Proximo-distal patellar position in three small dog breeds with medial patellar luxation

2015 ◽  
Vol 28 (04) ◽  
pp. 270-273 ◽  
Author(s):  
L. F. H. Theyse ◽  
H. A. W. Hazewinkel ◽  
C. Wangdee
Keyword(s):  
Clinical Significance ◽  
Ligament Length ◽  
Patellar Ligament ◽  
Trochlear Groove ◽  
Stifle Joint ◽  
Patellar Position ◽  
The Mean

SummaryIntroduction: Medial patellar luxation is thought to be associated with a high proximal position of the patella in the trochlear groove.Objective: To determine whether the ratio of patellar ligament length and patellar length (L:P) is influenced by the stifle angle (75°, 96°, 113°, 130°, and 148°) in small dog breeds and to compare the L:P ratio in dogs of three small dog breeds with and without medial patellar luxation.Methods: A mediolateral radiograph of the stifle joint was used to measure the L:P ratio in the stifle joints of dogs of three small breeds with and without medial patellar luxation. The L:P ratio was evaluated at five stifle angles (75°, 96°, 113°, 130°, and 148°) in 14 cadavers (26 stifle joints) of small dog breeds in order to identify the best stifle angle to measure the L:P ratio. Then the mean ± SD L:P ratio was calculated for normal stifles and stifles with medial patellar luxation grades 1, 2, and 3 in 194 Pomeranians, 74 Chihuahuas, and 41 Toy or Standard Poodles.Results: The L:P ratio was the same for all five stifle angles in the cadavers (p = 0.195). It was also not significantly different in the three breeds (p = 0.135), in normal and medial patellar luxation-affected stifles overall (p = 0.354), and in normal and medial patellar luxation-affected joints within each breed (p = 0.19).Clinical significance: We conclude that a proximo-distal patellar position is not associated with medial patellar luxation in Pomeranians, Chihuahuas, and Toy or Standard Poodles. Thus a longer patellar ligament length does not play a role in the pathophysiology of medial patellar luxation in these small dog breeds.

scholarly journals Examination of the proximodistal patellar position in small dogs in relation to anatomical features of the distal femur and medial patellar luxation

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252531
Author(s):  
Sawako Murakami ◽  
Masakazu Shimada ◽  
Yasuji Harada ◽  
Yasushi Hara
Keyword(s):  
Distal Femur ◽  
Femoral Condyle ◽  
Case Series ◽  
Ligament Length ◽  
Patellar Ligament ◽  
Control Group ◽  
Retrospective Case ◽  
Anatomical Features ◽  
Stifle Joint ◽  
Patellar Position

Objective To determine the influence of anatomical features of the distal femur on the proximodistal patellar position and compare the proximodistal patellar position between dogs with and without medial patellar luxation (MPL). Study design Retrospective case series (n = 71). Methods Mediolateral-view radiographs of clinical cases of dogs weighing less than 15 kg were obtained. The stifle joint angle, patellar ligament length, patellar length, size of the femoral condyle, trochlear length, and trochlear angle were measured and included in multiple linear regression analyses to ascertain their effects on the proximodistal patellar position. Radiographs were divided into MPL and control groups. The effects of MPL on the proximodistal patellar position and morphological factors were also examined. Results The final model for the proximodistal patellar position revealed that the patella became distal as the ratio of the patellar ligament length to patellar length decreased, the trochlear angle relative to the femur increased, the trochlear length relative to the patellar length increased, or the trochlear length relative to the femoral condyle width decreased. The proximodistal patellar position in the MPL group was not significantly different from that in the control group despite the trend towards a distally positioned patella (p = 0.073). The MPL group showed a significantly shorter trochlea (p<0.001) and greater trochlear angle relative to the femur (p = 0.029) than the control group. Conclusion The proximodistal patellar position depends on multiple factors, and its determination based on PLL/PL alone may not be appropriate. Dogs with MPL did not have a proximally positioned patella compared with dogs without MPL. Although hindlimbs with MPL had a shorter trochlea than those without patellar luxation, this difference did not appear to be sufficient to displace the patellar position proximally in small dogs, possibly compensated by increased trochlear angle relative to the femur.

