Teknik Operasi Luksasi Patella - 3A

ILMU BEDAH VETERINER KHUSUS
“TEKNIK OPERASI LUKSASI PATELA”
DISUSUN OLEH:
KELOMPOK 3A
1. Ni Putu Dyah Prashanti P 1809511010
2. Kresensia Cyntia Dosom 1809511011
3. Ni Putu Tiara Indriana 1809511012
4. Silvester Yesa G Palangan 1809511014
FAKULTAS KEDOKTERAN HEWAN
UNIVERSITAS UDAYANA
DENPASAR 2021
KATA PENGANTAR
Puji syukur kami haturkan kehadirat Tuhan Yang Maha Esa atas segala limpahan rahmat
dan hidayah-Nya sehingga Paper “ Teknik Operasi Luksasi Patela” ini dapat diselesaikan tepat
waktu. Makalah ini dibuat dalam rangka menyelesaikan tugas yang akan dijadikan landasan dalam
penilaian softskill pada proses pembelajaran MataKuliah Ilmu Bedah Khusus Veteriner Fakultas
Kedokteran Hewan Universitas Udayana.
Kami menyadari bahwa tulisan ini masih banyak kekurangan baik dari segi materi,
ilustrasi, contoh, maupun sistematika penulisan. Oleh karena itu,saran dan kritik dari para pembaca
yang bersifat membangun sangat kami harapkan. Besar harapan kami karya tulis ini dapat
bermanfaat baik bagi pembaca pada umumnya terutama bagi dunia kedokteran hewan di
Indonesia.
Denpasar, 9 November 2021
Penulis
ii
DAFTAR ISI
Kata Pengantar .............................................................................................................. ii
Daftar Isi ...................................................................................................................... iii
Daftar Gambar ............................................................................................................. iv
BAB I PENDAHULUAN
1.1 Latar Belakang ........................................................................................................ 1
1.2. Rumusan Masalah .................................................................................................. 2
1.3 Tujuan ..................................................................................................................... 2
1.4 Manfaat ................................................................................................................... 2
BAB II TINJAUAN PUSTAKA
2.1 Terminologi ............................................................................................................ 3
2.2 Indikasi ................................................................................................................... 4
2.3 Preoperasi ............................................................................................................... 5
2.4 Anestesi .................................................................................................................. 6
2.5 Teknik Operasi ........................................................................................................ 6
2.6 Pascaoperasi ............................................................................................................ 9
BAB III PENUTUP
3.1 Kesimpulan ........................................................................................................... 10
3.2 Saran ..................................................................................................................... 11
DAFTAR PUSTAKA
iii
DAFTAR GAMBAR
Gambar 1. Kelainan rangka yang berhubungan dengan luksasi patella ........................... 4
Gambar 2. Osteotomy ................................................................................................... 6
Gambar 3. Keadaan sebelum operasi ............................................................................ 7
Gambar 4. Radiografi ukuran yang tepat dari tuberositas tibia pasca oprasi ................... 7
Gambar 5. K-wire di arahkan cranio lateral dan caudo medial ....................................... 8
Gambar 6. Chuck Jacobs dapat digunakan untuk menggerakan k-wire .......................... 8
Gambar 7. Patela pada posisi yang benar ...................................................................... 9
iv
BAB I
PENDAHULUAN
1.1 Latar Belakang

Os patella merupakan tulang tempurung lutut yang termasuk tulang sesamoidea
yang berhubungan dengan trochlea dari os femur. Os sesamoidea adalah tulang yang
terdapat pada tendo di daerah persendian. Bagian- bagiannya terdiri atas basis, apex, margo
lateral, margo cranial dan proc Cartilaginous. Tulang patella sama seperti tulang lainnya
patella dapat mengalami trauma hingga menyebabkan tulang tersebut patah (fraktur
patella). Apabila fragmen-fragmen tulang yang patah pada patella belum mengalami
pergeseran karena kekuatan dari cederanya (undisplaced), maka tidak diperlukan tindakan
operasi. Tindakan yang dapat dilakukan ialah menggunakan casts atau spints untuk
menjaga posisi dari tulang patella, namun memerlukan waktu hingga 6-8 minggu sampai
tulang benar-benarsembuh agar bisa melakukan fungsinya lagi.
Apabila tulang patella yang patah terpisah (displaced) akibat tarikan yang kuat dari
m. Quadriceps femoris maka diperlukan tindakan operasi terutama pada patah tulang tipe
transverse dan comminutif. Tulang patella yang patah dan terpisah apabila tidak dioperasi
akan mengalami kesulitan penyembuhan bahkan mungkin tidak sembuh. Begitu juga
dengan patah tulang patella yang bersifat terbuka (open fracture) juga memerlukan
tindakan operasi. Operasi pada open fracture patella bersifat segera dan diperlukan
pembersihan luka terlebih dahulu.
Luksasi os patella adalah suatu keadaan dimana patella (tempurung lutut) seekor
anjing bergeser dari tempatnya (lekukan trochlea dari tulang paha/femur).
Kasus luksasio patella ini sering ditemukan pada anjing-anjing ras kecil dan sedang
seperti Chihuahua, Pomeranian, Poodle, Pekingese,Yorkshire terrier, Pug, dan Chow
chow. Luksasio os patella kadang-kadang juga ditemukan pada ras besar seperti German
Shepherd.
Tanda atau gejala klinis yang berhubungan dengan kejadian luksai patella sangat
bervariasi dengan tingkat keparahannya. Kondisi ini akan lebih mudah ditemukan pada
pemeriksaan fisik yang dilakukan secara rutin. Biasanya anjing yang mengalami luksasi
patella akan terlihat dari caranya berjalan, hewan tersebut akan mengalami ketimpangan
1
saat ia berjalan, terlihat gemetar,dan tentunya terlihat adanya ketidak nyamanan pada kaki
khususnya bagian patella.
1.2 Rumusan Masalah
Adapun rumusan masalah yang akan dibahas pada paper ini, yaitu :
1. Bagaimanakah terminology dari luksasi patela?
2. Bagaimanakah indikasi dari operasi luksasi patela?
3. Bagaimanakah anestesi dari operasi luksasi patela?
4. Bagaimanakah praoperasi dari teknik operasi luksasi patela?
5. Bagaimanakah operasi dari teknik operasi luksasi patela?
6. Bagaimanakah pascaoperasi dari teknik operasi luksasi patela?
1.3 Tujuan
Berdasarkan dari rumusan masalah tujuan dari penulisan paper yaitu :
1. Untuk mengetahui terminology dari luksasi patela
2. Untuk mengetahui indikasi dari operasi luksasi patela
3. Untuk mengetahui anestesi dari operasi luksasi patela
4. Untuk mengetahui praoperasi dari operasi luksasi patela
5. Untuk mengetahui teknik operasi luksasi patela
6. Untuk mengetahui pascaoperasi dari operasi luksasi patela
1.4 Manfaat
Mafaat dari penulisan paper ini, yaitu untuk memberikan infromasi dan
pengetahuan mengenai Teknik Operasi Lukasi Patela yang diharapkan dengan adanya
paper ini dapat memberikan pemahaman kepada pembaca dan penulis dalam menambah
ilmu pengetahuan tentang Teknik Operasi Luksasi Patela.
2
BAB II
TINJAUAN PUSTAKA
2.1 Terminologi
Luksasi patella adalah salah satu dari beberapa penyebab kepincangan pada anjing.
Ras anjing besar maupun kecil bisa terkena penyakit ini, bahkan kucing juga. Luksasi dapat
berupa luksasi medial, lateral, atau bidireksional. Sebagian besar luksasi bersifat medial
dan didaagnosis pada anjing ras kecil. Luksasi lateral lebih jarang terjadi, meskipun terjadi
biasanya didiagnosa pada anjing ras besar. Sebagian besar studi prevalensi menyatakan
bahwa anjing betina lebih cenderung terkena penyakit ini daripada anjing jantan. Luksasi
patella adalah penyakit umum pada anjing muda, tetapi tanda klinis sering terlihat saat
hewan tumbuh. Sehingga kebanyakan luksasi ini didiagnosis pada anjing muda umumnya
pada usia 3 tahun.
Luksasi patella merupakan gangguan pada anjing yang ditandai dengan tempurung
lutut terlepas atau bergeser dari posisi normalnya di bawah femur. Jika dibiarkan dapat
berkembang manjadi radang sendi, kemudian menyebabkan rasa sakit dan kepincangan.
Luksasi patella dapat disebabkan karena trauma atau kongenital. Luksasi patella karena
trauma biasanya terjadi ketika anjing melompat atau jatuh dari ketinggianhingga terjadi
rotasi tibia ke arah medial secara tiba tiba saat sendi ekstensi. Luksasi patella kongenital
disebabkan malformasi dari coxa vara, coxa valga atau genu vara, pembengkokan pada
bagian distal femur, dislokasi medial pada otot quadrisep, displasia epifisis femur, rotasi
sendi atau tibia, dan kedangkalan trochlea femur.
Luksasi patella pada anjing diklasifikasikan sebagai berikut (gambar 1).
• Grade I- Patella dapat secara manual mengalami luksasi namun kembali ke posisi
nomal ketika dilepaskan.
• Grade II- Luksasi patella dengan menakan fleksi atau manipulasi manual dan tetap
luksasi hingga menahan ekstensi atau pengembalian secara manual terjadi.
• Grade III-Luksasi patella berlanjut, dan bisa secara manual kembali tapi akan
merelaksasi secara spontan ketika tekanan manual dihilangkan
• Grade IV- Luksasi patela terus menerus dan tidak dapat diganti secara manual.
3
Normal Grade I Grade II Grade III Grade IV
Gambar 1. Kelainan rangka yang berhubungan dengan luksasi patella
Operasi luksasi os patella direkomendasi untuk anjing dengan kepincangan

intermiten atau permanen sebagai akibat dari keseleo patella atau pada anjing muda dalam
upaya untuk mengurangi efek negatif dari kondisi pada pertumbuhan tulang. Patologi sendi
meningkat seiring bertambahnya usia dan tingkat keseleo, dan koreksi bedah harus
dilakukan sedini mungkin untuk membatasi perkembangan lebih lanjut dari kelainan
tulang.
2.2 Indikasi
Tujuan utama dari operasi adalah untuk mengembalikan keselarasan normal otot
quadrisep dengan seluruh anggota badan. Teknik bedah dapat dibagi menjadi teknik yang
melibatkan pembentukan kembali tulang dan teknik yang hanya melibatkan rekonstruksi
jaringan lunak. Sebagian besar anjing yang menjalani operasi memerlukan beberapa
kombinasi teknik tulang dan jaringan lunak.
4
2.3 Preoperasi
Menurut Sudisma et al. (2016), terdapat beberapa hal yang perlu dipersiapkan
sebelum melakukan tindakan operasi. Hal ini bertujuan agar suatu operasi dapat berjalan
sukses dan kesembuhan operasi tidak terhambat. Adapun persiapan yang perlu dilakukan
yaitu :
a. Persiapan Alat dan Bahan

Alat-alat yang hendak digunakan untuk operasi harus disterilisasi terlebih dahulu
menggunakan alkohol 70% untuk menghindari adanya resiko kontaminasi yang dapat
menghambat proses penyembuhan luka pascaoperasi. Adapun alat dan bahan yang perlu
disiapkan yaitu surgery drape, kain kasa steril atau spons, blade dan scalpel, alat bedah
mayor, pin, bone plate, screw, external fixating rods & clamps, electric drill / bor tulang,
benang non absorbable dan absorbable, alcohol, yodium tincture, obat anastesi, antibiotik
dan anti inflamasi.
b. Persiapan Ruang Operasi
Persiapan ruang operasi meliputi ruang operasi harus bersih, lantai dan meja operasi
hendaknya dibersihkan dan didesinfeksi. Ruang operasi juga harus tertutup dan memiliki
penerangan yang cukup agar daerah operasi dapat terlihat.
c. Persiapan Hewan atau Pasien
Pemeriksaan fisik awal wajib untuk dilakukan sebelum operasi dilakukan. Pemeriksaan
fisik meliputi :
• Signalemen
• Berat badan
• Umur
• Pulsus
• Frekuensi nafas
• Suhu tubuh
Bila kondisi hewan dinyatakan normal atau sehat maka hewan dapat dilakukan operasi.
d. Persiapan Operator
Operator dan pembantu operator sebelum dan selama pelaksanaan operasi harus selalu
dalam kondisi steril. Sebelum operasi dilaksanakan, operator dan pembantu operator
5
mempersiapkan diri dengan mencuci tangan mulai dari ujung tangan sampai batas siku,
menggunakan air sabun, kemudian dibilas dengan air bersih yang mengalir, setelah itu
tangan direndam dalam larutan antiseptik dengan menggunakan larutan PK 4% atau
alkohol 70%. Selama operasi, operator dan pembantu operator harus menggunakan
masker, topi operasi, dan sarung tangan yang bersih serta pakaian khusus untuk operasi
untuk mengurangi kontaminasi. Apabila operator dan pembantu operator sudah dalam
keadaan steril maka tidak boleh bersentuhan atau memegang benda-benda yang tidak steril.
2.4 Premedikasi dan Anestesi
Sebelum operasi, hewan dipuasakan selama 12 jam. Setelah itu dilakukan
premedikasi dengan pemberian atropine sulfat (0,02 – 0,04 ml/kgBB secara SC) dan di
anestesi dengan pemberian ketamine (ml/kgBB secara IM) dan xylazine (ml/kgBB secara
IM). Hewan diposisikan lateral atau dorsal recumbency, tergantung pada preferensi dokter
hewan dan daerah yang akan dioperasi dibersihkan terlebih dahulu meliputi pencukuran
rambut serta pemberian yodium tincture kemudian dipasangi kain drape pada site operasi.
2.5 Teknik Operasi
Tibial Tuberosity Transposition Surgery
Gunakan pisau tajam untuk membuka bagian medial dari tuber tibial, jika perlu
tusuk dan angkat otot tibial cranial dari tibia lateral. Pastikan lebih mendekatkan alat
tambahan dari otot yang tidak keras misalnya. Otot harus diangkat sebagian untuk
meminimalisir kerusakan dari mata pisau. Lakukan osteotomy, oscaleting saw dapat
memotong dengan tepat. Lalu tempatkan elevator (pengangkat) freer atau retractor gelpi
dibawah ligament patella sebagai pelindung.
Gambar 2. Osteotomy
6
Ukuran tuberositas tibia dan posisi pembedahan tulang sangat penting untuk
meminimalisir terjadinya fraktur. Pembedahan tulang dilakukan di antara tibia proksimal
dan dasar tuberositas. Pertahankan periosteum distal tetap lengkap. Gambar 2 merupakan
keadaan sebelum oprasi untuk memperkirakan ukuran dan posisi dilakukanya
pembedahan. Gambar 3 menampilkan radiografi ukuran yang tepat dari tuberositas tibia
pasca oprasi. Jika pembedahan tulang salah posisi maka tuberositas tibia akan mengalami
fraktur.
Gambar 3. Keadaan sebelum operasi
Gambar 4. Radiografi ukuran yang tepat dari tuberositas tibia pasca oprasi.
Tuberositas tibia harus di pindahkan dari medial ke lateral. Gunakan pengangkat

