Vet Comp Orthop Traumatol 2017; 30(01): 20-27
DOI: 10.3415/VCOT-16-07-0103
Original Research
Schattauer GmbH

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
1   Veterinary Medical Center of Long Island, West Islip, NY, USA
,
Michael P. Kowaleski
2   Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
,
Ann M. Peruski
3   Care Center, Cincinnati, OH, USA
,
Antonio Pozzi
4   Vetsuisse Faculty, University Zurich, Zurich, Switzerland
,
Jonathan Dyce
5   Department of Veterinary Clinical Sciences, Ohio State University, Columbus, OH, USA
,
Kenneth A. Johnson
6   Faculty of Veterinary Science, School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia
,
Randy J. Boudrieau
2   Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received: 14. Juli 2016

Accepted: 01. August 2016

Publikationsdatum:
26. Dezember 2017 (online)

Summary

Objective: To describe a cohort of dogs with medial patellar luxation managed with a distal femoral lateral closing wedge ostectomy (DFO) as a component of comprehensive treatment, and to report radiographic and long-term clinical outcome of this technique.

Methods: Medical records of dogs that had a lateral closing wedge DFO as part of management of medial patellar luxation at three veterinary teaching hospitals were reviewed. Surgical reports as well as the preoperative, postoperative, and follow-up radiographs were reviewed. The anatomical lateral distal femoral angle (aLDFA) was determined. Long-term clinical outcome was assessed by telephone interview with the owner.

Results: A lateral closing wedge DFO was performed on 66 limbs. The mean pre- and postoperative aLDFA was 107.6° ± 5.8° and 94.1° ± 4.2°, respectively. Cranial cruciate ligament disease was identified in 28/66 affected limbs. Tibial angular deformity, torsional deformity, or both was identified in nine of the 66 limbs. Ostectomy healing was confirmed radiographically in 51/66 limbs. The mean time to union was 73 ± 37 days. All patellae were in the normal position and stable. Complications included infection (2/51), fixation failure (1/51), delayed healing (2/51), and persistent lameness (1/51).

Clinical significance: In this cohort of cases, DFO was a highly successful and repeatable component of surgical treatment for dogs with medial patellar luxation associated with femoral varus. This study also provides more evidence of the high rate of concurrent cranial cruciate ligament disease in cases of medial patellar luxation complicated by fe-moral varus, and supports an association between stifle instability and medial patellar luxation.

* Note: The reviewing and processing of this paper was fully conducted by the Deputy Editorin-Chief Simon Roe, and was completely independent of any involvement of the Editor-in-Chief. Original Submission received under a different manuscript number on April 20, 2016.