Effect of Medialization of the Trochlear Groove and Lateralization of the Tibial Tubercle on TT-TG Distance: A Cross-sectional Study of Dysplastic and Nondysplastic Knees

2021 ◽  
pp. 036354652098781
Author(s):  
Mathias Paiva ◽  
Lars Blønd ◽  
Per Hölmich ◽  
Kristoffer Weisskirchner Barfod
Keyword(s):  
Trochlear Dysplasia ◽  
Cross Sectional Study ◽  
Magnetic Resonance Images ◽  
Tibial Tubercle ◽  
Control Group ◽  
Trochlear Groove ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mean Values ◽  
The Mean

Background: Tibial tubercle–trochlear groove (TT-TG) distance is often used as a measure of lateralization of the TT and is important for surgical planning. Purpose: To investigate if increased TT-TG distance measured on axial magnetic resonance images is due to lateralization of the TT or medialization of the TG. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 84 knees (28 normal [NK], 28 with trochlear dysplasia [TD], and 28 with patellar dislocation without TD [PD]) were examined. The medial border of the posterior cruciate ligament (PCL) was chosen as the central anatomic landmark. The distance from the TT to PCL (TT-PCL) was measured to examine the lateralization of the TT. The distance from the TG to the PCL (TG-PCL) was measured to examine the medialization of the TG. Between-group differences were investigated by use of 1-way analysis of variance. Results: The mean values for TT-TG distance were 8.7 ± 3.6 mm for NK, 12.1 ± 6.0 mm for PD, and 16.7 ± 4.3 mm in the TD group ( P < .01). The mean values for TT-PCL distance were 18.5 ± 3.6 mm for NK, 18.5 ± 4.5 mm for PD, and 21.2 ± 4.2 mm in the TD group ( P = .03). The mean values for TG-PCL distance were 9.6 ± 3.0 mm for NK, 7.1 ± 3.4 mm for PD, and 5.1 ± 3.3 mm in the dysplastic group ( P < .01). Conclusion: The present results indicate that increased TT-TG distance is due to medialization of the TG and not lateralization of the TT. Knees with TD had increased TT-TG distance compared with the knees of the control group and the knees with PD. The TT-PCL distance did not differ significantly between groups, whereas the TG-PCL distance declined with increased TT-TG.

scholarly journals Arthroscopic Articular Cartilage Scores of the Canine Stifle Joint with Naturally Occurring Cranial Cruciate Ligament Disease

2020 ◽  
Author(s):  
Kimberly A. Agnello ◽  
Kei Hayashi ◽  
Dorothy Cimino Brown
Keyword(s):  
Articular Cartilage ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Meniscal Tear ◽  
Trochlear Groove ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Naturally Occurring ◽  
Medial Meniscal Tear ◽  
Severity Scores

Abstract Objective This study aimed to evaluate frequency, location and severity of cartilage pathology in dogs with naturally occurring cranial cruciate ligament (CCL) disease. Study Design Stifle arthroscopic video recordings (n = 120) were reviewed. A modified Outerbridge classification system (MOCS) (0–4) was used to score cartilage at 10 locations in the femorotibial (medial and lateral femoral condyles and tibial plateaus) and patellofemoral compartments (proximal, middle and distal locations of the patella and femoral trochlear groove) of the stifle joint. Synovial pathology was scored and the presence of a medial meniscal tear was recorded. A Kruskal–Wallis test was used to evaluate association of location and synovitis with cartilage score; and presence of meniscal tear with cartilage and synovitis scores. Bonferroni correction was utilized and p < 0.05 was considered significant. Results Cartilage pathology and synovitis were identified in all joints. Overall cartilage severity scores were low (median MOCS 1). The median MOCS of the proximal trochlear groove (2) was significantly higher than all other locations evaluated. Higher synovitis scores were significantly associated with higher cartilage severity scores and a medial meniscal tear had no association with cartilage severity scores or synovitis. Conclusion Arthroscopic articular cartilage lesions are common in dogs with CCL disease at the time of surgical intervention, although the severity of cartilage damage is mild. The proximal trochlear groove of the femur had the most severe cartilage score in the stifle joint.

scholarly journals SPONTANEOUS CORRECTION OF EXTERNAL TIBIOFEMORAL ROTATION AND TIBIAL TUBEROSITY-TROCHLEAR GROOVE DISTANCE OCCURS AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN FIXED OR OBLIGATORY DISLOCATORS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0013
Author(s):  
Alexandra H. Aitchison ◽  
Kenneth M. Lin ◽  
Daniel W. Green
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Extensor Mechanism ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Force Vector ◽  
Tibiofemoral Rotation ◽  
The Mean