periosteal secara perlahan untuk mengangkat tuberositas tibia dari tibia dan pindahkan ke
posisi hingga mencapai ligament patella. Jika tuberositas sulit di pindahkan, itu artinya
melakukan osteotomy tidak cukup butuh sedikit kerja tambahan. Ahli bedah menyiapkan
graft bed untuk fiksasi tuberositas tibia. Gunakan power drive untuk menempelkan k-wire
kedalam tuberositas tibia proksimal. K-wire harus di arahkan cranio lateral dan caudo
medial. Pada anjing yang lincah, jika tuberositas tibia terlepas disarankan menggunakan
tension band, perawatan harus dilakukan agar tidak merusak jaringan lunak, terutama
7
ligamentum patella. Pastikan ukuran k-wire sesuai dengan pasien. Chuck Jacobs dapat
digunakan untuk menggerakan k-wire sebagai pendorong k-wire melalui tulang tanpa
selip.
Gambar 5. K-wire di arahkan cranio lateral dan caudo medial.
Gambar 6. Chuck Jacobs dapat digunakan untuk menggerakan k-wire sebagai pendorong k-
wire melalui tulang tanpa selip.
Perhatikan posisi kaki anjing lihat kembali orientasi dari ligament patella dan posisi
tuborositas tibia. Patella harus dalam posisi semula. Rotasi internal dan eksternal tibia
harus sama dengan orientasi medial dan lateral ligamen patella.
8
Gambar 7. Patela pada posisi yang benar.
Amati stabilitas patella dengan melakukan ekstensi dan fleksi secara perlahan
dengan tibia di rotasi. Luksasi patella harus di selesaikan sebelum mentup jaringan lunak.
2.6 Pascaoperasi
Setelah dilakukan operasi, disarankan kepada pemilik hewan untuk membatasi
pergerakan berlebihan pada hewan tersebut selama 3 minggu kedepan. Gunakan Elizabeth
collar untuk mencegah anjing menjilat bekas jahitan. Latihan biasanya terbatas untuk jalan-
jalan tali selama 6 sampai 14 minggu tergantung pada prosedur yang dilakukan dan faktor
yang mempengaruhi kapasitas penyembuhan dari hewan peliharaan. Pemberian obat nyeri
dapat diresepkan selama seminggu setelah operasi. Pemberikan kompres dingin ke lutut
(5-10 menit sehari) juga bisa diberikan untuk membantu mengurangi peradangan.
Radiografi dapat diulang secara berkala untuk memantau penyembuhan tulang.
9
BAB III
PENUTUP
3.1 Kesimulan
Luksasi os patella adalah suatu keadaan dimana patella (tempurung lutut) seekor
anjing bergeser dari tempatnya (lekukan trochlea dari tulang paha/femur).
Kasus luksasio patella ini sering ditemukan pada anjing-anjing ras kecil dan sedang
seperti Chihuahua, Pomeranian, Poodle, Pekingese,Yorkshire terrier, Pug, dan Chow
chow. Luksasio os patella kadang-kadang juga ditemukan pada ras besar seperti German
Shepherd.
Apabila tulang patella yang patah terpisah (displaced) akibat tarikan yang kuat dari
m. Quadriceps femoris maka diperlukan tindakan operasi terutama pada patah tulang tipe
transverse dan comminutif. Tulang patella yang patah dan terpisah apabila tidak dioperasi
akan mengalami kesulitan penyembuhan bahkan mungkin tidak sembuh. Begitu juga
dengan patah tulang patella yang bersifat terbuka (open fracture) juga memerlukan
tindakan operasi.
3.2 Saran
Pada kasus luksasi patella meskipun dapat disembuhkan, namun anjing bekas penderita
luksasio os patella tidak dianjurkan untuk di breeding dikarenakan dapat diturunkan secara
kongenital.
10
DAFTAS PUSTAKA
American Academy of Orthopaedic Surgeon (2010). Patellar Kneecap Fractures
J.S Lara et al. 2018. Patellar Luxation and Articular Lesions in Dogs : a retrospective : study
research article. UFMG
Alfades Loa G.J et al. 2020. Laporan Kasus : Luksasi Patella Medial pada Miniatur Pinscher.
Fakultas Kedokteran Hewan. Universitas Udayana
Dona D. Francesco et al. 2018. Patellar Luxation in Dogs. Jurnal of Veterinary Medicine.
Rossanese Matteo et al. 2019. Complication Following Surgical Correction of Medial Pateellar
Luxation in Small –to-Medium-Size Dogs.
11
LUKSASI PATELLA
Kelompok 3A :
Ni Putu Dyah Prashanti Pusparini 1809511010
Kresensia Cyntia Dosom 1809511011
Ni Putu Tiara Indriana 1809511012
Silvester Yesa Gilbert P. 1809511014
terminologi
• Luksasi patella adalah salah satu dari beberapa penyebab kepincangan pada anjing.
• Luksasi dapat berupa luksasi medial, lateral, atau bidireksional.
• Luksasi patella merupakan gangguan pada anjing yang ditandai dengan tempurung lutut
terlepas atau bergeser dari posisi normalnya di bawah femur.
• Jika dibiarkan dapat berkembang manjadi radang sendi, kemudian menyebabkan rasa sakit
dan kepincangan.
• Luksasi patella dapat disebabkan karena trauma atau kongenital.
• Luksasi patella karena trauma biasanya terjadi ketika anjing melompat atau jatuh dari
ketinggianhingga terjadi rotasi tibia ke arah medial secara tiba tiba saat sendi ekstensi.
• Luksasi patella kongenital disebabkan malformasi dari coxa vara, coxa valga atau genu vara,
pembengkokan pada bagian distal femur, dislokasi medial pada otot quadrisep, displasia
epifisis femur, rotasi sendi atau tibia, dan kedangkalan trochlea femur.
Luksasi patella pada anjing diklasifikasikan sebagai berikut :
• Grade I- Patella dapat secara manual mengalami luksasi namun kembali ke
posisi nomal ketika dilepaskan.
• Grade II- Luksasi patella dengan menakan fleksi atau manipulasi manual dan
tetap luksasi hingga menahan ekstensi atau pengembalian secara manual
terjadi.
• Grade III- Luksasi patella berlanjut, dan bisa secara manual kembali tapi
akan merelaksasi secara spontan ketika tekanan manual dihilangkan
• Grade IV- Luksasi patela terus menerus dan tidak dapat diganti secara
manual.
Operasi luksasi os patella direkomendasi untuk anjing
dengan kepincangan intermiten atau permanen sebagai
akibat dari keseleo patella atau pada anjing muda dalam
upaya untuk mengurangi efek negatif dari kondisi pada
pertumbuhan tulang. Patologi sendi meningkat seiring
bertambahnya usia dan tingkat keseleo, dan koreksi bedah
harus dilakukan sedini mungkin untuk membatasi
perkembangan lebih lanjut dari kelainan tulang.
indikasi
Tujuan utama dari operasi adalah untuk
mengembalikan keselarasan normal otot quadrisep
dengan seluruh anggota badan. Teknik bedah
dapat dibagi menjadi teknik yang melibatkan
pembentukan kembali tulang dan teknik yang
hanya melibatkan rekonstruksi jaringan lunak.
preoperasi
Persiapan Ruang Operasi Persiapan Hewan
Pemeriksaan fisik awal wajib untuk dilakukan
sebelum operasi dilakukan. Pemeriksaan fisik
Persiapan ruang operasi meliputi
meliputi :
ruang operasi harus bersih, lantai
• Signalemen
dan meja operasi hendaknya
• Berat badan
dibersihkan dan didesinfeksi.
• Umur
Ruang operasi juga harus tertutup
• Pulsus
dan memiliki penerangan yang
• Frekuensi nafas
cukup agar daerah operasi dapat
• Suhu tubuh
terlihat.
Bila kondisi hewan dinyatakan normal atau
sehat maka hewan dapat dilakukan operasi.
Persiapan Operator Premedikasi dan Anestesi
Sebelum operasi, hewan dipuasakan

selama 12 jam. Setelah itu dilakukan
Operator dan pembantu operator
premedikasi dengan pemberian atropine
sebelum dan selama pelaksanaan
sulfat (0,02 – 0,04 ml/kgBB secara SC)
operasi harus selalu dalam kondisi
dan di anestesi dengan pemberian
steril.
ketamine (ml/kgBB secara IM) dan
xylazine (ml/kgBB secara IM). Hewan
diposisikan lateral atau dorsal recumbency
teknik
operasi
Gunakan pisau tajam untuk membuka bagian medial dari tuber tibial, jika perlu tusuk dan
angkat otot tibial cranial dari tibia lateral. Pastikan lebih mendekatkan alat tambahan dari otot
yang tidak keras misalnya. Otot harus diangkat sebagian untuk meminimalisir kerusakan dari
mata pisau. Lakukan osteotomy, oscaleting saw dapat memotong dengan tepat. Lalu tempatkan
elevator (pengangkat) freer atau retractor gelpi dibawah ligament patella sebagai pelindung
Gambar Osteotomy
Ukuran tuberositas tibia dan posisi pembedahan tulang sangat penting untuk
meminimalisir terjadinya fraktur. Pembedahan tulang dilakukan di antara tibia
proksimal dan dasar tuberositas. Pertahankan periosteum distal tetap lengkap.
Gambar 1 merupakan keadaan sebelum oprasi untuk memperkirakan ukuran dan
posisi dilakukanya pembedahan. Gambar 2 menampilkan radiografi ukuran yang
tepat dari tuberositas tibia pasca oprasi. Jika pembedahan tulang salah posisi
maka tuberositas tibia akan mengalami fraktur.
Gb 1. Gb 2. Radiografi
Keadaan ukuran yang tepat
sebelum dari tuberositas
operasi tibia pasca oprasi.
Tuberositas tibia harus di pindahkan dari medial ke lateral. Gunakan pengangkat
periosteal secara perlahan untuk mengangkat tuberositas tibia dari tibia dan
pindahkan ke posisi hingga mencapai ligament patella. Jika tuberositas sulit di
pindahkan, itu artinya melakukan osteotomy tidak cukup butuh sedikit kerja
tambahan. Ahli bedah menyiapkan graft bed untuk fiksasi tuberositas tibia.
Gunakan power drive untuk menempelkan k-wire kedalam tuberositas tibia
proksimal. K-wire harus di arahkan cranio lateral dan caudo medial. Pada anjing
yang lincah, jika tuberositas tibia terlepas disarankan menggunakan tension band,
perawatan harus dilakukan agar tidak merusak jaringan lunak, terutama
ligamentum patella.
Pastikan ukuran k-wire sesuai dengan pasien. Chuck Jacobs dapat digunakan
untuk menggerakan k-wire sebagai pendorong k-wire melalui tulang tanpa selip.
K-wire di arahkan
cranio lateral dan
caudo medial
Chuck Jacobs dapat
digunakan untuk
menggerakan k-wire
sebagai pendorong kwire
melalui tulang tanpa selip.
Perhatikan posisi kaki anjing lihat kembali orientasi dari ligament

