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Biomechanical Comparison of Soft Tissue Reconstructions in the Treatment of Medial Patellar Luxation in Dogs

  • Kim, Sang-Yeoun (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Moon, Hee-Sup (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Park, Sung-Guon (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Hong, Sung-Jin (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Choi, Hee-Bok (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Hwang, Tae-Sung (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Lee, Hee-Chun (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Hwang, Yong-Hyun (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Lee, Jae-Hoon (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University)
  • 투고 : 2017.10.28
  • 심사 : 2017.12.13
  • 발행 : 2017.12.31

초록

The present study aimed to document the biomechanical findings of soft tissue reconstruction surgeries for the treatment of medial patellar luxation in dogs. Stifle joints (n = 12) from dogs weighing 4.1-8.4 kg were used in this study. The following soft tissue reconstruction techniques used for the treatment of medial patellar luxation were selected for this study: vastus medialis release, medial retinacular release, and capsule release for medial realignment (n = 6), and retinacular imbrication and anti-rotational suture for lateral realignment (n = 6). A 5-kg traction using an electronic scale was applied at $45^{\circ}C$ laterally for medial realignment and medially for lateral realignment. Fluoroscopic imaging was used to measure the length of patellar displacement (LPD) in each technique. Among medial realignment techniques, capsule release had the highest horizontal LPD; vastus medialis release had significantly higher horizontal LPD than medial retinacular release. Vastus medialis release had the smallest increase statistically in vertical LPD, and vertical LPD did not differ significantly between medial retinacular and capsule release. Among lateral realignment techniques, the horizontal LPD was significantly higher in anti-rotational suture with retinacular imbrication than in retinacular imbrication alone, but the vertical LPD did not differ significantly between the two groups. Our findings indicated that vastus medialis release could decrease the medial tension on the patella without inducing patellar instability in dogs. Both medial retinacular and capsule release could increase patellar instability; moreover, medial retinacular release does not decrease the medial tension on the patella. Antirotational suture with retinacular imbrication provides more lateral tension than retinacular imbrication alone.