 
  • References

  • 1 Ruble RP., Hird DW.. Congenital abnormalities in immature dogs from a pet store: 253 cases (1987-1988). J Am Vet Med Assoc 1993; 202: 633-636.
  • 2 Gibbons SE., Macias C., Tonzing MA.. et al. Patellar luxation in 70 large breed dogs. J Small Anim Pract 2006; 47: 3-9.
  • 3 Hayes AG., Boudrieau RJ., Hungerford LL.. Frequency and distribution of medial and lateral patellar luxation in dogs - 124 cases (1982-1992). J Am Vet Med Assoc 1994; 205: 716-720.
  • 4 Johnson AL., Broaddus KD., Hauptman JG.. et al. Vertical patellar position in large-breed dogs with clinically normal stifles and large-breed dogs with medial patellar luxation. Vet Surg 2006; 35: 78-81.
  • 5 Remedios AM., Basher AWP., Runyon CL.. et al. Medial patellar luxation in 16 large dogs - a retrospective study. Vet Surg 1992; 21: 5-9.
  • 6 Arthurs GI., Langley-Hobbs SJ.. Complications associated with corrective surgery for patellar luxation in 109 dogs. Vet Surg 2006; 35: 559-566.
  • 7 Bound N., Zakai D., Butterworth SJ.. et al. The prevalence of canine patellar luxation in three centres: clinical features and radiographic evidence of limb deviation. Vet Comp Orthop Traumatol 2009; 22: 32-37.
  • 8 Piermattei DL., Flo GL., Decamp CE.. Patellar luxation. In: Piermattei DL., Flo GL., Decamp CE.. editors. Handbook of Small Animal Orthopedics and Fracture Repair. 4th ed St. Louis: Saunders; 2006: 562-582.
  • 9 Hulse DA.. Pathophysiology and management of medial patellar luxation in the dog. Vet Med Small Anim Clin 1981; 76: 43-51.
  • 10 Willauer CC., Vasseur PB.. Clinical results of surgical correction of medial luxation of the patella in dogs. Vet Surg 1987; 16: 31-36.
  • 11 Slocum B., Slocum TD.. Patellar luxation algorithm. In: Bojrab M.. editor. Current Techniques in Small Animal Surgery. 4th ed Baltimore: Williams & Wilkins; 1998: 1222-1231.
  • 12 Dudley RM., Kowaleski MP., Drost WT., at al.. Radiographic and computed tomographic determination of femoral varus and torsion in the dog. Vet Radiol Ultrasound 2006; 47: 546-552.
  • 13 Peruski AM., Kowaleski MP., Pozzi A.. Treatment of medial patellar luxation and distal femoral varus by femoral wedge osteotomy in dogs: 30 Cases (2000-2005). Proceedings of the 2nd World Veterinary Orthopaedic Congress 2006. February 25-March 4 Keystone, CO, USA: 240.
  • 14 Roch SP., Gemmill TJ.. Treatment of medial patellar luxation by femoral closing wedge ostectomy using a distal femoral plate in four dogs. J Small Anim Pract 2008; 49: 152-158.
  • 15 Kaiser S., Cornely D., Golder W.. et al. The correlation of canine patellar luxation and the anteversion angle as measured using magnetic resonance images. Vet Radiol Ultrasound 2001; 42: 113-118.
  • 16 Swiderski JK., Palmer RH.. Long-term outcome of distal femoral osteotomy for treatment of combined distal femoral varus and medial patellar luxation: 12 cases (1999-2004). J Am Vet Med Assoc 2007; 231: 1070-1075.
  • 17 Kowaleski MP.. Femoral corrective osteotomy for medial patellar luxation. Proceedings of the Americal College of Veterinary Surgery Symposium 2006. October 5-7 Washington, DC, USA: 473-476.
  • 18 Tomlinson J., Fox D., Cook JL.. et al. Measurement of femoral angles in four dog breeds. Vet Surg 2007; 36: 593-598.
  • 19 Kowaleski MP., Boudrieau RJ., Pozzi A.. The stifle joint. In: Tobias KM., Johnson SA.. editors: Veterinary Surgery - Small Animal St. Louis, MO: Elsevier Saunders; 2012: 906-998.
  • 20 Langenbach A., Marcellin-Little DJ.. Management of concurrent patellar luxation and cranial cruciate ligament rupture using modified tibial plateau levelling. J Small Anim Pract 2010; 51: 97-103.
  • 21 Weh JL., Kowaleski MP., Boudrieau RJ.. Combination tibial plateau levelling osteotomy and transverse corrective osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs. Vet Surg 2011; 40: 670-686.
  • 22 Glaser D., Langlais F.. The ISOLS radiological implants evaluation system. In: Langlais F., Tomeno B.. editors. Limb Salvage: Major Reconstrucitons in Oncologic and Nontumoral Conditions Berlin, Germany: Springer; 1991: xxiii-xxi.
  • 23 Innes JF., Bacon D., Lynch C.. et al. Long-term outcome of surgery for dogs with cranial cruciate ligament deficiency. Vet Rec 2000; 147: 325-328.
  • 24 Hans EC., Kerwin SC., Elliott AC.. et al. Outcome following surgical correction of grade 4 medial patellar luxation in dogs: 47 stifles (2001-2012). J Am Anim Hosp Assoc 2016; 52: 162-169.