patella dan posisi tuborositas tibia. Patella harus dalam posisi semula.
Rotasi internal dan eksternal tibia harus sama dengan orientasi medial
dan lateral ligamen patella.
Patela pada posisi yang
benar
Amati stabilitas patella dengan melakukan ekstensi dan fleksi secara perlahan
dengan tibia di rotasi. Luksasi patella harus di selesaikan sebelum mentup
jaringan lunak.
pascaoperasi
Setelah dilakukan operasi, disarankan kepada pemilik hewan untuk
membatasi pergerakan berlebihan pada hewan tersebut selama 3 minggu
kedepan. Gunakan Elizabeth collar untuk mencegah anjing menjilat bekas
jahitan. Latihan biasanya terbatas untuk jalan-jalan tali selama 6 sampai 14
minggu tergantung pada prosedur yang dilakukan dan faktor yang
mempengaruhi kapasitas penyembuhan dari hewan peliharaan.
Pemberian obat nyeri dapat diresepkan selama seminggu setelah operasi.
Pemberikan kompres dingin ke lutut (5-10 menit sehari) juga bisa
diberikan untuk membantu mengurangi peradangan. Radiografi dapat
diulang secara berkala untuk memantau penyembuhan tulang.
Indonesia Medicus Veterinus Januari 2020 9(1): 129-138
pISSN : 2301-7848; eISSN : 2477-6637 DOI: 10.19087/imv.2020.9.1.129
online pada http://ojs.unud.ac.id/php.index/imv
Laporan Kasus: Luksasi Patella Medial pada Miniatur Pinscher
(CASE REPORT: MEDIAL PATELLAR LUXATION IN MINIATURE PINSCHER)
Gabriella Jenni Alfades Loa1, Sri Kayati Widyastuti2, Made Suma Anthara2
1
Mahasiswa Pendidikan Profesi Dokter Hewan
2
Laboratorium Ilmu Penyakit Dalam Veteriner
Fakultas Kedokteran Hewan Universitas Udayana,
Jl. P.B. Sudirman, Sanglah, Denpasar, Bali, Indonesia, 80234; Telp/Fax: (0361) 223791
e-mail: jennigabriella0@gmail.com
ABSTRAK
Anjing pada kasus ini merupakan anjing ras miniatur pinscher berumur 3 tahun 6 bulan dan
berjenis kelamin jantan. Anjing mengalami kepincangan dari 4 hari yang lalu, Pada pemeriksaan
klinis teramati anjing beberapa kali mengangkat kaki belakang kiri ketika berjalan, berlari dan berdiri,
anjing merespon sakit saat dipalpasi dan tidak ada krepitasi. Setelah dilakukan pemeriksaan radiologi
teramati patella luksasi ke arah medial dari trochlear, deviasi medial dari tuberositas tibial, dan patella
tidak melekat pada sulcus trochlear. Anjing kasus didiagnosa mengalami luksasi patella medial grade
II. Berdasarkan pertimbangan tingkat luksasi patella dan derajat kepincangan yang ringan,maka
diberikan terapi suportif berupa antiinflamasi non-steroid carprofen 2,2 mg/kg BB/hari selama 7 hari,
suplemen untuk tulang dan sendi dengan dosis 1 cap/hari, fish oil dosis 1 kapsul/hari dan vitamin B1
50mg/ekor/hari, terapi fisik, perbaikan nutrisi dengan pakan diet rumahan, massage, dan edukasi ke
pemilik untuk mengontrol berat badan anjing.
Kata-kata kunci: anjing; miniatur pinscher; luksasi patella medial
ABSTRACT
The dog in this case was miniature pinscher dog age three years six months old male. The
dog was lameness from four day ago. Based on clinical examination, the dog was observed flexing
left hindlimb several times when walking, running, and standing, the dog responded to pain when
palpated and there was no crepitation. The radiographic evaluation showed the patella was medially
displaced from trochlea, deviation medial of the tibial tuberosity, the patella was not sticking in the
sulcus trochlea. The dog was diagnosed with medial patellar luxation grade II. Based on consideration
of the grade of patellar luxation and degree of mild lameness supportive therapy was given. Those
were non-steroid anti-inflammatory carprofen 2,2 mg/kg body weight daily, bone and joint suplement
with a dose 1 cap daily, fish oil with a dose 1 capsul daily and vitamin B1 50mg per dog daily,
physical therapy, improvement of nutrition through home-based diet, massage, and education for the
owner to control dog’s body weight.
Keywords: dog; miniature pinscher; medial patellar luxation
PENDAHULUAN
Luksasi patella medial adalah gangguan yang paling umum menyerang sendi pada
anjing. Luksasi patella tidak hanya menyerang anjing ras besar, seperti Labrador, anjing ras
kecil juga bisa terkena, yaitu Yorkshire Terrier dan Poodle. Luksasi patella medial lebih
umum terjadi dibandingkan luksasi patella lateral yaitu sebanyak 75-80% kasus dan
129
mencapai 98% pada ras kecil. Luksasi patella medial sering terjadi pada ras besar, dengan
presentase luksasi patella lateral pada ras besar lebih tinggi daripada anjing ras kecil.
Berdasarkan jenis kelamin, kasus luksasi patella medial pada betina ras kecil dan jantan ras
besar lebih sering terjadi. Pada kucing, kasus luksasi patella medial juga lebih umum terjadi
daripada luksasi patella lateral (Pérez dan Lafuente, 2014).
Luksasi patella merupakan gangguan pada anjing muda dan tanda-tanda klinis
menjadi sering terlihat pada hewan yang mengalami pertumbuhan (Di Dona et al., 2018).
Anjing ras Miniature Pinscher dan Toy Breeds paling sering mengalami luksasi patella, hal
tersebut sesuai dengan hasil penelitian yang dilakukan oleh Nganvongpanit dan Yano (2011)
yang mengatakan bahwa ras anjing merupakan faktor predisposisi luksasi patella pada anjing
Poodle, Pomeranian, Chihuahua, Yorkshire Terrier, Shih Tzu, Miniature Pinscher, Siberian
Husky dan anjing lokal.
Luksasi patella digambarkan sebagai suatu kondisi dimana tempurung lutut (patella)
terlepas atau bergeser dari alur normalnya dibawah femur. Kondisi ini awalnya tidak
menyakitkan tetapi dapat berkembang menjadi radang sendi, kemudian menyebabkan rasa
sakit dan kepincangan (O’Neill et al., 2016). Luksasi patella dapat disebabkan karena trauma
ataupun kongenital. Luksasi patella kongenital disebabkan karena malformasi dari coxa vara,
coxa valga atau genu vara, pembengkokan pada bagian distal femur, dislokasi medial pada
otot quadriceps, displasia epifisis femur, rotasi sendi atau tibia, dan kedangkalan trochlea
femur. Trauma luksasi patella biasanya terjadi ketika anjing melompat atau jatuh dari
ketinggian dimana rotasi tibia ke arah medial secara tiba-tiba saat sendi ekstensi
(Nganvongpanit dan Yano, 2011).
Stabilitas sendi yang terganggu ketika patella tidak pada posisi normal, hal ini dapat
menyebabkan hewan cidera ligament, khususnya cranial cruciate ligament (CCL) yang dapat
menyebabkan perkembangan osteoarthritis (Nganvongpanit dan Yano, 2011). Campbell et al.
(2010) mengamati seiring dengan rupture cranial cruciate ligament (CCL) 41% dari kasus
luksasi patella, sementara yang lain melaporkan bahwa 15-20% dari kasus luksasi patella
kronis dapat berkembang menjadi rupture CCL (Denny dan Butterworth, 2000). Tujuan dari
laporan kasus ini adalah untuk mengetahui cara mendiagnosa kasus dan terapi yang
digunakan untuk luksasi patella grade II.
130
REKAM MEDIK
Sinyalemen
Pada tanggal 10 Januari 2018, telah dilakukan pemeriksaan klinis terhadap anjing ras
kelompok toy yaitu Miniatur Pinscher berjenis kelamin jantan, berumur 3 tahun 6 bulan
dengan berat badan 5,79 kg. Anjing kasus memiliki warna rambut cokelat tua hampir di
keseluruhan badan kecuali sekitar mulut, dada, dan kaki yang berwarna cokelat muda.
Anamnesis
Anjing mengalami pincang secara tiba-tiba pada kaki belakang kiri sudah dari 4 hari
yang lalu. Anjing mengangkat kaki belakang kiri saat berjalan maupun saat berlari, terkadang
anjing juga mengangkat kaki saat berdiri. Anjing mengalami kesulitan saat melompat dan
saat menaiki tangga. Pemilik anjing tidak mengetahui bagaimana awal penyebab anjing
mengalami pincang di bagian kaki belakang kiri. Anjing biasa dilepaskan di dalam area
tempat tinggal. Hewan diberikan makan setiap hari berupa dog food kering. Selama sakit
anjing belum pernah mendapatkan terapi pengobatan.
Gambar 1. Gambaran fisik anjing kasus
Pemeriksaan Klinis
Status presens anjing kasus adalah sebagai berikut: frekuensi detak jantung 80
kali/menit, frekuensi pulsus 104 kali/menit, frekuensi respirasi 148 kali/menit, suhu tubuh
38,5oC dan nilai capillary refill time (CRT) kurang dari 2 detik. Pemeriksaan fisik terhadap
anggota gerak dan muskuloskeletal ditemukan abnormalitas yaitu anjing sering mengangkat
kaki ketika berjalan dan berlari dan sesekali pada saat berdiri. Saat evaluasi cara berjalan dan
berlari, kepincangan terjadi secara kontinyu, deformitas ringan, dan hewan terkadang terlihat
mencoba untuk merenggangkan kaki ke belakang. Pemeriksaan saat berdiri teramati
131
ketidaksimetrisan antara tungkai kaki belakang kiri dan kanan, karena kaki belakang kiri
mengalami fleksi secara intermitten. Otot-otot di sekitar kaki belakang kiri bagian proksimal
bengkak. Hewan dibaringkan secara lateral recumbency dan dipalpasi pada bagian kaki
belakang kiri, anjing merespon sakit saat dipalpasi di sekitar sendi, sulkus trokhlear teraba,
dan posisi patella ke arah medial. Tidak adanya krepitasi. Pada pemeriksaan saraf tidak
ditemukan adanya abnormalitas, demikian juga pada pemeriksaan sirkulasi, respirasi,
urogenital, pencernaan, limfonodus, kulit dan kuku serta mukosa.
PEMERIKSAAN LABORATORIUM
Pemeriksaan laboratorium yang dilakukan untuk mendukung diagnosa adalah
pemeriksaan radiologi menggunakan x-ray pada area kedua kaki belakang dengan posisi
ventro-dorsal dan lateral.
Gambar 2. Patella bergeser ke arah medial (tanda panah putih) dan deviasi tibialis dimana corpus os
tibia bergeser ke arah medial (tanda panah kuning)
Gambar 3. Patella tidak melekat pada sulcus trokhlear (tanda panah biru)
132
Diagnosa
Berdasarkan hasil anamnesis, pemeriksaan klinis dan pemeriksaan lanjutan yaitu
pemeriksaan radiologi anjing didiagnosa mengalami luksasi patella medial grade II.
Prognosis
Berdasarkan kondisi fisik anjing kasus dan tingkat luksasi patella yang dilihat pada
pemeriksaan radiologi maka prognosa adalah infausta.
Terapi
Terapi yang dilakukan pada anjing kasus adalah pemberian antiradang non-steroid
Rimadyl® (Zooetis Inc, Kalamazoo, Michigan) dengan kandungan carprofen 25 mg dengan
dosis pemberian 2,2 mg/kg BB (0,5 tab) perhari selama 7 hari dan diberikan suplemen untuk
tulang dan sendi Osteor Plus® (PT. Pyridam Farma, Cianjur, Indonesia) dengan kandungan
berupa glucosamine, chondroitin sulfate, vitamin C, mangan, magnesium, zinc, selenium, dan
methylsulfonylmethane dengan dosis pemberian 1 cap per hari serta suplemen pendukung
berupa vitamin B1 (Vitamin B1®, PT. Kimia Farma, Bandung, Indonesia) dengan dosis
50mg/ekor/hari dan fish oil (Salveo®, PT. Salveo Inc, Missisipi, US) dengan dosis 1 kapsul
perhari. Pemilik dianjurkan untuk mengajak hewan jalan-jalan agar membuat anjing lebih
sehat secara fisik, mengontrol berat badan hewan untuk mengurangi penekanan pada sendi
yang kaku, perbaikan nutrisi melalui diet raw atau pakan diet rumahan dengan daging sapi
atau kaki ayam yang akan menambah glukosamin dan memperbaiki kondisi sendi, serta
treatment dengan cara massage.
PEMBAHASAN
Berdasarkan penelitian yang dilakukan Garnoeva et al. (2016), anjing ras Pinscher
paling sering mengalami luksasi patella, yang semua kasus lebih banyak disebabkan karena
congenital karena tidak ada riwayat trauma dan frekuensi luksasi pada kaki belakang kiri
adalah 1,3 kali lebih tinggi. Penyebab dasar dari luksasi patella medial belum sepenuhnya
dipahami, beberapa penyelidikan menunjukkan coxa vara (penurunan sudut kemiringan leher
femur) dan berkurangnya sudut anteversion (relatif retroversion) adalah penyebab utama.
Deformitas dari luksasi patella medial meliputi ketidakselarasan otot quadriceps femoris,
coxa vara, femoral varus, genu varum, alur trochlear dangkal dengan trochlear ridge yang
tidak berkembang atau bahkan tidak ada, hipoplasia kondilus femoral medial, perpidahan
medial dari tuberositas tibialis, rotasi internal tibia, proximal tibial varus, dan rotasi internal
kaki. Secara normal, patella memberikan tekanan pada articular cartilage dari alur trochlear
133
selama pertumbuhan, membuat alur trochlear kedalaman dan lebar yang memadai. Tidak
adanya tekanan fisiologis ini pada kasus luksasi patella medial menyebabkan hipoplasia
trochlear. Luksasi dan reduksi intermitten pada trochlear ridge medial, yang mengakibatkan
terjadinya ketidakstabilan dan kecenderungan untuk luksasi (Pérez dan Lafuente, 2014).
Ketika otot quadriceps berkontraksi pada tungkai yang normal, patella ditarik ke arah
proksimal pada trokhlear femur, namun jika femur tidak normal, patella akan terdorong ke
arah medial atau lateral yang menyababkan patella luksasi (Vidoni et al.,2005). Otot
quadriceps yang atrofi dan tegang, terutama rectus femoris, membuat “bowstring effect” yang
memutar tibia secara internal, oleh karena itu menyebabkan patella bergerak secara medial
(L’Eplattenier dan Montavon, 2002).
Diagnosa luksasi patella dilakukan dengan inspeksi dalam posisi berdiri dan selama
bergerak, serta dengan palpasi sendi pada posisi berdiri dan posisi recumbency lateral
(Vidoni et al., 2005). Pemeriksaan fisik diperlukan untuk mengkarakterisasikan tingkat
luksasi. Evaluasi cara berjalan dan berlari dilakukan untuk mengevaluasi konformasi
keseluruhan dan untuk melihat deformitas kerangka tubuh, serta untuk menentukan tingkat
dan karakter kepincangan. Ini adalah faktor yang penting untuk dipertimbangkan ketika
membuat rencana terapeutik (Pérez dan Lafuente, 2014). Berdasarkan anamnesis dan
pemeriksaan fisik yang dilakukan, anjing mengalami gangguan pada kaki belakang bagian
kiri. Kaki belakang kiri fleksi saat berjalan dan berlari secara kontinyu, terkadang kaki kiri
belakang juga fleksi secara intermitten saat anjing berdiri. Anjing merespon sakit saat
dipalpasi di sekitar sendi dan tidak ada krepitasi.
Berdasarkan gambaran evaluasi radiografi didapatkan hasil pada kaki kiri belakang
mengalami luksasi patella medial terlihat dari deviasi medial dari tuberositas tibial dan patella
bergeser ke arah medial (tidak terletak pada trochlear femur) (Gambar 2), serta patella tertarik
ke dalam trochlear (Gambar 3). Hasil pemeriksaan menunjukan anjing mengalami luksasi
patella grade II. Anjing dikategori mengalami luksasi patella grade I apabila patella dapat
luksasi secara manual, tetapi kembali ke alur trochlear setelah tekanan manual dilepaskan,
tidak ada krepitus selama pergerakan sendi, tidak ada deformitas tulang dan tanda-tanda
klinis biasanya tidak ada, sedangkan grade II patella luksasi dengan sendi mengalami fleksi
dan tetap mengalami luksasi saat sendi ekstensi, luksasi spontan terjadi dengan tanda-tanda
klinis kepincangan, dan deformitas ringan berkembang (rotasi intermal tibia) (Roush, 1993;
Pérez dan Lafuente, 2014)
134
Grade III patella luksasi secara terus-menerus, dan dapat dikembalikan secara manual
tetapi akan luksasi secara spontan ketika tekanan manual dihilangkan, deformitas tulang yang
parah, alur trochlear dangkal ketika patella luksasi dipalpasi, kepincangan diakibatkan karena
tingkat erosi kartilago dari permukaan artikuler patella dan trochlear ridge medial femur,
abnormal gaya berjalan “skipping” secara intermiten, kaki semifleksi, posisi rotasi internal,
sedangkan anjing dengan grade IV patella terus-menerus luksasi dan tidak dapat
dikembalikan ke posisi normal secara manual (permanen), deformitas tulang yang parah: tibia
diputar 60 derajat ke 90 derajat ke bidang sagital, varus femoralis, varus proksimal tibia, dan
rotasi internal tibialis, serta postur seperti “kepiting” (Roush, 1993; Pérez dan Lafuente,
2014)
Tanda-tanda kepicangan akibat luksasi patella yang bertambah buruk dapat
menyebabkan penyakit sekunder seperti osteoarthritis dan ruptur cranial cruciate ligament
berkembang. Prognosa dalam kasus ini infausta, karena penanganan kasus lebih banyak
dilakukan dengan pembedahan. Penanganan kasus luksasi patella dapat dilakukan dengan
management konservatif dan bedah. Beberapa teknk operasi yang digunakan adalah medial
restraint release, lateral retraint reinforcement, capsulolabral reconstruction, trochlear
grove deeping (block recession and trochlear chondroplasty) dan tibial tuberosity
transposition (Isaka et al., 2014).
Laporan kasus ini menggunakan penanganan secara management konservatif dengan
melakukan pertimbangan berdasarkan tingkat luksasi patella yaitu grade II dan derajat
kepincangan yang ringan Perawatan konservatif, termasuk rehabilitasi mekanisme quadriceps
yaitu pada grade I tanpa tanda-tanda klinis yang terkait, disisi lain dalam kasus luksasi grade
III dan grade IV perlu dilakukan pembedahan (Pérez dan Lafuente, 2014). Landasan
manajemen konservatif luksasi patella adalah manajemen berat badan, istirahat, terapi
antiinflamasi, modifikasi latihan dan rehabilitasi fisik (Fauron dan Perry, 2016). Jika
frekuensi kepincangan ringan dan jarang dan derajat osteoarthritis ringan dan tidak progresif,
treatment konservatif dapat dilakukan (Pérez dan Lafuente, 2014). Berdasarkan penelitian
Gibbons et al. (2006) satu pasien yang berhasil ditangani tanpa pembedahan yang juga
mengalami ruptur cranial cruciate ligament bersamaan mendapatkan hasil sangat bagus.
Meskipun terdapat kelainan anatomi yang parah, beberapa anjing dengan patella luksasi
memiliki fungsi klinis yang baik. Dua anjing dengan luksasi patella grade 4 yang dirawat
tanpa pembedahan itu sehat atau lumpuh ringan.
135
Penanganan yang diberikan untuk mencegah berkembangnya penyakit sekunder dari

