Patellar ligament‐bone autograft for reconstruction of a distal patellar ligament defect in a dog

Abstract

A 3 · 5-year-old whippet was presented 4 weeks after sustaining a traumatic injury to the right stifle joint. A penetrating injury had resulted in patellar ligament (PL) rupture. Magnetic resonance imaging revealed a normal appearing proximal half of the PL and absence of normal fibres within the distal half of the ligament. Surgical repair involved reconstruction of the defect using an autogenous graft harvested from the medial third of the ipsilateral PL. This repair was augmented with a pedicle hamstring graft. A transarticular external skeletal fixator was used to protect the repair for 4 weeks. Seven months after surgery, the dog was able to exercise normally without lameness. To the author's knowledge, this is the first veterinary report of PL grafting of a PL defect, and the first report of surgical augmentation using a hamstring graft.

Patellar ligament rupture in the dog: repair methods and patient outcomes in 43 cases

“…Although several case reports (Bloomberg and Parker 1984, Aron and others 1997, Smith and others 2000, Gemmill and Carmichael 2003, Shipov 2008, Farrell and Fitzpatrick 2013) detail the treatment of RPL, only one case series has previously been published (Brunnberg and others 1993). The eight dogs in that study all received a form of sutured anastomosis with or without protection of the repair with a transpatellar or circumpatellar wire, and postoperative limb immobilisation with a padded splint.…”

“…At final assessment however, only one patient was reported to demonstrate a residual lameness. Subsequent isolated case reports have proposed modifications to the surgical techniques for repair of RPL including reconstruction with a PL graft (Farrell and Fitzpatrick 2013), the use of nylon rather than wire for the protection of the suture anastomosis (Smith and others 2000, Gemmill and Carmichael 2003), the use of a fascia lata or hamstring graft in the repair (Aron and others 1997, Gemmill and Carmichael 2003, Farrell and Fitzpatrick 2013) and postoperative immobilisation of the stifle with taESF (Bloomberg and Parker 1984, Aron and others 1997, Cabassu and others 2001, Shipov and others 2008, Farrell and Fitzpatrick 2013). …”

“…Stifle immobilisation following surgery to address RPL has been recommended (Piermattei and others 2006a, Kowaleski and others 2012, Farrell and Fitzpatrick 2013) and in this series was performed using EC (8 cases) or taESF (17 cases). Our data would support this recommendation for stifle immobilisation since 4 out of the 18 cases in which the stifle joint was not immobilised experienced a failure of repair compared with only one of the 25 cases immobilised either with taESF or EC.…”

“…The use of a fascia lata autograft, either to augment a primary PL repair or to span a defect in cases of chronic rupture, has also been described (Aron and others 1997, Gemmill and Carmichael 2003). Most recently, reconstruction of the PL using an ipsilateral PL graft augmented with a modified hamstring graft has been reported (Farrell and Fitzpatrick 2013). Postoperative immobilisation of the stifle joint has been recommended either by external coaptation (EC) (Piermattei and others 2006a) or placement of a transarticular external skeletal fixator (taESF) (Bloomberg and Parker 1984, Aron and others 1997, Cabassu and others 2001, Shipov and others 2008, Kowaleski and others 2012, Farrell and Fitzpatrick 2013).…”

Treating canine patellar ligament rupture

“…Reapposition of fibres should be possible in cases of acute RPL. Three cases of chronic RPL have been reported in which the ligament fibres were not apposable and connective tissue autografts were employed as patellar ligament replacements (Aron and others 1997, Gemmill and Carmichael 2003, Farrell and Fitzpatrick 2013). …”