Canine Patella Luxation

The patient is positioned in lateral or dorsal recumbency under general anesthesia. A hanging limb technique with aseptic preparation and appropriate draping should be performed. The use of a stockinette or adherent impervious drape is recommended to keep the suture from coming in contact with the skin. This technique guide is demonstrating the use of Patella Sling Suture for surgical management of MPL, the opposite could be used for LPL.

A lateral parapatellar approach is performed. Make an incision along the patella ligament, starting proximal to patella, coursing down laterally to the tibial crest. Cut through subcutaneous tissue and tent deep fascia to make stab incision. Separate fascia from the joint capsule with stifle in extension. Inset: Perform arthrotomy along incision and luxate patella. You can perform this procedure using either a 5 mm Corkscrew® Suture Anchor with a knot being tied on the lateral femoral condyle or a knotless version using a 3.5 or 4.75 mm PEEK SwiveLock®.

Postoperative Care Suggestions:

• Cefazolin - 22 mg/kg IV 30 minutes prior to incision, 90 minutes later, then every 6 hours

• Cephalexin - 22-30 mg/kg orally every 8-12 hours for 10 days post-op

• Bandaging at your discretion (soft-padded bandage for at least 24 hours is typical)

• Restrict to kennel rest when unobserved and controlled muscle-building activities (i.e., leash-walking) for 8 weeks post-op

• Professional rehabilitation is encouraged

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1

A lateral parapatellar approach is performed. Make an incision along the patella ligament, starting proximal to patella, coursing down laterally to the tibial crest. Cut through subcutaneous tissue and tent deep fascia to make stab incision. Separate fascia from the joint capsule with stifle in extension. Inset: Perform arthrotomy along incision and luxate patella.

You can perform this procedure using either a 5 mm Corkscrew® Suture Anchor with a knot being tied on the lateral femoral condyle or a knotless version using a 3.5 or 4.75 mm PEEK SwiveLock®.

2

Determine if the trochlear groove needs to be deepened.Perform trochlear block resection or wedge resection if necessary.

3

Locate anchor placement in the lateral femoral condyle making sure the anchor is centered on the trochlear grove and caudal enough not to interfere with trochlear recession. Inset: Make an incision in the joint capsule so suture material is extracapsular.

4

Drill .045 K-wire where you will place the anchor in the lateral femoral condyle. Slide the 2.5 mm Cannulated Drill over the K-wire and drill. Drill a 1 cm deep bone tunnel.

5

Insert a Corkscrew Suture Anchor until horizontal laser line is flush with surface of the condyle and vertical laser line is positioned upward towards midline of the extent of the trochlear ridge.

6

Place the patella back into the trochlear groove.

7

Place an 18g needle from medial to lateral through the insertion of the quadricep tendon at the proximal pole of the patella. Slide the suture passer from lateral to medial through the needle then remove the needle. Pull one arm of the #5 FiberWire® through the quadricep tendon.

8

Place an 18g needle medial to the patella and slide the Tibial Suture Passer through. Pull the suture through soft tissue.

9

Place an 18g needle lateral to medial through the origin of the patella ligament at the distal pole of patella ligament. Slide the suture passer through the needle. Pull suture through soft tissue.

10

Tension the suture while applying pressure to the top of patella. Tie a surgeon's knot to prevent medial luxation but not to create excessive lateral tension that could result in lateral luxation. Put the stifle through range-of-motion to test tension. Close lateral fascia in "vest-over-pants" suture pattern.

10b

Alternative SwiveLock Anchor Application

Steps 1-3 Same as Corkscrew Suture Anchor method.

Step 4 Drill anchor location with 3.5 or 4.5 mm Drill, and make a stab incision in the joint capsule so suture material is extracapsular. Tap predrill hole using 3.5 or 4.5 mm Tap.

Step 5 Place the patella back into the trochlear groove.

Step 6 Place an 18g needle through the proximal pull of the patella ligament, slide the Tibial Suture Passer through the needle. Pull FiberTape® through soft tissue.

Step 7 Place an 18g needle medial to the patella and slide the suture passer through, pull suture through soft tissue.

Step 8 Place an 18g needle through the distal pull of the patella ligament, slide the suture passer through needle. Pull suture through soft tissue.

Step 9 Thread FiberTape through the eyelet of the SwiveLock, leaving slack so the eyelet can be placed into the bottom of predrilled hole. While holding the flange of the driver, turn the knob to insert SwiveLock into bone. Make sure anchor sits below the surface of the bone. Put the stifle through range-of-motion to test tension. Close fascia in "vest-over-pants" suture pattern.

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