luksasi patella yaitu osteoarthritis. Dengan pemberian suplemen Osteor Plus® yang
mengandung glucosamine, chondroitin sulfate, vitamin C, mangan, magnesium, zinc,
selenium, dan methylsulfonylmethane, serta diberikan vitamin B1®, fish oil (Salvero®) dan
antiradang non-steroid carprofen 25 mg (Rimadyl®). Chondroitin sulfate dan glucosamine
sulfate adalah aminosakarida yang bertindak sebagai substrat untuk biosintesis rantai
glikosaminoglikan dan kemudaian produksi aggrecan (Comblain et al., 2015). Glucosamine
digunakan sebagai agen untuk membantu meringankan gejala dan menunda perkembangan
osteoarthritis dan chondroitin sulfate membantu menjaga viskositas sendi, menstimulasi
perbaikan tulang rawan, serta menghambat enzim yang mendegradasi tulang rawan
(Huskisson, 2008). Antiinflamasi non-steroidal (AINS) tidak dapat digunakan jangka
panjang. Resiko potensial dari pengobatan jangka panjang menyebabkan anjing toleransi
terhadap obat dan peningkatan efek samping AINS (Innes et al., 2010). Antiinflamasi non-
steroidal menyebabkan penyakit ginjal, meningkatkan resiko kerusakan gastrointestinal dan
nefrotoksik dan memiliki dampat negatif pada fungsi platelet anjing (KuKanich et al., 2012).
Efek suplemen fish oil omega 3-fatty acid meningkatkan beberapa hasil klinis dan penahan
berat badan, juga dapat mengurangi dosis karprofen jika digunakan secara bersamaan (Fritsch
et al., 2010)
Manajemen berat badan hewan dan latihan fisik yang sesuai sangat berpengaruh
dalam terapi kasus ini. Kelebihan berat badan berkontribusi terhadap peningkatan sendi, yang
merupakan faktor resiko untuk perkembangan osteoarthritis, selain itu merupakan faktor yang
berkontribusi terhadap peningkatan stress pada persendian yang mempercepat perkembangan
penyakit (Elliot et al., 2007; Rychel, 2010). Terapi dalam kasus ini dapat mengurangi
frekuensi tanda-tanda klinis yang terkait dengan luksasi patella, yang mana diharapkan tidak
terjadi peningkatan grade luksasi.
SIMPULAN
Berdasarkan hasil anamnesis, pemeriksaan klinis dan pemeriksaan radiologi dapat
disimpulkan bahwa anjing kasus mengalami luksasi patella medial. Terapi yang diberikan
adalah terapi suportif berupa pemberian AINS, suplemen tulang dan sendi, fish oil dan
vitamin B1 untuk membantu mengurangi tanda-tanda klinis terkait dengan luksasi patella.
136
SARAN
Pemilik perlu mengontrol berat badan pada anjing yang mengalami luksasi patella,
sehingga akan mengurangi beban sendi dalam menopang tubuh. Makanan yang mengandung
glukosamin dan kondroitin baik diberikan pada anjing yang mengalami masalah persendian.
UCAPAN TERIMA KASIH

Penulis mengucapkan terima kasih kepada staf Laboratorium Penyakit Dalam
Fakultas Kedokteran Hewan Universitas Udayana dan kelompok Koasistensi 13D yang telah
membantu dalam penyelesaian laporan kasus ini.
DAFTAR PUSTAKA
Campbell CA, Horstman CL, Mason DR, Evans RB. 2010. Severity of patellar luxation and
frequency of concomitant cranial cruciate ligament rupture in dogs: 162 cases (2004-
2007). Journal of the American Veterinary Medical Association. 236(8): 887–891.
Comblain F, Serisier S, Barthelemy N, Balligand M, Henrotin Y. 2015. Review of Dietary
Supplements for The Management of Osteoarthritis in Dogs in Studies from 2004-
2014. Journal of Veterinary Pharmacology and Therapeutics. 39: 1-15.
Denny HR, Butterworth SJ. 2000. A Guide to Canine and Feline Orthopedic Surgery. 4th ed.
Oxford: Blackwell Sci. pp: 517–525.
Di Dona F, Valle GD, Fatone G. 2018. Patellar Luxation in Dogs. Veterinary Medicine:
Research and Reports. 9: 23-32.
Elliot D, Servet, E, Biourge V. 2007. Nutritional management of canine osteoarthritis.
Veterinary Focus. 17: 6.
Fauron L, Perry KL. 2016. Treatment and Outcomes for Canine Patellar Luxation: Part 2.
https://www.researchgate.net/publication/302755538 diakses tanggal 3 September
2019.
Fritsch DA, Allen TA, Dodd CE, Jewell DE, Sixby KA, Leventhal PS, Brejda, J, Hahn KA.
2010. A multicenter study of the effect of dietary supplementation with fish oil
omega-3 fatty acids on carprofen dosage in dogs with osteoarthritis. Journal of the
American Veterinary Medical Association. 236(5): 535–539.
Garnoeva R, Paskalev M, Bengyuzov N. 2016. Investigations on The Prevalence of Patellar
Luxation in Dogs. Tradition and Modernity in Veterinary Medicine. 1(1): 53-59.
Gibbons SE, Macias C, Tonzing MA, Pinchbeck GL, McKee WM. 2006. Patellar Luxation in
70 Large Breed Dogs. Journal of Small Veterinary Practice. 47: 3-9.
Huskisson EC. 2008. Glucosamine and Chondroitin for Osteoarthritis. The Journal of
International Medical Research. 36(6): 1-19.
Innes J, O’Neill T, Lascelles D. 2010. Use of Non-steroidal Anti-inflammatory Drugs for The
Treatment of Canine Osteoarthritis. In Practice. 32: 126–137.
Isaka M, Befu M, Nami M, Ishikawa M, Arase Y, Tsuyama T, Doi A, Namba S. 2014.
Corrective Surgery for Canine Patellar Luxation in 75 Cases (107 limbs): Landmark
for Block Recession. Veterinary Science Development. 4(2): 30-32.
KuKanich B, Bidgood T, Knesl O. 2012. Clinical Pharmacology of Nonsteroidal Anti-
inflammatory Drugs in Dogs. Veterinary Anesthesia and Analgesia. 39: 69–90.
137
L’Eplattenier H, Montavon P. 2002. Patellar luxation in dogs and cats: pathogenesis and
diagnosis. Compendium on Continuing Education for the Practising Veterinarian
24(3): 234-240.
Nganvongpanit K and Yano T. 2011. Prevalence and Risk Factors of Patellar Luxation in
Dogs in Chiang Mai, Thailand, during the Years 2006-2011. Thai J Vet Med. 41 (4):
449-454.
O’Neill DG, Meeson RL, Sheridan A, Church DB, Brodbelt DC. 2016. The Epidemiology of
Patellar Luxation in Dogs Attending Primary-Care Veterinary Practices in England.
Canine Genetics and Epidemiology. 3(4):1-12.
Pérez P, Lafuente P. 2014. Management of Medial Patellar Luxation in Dogs: What You
Need to Know. Veterinary Ireland Journal. 4(12): 634-640.
Roush JK. 1993. Canine Patellar Luxation. Vet Clin North Am Small Anim Pract. 23(4): 855–
868.
Rychel JK. 2010. Diagnosis and Treatment of Osteoarthritis. Topics in Companion Animal
Medicine, 25: 20–25.
Vidoni B, Sommerfeld-Stur I, Eisenmenger E. 2005. Diagnostic and genetic aspects of
patellar luxation in small and miniature breed dogs in Austria. Wien Tierärztliche
Monatsschrift, 92: 170-181.
138
Issue 6 t +44 (0)114 258 8530 info@vetinst.com www.vetinst.com
Academy Step by Step
Patellar Luxation - A Step By Step Guide

