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Exam 4
Medial & Lateral Patellar Luxation
22
Veterinary Medicine
Professional
12/07/2016

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Cards

Term
What are the components of extensor mechanism of the stifle?
Definition
-quadriceps muscle group
-patella
-patellar tendon: inserts of the tibial tuberosity
Term
What is the purpose fo the trochlear groove on the distal femur?
Definition
-normal location for patella to sit
Term
What is the purpose of the trochlear ridges on the distal femur?
Definition
-help hold the patella in place
Term
What is a patellar luxation?
Definition
-occurs when the patella rides outside of the trochlear groove
Term
What etiologies are behind patellar luxation?
Definition
-trauma
-CONGENITAL
Term
Describe the presentation of congenital patellar luxation.
Definition
-small/toy breeds most common
-present at young age
-50% bilateral
-MPL >>>>>> LPL (if LPL occurs it is in large breed dogs)
Term
Is traumatic patellar luxation usually bilateral or unilateral?
Definition
-unilateral
Term
Describe the pathophysiology of medial patellar luxation?
Definition
-shallow/absent troclear groove
-malalignment of extensor mechanism
-abnormal hip joint conformation
-femoral malformation: angulation, rotational/torsional
-tibial malformation
-dviaiton of tibial crest
-quadriceps tightness
Term
Describe a Grade I medial patellar luxation.
Definition
-patella can be luxated, but returns to its normal position spontaneously
-functionally normal
Term
Describe a Grade II medial patellar luxation.
Definition
-patella luxates out of its groove occasionally
-can be replaced back into the groove with manipulation or reduces spontaneously
Term
Describe a Grade III medial patellar luxation.
Definition
-patella luxates out of its groove most of the time
-CAN BE REPLACED BACK INTO THE GROOVE
Term
Describe a Grade IV medial patellar luxation.
Definition
-patella luxates out of its groove all the time
-CANNOT BE REPLACED BACK INTO THE GROOVE
Term
What clinical presentation do we see for congenital medial patellar luxation?
Definition
-skipping
-kicks leg straight backwards (trying to pop it back into place)
-lameness
Term
What clinical presentation do we see with traumatic medial patellar luxation?
Definition
-acute, non-weight bearing lameness
Term
What do we do on physical exam with a medial patellar luxation?
Definition
-fully extend stifle joint
-internally rotate the tibia
-apply medially directed pressure to the patella as you begin to flex the stifle
Term
Why would we evaluate a medial patellar luxation for CrCL ligament tear?
Definition
-15-20% of patient with chronic MPL habe a CrCL tear
Term
When would we choose surgery to treat a medial patellar luxation?
Definition
-when the patient is clinically affected
Term
What soft tissue procedures can we use to treat medial patellar luxation?
Definition
-medial retinacular release
-lateral retinacular imbrication
Term
What are our surgical treatment options for medial patellar luxation?
Definition
-soft tissue procedures
-tibial crest transposition
-recession trochleoplasty
-corrective femoral/tibial osteotomies
-anti-rotational suture: lateral stabilization, patellofabellar suture
Term
How do we treat a grade 4 medial patellar luxation?
Definition
-distal femoral osteotomy
-proximal tibial osteotomy
Term
Describe the postop care for patellar luxation surgery.
Definition
-confinement for 8w
-modified robert jones for 2w
-pain control + OA
-recheck rads if TTT performed (K wire has to be removed)
Term
What is the prognosis for patellar luxation surgery?
Definition
-Good (Grade 1-3) & poor/guarded (grade 4)
-OA will continue to progress AT SAME RATE
-up to 50% can reluxate postop
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