Medial Patellar Desmotomy

INTRODUCTION

The patella is a large sesamoid bone which

develops in the tendon of quadriceps femoris
muscle .it is connected to the femur by
collateral ligament and to the cranial tibial
tuberosity by patellar ligaments. The patellar
ligaments are medial, middle and lateral .
 Stifle joint

• The stifle joint consist of two separate joints, the femoropatellar and
femorotibial joint is formed between the trochela of the femur and the
articular surface of the patella .
•The trochela is bounded by two oblique ridges ,medial and lateral.
•The medial ridge is longer and wider , especially at its proximate part
over which the fibrocartilage glides.
•The patella is a large sesamoid bone which develops in the tendon of
quadriceps femurs muscle .
•The patellar ligament, medial, middle and lateral are the continuations of
fibrous bands of quadriceps muscle to the cranial tibia tuberosity.
•The middle patellae ligament is thick and strong as compared to other
two ligaments. the medial patellar ligament is widely separated from the
middle patellar ligament at both the ends.
•The lateral patellar ligament is flat and lies close to the middle ligament
at both the extremities.
•Laxity of the patellar ligaments predisposes
the animal to upward fixation of the patella .

•Relaxed ligaments allow the patella to glide

freely on the articular surface of the trochlea.

•If the limb is overextended due to muscular

cramps or a confirmatory defect then the
patellar apex may get jammed between the
trochlear ridge this would lead to complete
extension of the limb in bovine.
Figure 1. Anatomy of right stifle joint , distal part of femur. A, medial patellar ligament. a,
position of desmotomy. B, middle patellar ligament. C, lateral patellar ligament. D, medial
collateral ligament . E, femur. F, patella. G, medial ridge of trochlea. H, lateral ridge of trochlea
(below lateral patellar ligament). I, tuberosity of tibia. J, notch between medial trochlear ridge
and femur.
 UPWARD FIXATION OF PATELLA(UFP)

•Upward fixation of patella occurs when medial patellar

ligament (MPL) becomes caught over the medial trochlear
ridge.
•If it becomes fixed in that position, the hind limb cannot
be flexed and the animal assumes a posture with the
affected limb extended in a caudally abducted position
with the fetlock flexed due to reciprocal apparatus.
•It occurs in cattle and horse.
•The condition is economically important as it reduce the
market value of the affected animal.
•The working bullocks are most often affected; however
the condition is also common in cows.
•The occurrence of upward patellar fixation was
lowest in summer season and highest in winter.

•The lameness immediately after the rest is the

most typical one symptoms.

•The condition my be unilateral or bilateral.

•In most cases , one of the limbs is affected more

of the other . therefore ,it is advisable to operate
on both the limbs even if only one limb is affected
at the time of surgery.
 Etiology.

•Major potential factors for patellar fixation in

cattle are “nutrition deficiency”.
•Exploitation activity.
•External traumas.
•Breed and Genetic predisposition.
•Morphological changes of the medial trochlea
ridge of the femur.
•Occupational trauma ,age of animal or climatic
conditions act only as secondary factors to
aggravate the signs following development of the
condition .
 CLINICAL SIGNS
• In bovines the posture of the animal is normal
while at rest but every attempt to move the animal
backwards is resisted. The affected limb is
brought forward with a jerky flexion on every
step. These signs disappear after few step but
reappear after prolonged rest.
• Some animals keep the limb in extension during
progression, raise the hindquarters on the
affected side. Some animals the symptoms are so
severe due to complete extension of the limbs,
that they are unable even to move.
 Treatment.
•Medial patellar ligament in stifle joint has surgical importance
for the medial patellar desmotomy during upward patellar
fixation.
• In bovines, most common and only successful treatment to

correct upward fixation of patella is medial patellar

desmotomy.
•It can be done by open or close methods.
• For the medial patellar desmotomy, usually stab/close

method is preferable, because of little or no hemorrhage, no

suturing, rapid healing with less postoperative complication.
•In some cases of blind method, two or more attempts to

severe the medial patellar ligament require during incomplete

severe of this ligament.
• In blind method, it is very important to identify the
medial patellar ligament which of course not an easy
task without having the knowledge of topographic
anatomy of this ligament through it becomes thick,
hard and less elastic during upward fixation of
patellar ligaments.
•Crushing sound and immediate relief of the
characteristic jerky flexions during progression is
the indication of a successful medial patellar
desmotomy.
• In bovine the subcutaneous division of the medial
patellar ligament is the common surgical treatment
to correct upward fixation of patella. Two types
1.open method 2.closed method
 OPEN METHOD

•Sedative with xylazine hydrochloride 0.1

mg/kg IM along with local anesthesia 5-8ml
LOX 2%.
•Restrain with a rope in lateral recumbency
with affected limb downward.
•Prepared aseptically for surgery.
• A small incision is made in the skin directly over the medial
ligament, in front of the medial tuberosity ,towards the cranial tibial
tuberosity. Index finger is passed into the wound and the skin
separated from the fascia all around the site. The fascia is dissected
to expose white glistening medial patellar ligament. The ligament is
exteriorized by passing curved scissors

• The ligament is then sectioned near its insertion using a knife. •

The cutaneous wound is sutured with one or two interrupted
sutures which are removed on 7th or & h post operative day.
Protrusion of the adipose tissue through the gape created by the
cut ends of ligament, cessation of crunching sound is a
indications of a successful mpd.
 CLOSE METHOD
•A stab incision made in to the skin with the B.p
blade in front of the medial tibial tuberosity.
Through the incision, the abscess knife, curved
probe pointed knife is passed flat wise, with its tip
fixed in a V shaped groove between the medial and
middle patellar ligament and the sharp edge of the
instrument is directed towards the ligament.

• The ligament is then transected by withdrawing

the knife towards the operator. • In bovine a piece
of the ligament is removed to prevent the reunion of
cut the ends of the ligament
Subcutaneous and deep infiltration with 8mL of 2% lignocaine
hydrochloride
over the medial and middle patellar ligaments
A 3 cm linear incision was made 0.5 cm lateral to the medial
patellar ligament near its insertion on the tibial tuberosity.
•Artery forceps were used to bluntly dissect the fascia from underneath the
medial patellar ligament, When the forceps could be under the medial
patellar ligament.
 Postoperative care.

•The postoperative therapy was given with the

systemic antibiotic with pain killer. The
antibiotic, penicillin-streptomycin combined
preparation was given. 2.5gm dicrysticin-s
powder was diluted with 10ml distilled water
and injected intra muscularly.
• As a Pain killer inj melonex 10-15ml was
given intramuscularly.
• Regular dressing of the wound was advised
with povidone iodine.
Thank You