Patellar luxation is the condition where the
patella luxates out of the femoral trochlear
sulcus instead of tracking up and down
within it. Most commonly the patella luxates
medially but lateral luxation also occurs. It
can occur in any size or breed of dog but is
more common in small breed dogs.
Cats have a broad and flat patella and the
femoral trochlear sulcus is shallow; therefore
the normal cat patella is much more mobile
medial to lateral and relatively unstable
compared to dogs.
Patellar subluxation is common in cats
but, clinically significant patellar luxation is
uncommon.
Patellar luxation is usually a diagnosis made from Grade 3: The patella is always luxated but
the patient history and signalment, and by stifle can be returned to the normal position in the
manipulation and palpation, rather than from trochlear sulcus by digital manipulation. Once
radiographs. This is because the luxating patella such manipulation stops, patellar luxation recurs.
is mobile and can change position which can be This causes an abnormality of stifle function i.e.
easily palpated but not necessarily appreciated on a inability to extend the stifle and associated hindlimb
radiograph. lameness. Surgical correction is beneficial to the
Patellar luxation is graded depending on its severity patient as it restores normal stifle function including
and there are many ways of doing this. The most the quadriceps ability to extend the stifle.
commonly used grading system is the Putnam/ Grade 4: The patella is permanently luxated and
Singleton system which can be described as: cannot be reduced to a normal position despite
Grade 1: The patella tracks normally but luxates manipulation. This causes permanently abnormal
with digital pressure or manipulation of the tibia. stifle function with lameness and inability to extend
Once manipulation is discontinued, the patella the stifle and can result in debilitating lameness
tracks normally in the trochlear groove. This with a crouched pelvic limb stance and gait. Surgical
causes minimal clinical problem with infrequent or correction is of benefit. In puppies and young dogs
no clinical signs. Surgical correction is usually not with severe grade 4 developmental patellar luxation,
indicated nor of direct benefit to the patient. surgery should be considered as soon as possible to
Grade 2: The patella intermittently and prevent the progression of skeletal deformities that
spontaneously luxates and resolves. This may be may otherwise develop. Surgical correction of grade
mild and infrequent to severe and frequent, and 4 patellar luxation is challenging.
anywhere in-between. Luxation normally happens
as the stifle is flexed, and resolves when the stifle NB Throughout this text for the purpose of clarity,
is extended. The typical history is of a dog with patellar luxation and its treatment will refer to
intermittent skipping hindlimb lameness. Surgical medial patellar luxation. For cases of lateral patellar
correction is usually of benefit to the patient, luxation, the terminology and text is interchangeable
particularly the more frequently patellar luxation but references to position should be switched i.e.
occurs. medial to lateral and vice versa.
Causes Of Patellar Luxation 1. Malalignment Of The Quadriceps
Mechanism And Trochlear Sulcus
Usually a combination of different factors cause
patellar luxation. For successful correction, the The stifle extensor mechanism comprises the
surgeon must make an individual assessment of each quadriceps muscle with the origin of the three
patient, identify each factor present and vastus muscles on the proximal femur and
correct each individiually. The common problems rectus femoris on the pelvis just cranial to the
are illustrated below: acetabulum, the patella, patellar tendon/ligament
and tibial tuberosity. The relative position of these,
in particular the patella and the trochlear sulcus is
important. For normal patellar tracking, the line-of-
pull of the quadriceps mechanism and the patella
should lie directly over the femoral trochlear sulcus.
Factors that affect quadriceps alignment are:

• Bowing of the distal femur. This changes the
position and alignment of the femoral trochlear
sulcus relative to the quadriceps mechanism.
Femoral bowing can be assessed from physical
assessment, radiographs and CT images, but
interpretation can be challenging and the normal
range is not been well defined.
• Tibial malformation i.e. a rotational (torsional)
deformity of the tibial tuberosity can cause
malalignment of the quadriceps mechanism due
to abnormal positioning of the tibial tuberosity
relative to the femoral trochlear sulcus.
• Bowing of the proximal tibia; often the proximal
tibia is bowed in the opposite direction to the
distal femur.
• Hip conformation and pathology; for example
cranio-dorsal hip luxation causes functional
foreshortening of the femur with external
rotation; this in turn causes quadriceps/ femoral
trochlear sulcus malalignment and patellar
luxation can occur.
2. Shallow Femoral Trochlear Sulcus
Too shallow a sulcus or insufficiently high medial

or lateral trochlear ridges can result in inadequate
constraint of the patella and subsequent luxation.
Assessment of sulcus depth and trochlear
ridge height is subjective; there is no guide that
differentiates normal from abnormal.
3. Excessively Tight Medial Soft Tissues
a b i.e. retinaculum and joint capsule. If the soft

a. conformation of pelvic limb of normal dog. tissues medial to the patella are too tight, they will
b. conformation of pelvic limb of dog with medial bowing (varus) of constrain its movement by permanently ‘pulling’ it
the femur, internal rotation of the tibia and medial tibial tuberosity medially. It is likely that these tissues become tight
malpositioning i.e. malalignment of the quadriceps mechanism relative as a consequence of chronic patellar luxation, rather
to the femoral trochlear sulcus, and medial patellar luxation.
Red line indicates central axis of the limb. than causing it.
4. Slack Lateral Soft Tissues Surgical Solutions
i.e. retinaculum, joint capsule and femero-patellar The four commonly performed surgical options
ligament; if these tissues are loose, then the patella available to correct patellar luxation include:
is not ‘pulled’ or constrained laterally i.e. patellar
luxation can occur. These tissues are loose in the 1. Femoral Trochlear sulcoplasty i.e. deepen
opposite direction to the patellar luxation, and most the trochlear sulcus to constrain the patella and
likely develop as a result of patellar luxation rather prevent luxation. This is done if the trochlear
than causing it. sulcus is assessed to be too shallow.
2. Tibial Tuberosity Transposition i.e. realign

5. Co-Existing Rupture Of The Cranial the quadriceps mechanism by osteotomy
Cruciate Ligament and re-pos itioning the tibial tuberosity
more laterally. This is done if malalignment of
Patellar luxation may occur in association with the quadriceps mechanism and the femoral
cranial cruciate ligament rupture. When the cranial trochlear sulcus are present.
cruciate ligament ruptures, cranial and internal
rotational stability of the tibia relative to the 3. Medial Release i.e. transect the medial soft
femur is lost; this causes malpositioning of the tissues (joint capsule and/ or retinaculum) if
tibial tuberosity relative to the femoral sulcus, and they are excessively tight. This is done if medial
quadriceps malalignment. soft tissue tension prevents the patella from
tracking in the trochlear sulcus, usually only
necessary in grade 3 or 4 luxations
4. Lateral Imbrication i.e. tighten the lateral

soft tissues (joint capsule and retinaculum) to
prevent patellar luxation. This is done if the soft
tissues are too loose, but it should not be relied
on to correct patellar luxation because future
tissue loosening will likely develop if quadriceps
alignment or inadequate sulcus depth persist.
Other surgical produces may be used to correct

patellar luxation, but these are more demanding
procedures. TPLO or lateral fabella suture may
be used with concurrent cranial cruciate ligament
disease. Corrective osteotomies of the distal
femur and/ or proximal tibia may be performed if
there is significant femoral/ tibia malalignment, but
the inclusion criteria are poorly defined. Partial
parasagittal patellectomy may be performed in cats
if patellar luxation cannot be constrained using
traditional means. If significant hip pathology is
present such as hip subluxation, this may need to be
addressed to successfully correct patellar tracking.
However, these are demanding surgeries, and best
undertaken by experienced surgeons.
Surgical Technique For (Medial) Patellar
Luxation 3 Position the patient in dorsal recumbency
(Fig 3) and prepare a full aseptic surgical
Initial Approach And Assessment preparation of the limb with the entire
distal limb draped in (Fig 4) and the foot in
a sterile impervious dressing. This allows full
1 Pre-operative assessment includes a full
access and manipulation of the limb
during surgery.
clinical examination of the patient including
gait assessment and orthopaedic examination.
Patellar stability and pelvic limb alignment
should be assessed.
2 Take orthogonal radiographs of the stifle.

Consider including a full caudo-cranial view
of the entire hindlimb from hip to tarsus to
assess bowing deformities of the tibia and
femur (Fig 1).
The radiographs allow other differential
diagnoses to be excluded, possibly the
diagnosis to be confirmed, and preoperative
measurements made to plan the correct
position of the osteotomy for tibial
tuberosity transposition (Fig 2).
Fig 3
Fig 4
Fig 1 Fig 2
4 Before starting the surgery, check patella 7 Repeat assessment of the alignment of the
position and anatomic landmarks that will quadriceps mechanism. Stand at the toe of
guide the surgery i.e. patella, patellar ligament the dog and visualise the course and position
and tibial tuberosity (Fig 5).Visualise the of the quadriceps mechanism. Review this
patellar ligament/ tendon and assess whether whilst flexing the stifle and internally rotat-
it is laterally, neutrally or medially positioned ing the tibia. Note whether the quadriceps
from patella to tibial tuberosity. Do this with mechanism is aligned or malaligned i.e. does
the tibia internally rotated, in neutral, and the patellar ligament deviate medially, laterally
externally rotated. This will give an indication or is it neutral? (Fig 3 & 4).
of whether a tibial tuberosity transposition is
necessary, and if so by how much.
8 Sharply incise the lateral retinaculum approx.
1cm lateral to the patella. Dissect free from
the underlying joint capsule. This incision
extends proximal to the patella. The joint
capsule is exposed underneath (Fig 8).
Fig 5
5 Make a lateral para-patellar skin incision over

the stifle about 1cm lateral to the patella,
extending from proximal to the patella to the
tibial tuberosity (Fig 6).
Fig 8
9 Sharply incise the joint capsule. This incision

extends proximal to the patella, extending
slightly into distal vastus lateralis. Use suction
to aspirate synovial fluid. Luxate the patella
medially, flex the stifle and use Gelpi
retractors to maintain position (Fig 9).
Fig 6
6 Dissect the subcutaneous fascia until the

patellar ligament and tibial tuberosity are
clearly seen (Fig 7).
Fig 9
10 Inspect and confirm that the cranial cruciate

ligament is normal.
Fig 7
11 Assess the depth of the trochlear groove
(subjective), and inspect for cartilage erosions
of the femoral trochlear sulcus. Fig 10 shows
full thickness cartilage erosion (circled
green) of the proximal medial trochlear
ridge where the patella has been luxating,
a relatively shallow trochlea and a medial
trochlear ridge with poor height.
Fig 10
12 Remove the Gelpi retractors, retroflex the

patella and assess the articular cartilage
damage on the caudal aspect of the patella.
Fig 11 shows a large full thickness articular
cartilage defect on the caudal aspect of this
patella; this may adversely affect prognosis.
Fig 11
Medial Release
Medial release is not necessary for most cases but is

necessary when the tension in the medial tissues
is such that the patella cannot be returned to
the trochlear sulcus without performing release,
or if the tension is adversely influencing patellar
tracking i.e. grade 4 or severe grade 3 patellar
luxation. If medial release is to be performed, it is
best performed as the first step i.e. before femoral
trochlear sulcoplasty, and certainly before tibial
tuberosity transposition. To perform medial release,
a medial approach is made to the stifle in a similar
way as described above for the lateral approach.
The incision extends far enough proximally until
all excessive soft tissue tension has been abolished.
In most dogs, this means releasing both the medial
retinaculum and the joint capsule in the region of
and just proximal to the stifle. If severe, the release
may need to extend up to the proximal femur and
pelvis.
Femoral Trochlear Sulcoplasty 3. Abrasion Sulcoplasty (Rasping)
A bone rasp (Fig 13) is used to rasp the
Assess the depth of the femoral trochlear sulcus trochlear sulcus until adequate depth is
and the need for sulcoplasty; this is a subjective achieved. This is the least favourable option as all
judgement (Fig 10). If the trochlear sulcus is articular cartilage is destroyed. This technique is
deep enough, sulcoplasty is not necessary. When not recommended unless no articular cartilage
assessing whether to perform sulcoplasty or not, is present, which is unlikely except in revision
consider that the detrimental effect of sulcoplasty is surgery. Inexperienced surgeons may choose to
unavoidable cartilage damage and this needs to be start using this technique, particularly in very
carefully balanced against the benefits. Methods for small stifles where the osteotomy techniques
sulcoplasty include: above may be challenging and carry a risk of
fracture of the osteochondral graft or the femur
1. Block Recession Sulcoplasty if the cuts are made too deep.
In adult dogs, this is the best option as it
preserves the largest amount of articular
cartilage, it enables a larger amount of the
sulcus to be deepened, and it creates a deeper
femoral trochlea proximally compared to wedge
recession sulcoplasty. However, it is also the
most fiddly and technically demanding method
and requires precise surgical technique and a
modular osteotome (Fig 12) with thin, sharp
blades of different widths. It is challenging to
do this well single-handed; a surgical assistant is Fig 13
necessary.
4. Chondroplasty
This is rarely performed as it can only be done
in very young patients less than 6 months of age
Fig 12 as the cartilage is not flexible enough in older
patients. The articular cartilage of the trochlear
2. Wedge Recession Sulcoplasty sulcus is sharply dissected away from the
This is the next best option as it preserves subchondral bone and remains attached distally.
some articular cartilage, but it does not deepen The underlying bone is deepened, then the
the trochlear sulcus as well as block recession articular cartilage is laid back in the trochlear
sulcoplasty. It is simpler to perform, can be done groove.
with less specialised equipment or experience,
and the risk of graft fracture is less.
Block Recession Sulcoplasty
3 Use the modular osteotome and mallet
to cut the base of the block from distal
to proximal. (Fig 15) Start just cranial to
the intercondylar notch and aim for the
osteochondral junction of the trochlear
groove proximally. This must be done
very carefully and with great care to avoid
fracturing the block. A thick osteotome will
increase the chance of fracture. If the block
fractures, it can be salvaged.
1 Determine the width of the intended

sulcoplasty by choosing the modular
osteotome blade that best fits the maximum Fig 15
width of the trochlea. Using a #11 blade,
gently score the intended cut position on
medial and lateral trochlear ridges.
4 Carefully remove the osteochondral block
from the femoral trochlea (Fig 16).
2 Using a fine X-ACTO saw or similar, make

the lateral and medial cuts that will define
the edges of the osteochondral block. (Fig
14) Make sure the base of the cuts are flat
and not domed. Be careful to make the
osteotomy as wide as possible, yet leave
enough lateral and trochlear ridge width that
neither is weakened.
Fig 16
5 Recess the block by taking further

subchondral bone away, either from the
exposed femoral subchondral bone or from
the base of the osteochondral block.
Fig 14
6 Re-position the osteochondral block in the 2 Carefully remove the cut wedge from the
graft site and review for closeness of fit, femoral trochlea (Fig 19).
stability, and depth of recession achieved (Fig
17). Adjust until satisfactory and stable.
Fig 19
Fig 17
7 Remove the Gelpi retractors, return the

patella to the trochlear sulcus and assess the
patella for normal tracking and medial-lateral
stability.
Wedge Recession Sulcoplasty