Background: Tibial tubercle to trochlear groove distance (TT-TG) and external tibiofemoral rotation (TFR) through the knee joint have been identified potential contributing factors to patellar instability. In patients with a fixed or obligatory lateral patella dislocation (FOD), the normal force vector of the extensor mechanism is altered, so instead of a direct axial pull to cause extension, it exerts a lateralizing and external rotatory force on the tibia via the tibial tubercle. Hypothesis/Purpose: The purpose of this study is to investigate postoperative changes in TT-TG and TFR after medial patellofemoral ligament reconstruction (MPFLR) in two clinical cohorts: standard traumatic patellar instability (SPI) patients and FOD patients. We hypothesized that by surgically relocating the patella in the trochlea, and re-establishing medial sided soft tissue tension, the increased medializing force vector on the patella may exert enough force to alter resting rotation of the tibia in relation to the femur in the FOD group. Methods: A retrospective study was performed from April 2009 to February 2019. FOD and SPI patients under 18 years with available magnetic resonance imaging (MRI) of the knee before and after MPFLR were eligible. All FOD patients in the time frame were analyzed and SPI patients were randomly selected. Exclusion criteria were outside institution MRI, concomitant alignment procedures done at the time of MPFLR, and prior MPFLR or tibial tubercle osteotomy. TT-TG and TFR (using the posterior femoral and tibial condylar lines) were measured blindly on initial axial MRI. Statistical analysis using a paired sample t-test was performed with significance set at p<0.05. Results: A total of 30 patients were included, 14 in the FOD group and 16 in the SPI group. The mean age at time of surgery was 13.9 years (range 10-17 years), 53% of the cohort was female, and the mean time from surgery to follow-up MRI was 2.0 years. Demographics by group are shown in Table 1. TT-TG and TFR were not significantly different preoperatively versus postoperatively in the SPI group (Table 2). In the FOD group, both TT-TG (17.7 vs 13.7, P=.019) and TFR (8.6 vs 3.1, P=.025) decreased significantly on postoperative MRI. Conclusion: The postoperative decrease in TT-TG and TFR in the FOD group suggests that MPFLR in fixed or obligatory dislocators can improve the external rotation deformity through the level of the joint, and thus may help normalize the forces acting through the extensor mechanism. Tables/ Figures [Table: see text][Table: see text]

Internal Fixation of Lateral Trochlear Groove Osteochondritis Dissecans With Simultaneous Lateral Retinacular Lengthening in Adolescent Athletes

2021 ◽  
pp. 036354652110478
Author(s):  
Dhong Won Lee ◽  
Joon Kyu Lee ◽  
Young Chang Cho ◽  
Sang Jin Yang ◽  
Seung Ik Cho ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Vertical Jump ◽  
Lysholm Score ◽  
Trochlear Groove ◽  
Adolescent Athletes ◽  
Isokinetic Muscle Strength ◽  
Subjective Score ◽  
The Mean ◽  
Tegner Activity Scale

Background: The goals of operative treatment for the adolescent athlete with unstable osteochondritis dissecans (OCD) lesion are rigid fixation and prevention of recurrence. Purpose: To evaluate clinical and radiological outcomes of internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening. Study Design: Case series; Level of evidence, 4. Methods: Adolescent athletes who had undergone internal fixation and simultaneous lateral retinacular lengthening for an unstable OCD lesion of the lateral trochlear groove were retrospectively reviewed. Subjective assessments included the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Tegner activity scale, and an athletic questionnaire. Functional tests included isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance. Pre- and postoperative radiographs and magnetic resonance images were reviewed. Results: The mean ± SD age of the 17 patients included in this study was 15.9 ± 0.9 years; last clinical follow-up duration was 37.7 ± 8.1 months. At the last follow-up, the Lysholm score improved from 68.7 ± 15.3 to 93.4 ± 12.4 and the IKDC subjective score from 60.2 ± 14.7 to 88.7 ± 12.7 ( P < .001). The mean Tegner activity scale score was 9.4 ± 0.5 before injury and 8.9 ± 1.2 at the last follow-up ( P = .059). The limb symmetry indices of isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance improved at the last follow-up; the mean limb symmetry index was ≥85% in each functional test. Regarding the athletic questionnaire, 16 (94.1%) patients were satisfied with the surgery. At the last follow-up, 2 patients had higher ability after returning to sports, 11 had the same ability, and 3 had lower ability than the preinjury level. Postoperative magnetic resonance imaging at 12-month follow-up showed that the OCD lesion appeared healed in 7 (41.2%) patients and partially healed in 9 (52.9%). Conclusion: Internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening in adolescent athletes achieved satisfactory clinical and radiological outcomes. Therefore, this combined surgical technique could be considered an effective treatment for lateral trochlear groove OCD, with a high rate of return to sport.

