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Diagnosis and management of a partial patella ligament rupture in a dog
Abstract
Patella ligament injuries are an uncommon cause of stifle disease in dogs. This report describes the diagnostic imaging and surgical management of a three-year-old working dog that was presented with a three week history of acute lameness, isolated to the stifle. Radiology and ultrasound were used to diagnose a partial tear to the musculotendinous insertion of the quadriceps tendon on the proximal patella. Also, a tear was present just proximal to the patella ligament insertion on the tibia. Surgical treatment was undertaken involving suturing the torn portion of the ligament and augmentation of the repair with orthopaedic wire. Post-operative complications included infection and wire irritation. Five months following surgery, the owners reported full functional recovery.
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Treatment of unilateral patellar ligament rupture resulting from laceration is described in three large dogs. Surgical repair involved debridement and suturing of the ligament ends. Augmentation was provided with encircling loops of 27 kg test monofilament nylon passed through transverse holes drilled in the patella and proximal tibial tuberosity. All of the dogs returned to a pre-injury level of activity without any lameness being observed when they were reevaluated five to 24 months after their operation. The method described is a useful technique for repair of patellar ligament rupture that produced excellent and enduring results in these cases.
Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases. We report the case of a 67-year-old man with bilateral ruptures of the patellar tendons caused by minor trauma and with a good functional end result.
Sonography of the musculoskeletal system in dogs and cats was undertaken to evaluate the application of this imaging procedure in orthopedics. In most of the patients a 7,5 MHz linear transducer was used because of its flat application surface and its resolving power. The evaluation of bone by sonography is limited, but sonography can provide addition information regarding the bone surface and surrounding soft tissue. Ultrasound is valuable for assessing joint disease. Joint effusion, thickening of the joint capsule and cartilage defects can be identified sonographically. It is also possible to detect bone destruction. Instabilities are often identified with the help of a dynamic examination. Soft tissue abnormalities of the musculoskeletal system lend themselves to sonographic evaluation. Partial or complete muscles or tendon tears are able to be differentiated and the healing process can be monitored. Most of the diseases that are in the area of the biceps or the achilles tendon, such as dislocation of the tendon, old injuries with scarification, free dissecates in the tendonsheath, tendinitis and/or tendosynovitis can be differentiated by sonography. In addition, with clinical and laboratory findings, it is often possible to make a correct diagnosis with ultrasound in patients with abscesses, foreign bodies, hematomas, soft tissue tumors and lipomas.
Ultrasonographic examination of the normal canine stifle joint was performed to characterize its normal anatomy. Stifles of four normal adult dogs were imaged in sagittal and transverse planes and each anatomic structure visualized was recorded. Normal anatomic structures consistently seen included the patellar tendon, medial and lateral menisci, the cranial cruciate ligament and femoral condyle cartilage. The caudal cruciate ligament was visualized in two dogs. Collateral ligaments and meniscal ligaments were not visualized. The dogs were then euthanized and each stifle was isolated. Following removal of superficial muscles and skin, each stifle was imaged in a water bath to definitively identify the structures that had previously been visualized on the live dogs. The ultrasonographic appearance of the isolated stifle specimens was similar to that found in live dogs. The results of this study indicate that ultrasound can be used to image the normal anatomy of the canine stifle. The echogenicity of the patellar ligament, cruciate ligaments, menisci and articular cartilage was similar to that previously reported in equine stifles and human knees.
When diagnosing disease of the stifle in dogs ultrasonography is a good addition to clinical and radiological examination. Radiology can evaluate the bony aspects of the joint and their relationship to each other. In contrast, sonography allows visualization of the soft tissue. For most evaluations the 7.5 MHz linear scanner is suited best. Normal stifles of 58 dogs of different breeds were evaluated using a standardized examination procedure. This procedure had been derived from that used in humans. The stifle is divided into several regions which are examined and evaluated. These are the suprapatellar, infrapatellar, lateral, caudal and medial region. One hundred twenty seven patients which had problems associated with the stifle joint were examined sonographically after a clinical and radiographic exam. Osteochondrosis dissecans, ruptured cranial cruciate ligament, meniscal damage, arthritis, tumor, post surgical conditions, injuries of the patella, patellar ligament or tibia1 tuberosity and luxating patella were examined sonographically and the findings recorded.
The case histories, treatment and post–operative progress of 297 dogs referred to this Department for investigation of stifle conditions between September 1968 and September 1972 are described with particular emphasis on the long term results of treatment.Résumé. Les antécédents commémoratifs, le traitement et les progrès postopératoires de 297 chiens, remis à ce département entre Septembre 1968 et Septembre 1972 pour investigation à l'égard de l'état du grasset, ont été décrits en mettant surtout l'emphase sur les résultats thérapeutiques à long terme.Zusammenfassung. Nachdrùcklich der langfristigen Behandlungsfolgen von Kniegelenke-Zustànden, sind Befunde, Behandlungen und postoperative Fortschritte der, von den zwischen September 1968 und September 1972 diesem Abteil zum Forschungszweck iiberreichten 297 Hunde, mit besonderem Hinweis auf Endergebnisse, dargestellt.
Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases. We report the case of a 67-year-old man with bilateral ruptures of the patellar tendons caused by minor trauma and with a good functional end result.
The function of muscle, tendons, and ligaments is to transmit tensile forces. Healing by scar tissue compromises this function because scar tissue is weaker and more elastic than the tissue it replaces. First intention healing is promoted by suturing with strong, inelastic materials (eg, monofilament nylon, polyesters, etc) in a locking loop or three-loop pulley pattern to prevent gap formation, maintain vascularity, and decrease adhesions. Postoperative care should include restriction of active motion to avoid rerupture or gap formation across the suture line during tensile loading. However, immobilization for 6 weeks results in a wound with approximately 50% the normal tensile strength for tendons and ligaments and "significant weakening" of muscles. Earlier tension across a muscle, ligament, or tendon wound orients the healing fibers and results in stronger healing. For example, medial collateral ligaments of canine stifles sutured with polyester suture in a locking loop pattern and immobilized for 3 weeks, followed by active motion, resulted in valgus-varus laxity 1.5 times of controls and in strength, 92% that of controls. In comparison, 6 weeks of immobilization resulted in valgus-varus laxity three times that of controls and in strength, 14% that of controls. Canine tendons immobilized for 3 to 6 weeks after surgery also have sufficient strength to allow active motion. Current knowledge of healing muscle, tendons, and ligaments suggests that postoperative immobilization for 3 weeks will allow acceptable return to function while minimizing the risk of rerupture. However, the amount and type of exercise allowed immediately after immobilization devices are removed should be severely limited, and increased gradually as time passes.
The stifle is a complex, condylar, synovial joint that allows motion in three planes. The complexity of the normal motion is directly related to the structure and functions of the anatomical components that form the joint. Alteration in any one of these components often leads to dysfunction as well as an increased risk of damage to other structures in the joint. Thus understanding of the normal anatomy and function of each stifle joint component is essential for proper diagnosis and treatment of any stifle joint injury. This review highlights the basic anatomy and function of the stifle joint components.
The value of ultrasonography in the diagnosis of lesions of the Achilles tendon was Investigated in 42 dogs and seven cats. A standardised four-part ultrasonographic examination was established. Linear transducers with a frequency of more than 7.5 MHz were used. Ultrasonography allowed identification and differentiation of total ruptures and the differentiation of partial ruptures into deep or superficial ruptures, or those comprising muscular tears. The healing process could be monitored and imaged using this technique. Suture material was readily visible in surgically treated cases. Displacement of the superficial digital flexor tendon could be identified. In such cases, the tendon tissue was seen either medially or laterally to the calcaneus. The healing process of the Achilles tendon could also be documented using ultrasonography. However, it was not possible to determine the age of the injury and the exact end of the healing process. Ultrasonography therefore proved to be an excellent diagnostic method for imaging lesions of the Achilles tendon and associated injuries in dogs and cats. After physical examination, the technique should be the next logical step in the evaluation of a suspected injury to the Achilles tendon.
The aim of the study was to investigate the long-term effects of postoperative immobilization as opposed to mobilization on the biomechanical attributes of healing Achilles tendons in a new experimental mouse model. In 114 Balb-C-mice the left Achilles tendon was transected and sutured by the Kirchmayr-Kessler technique. The tendons healed either under postoperative immobilization effected by fixing the upper ankle joint in equinus position or under mobilization through a limited range of movement. The contralateral Achilles tendons served as internal control. All tendons were tested biomechanically at short intervals up to the 112th postoperative day in terms of load to failure [N], tendon deflection [mm] and tendon stiffness [N/mm], and were evaluated histologically after 8 and 112 days. Postoperative mobilization resulted in a continuous and significantly more rapid restoration of load to failure in comparison to the immobilization group. Tendon deflection was decreased by postoperative mobilization, whereas under immobilization it paradoxically increased still further in the later course. After 112 days the tendons of the mobilization group had regained their original tendon stiffness, whereas the tendons after immobilization reached only about half the values seen in the control tendons. Histologically, postoperative mobilization led to increased immigration of inflammatory cells in the early phase. In the late phase, as compared to immobilization, tendon structure was more mature, with fibre bundles arranged in parallel and interposed tendocytes. Tensile loading of the healing tendon by postoperative mobilization leads to fundamental changes in the biological process of tendon healing resulting in accelerated restoration of load to failure and reduced tendon deflection.
A novel technique for the repair of a chronically lacerated patellar ligament in a pet greyhound is described. The injury had been sustained traumatically, and a previous surgical repair had proved unsuccessful. On further surgical investigation, identification of the ruptured ligament ends was not possible. A double fascia lata graft was employed to reconstruct the lateral and medial portions of the ligament. This repair was augmented with 27 kg monofilament nylon anchored through tunnels from the proximal tibia to the patella and quadriceps tendon. A concurrent skin deficit was managed with a superficial epigastric axial pattern flap. To the authors' knowledge, only one previous case requiring complete patellar ligament replacement has been documented in the veterinary literature. This report details a simplified surgical technique which may have advantages over the previously described technique.