3 Recess the wedge by removing a further thin
section of subchondral bone; either from
the exposed femoral trochlear sulcus (Fig
1 Using a #11 blade, score the highest points of
20) which is best, or from the wedge itself
but the latter is much more difficult and will
the medial and lateral trochlear ridges of the make the wedge narrower and lose more
femur; this marks the cutting points. Using an articular cartilage.
fine X-ACTO saw, create an osteochondral
wedge from the trochlear sulcus. The lateral
and medial saw cuts should be oriented to
meet just cranial to the intercondylar notch
of the femur distally and proximally at the
osteochondral junction (Fig 18).
Fig 20
Fig 18
Tibial Tuberosity Transposition
4 Replace the osteochondral wedge in the Assess the need for tibial tuberosity transposition
recessed femoral sulcus and review for prior to surgery, an indication should have
closeness of fit, stability, and depth of been derived from physical examination and
trochlear recession achieved. Adjust until radiographs or CT scan. The dog should be in dorsal
satisfactory (Fig 21). Some surgeons prefer recumbency. Stand at the foot of the dog, looking
to remove subchondral bone from the base up the pelvic limb (Fig 3 & 4). Hold the stifle in full
(apex) of the wedge with rongeurs; this extension. Observe the orientation and position of
can give a better fit and stop the graft from the patellar ligament, patella and tibial tuberosity
rocking on the ridge of the base. whilst the stifle is extended and flexed and the tibia
is rotated internally and externally; the most likely
position for patellar luxation is flexing with internal
tibial rotation. If patellar ligament orientation is not
neutral and patellar luxation occurs, tibial tuberosity
transposition is indicated.
As an example, (Fig 22) shows the relative positions
of the patella (reduced and luxated), the position of
the tibial tuberosity and the medial orientation of
the patella, patellar ligament and tibial tuberosity.
Fig 21
Fig 22
5 Remove the Gelpi retractors, return the
patella to the trochlear sulcus and assess
the patella for stability through a full range
of physiological stifle movement, specifically
flexing from full extension with tibial internal
rotation - these are the positions most likely
to cause luxation. Patellar luxation should be
resolved prior to soft tissue closure - do not
rely on soft tissue closure to ensure patellar
stability.
Fig 25 shows a postoperative radiograph with
1 Use sharp dissection (#11 blade and a good to large sized tibial tuberosity. If the
periosteal elevator) to expose the medial osteotomy is made in the wrong position,
aspect of the tibial tuberosity. either the tibial tuberosity or the tibia are at
risk of fracture.
2 If using a finger saw or hacksaw (not if using

an oscillating saw), sharply dissect and elevate
the cranial tibial muscle from the lateral tibial
tuberosity. Ensure that the most proximal at-
tachments of the muscle are not severed i.e.
the muscle should only be partially elevated
to minimise damage from the saw blade, but
not fully elevated.
3 Perform an osteotomy of the tibial tuberosity

Fig 24 Fig 25
(Fig 23). An oscillating saw gives the most
controlled and precise cut but alternatively
use a hand saw, bone cutters or osteotome).
Place a Freer elevator or Gelpi retractor
5 The tibial tuberosity should now be mobile
under the patellar ligament to protect it from proximally (medial to lateral) but the distal
the saw. aspect should remain attached. Using a
periosteal elevator, gently and minimally
elevate the tibial tuberosity from the tibia
and transpose it laterally to a position that
achieves neutral orientation of the patellar
ligament and quadriceps mechanism (Fig 26).
If the tuberosity is not readily mobile, this
usually means the osteotomy is not quite
complete enough and needs slightly more
work distally. Some surgeons like to prepare
the graft bed prior to tibial tuberosity
fixation; to do this, the ridge from the lateral
edge of the parent tibial tuberosity site is
removed using rongeurs.
Fig 23
4 The size of tibial tuberosity and position

of osteotomy is important to minimise the
chance of fracture. As a guide, the cranio-
caudal depth of the osteotomised tibial
tuberosity should be about 30% the cranio-
caudal dimensions of the tibia at that point.
The osteotomy should go between the
proximal tibia and the base of the tibial
tuberosity, keeping a bridge of intact cortical
bone and periosteum distally. Fig 24 shows
pre-operative plan for size and position of
Fig 26
the tuberosity osteotomy; a sterile ruler
can be used during surgery to replicate the
measurements and ensure the osteotomy is
in the correct position.
6 Using a power drive where available, place a
K-wire into the proximal tibial tuberosity just
proximal to the distal insertion point of the
patellar ligament. This immobilises the tibial
tuberosity in its new laterally transposed
position (Fig 27, 28 & 29).
Fig 30
Fig 27
Fig 31
7 Application of a figure-of-8 tension band is

highly advisable; care must be taken during
placement to not damage the soft tissues,
particularly the patellar ligament.
8 Looking from the position of the dog’s

foot, review the orientation of the patellar
Fig 28 ligament and the position of the tibial
tuberosity. The patellar tendon/ ligament
should be in a neutral position. internal and
external rotation of the tibia should cause
equal medial and lateral orientation of the
patellar ligament with no patellar luxation
(Fig 30 & 31) with internal and external
rotation respectively; note the changing
alignment of the patellar ligament as the tibia
is rotated. Fig 32 & 33 show the patella in the
correct position.
Fig 29
The K-wire should be directed slightly
cranio-lateral to caudo-medial. Ideally 2
parallel K-wires are placed adjacent to
each other. The size of K-wire should be
appropriate to the patient (Fig 30 & 31).
A Jacobs chuck can be used to drive the
K-wires but this is harder to drive the wire
through the bone without slippage and wire
bending.
Fig 32 Fig 33
Closure
9 Review the stability of the patella and
specifically assess for luxation. Start with the Before considering the surgery complete, once
stifle in full extension and slowly flex with again check patellar stability through a normal
the tibia in full internal and then external physiological range of stifle movement, particularly
rotation as these are the positions most flexing the stifle from full extension with tibial
likely to cause (medial and lateral) luxation. internal and external rotation. If patellar luxation
The patella should now be stable through a persists, the surgery needs to be reviewed
full range of normal physiological movement and revised. The surgical site should be flushed
and should not luxate. thoroughly and then closed:
NOTE - Patellar luxation should be • Appose and close the joint capsule incision;
resolved prior to soft tissue closure - do unless release was performed, then not on that
not rely on soft tissue closure to ensure side.
patellar stability. • Appose and close the retinacular incision unless
release was performed, then not on that side.
• Appose and close the subcutaneous fascia.
• Appose and close the skin.
Post-operative radiographs of the stifle are taken
Lateral Imbrication to confirm the patella has been returned to the
trochlear sulcus, that the positions of the sulcoplasty
For most cases of patellar luxation, once sulcoplasty and tibial tuberosity transposition are correct and
and tibial tuberosity transposition have been appropriate, and that implants are in the correct
performed, the patella should be stable, luxation position (Fig 34 & 35). Radiographs should be
should not be impossible and further surgery critically assessed for potential problems before the
(other than routine closure) should not be patient is recovered from the anaesthetic.
necessary. If the patella is not stable at this stage,
the trochlear sulcoplasty and tibial tuberosity
transposition should be critically reviewed, and
revised as necessary.
Performing lateral imbrication without adequate
trochlear sulcoplasty or tibial tuberosity
transposition is not recommended as it is associated
with a high risk of patellar re-luxation.
Lateral imbrication tightens the soft tissues on the
lateral aspect of the stifle joint; the joint capsule and
retinaculum can be closed separately. Imbrication
can be achieved by one of two methods:
• Using Mayo scissors, resect a strip from one
edge of the retinaculum and/ or joint capsule.
Don’t take so much tissue that it cannot then be Fig 34 Fig 35
sutured together. The tissue should close snugly
but without tension. Close the joint capsule and
retinaculum separately with simple interrupted
appositional sutures.
• Or place modified Mayo Mattress (vest over
pants) sutures to close the retinaculum and/
or joint capsule in an overlying instead of an
appositional fashion.
Patellar Luxation Instrumentation Modular Osteotome with Ultra-thin
Interchangeable Blades and Diamond Rasp
X-Acto Saw
XACTOB/H X-Acto Saw Complete 270mm

XACTOHANDLE X-Acto Saw Handle only 140mm
XACTOBLADE X-Acto Saw Blade 0.3mm cut 140mm
XACTOSTERILE-A X-Acto Saw Blade Sterile 0.3mm cut 140mm
Hard Backed Orthopaedic Saw 001380 Modular Osteotome complete with 7 Blades
001382 Modular Osteotome Replacement Blade 4mm
001389 Modular Diamond Rasp 6mm
001380SCREW Spare Screw for Modular Osteotome
Orthopaedic Mallet
001004 Orthopaedic Hard Back Saw 0.4mm cut Stainless Steel 145mm
Adjustable Bone Saw
001320 Mallet 300g 220mm Long
Rectangular Sulcoplasty Instruments
001000 Adjustable Bone Saw c/w 5 Fine Blades

001001 Spare Fine Blades Pack of 5 Chrome Plated
001000SS Adjustable Bone Saw Blade (Single) Sterile
Gordon Coronoid Osteotome
AR-17-30 Gordon Coronoid Osteotome (4mm)

AR-17-29 Gordon Coronoid Osteotome (2mm)
001017 Super Slim Osteotome 8mm 180mm
001018 Rectangular Bone Rasp 210mm
Universal Sulcoplasty Rasp MiniDriver Sets
VIMDB2 MiniDriver Basic Set (inc MkII Saw)

001021 Universal Sulcoplasty Rasp 210mm Long
Vi Black Series Battery Powered Drill/ Saw Set
Osteophyte Rasp
BLACKKIT Vi Black Series Drill/ Saw Set
Variable Speed Orthopaedic Drill

001019 Osteophyte Rasp
Trochlea Rasp
001020 Trochlea Rasp 11mm max 5mm min Diameter

001600 Variable Speed Orthopaedic Drill (Milwaukee) Kit -
001022 Trochlea Rasp Small 8mm max 3mm min Diameter
Drill, Chuck, Key, Shroud, Extension & 2 x Batteries
Multi Saw Battery Powered
001708.134 Multi Saw Surgical Kit incl Convertor, Shroud,

Titanium Nitride Coated Blade and SB5071-134 Blade
Rongeurs
001300 Small Curved Rongeur 4mm Bite 170mm Long
142502 Micro-Friedman Rongeur Curved 2.2mm Bite 155mm Long
Simple Action Cutters

001310 Small Angled Cutter 15mm Blade 170mm Long
001311 Large Angled Cutters 19mm Jaw 230mm Long
Orthopaedic Wire
OW0210 0.2 (diameter in mm)
OW0310 0.3
OW0410 0.4
OW0510 0.5
OW0610 0.6
OW0710 0.71
OW0810 0.8
OW0910 0.9
OW1010 1.0
OW1012 1.2
OW1015 1.5
Wire Twister/ Shear Cutter

001260 Wire Twister/ Shear Cutter 165mm Long
001261 Wire Twister/ Shear Cutter - Tungsten Carbide Jaws 165mm Long
Kirschner Wire
090030 0.9mm diameter 125mm Long Pack of 10
090030/3M Pack of mixed Kirschner Wires
Arthrodesis Wire
090025S Pack of mixed Arthrodesis Wires
Jacobs Chuck
001220 Small Jacobs Chuck with Handle 5/32” Capacity 260mm
001221 Standard Jacobs Chuck with Handle 1/4” Capacity
Small Pin Vice ‘K’ Wire Bender

