VARUS AND VALGUS DEFORMITIES TREATED BY TOTAL KNEE ARTHROPLASTY
SEVERE VARUS AND VALGUS DEFORMITIES TREATED BY TOTAL KNEE ARTHROPLASTY Th. KARACHALIOS, P. P. SARANGI, J. H. NEWMAN From Winford Orthopaedic Hospital, Bristol, England We report a prospective case-controlled
More informationBone grafting developments used in veterinary orthopaedics part two
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Bone grafting developments used in veterinary orthopaedics part two Author : John Innes, Peter Myint Categories : Vets Date
More informationTypes of Plates 1. New Dynamic Compression Plate: Diaphyseal fracture: Radius, Ulna, Humerus, Rarely tibia
Types of Plates 1. New Dynamic Compression Plate: DCP Diaphyseal fracture: Radius, Ulna, Humerus, Rarely tibia 1. Undercut adjacent to the holes low contact: less stress shield 2. Undercut at the undersurface
More informationOPERATIVE TECHNIQUE. Limb Reconstruction System. Part B: Correction of Deformities. By Dr. S. Nayagam
OPERATIVE TECHNIQUE 11 Limb Reconstruction System Part B: Correction of Deformities By Dr. S. Nayagam CONTENTS LIMB RECONSTRUCTION SYSTEM Part B: Correction of Deformities QUICK REFERENCE GUIDE... Page
More informationOperative Technique. by PROF. NAYAGAM. LIMB RECONSTRUCTION SYSTEM Part B: Correction of Deformities
Operative Technique by PROF. NAYAGAM LIMB RECONSTRUCTION SYSTEM Part B: Correction of Deformities 11 Quick Reference Guide CONTENTS LIMB RECONSTRUCTION SYSTEM Part A: General Principles Page N o I Introduction
More informationACTA VET. BRNO 2013, 82: ; doi: /avb
ACTA VET. BRNO 2013, 82: 215 218; doi:10.2754/avb201382020215 Radiographic changes of the patellar ligament in dogs after tibial tuberosity advancement Ladislav Stehlík 1, Pavel Proks 1, Petra Fedorová
More information