Radiographic evaluation of patellar ligament length after tibial plateau leveling osteotomy in dogs

2019 ◽  
Vol 80 (6) ◽  
pp. 607-612
Author(s):  
Maureen R. Jay ◽  
John S. Mattoon ◽  
Peter J. Gilbert ◽  
Ty T. Tanaka ◽  
Brenda L. Beaty
Keyword(s):  
Tibial Plateau ◽  
Ligament Length ◽  
Patellar Ligament ◽  
Radiographic Evaluation

The Difference between Computed Tomography and Magnetic Resonance Imaging Measurements of Tibial Tubercle–Trochlear Groove Distance for Patients with or without Patellofemoral Instability: A Systematic Review and Meta-analysis

2019 ◽  
Vol 33 (08) ◽  
pp. 768-776 ◽  
Author(s):  
Si Heng Sharon Tan ◽  
Beatrice Ying Lim ◽  
Kiat Soon Jason Chng ◽  
Chintan Doshi ◽  
Francis K.L. Wong ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Patellofemoral Instability ◽  
Tibial Tubercle ◽  
Control Group ◽  
Trochlear Groove ◽  
Resonance Imaging ◽  
The Mean ◽  
Ct And Mri

AbstractThe tibial tubercle–trochlear groove (TT–TG) distance was originally described for computed tomography (CT) but has recently been used on magnetic resonance imaging (MRI) without sufficient evidence demonstrating its validity on MRI. The current review aims to evaluate (1) whether there is a difference in the TT–TG distances measured using CT and MRI, (2) whether both the TT–TG distances measured using CT and MRI could be used to differentiate between patients with or without patellofemoral instability, and (3) whether the same threshold of 15 to 20 mm can be applied for both TT–TG distances measured using CT and MRI. The review was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRSIMA) guidelines. All studies that compared TT–TG distances either (1) between CT and MRI or (2) between patients with and without patellofemoral instability were included. A total of 23 publications were included in the review. These included a total of 3,040 patients. All publications reported the TT–TG distance to be greater in patients with patellofemoral instability as compared to those without patellofemoral instability. This difference was noted for both TT–TG distances measured on CT and on MRI. All publications also reported the TT–TG distance measured on CT to be greater than that measured on MRI (mean difference [MD] = 1.79 mm; 95% confidence interval [CI]: 0.91–2.68). Pooling of the studies revealed that the mean TT–TG distance for the control group was 12.85 mm (95% CI: 11.71–14.01) while the mean TT–TG distance for patients with patellofemoral instability was 18.33 mm (95% CI: 17.04–19.62) when measured on CT. When measured on MRI, the mean TT–TG distance for the control group was 9.83 mm (95% CI: 9.11–10.54), while the mean TT–TG distance for patients with patellofemoral instability was 15.33 mm (95% CI: 14.24–16.42). Both the TTTG distances measured on CT and MRI could be used to differentiate between patients with and without patellofemoral instability. Patients with patellofemoral instability had significantly greater TT–TG distances than those without. However, the TT–TG distances measured on CT were significantly greater than that measured on MRI. Different cut-off values should, therefore, be used for TT–TG distances measured on CT and on MRI in the determination of normal versus abnormal values. Pooling of all the patients included in the review then suggest for 15.5 ± 1.5 mm to be used as the cut off for TT–TG distance measured on CT, and for 12.5 ± 2 mm to be used as the cut-off for TT–TG distance measured on MRI. The Level of evidence for this study is IV.