001223 Small Pin Vice 100mm Long
001362 ‘K’ Wire/ Small Pin Bender 140mm Long
Implant Cutters ‘K’ Wire/ Small Pin Punch

001237 Implant Cutter Stainless Steel Cuts to 2.2mm Capacity 230mm Long 001360 Pin Punch 135mm Long
001238 Implant Cutter Stainless to 1.5mm Capacity Close Cut 150mm Long 001361 Small Pin Punch 1.6mm Tip 135mm Long
To place an order contact our Vi Advisor Team on 0345 130 9596 or email info@vetinst.com
Veterinary Instrumentation
Distington House, 26 Atlas Way,
Sheffield, U.K. S4 7QQ
t 0345 130 9596 overseas +44 (0)114 258 8530
info@vetinst.com www.vetinst.com
JWN SBS6 ISSUE 2 JULY 2019 PAT LUX

http://dx.doi.org/10.1590/1678-4162-9245
Arq. Bras. Med. Vet. Zootec., v.70, n.1, p.93-100, 2018
Patellar luxation and articular lesions in dogs: a retrospective: study research article
[Luxação de patela e lesões articulares em cães: estudo retrospectivo]
J.S. Lara1, E.G. L.Alves2, H.P. Oliveira3, J.A.C. Varón1*, C.M.F. Rezende3
1
Aluno de pós-Graduação – Universidade Federal de Minas Gerais – UFMG – Belo Horizonte, MG
2
Universidade de Uberaba – Uniube – Uberaba, MG
3
Universidade Federal de Minas Gerais – UFMG – Belo Horizonte, MG
ABSTRACT
This study describes lesions that occur in the stifle joints of dogs with patellar luxation. These lesions are
associated with the animal’s age, body weight, and degree of luxation. The rate of redislocation was also
evaluated. The patellar lesions found include articular cartilage erosion, subchondral bone exposure, a
flattened or concave patellar surface, and enthesophytes. Extra-patellar lesions included synovitis,
osteophytes, blunting of the trochlear groove, an absent trochlea, erosion of the condylar margins, capsule
thickening, a long digital extensor tendon injury, cranial cruciate ligament rupture, and meniscal prolapse.
Such lesions were frequently found in animals with Grade II or III luxation who were aged 24 months or
more, and they were more severe in dogs weighing more than 15 kg. Patellar luxation causes changes that
favor articular degeneration and should be treated surgically. Conservative treatment relieves pain, but
does not address tissue alterations.
Keywords: dog, luxation, patella, lesions, joint
RESUMO
O estudo descreve as lesões articulares em cães com luxação de patela. Elas foram associadas com a
idade do animal, massa corporal e grau de luxação. Foi avaliada também a porcentagem de casos com
recidiva. As lesões patelares observadas foram erosão da cartilagem articular, exposição óssea
subcondral, superfície patelar achatada ou côncava e entesófitos. As lesões extra patelares incluíram
sinovite, osteófitos, ausência do sulco troclear, erosão das bordas condilares, espessamento da cápsula,
lesão do tendão do músculo extensor digital, ruptura do ligamento cruzado cranial e prolapso de
menisco. As lesões foram encontradas com maior frequência em animais com luxação de Grau II ou III e
idade de 24 meses ou mais, sendo mais graves em cães com massa corporal superior a 15 kg. A luxação
patelar ocasiona alterações que favorecem a degeneração articular e devem ser tratadas cirurgicamente.
O tratamento conservativo alivia a dor, mas não corrige as alterações teciduais.
Palavras chaves: cão, luxação, patela, lesões, articulação
INTRODUCTION but instead, is considered a consequence of


complex skeletal abnormalities that alter limb
Patellar luxation is a frequent occurrence in dogs alignment (Piermattei et al., 2006).
and thus, represents a common finding in
everyday veterinary trauma and orthopedic The incidence of severe articular lesions found
practice (Roush, 1993). Although the during routine surgeries in small-, medium-, or
pathophysiology of congenital luxation has not large-breed dogs presenting with patellar
yet been elucidated (L’Eplattenier e Montavon, luxation is high. In some cases, the patella injury
2002; Souza et al., 2010), this malady is not is so serious that correction is not possible or
considered an independent stifle joint disease, prudent. In these instances, the only treatment
option is prosthetic replacement.

Recebido em 15 de junho de 2016
Aceito em 21 de outubro de 2016
*Autor para correspondência (corresponding author)
E-mail: jesikastro@hotmail.com
Lara et al.
According to the literature (Piermattei et al., enthesophytes. Extra-patellar lesions included

2006), surgery might not be necessary in cases the presence of erosion and subchondral bone
without clinical manifestations or when lameness exposure in the medial or lateral femoral
is mild; however, even under such condyles; the presence of osteophytes, synovitis,
circumstances, the joint damage is irreversible. capsular thickening, or shallowing of the
trochlea; and an absent or convex trochlear
Patellar luxation is a degenerative illness, and groove; cruciate ligament rupture, injury of the
surgical treatment should be performed as early long digital extensor tendon, and the menisci.
as possible and while clinical signs are mild or
even before the appearance of clinical symptoms. The frequency of lesions in the stifle joint was
The aims of this study were to perform a subjected to descriptive analysis, and the rate of
retrospective survey of the lesions found in the patellar reluxation was assessed by means of the
stifle joints of dogs with patellar luxation; to chi-square test. The significance level set at
investigate the associations between these lesions P<0.05.
and the animal’s age, body weight, and degree of
luxation; and to estimate the incidence of RESULTS
reluxation after surgical treatment.
A total of 252 luxated joints from 187 dogs were
MATERIALS AND METHODS assessed, and 218 were in medial luxation,
whereas 34 were in lateral luxation. Sixteen
This was a retrospective study that assessed the (6.3%) were classified as Grade I, 109 (43.3%)
clinical surgical records of dogs treated for as Grade II, 49 (19.4%) as Grade III (19.4%),
patellar luxation from January 2000 to July 2010 and 78 (31.0%) as Grade IV.
at the Veterinary Hospital of the Federal
University of Minas Gerais (FUMG) in Brazil. The patellar lesions identified included cartilage
Data describing age, body weight, and the degree erosion of one-fourth (13.1%), one-half (10.7%),
of patellar luxation at admission were collected or all (2.0%) of the patella, exposure of
for each animal. The animals were then subchondral bone (3.2%), a flattened or concave
categorized based on body weight (≤5 kg, 5–15 patellar surface (15.1%), (Fig. 1), the presence of
kg, and ≥15 kg), age (<12 months, 12-24 months, enthesophytes (9.5%), and lesions caused by the
and >24 months), and degree of luxation patella rubbing on the long digital extensor
according to Putnam’s (1968) classification as tendon (Fig. 2). Tables 1 and 2 show the lesions
adapted by Singleton (1969). In addition, data according to degree of dislocation, weight, and
relative to the intraoperative period were age.
recorded, and this included the presence of stifle
joint damage, classified as patellar or extra- One rare instance of resorption of the patella was
patellar lesions, and the frequency of diagnosed in a dog with Grade III luxation. Some
postoperative reluxation. The associations remnants of the bone were found adhered to the
between patellar or extra-patellar lesions and the patellar tendon, while the central area was soft
animal’s age, body weight, and degree of and exhibited loss of bone and cartilage. A one-
luxation were investigated. Patellar lesions year history of severe lameness with frequent
included the presence of cartilage erosion, the non-weight-bearing and Grade II medial luxation
extent of the erosion (one-fourth, one-half, or the in the contralateral limb existed. Resorption of
full patellar articular surface), the morphology of the patella was treated with implantation of a
the patella (concave or flat), the exposure of polyhydroxybutyrate patellar prosthesis.
subchondral bone, and the presence of
94 Arq. Bras. Med. Vet. Zootec., v.70, n.1, p.93-100, 2018

Patellar luxation…
Figure 1. Photograph of the stifle joint of a dog subjected to surgery for patellar luxation. Notice the
erosion of the patellar articular surface (black arrow). A) – Superficial erosion, B and C) – Severe
erosion, D) Severe erosion in the whole extension of the patella. E) Erosion of the edge of the medial
condyle and erosion of the patella with subchondral bone exposure (blue and black arrows). F) Notice the
flattened patellar surface (black arrow) and shallow trochlear groove (blue arrow). G) Convex femoral
trochlea (black arrow). H) Patella concave.
Figure 2. Photograph of the stifle joint of a dog subjected to surgery for patellar luxation. Notice the
lesion by rubbing of the patella on the long digital extensor tendon (black arrow).
Arq. Bras. Med. Vet. Zootec., v.70, n.1, p.93-100, 2018 95

Lara et al.
Table 1. Estimated patellar lesions in dogs with patellar luxation treated at the Veterinary Hospital,
FUMG, 2000-2010 according to the degree of luxation, body weight, and age
Cartilage erosion
Subchondral Flattened/concave Enthesophytes Assessed joints
¼ patella ½ patella Full patella
bone exposure patella
Severity n° % n° % n° % n° % n° % n° % n°
Grade I 1 6.3 0 0 0 0 0 0 0 0 0 0 16
Grade II 21 19.3 14 12.8 0 0 5 4.9 12 11.0 11 9.1 109
Grade III 9 18.3 8 16.3 2 4.1 2 4,4 8 16.3 9 18.4 49
Grade IV 2 2.6 5 6.4 3 3.9 1 1.3 18 23.1 3 3.9 78
Total 33 27 5 8 32 23 252
Weight Assessed dogs (nº)

<5 kg 16 15.5 5 4.9 3 2.9 0 0 14 13.6 9 8.7 103
5–15 kg 8 18.1 7 15.9 1 2.3 3 6.8 7 15.9 8 18.2 44
>15 kg 6 21.4 10 35.7 2 7.1 5 17.8 5 17.8 4 14.3 28
Total 30 22 6 8 26 21 175*
Age (nº)
<12 months 5 6.1 5 6.1 3 3.7 5 6.1 11 13.4 3 3.7 82
12-24 months 3 16.7 1 5.6 0 0 0 0 1 5.6 1 5.6 18
22 27.2 16 19.7 4 4.9 5 6.2 16 19.7 18 22.2 81
>24 months
Total 30 22 7 10 28 22 181**
* The weight was not reported in twelve animals and they were excluded from this assessment
** The age was not reported in six animals and they were excluded from this assessment
The frequency of cartilage erosion affecting one- absent trochleae, 34.9% exhibited cartilage
fourth or one-half of the patella accompanied by erosion in condylar margins, 5.6% exhibited
subchondral bone exposure was higher among subchondral bone exposure in condylar margins,
those with Grade II or III luxation. Erosion of the 19.4% had thickened capsules (Table 2), 2.7%
full patellar surface occurred only in Grade III or had long digital extensor tendon injuries
IV luxation. Patellar lesions were frequently associated with lateral luxation, 9.3% had
observed on the lateral surface in medial ruptured cranial cruciate ligaments, and 3.1%
luxation, but were seen on the medial surface in exhibited prolapse of the menisci. Synovitis
lateral luxation. Anatomical changes of the occurred in 37.5% of the animals with Grade I
patella, such as a flattened or concave surface, luxation. Periarticular osteophytes and shallow
occurred primarily in Grade III or IV luxation, trochlear grooves were most frequently found
whereas enthesophytes were most frequently among the animals with Grade II or III luxation.
found in Grade III luxation. In animals older than Erosion of the femoral condylar margins and
24 months, the lesions most frequently found thickened capsules occurred most frequently
were cartilage erosion affecting one-fourth or among those with Grade III luxation, while
one-half of the patella, subchondral bone absent trochlear grooves were most frequent
exposure, and the presence of enthesophytes. The among those with Grade IV luxation. Exposure
frequency of anatomical changes of the patella of subchondral bone on the condylar margins
(flattened or concave surface) was highest among predominated among those with Grade III or IV
those aged more than 24 months and lowest in luxation. Lesions in medial condyles were
those aged 12-24 months. The frequency of observed in joints in medial luxation, whereas
patellar lesions was proportionally higher among lesions in lateral condyles were frequent in joints
those animals weighing over 15kg (Tab. 1). in lateral luxation. Extra-patellar lesions were
proportionally higher among those weighing
Several extra-patellar lesions involving soft or over 15kg.
hard tissue were found. On intraoperative
assessment, 25.0% of the joints exhibited The frequency of extra-patellar articular lesions
synovitis, 25.8% had periarticular osteophytes, according to age, body weight, and degree of
42.1% had shallow trochlear grooves, 13,1% had luxation is presented in Table 2.

