When treating medial patellar luxation in dogs is a block trochleoplasty superior over a wedge trochleoplasty?

Published:

2022-07-15

Share
Open Access Logo

DOI

https://doi.org/10.18849/ve.v7i3.517

Abstract

PICO question

As part of the surgical correction for medial patellar luxation in dogs, which procedure results in a better outcome for the patient: block or wedge recession trochleoplasty?

 

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Three studies satisfied the inclusion criteria for answering the PICO; one cadaver study, one retrospective observational study and one clinical case series

Strength of evidence

Weak

Outcomes reported

Postoperative complications including reluxation rates.

Ex vivo: Trochlear groove depth, patella articular contact, percentage of recessed trochlear surface area, resistance to medial patella luxation

Conclusion

There is only weak evidence to support block recession trochleoplasty over wedge recession trochleoplasty as part of the surgical correction for medial patella luxation in dogs. Both procedures are associated with a good clinical outcome. There are some proposed benefits to trochlear block recession made from an ex vivo study comparing the two procedures. These include an increased patellar volume under the trochlear ridges when the stifle is extended. The articular contact and recessed trochlear surface area were also increased in the trochlear block recession group when compared to trochlear wedge recession. However, the clinical relevance of these perceived benefits remains unproven. In practice, and until prospective randomised controlled trials are carried out, veterinary surgeon preference and previous experience remain relevant factors in choosing which procedure to perform

 

How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

 

Open Access Peer Reviewed

References

Arthurs, G.I. & Langley-Hobbs, S.J. (2006). Complications associated with corrective surgery for patellar luxation in 109 dogs. Veterinary Surgery. 35(6), 559–566. DOI: https://doi.org/10.1111/j.1532-950x.2006.00189.x

Ballatori, C., Modenato, M. & Sbrana, S. (2005). Comparison of trochlear block recession and trochlear wedge recession in four dogs with bilateral patellar luxation. Annali della Facolta di Medicina Veterinaria di Pisa. 58, 295–303. [online]. Available from: http://eprints.adm.unipi.it/209/1/295.pdf [Accessed 26 May 2021].

Blackford-Winders, C. L., Daubert, M., Rendahl, A. K. & Conzemius, M. G. (2021). Comparison of Semi-Cylindrical Recession Trochleoplasty and Trochlear Block Recession for the Treatment of Canine Medial Patellar Luxation: A Pilot Study. Veterinary and Comparative Orthopaedics and Traumatology. 34(3), 183–190. DOI: https://doi.org/10.1055/s-0040-1721107

Cashmore, R. G., Havlicek, M., Perkins, N. R., James, D. R., Fearnside, S. M., Marchevsky, A. M. & Black, A. P. (2014). Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs. Veterinary and Comparative Orthopaedics and Traumatology. 27(4), 263–270. DOI: https://doi.org/10.3415/vcot-13-08-0100

Chase, D. & Farrell, M. (2010). Fracture of the lateral trochlear ridge after surgical stabilisation of medial patellar luxation. Veterinary and Comparative Orthopaedics and Traumatology. 23(3), 203–208. DOI: https://doi.org/10.3415/vcot-09-11-0117

Ellis, L.F. & House, A.K. (2021). Trochlear block recession sulcoplasty migration in a dog. Journal of Small Animal Practice. 62(9),823. DOI: https://doi.org/10.1111/jsap.13340

Gallegos, J., Unis, M., Roush, J. K. & Agulian, L. (2016). Postoperative Complications and Short-Term Outcome Following Single-Session Bilateral Corrective Surgery for Medial Patellar Luxation in Dogs Weighing <15 kg: 50 Cases (2009–2014). Veterinary Surgery. 45(7), 887–892.DOI: https://doi.org/10.1111/vsu.12525

Gibbons, S.E., Macias, C., Tonzing, M.A., Pinchbeck, G.L. & McKee, W.M. (2006). Patellar luxation in 70 large breed dogs. The Journal of Small Animal Practice. 47(1), 3–9. DOI: https://doi.org/10.1111/j.1748-5827.2006.00004.x

Johnson, A.L., Probst, C.W., Decamp, C.E., Rosenstein, D.S., Hauptman, J.G., Weaver, B.T. & Kern, T.L. (2001). Comparison of trochlear block recession and trochlear wedge recession for canine patellar luxation using a cadaver model. Veterinary Surgery. 30(2), 140–150. DOI: https://doi.org/10.1053/jvet.2001.21391

Talcott, K.W., Goring, R.L. & de Haan, J.J. (2000). Rectangular Recession Trochleoplasty for Treatment of Patellar Luxation in Dogs and Cats. Veterinary and Comparative Orthopaedics and Traumatology. 13(1), 39-43. DOI: https://doi.org/10.1055/s-0038-1632628

Slocum, B., Slocum, D.B., Devine, T. & Boone, E. (1982). Wedge recession for treatment of recurrent luxation of the patella: a preliminary report. Clinic Orthopaedics and Related Research. (164), 48–53.

Rossanese, M., German, A.J., Comerford, E., Pettitt, R., Tomlinson, A. & de Vicente, F. (2019). Complications Following Surgical Correction of Medial Patellar Luxation in Small-to-Medium-Size Dogs. Veterinary and Comparative Orthopaedics and Traumatology. 32(4), 332–340. DOI: https://doi.org/10.1055/s-0039-1683872

Vol. 7 No. 3 (2022): The third issue of 2022

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  /  Exotics  /