Modelling the Effects of Cranial Cruciate Ligament Transection, Medial Meniscal Release and Triple Tibial Osteotomy on Stability of the Canine Stifle Joint

2020 ◽  
Vol 33 (03) ◽  
pp. 174-182
Author(s):  
Tanja V. Jensen ◽  
Signe S. Kristiansen ◽  
Lene E. Buelund ◽  
James E. Miles
Keyword(s):  
Ex Vivo ◽  
Cruciate Ligament ◽  
Patellar Ligament ◽  
Tibial Osteotomy ◽  
Joint Angles ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Wide Range ◽  
Loading Ratio ◽  
Canine Stifle

Abstract Objective The aim of this study was to evaluate the ex vivo effects of sequential cranial cruciate ligament transection (CCLx), medial meniscal release (MMR) and triple tibial osteotomy (TTO) on canine stifle stability compared with the intact state, across a wide range of joint angles. Study Design Nine right hind limb preparations were instrumented to provide constant quadriceps and gastrocnemius loads in a 3:1 ratio, and extended from full flexion during fluoroscopic recording. Recordings were repeated after each of CCLx, MMR and TTO. Fluoroscopic landmarks were used to calculate tibial subluxation and patellar ligament angle. Results Medial meniscal release resulted in additional cranial tibial subluxation compared with CCLx. Triple tibial osteotomy restored stifle stability up to a joint angle of 125 degrees. The presence of the crossover angle could be inferred from the patellar ligament angle and subluxation curves. Conclusion Our results suggest that in the cranial cruciate ligament-deficient stifle, the crossover angle at which loading shifts between the caudal and cranial cruciate ligaments is dependent on both loading and integrity of the medial meniscus. Triple tibial osteotomy improves stifle stability over a wide range of joint angles under a quadricep to gastrocnemius loading ratio of 3:1 by converting cranial tibial thrust to caudal tibial thrust, due to TTO increasing the amount of joint extension required to reach the crossover angle.

scholarly journals Radiographic assessment of the proximal tibial angles in dogs and cats with and without cranial cruciate ligament rupture

2018 ◽  
Vol 38 (6) ◽  
pp. 1190-1195 ◽  
Author(s):  
Ana Flávia D.P. Arruda ◽  
Leonardo A.L. Muzzi ◽  
Antonio C.C. Lacreta Junior ◽  
Ruthnéa A.L. Muzzi ◽  
Gabriela R. Sampaio ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Patellar Ligament ◽  
Common Tangent ◽  
Cranial Cruciate Ligament ◽  
Mean Values ◽  
Stifle Joint ◽  
Significant Difference ◽  
Tangent Method ◽  
Healthy Dogs

ABSTRACT: The influence of the proximal tibial angles in the cranial cruciate ligament (CCL) rupture in dogs is still controversial, and little is known regarding this topic in cats. The aim of this study was to evaluate and compare the angles of the proximal portion of the tibia in dogs and cats with and without CCL rupture. Retrospective and prospective radiographs of the stifle joints were obtained and divided into four groups. Group 1 was composed of 70 stifle joint images of dogs without orthopedic disorders (healthy dogs), group 2 had 70 stifle joint images of dogs with CCL rupture, group 3 had 50 stifle joint images of cats without orthopedic disorders (healthy cats) and group 4 had 25 stifle joint images of cats with CCL rupture. Radiographs were taken with the stifle joint in the mediolateral projection, positioned at the angle of hind limb support. Between the two groups of dogs evaluated, the dogs with CCL rupture had statistically greater tibial plateau angle (TPA) compared with healthy dogs. No difference was shown in relation to the TPA between healthy cats and cats with CCL rupture. In relation to the patellar ligament angle by tibial plateau method the values for the healthy dogs were significantly higher than those for the CCL ruptured dogs. Similarly, healthy cats had significantly higher mean values than cats with CCL rupture. In the patellar ligament angle by common tangent method there was no significantly difference between the two groups of dogs. Between the two groups of cats, animals with CCL rupture had statistically higher mean values than healthy cats. In general, the groups of dogs showed higher mean values than the groups of cats. For the patellar ligament insertion angle (PLIA) healthy dogs showed a significantly higher mean than dogs with CCL rupture. There was no significant difference between the groups of cats. In conclusion, the TPA and the PLIA possibly influence the etiology of CCL rupture in dogs but not in cats. The low patellar ligament angle measured by common tangent method may favorably influence the reduced incidence of CCL rupture in cats.

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