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참고문헌

  1. Aglietti P, Pisaneschi A, De Biase Pm. Recurrent dislocation of patella: three kinds of surgical treatment. Ital J Orthop Traumatol 1992; 18: 25-36.
  2. Alam MR, Lee HB, Kim MS, Kim NS. Surgical model of osteoarthritis secondary to medial patellar luxation in dogs. Vet Med 2011; 56: 123-130. https://doi.org/10.17221/3155-VETMED
  3. Antich TJ, Brewster CE. Modification of quadriceps femoris muscle exercises during knee rehabilitation. Phys Ther 1986; 66: 1246-1251. https://doi.org/10.1093/ptj/66.8.1246
  4. Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patellar luxation in 109 dogs. Vet Surg 2006; 35: 559-566. https://doi.org/10.1111/j.1532-950X.2006.00189.x
  5. Basmajian JV. Reeducation of vastus medialis: a misconception. Arch Phys Med Rehabil 1970; 51: 245-247.
  6. Bose K, Kanagasuntheram R, Osman MB. Vastus medialis oblique: an anatomic and physiologic study. Orthopedics 1980; 3: 880-883.
  7. Brinker WO, Piermattei DL, Flo GL. The Stifle Joint. In: Handbook of Small Animal Orthopedics and Fracture Repair, 4th ed. Philadelphia: Saunders, 2006: 516-580.
  8. Brwon NP, Bertocci GE, Marcellin-Little DJ. Development of a canine stifle computer model to evaluate cranial cruciate ligament deficiency. J Mech Med Biol 2013; 13: 1350043. https://doi.org/10.1142/S0219519413500437
  9. Cashmore RG, Havlicek M, Perkins NR, James DR, Fearnside SM, Marchevsky AM, Black AP. Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs. Vet Comp Orthop Traumatol 2014; 27: 263-270. https://doi.org/10.3415/VCOT-13-08-0100
  10. Conlan T, Garth WP, Jr, Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 1993; 75: 682-693. https://doi.org/10.2106/00004623-199305000-00007
  11. Dainer RD, Barrack RL, Buckley SL, Alexander AH. Arthroscopic treatment of acute patellar dislocations. Arthroscopy 1988; 4: 267-271. https://doi.org/10.1016/S0749-8063(88)80042-2
  12. DeAngelis M, Hohn RB. Evaluation of surgical correction of canine patellar luxation in 142 cases. J Am Vet Med Assoc 1970; 156: 587-594.
  13. DeCamp CE, Riggs CM, Olivier NB, Hauptman JG, Hottinger HA, Soutas-Little RW. Kinematic evaluation of gait in dogs with cranial cruciate ligament rupture. Am J Vet Res 1996; 57: 120-126.
  14. Denny HR, Minter HM. The long term results of surgery of canine stifle disorders. J Small Anim Pract 1973; 14: 695-713. https://doi.org/10.1111/j.1748-5827.1973.tb06408.x
  15. Dhaher YY, Kahn LE. The effect of vastus medialis forces on patello-femoral contact: a model-based study. J Biomech Eng 2002; 124: 758-767. https://doi.org/10.1115/1.1516196
  16. Flo GF, Brinker WO. Fascia lata overlap procedure for surgical correction of recurrent medial luxation of the patella in the dog. J Am Vet Med Assoc 1970; 156: 595-599.
  17. Fu YC, Torres BT, Budsberg SC. Evaluation of a threedimensional kinematic model for canine gait analysis. Am J Vet Res 2010; 71: 1118-1122. https://doi.org/10.2460/ajvr.71.10.1118
  18. Fulkerson JP, Shea KP. Disorders of patellofemoral alignment. J Bone Joint Surg Am 1990; 72: 1424-1429. https://doi.org/10.2106/00004623-199072090-00027
  19. Goh JC, Lee PY, Bose K. A cadaver study of the function of the oblique part of vastus medialis. J Bone Joint Surg Br 1995; 77: 225-231. https://doi.org/10.2106/00004623-199502000-00008
  20. Hulse DA. Pathophysiology and management of medial patellar luxation in the dog. Vet Med Small Anim Clin 1981; 76: 43-51.
  21. Johnson AL, Probst CW, Decamp CE, Rosenstein DS, Hauptman JG, Weaver BT, Kern TL. Comparison of trochlear block recession and trochlear wedge recession for canine patellar luxation using a cadaver model. Vet Surg 2001; 30: 140-150. https://doi.org/10.1053/jvet.2001.21391
  22. Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S, Lateral release of the patella: indications and contraindications. Am J Sports Med 1990; 18: 359-365. https://doi.org/10.1177/036354659001800405
  23. Lattermann C, Toth J, Bach BR, Jr. The role of lateral retinacular release in the treatment of patellar instability. Sports Med Arthrosc 2007; 15: 57-60. https://doi.org/10.1097/JSA.0b013e318042af30
  24. Lee TQ, Sandusky MD, Adeli A, McMahon PJ. Effects of simulated vastus medialis strength variation on patellofemoral joint biomechanics in human cadaver knees. J Rehabil Res Dev 2002; 39: 429-438.
  25. Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G. Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 2006; 14: 7-12. https://doi.org/10.1007/s00167-005-0631-z
  26. Remedios AM, Basher AW, Runyon CL, Fries CL. Medial patellar luxation in 16 large dogs. A retrospective study. Vet Surg 1992; 21: 5-9. https://doi.org/10.1111/j.1532-950X.1992.tb00003.x
  27. Richards CD. Surgical correction of medial patellar luxation: tibial crest transplantation and trochlear arthroplasty. Vet Med Small Anim Clin 1975; 70: 322-325.
  28. Roush JK. Canine patellar luxation. Vet Clin North Am Small Anim Pract 1993 23: 855-868. https://doi.org/10.1016/S0195-5616(93)50087-6
  29. Schulz KS. Disease of the Joints. In: Small animal surgery, 4th ed. St. Louis: Elsevier Mosby. 2013: 1353-1360.
  30. Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br 2005; 87: 577-582.
  31. Singleton WB. The surgical correction of stifle deformities in the dog. J Small Anim Pract 1969; 10: 59-69. https://doi.org/10.1111/j.1748-5827.1969.tb04021.x
  32. Slocum B, Devine T. Trochlear recession for correction of luxating patella in the dog. J Am Vet Med Assoc 1985; 186: 365-369.
  33. Tobias K, Johnston S, Sowaleski M, Boudrieau R, Pozzi A. Stifle joint. In: Veterinary surgery small animal, 1st ed. St. Louis Missouri: Saunders Elsevier 2012: 973-982.

피인용 문헌

  1. Surgical Correction of Medial Patellar Luxation including Release of Vastus Medialis without Trochleoplasty in Small Breed Dogs: A Retrospective Review of 22 Cases vol.35, pp.3, 2018, https://doi.org/10.17555/jvc.2018.06.35.3.71