[논문]Bilateral Patellar Groove Replacement in a Dog with Iatrogenic Trochlear Groove Damage

Kim, Yongrak; Park, Yunsik; Park, Jiyoung; Jeong, Seong Mok; Lee, Haebeom

doi:10.17555/jvc.2016.10.33.5.295

Bilateral Patellar Groove Replacement in a Dog with Iatrogenic Trochlear Groove Damage 원문보기

Journal of veterinary clinics = 한국임상수의학회지, v.33 no.5, 2016년, pp.295 - 299

Kim, Yongrak (College of Veterinary Medicine, Chungnam National University) , Park, Yunsik (College of Veterinary Medicine, Chungnam National University) , Park, Jiyoung (College of Veterinary Medicine, Chungnam National University) , Jeong, Seong Mok (College of Veterinary Medicine, Chungnam National University) , Lee, Haebeom (College of Veterinary Medicine, Chungnam National University)

Abstract ▼ AI-Helper

A 2-year-old, 1.94 kg spayed female Toy Poodle was referred for revision surgery for patellar reluxation following surgery for bilateral medial patellar luxation (MPL). Intermittent non-weight-bearing lameness of the right hindlimb and weight-bearing lameness of the left hindlimb were evident on general inspection. A physical examination revealed that there was a bilateral grade 4 MPL. On radiographs, the medial and lateral trochlear ridge was bilaterally worn out. Patellar groove replacement (PGR) was performed in two stages to replace the bilateral femoral trochlea that had a severely worn out groove. Corrective femoral osteotomy with increasing anteversion angle, tibial tuberosity transposition, medial releasing, lateral imbrications and PGR were performed on the right hindlimb. Six months after surgery on the right hindlimb, a PGR prosthesis was positioned medially on the frontal plane and tibial tuberosity transposition and lateral imbrications were performed on the left hindlimb. Two weeks after surgery, reluxation of the patella occurred on the left hindlimb. The tibial tuberosity transposition was performed to realign the patella more laterally than the previous surgery, and a patellar sling was applied. Two years after the last surgery, the patient showed no pain on the stifle joint and satisfactory weight-bearing ambulation. Reluxation did not recur. PGR maybe a successful treatment for dogs with iatrogenically damaged and/or worn out patellar grooves.

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문제 정의

The objective of this case report is to describe the surgical technique and long-term outcome of applying the PGR with and without femoral corrective osteotomy on the right and left hindlimbs, of patients with bilateral iatrogenic trochlear groove damage.

제안 방법

In the present case, the patient had a condition of intermittent non-weight-bearing lameness of the right hindlimb and weight-bearing lameness of the left hindlimb before surgery. However, when the patella was stably positioned on the prosthesis using PGR, the patient showed functional recovery through two years of follow-up. Although the patient was shown to achieve acceptable ambulation without pain in this case, enthesophytes were observed at the patellar articular surface in the two year postoperative radiographs, and the range of motion in the stifle joint was decreased by progressive osteoarthritis.
The femoral anteversion angle increased from 10° preoperatively to 30° postoperatively (Fig 3H and I). The patient performed exercise restriction and gentle passive range of motion for six weeks. Five months after surgery, the lateral bone plate and screws were removed from the right hindlimb.
The patient underwent epidural anesthesia with 2% lidocaine (1 ml/4.5 kg, Lidocaine Hcl Dalhan Inj®, Dai Han Pharm, Korea).

대상 데이터

A 2-year-old, 1.94 kg, intact female, Toy poodle was referred with lameness after correction of bilateral MPL at a local animal hospital eight months ago. Intermittent non-weight-bearing lameness of the right hindlimb and weightbearing lameness of the left hindlimb was evident on general inspection.
In this case, osteotomy of the trochlea for exposing the fresh cancellous bone was impossible because the trochlear groove was almost worn out iatrogenically. Furthermore, the patient was a small toy breed dog weighing 1.9 kg. Therefore, the fibrous tissue and osteophyte was removed, and the trochlea was flattened using a high speed burr.

성능/효과

Five months after surgery, the lateral bone plate and screws were removed from the right hindlimb. Six months after surgery, the clinical function of the right hindlimb was significantly improved without lameness and there were no complications associated with surgery (Table 1). A staged surgery was performed on the left hindlimb.

후속연구

Corrective femoral osteotomy is necessary to correct bone deformity; however, the quadriceps mechanism can be aligned by adjusting the position of the PGR prosthesis without corrective femoral osteotomy. However, more research is necessary to determine whether patients with bone deformity may benefit from this technique without corrective femoral osteotomy.

참고문헌 (21)

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Bilateral Patellar Groove Replacement in a Dog with Iatrogenic Trochlear Groove Damage 원문보기

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Bilateral Patellar Groove Replacement in a Dog with Iatrogenic Trochlear Groove Damage 원문보기

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