Table 2. Estimated extra-patellar articular lesions in dogs with patellar luxation treated at the Veterinary
Hospital, UFMG, 2000-2010 according to degree of luxation, body weight, and age
Extra-patellar articular lesions
Assessed
Shallow Absent Femoral Thickened Subchondral
Synovitis Osteophytes joints
trochlea trochlea condyle erosion capsule bone exposure
Severity n° % n° % n° % n° % n° % n° % n° % n°
Grade I 6 37.5 1 6.25 0 0 0 0 0 0 0 0 0 0 16
Grade II 34 31.2 37 33.9 51 46.8 4 3.7 37 33.9 21 19.3 4 3.7 109
Grade III 14 28.6 16 32,7 23 46.9 3 6.1 29 59.2 13 26.6 6 12.2 49
Grade IV 9 11.5 11 14.1 32 41.0 26 33.3 22 28.2 15 19.2 9 11.5 78
Total 63 65 106 33 88 49 19 252
Assessed
Weight
dogs (nº)
<5 kg 18 17.5 20 19.4 37 35.9 17 16.5 23 22.3 13 12.6 2 1.9 103
5–15 kg 15 34.1 15 34.1 22 50.0 3 6.8 15 34.1 6 13.6 5 11.4 44
>15 kg 11 39.3 17 60.7 13 46.4 1 3.6 27 96.4 13 46.4 6 21.4 28
Total 44 52 72 21 65 32 13 175
Age nº
<12 months 9 10.9 6 7.3 40 48.8 18 21.9 15 18.3 13 15.8 5 6.1 82
12-24 7 38,9 3 16,6 4 22,2 1 5,5 5 27,8 4 22,2 0 0 18
months
>24 months 26 32.1 41 50.6 32 39.5 3 3.7 30 37.0 15 18.5 8 9.9 81
Patellar reluxation after surgical repair occurred patellar" and "degree of luxation," “type of
in 13.5% of the joints, and this was distributed luxation (medial or lateral),” and “body weight”
across all grades, ranging between 6% and 15%. (P>0.05).
Statistical analysis using the chi-square test
suggests that no statistically significant The frequency of reluxation according to body
differences exist between the variable "reluxation weight, type, and degree of luxation is shown.
Table 3. Estimated patellar reluxation in dogs treated at the Veterinary Hospital, FUMG, 2000-2010
according to the type (medial or lateral) of luxation, degree of luxation, and body weight. The rate of
patellar reluxation was assessed using the chi-square test
Severity n Reluxation (%) NO reluxation (%)
Grade I 16 1 (6.2)a 5 (93.8)a
a
Grade II 106 14 (13.2) 95 (87.2)a
a
Grade III 49 7 (14.3) 42 (85.7)a
a
Grade IV 78 12 ( 15.4) 66 (84.6)a
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Total 252 34 (13.5) 218 (86.5)

Medial luxation 218 30 (13.8)a 188 ( 86.2)a
Lateral luxation 34 4 (11.8)a 30(88.2)a
In the columns, frequencies with different letters differ between groups using the chi-square test (P<0.05).
DISCUSSION mainly in heavier dogs and with Grade IV

patellar luxation.
In the literature, there are few descriptions of
lesions occurring in the stifle joints of dogs with The results of this study indicate a high
patellar luxation. Cartilage erosion on the frequency of patellar and extra-patellar lesions,
patellar articular surface was reported by especially in Grades II and III luxation.
Remédios et al. (1992); however, they did not According to the literature, although these
provide information about the extent of the animals exhibit intermittent and persistent
erosion or the weight, age, or degree of luxation. lameness, respectively (Roush, 1993; Vasseur,
Daems et al. (2009) report cartilage erosions 2003; Piermattei, 2006) they continue to use the
affected limb for ambulation. These facts

Lara et al.
account for the larger number of lesions found patella and condyle edge. In Grade IV luxation,
among animals with Grade II or III luxation. The there is a serious decreased range of extension in
use the affected limb leads to joint wear. This is the joint associated with contracture of the soft
different from animals with Grade IV luxation, tissues caudal to the joint (Denny and
who do not bear their weight on the affected Butterworth, 2006) which prevents the friction
limb, but drag or carry it while the weight is pressure between the condyle and patellar edge.
transferred to the front limbs. Patellar luxation is also responsible for the
resulting absence of a trochlear groove.
Roy et al. (1992) did not find a significant
association between the degree of luxation and In this study, the frequency and severity of
the progression of radiological articular changes, articular lesions were higher among the animals
which suggests that some of the alterations that weighing at least 15 kg, as Daems et al. (2009)
are visible during surgery might not be observed. This finding might be attributed to the
detectable in radiological exams. biomechanical instability resulting from the
greater load to which the stifle joint is subjected.
Because of the anatomy and biomechanics of the Biomechanical stability is considered to be
member, the friction between the articular essential for an appropriate supply of blood to
surfaces of the patella and femoral trochlea will the articular cartilage (L’Eplattenier and
cause erosion of the medial femoral condyle and Montavon, 2002) because inadequate nutrition
lateral patellar surface in medial luxation and of results in joint degeneration, which is observed
the lateral femoral condyle and medial patellar in cases of patellar luxation.
surface in lateral luxation.
The high frequency of patellar lesions among
Erosion of the articular surfaces is a result of animals aged more than 24 months might be the
friction between the patella and the condylar result of disease duration. As some authors have
edge, causing wear on both the patella and the observed (Remedios et al., 1992; Hayes et al.,
condyle. The quadriceps mechanism is 1994; Gibbons et al., 2006; Piermattei et al.,
responsible for the extension member, and a 2006), patellar luxation mainly affects young
healthy patellofemoral joint is essential for animals still in the growing phase, and they are
implementation of this function. The often not referred for treatment for several
patellofemoral joint greatly increases the reasons, among which, the lack of symptoms or
efficiency of the quadriceps mechanism and the presence of merely mild clinical signs, stands
facilitates extension. The quadriceps extensor out. Consequently, alterations of the patella
mechanism consists of the quadriceps, patella, resulting from chronic friction have already
trochlea, patellar tendon, and tibial tuberosity. appeared by the time surgery is performed.
These structures must be aligned. Abnormal
alignment of the extensor mechanism reduces the The reluxation rate observed in this study
extensor moment of the stifle (McKee and Cook, (13.5%) is within the range reported by Arturs
2006). and Langlay-Hobbs (2006) and Wandgee (2013),
although up to 50% has been reported (Pérez,
Misalignment of the quadriceps leads the 2014). Arthurs and Langley-Hobbs (2006) report
kneecap to become dislocated and press and greater frequency of major and patellar
brush on the lateral or medial condyle surface reluxation complications in dogs weighing 20kg
during limb movement. Erosion is observed in or more, compared to smaller dogs. The opposite
dislocations when the quadriceps’ extension was observed in this study; there were two
function is maintained. In these cases, the reluxations among the 46 dogs who weighed
pressure of the quadriceps extensor during more than 20kg. Our results did not indicate a
movement, acting on an improper surface for significant association between body weight and
receiving the force, causes wear injuries. The reluxation.
injury is more severe in animals weighing more
than 15 kg. The greater frequency of lesions in Recurrence of patellar luxation is a common
Grades II and III luxation can be explained by complication associated with surgery, and among
moderate functional changes that allow member the factors that contribute to redislocation are the
extension, promoting compression between the severity of the lesions, because Grade III and IV

luxations indicate poor shaft alignment; failure to REFERENCES

align the tuberosity of the tibia with trochlea; and
contracture of soft tissues caudal to the joint, ARTHURS, G.I.; LANGLEY-HOBBS, S.J.
affecting the joint range of motion Complications associated with corrective surgery
postoperatively (McKee and Cook, 2006). As for patellar luxation in 109 dogs. Vet. Surg. v.35,
with the loss of convexity of the patella, it loses p.559-566, 2006.
its slot in the femoral trochlea. Daems et al.
DAEMS, R.; JANSSENS, L.A.; BÉOSIER,
(2009) postulate that one of the reasons for
Y.M. Grossly apparent cartilage erosion of the
surgical failure in stable post-surgical patellas is
patellar articular surface in dogs with congenital
the presence of cartilage erosion. Mostafa et al.
medial patellar luxation. Vet. Comp. Orthop.
(2008) proposed that the proximodistal
Traumatol., v.22, p.222-224, 2009.
malalignment of the patella (patella alta and
baja) influenced reluxation. Patella alta is DENNY, H.R.; BUTTERWORTH, S.T. The
defined as the proximal displacement of the stifle. In: A guide to canine and feline
patella within the femoral trochlear groove. It has orthopaedic surgery. 4.ed. Iowa: Blackwell
been speculated that patella alta may play a role Publishing, 2006. 512-553p.
in canine patellar luxation (Johnson et al., 2002;
GIBBONS, S.E.; MACIAS, C.; TONZING,
Johnson et al., 2006). The position of the patella
in the trochlea, as Mostafa et al. (2008) M.A. et al. Patellar luxations in 70 large breed
observed, might be the reason for one case of dogs. J. Small Anim. Pract., v.47, p.3-9, 2006.
patellar reluxation in our study. One dog, HAYES, A.G.; BOUDRIEAU, R.J.;
weighing more than 20kg with recurrent Grade II HUNGERFORD, L.L. Frequency and
bilateral medial luxation, was evaluated. To distribution of medial and lateral patellar
assess the patellar position on the femoral luxation in dogs: 124 cases (1982-1992). J. Am.
trochlea, radiographic evaluation was performed Vet. Med. Assoc., v.57, p.105-109, 1994.
according to the method described by Mostafa et
al. (2008). After osteotomy of the tibial JOHNSON, A.L.; BROADDUS, K.D.;
tuberosity, as described by Johnson et al. (2006) HAUPTMAN, J.G. et al. Vertical patellar
and distally transposing 0.5cm the tibial tubercle, position in large-breed dogs with clinically
the patella remained in the groove. normal stifle and large-breed dogs with medial
patellar luxation. Vet. Surg., v.35, p.78-81, 2006.
We found no instance of implant failure among JOHNSON, A.L.; PROBST, C.W.; DECAMP,
animals weighing at least 15kg because the C.E. et al. Vertical position of the patella in the
implants used were compatible with the dogs’ stifle joint of the clinically normal large-breed
weights. dogs. Am. J. Vet. Res., v.63, p.42-46, 2002.
Postoperative measures, such as activity L’EPLATTENIER, H.; MONTAVON, P.

restriction and physical therapy, contribute to the Patellar luxation in dogs and cats: Pathogenesis
success of treatment and might prevent some and diagnosis. Small Anim. Exotics, v.24, p.234-
postoperative complications and favor an early 240, 2002.
recovery of the muscle mass and the functional MCKEE, M.W.; COOK, J.L. The stifle. In:
performance of the limb. HOULTON, J.E.F.; COOK, J.L.; INNES, J.F.;
LANGLEY-HOBBS, S.J. (Eds.). BSAVA
Based on these results, we conclude that patellar manual of canine and feline musculoskeletal
luxation should be subjected to surgical repair disorders. ]Gloucestershire]: BSAVA, 2006.
even when the clinical signs of disease are mild p.350-374.
or absent, because this condition triggers patellar
and extra-patellar changes that result in a more MOSTAFA, A.A.; GRIFFON, D.J.; THOMAS,
difficult surgery and promote the progression of M.W. et al. Proximodistal alignment of the
joint degeneration, thus reducing the odds of a canine patella: radiographic evaluation and
full and painless recovery of joint function. association with medial and lateral patellar
luxation. Vet. Surg., v.31, p.201-211, 2008.

Lara et al.
PÉREZ, P.; CHELSEA, W.T.; LAFUENTE, P. SINGLETON, W.B. The surgical correction of
Management of medial patellar luxation in dogs: stifle deformities in the dog. J. Small Anim.
what you need to know. Vet. Ireland J., v.4, Pract., v.10, p.59-69, 1969.
p.636-640, 2014.
SOUZA, M.M.D.; RAHAL, S.C.; PADOVANI,
PIERMATTEI, D.L.; FLO, G.L.; DECAMP, C.R. et al. Estudo retrospectivo de cães com
C.E. The stifle joint. In: Handbook of small luxação patelar medial tratados cirurgicamente
animal orthopedics and fracture repair. 4.ed. [retrospective study of dogs with surgically
Philadelphia: Saunders, 2006. p.562-632. treated medial patellar luxation]. Cienc. Rural,
v.40, p.31-36, 2010.
PUTNAM, R.W. Patellar luxation in the dog.
1968. Dissertation (Mestrado) - University of VASSEUR, P.B. Stifle joint. In: SLATTER, D.
Guelph, Ontario, CA. (Ed.). Textbook of small animal surgery. 3.ed.
Philadelphia: Saunders, 2003. p.2090-2133.
REMEDIOS, A.M.; BASHER, A.W.P.;
RUNYON, C.L. et al. Medial patellar luxation in WANDGEE, C. Evaluation of surgical treatment
16 large dogs: a retrospective study. Vet. Surg., of medial patellar luxation in Pomeranian dogs.
v.21, p.5-9, 1992. Vet. Comp. Orthop. Traum., v.26, p.435-439,
2013.
ROUSH, J.K. Canine patellar luxation. Vet. Clin.
N. Am. Small Anim. Pract., v.23, p.855-868,
1993.
ROY, R.G.; WALLACE, L.J.; JOHNSTON,
G.R. et al. A retrospective evaluation of stifle
osteoarthritis in dogs with bilateral medial
patellar luxation and unilateral surgical repair.
Vet. Surg., v.21, p.475-479, 1992.

Teknik Operasi Luksasi Patella - 3A

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Teknik Operasi Luksasi Patella - 3A

Diunggah oleh

Hak Cipta:

Format Tersedia

ILMU BEDAH VETERINER KHUSUS

“TEKNIK OPERASI LUKSASI PATELA”

1. Ni Putu Dyah Prashanti P 1809511010

2. Kresensia Cyntia Dosom 1809511011

3. Ni Putu Tiara Indriana 1809511012

4. Silvester Yesa G Palangan 1809511014

FAKULTAS KEDOKTERAN HEWAN

Denpasar, 9 November 2021

Kata Pengantar .............................................................................................................. ii

Daftar Isi ...................................................................................................................... iii

Daftar Gambar ............................................................................................................. iv

1.1 Latar Belakang ........................................................................................................ 1

1.2. Rumusan Masalah .................................................................................................. 2

1.3 Tujuan ..................................................................................................................... 2

1.4 Manfaat ................................................................................................................... 2

BAB II TINJAUAN PUSTAKA

2.1 Terminologi ............................................................................................................ 3

2.2 Indikasi ................................................................................................................... 4

2.3 Preoperasi ............................................................................................................... 5

2.4 Anestesi .................................................................................................................. 6

2.5 Teknik Operasi ........................................................................................................ 6

2.6 Pascaoperasi ............................................................................................................ 9

BAB III PENUTUP

3.1 Kesimpulan ........................................................................................................... 10

3.2 Saran ..................................................................................................................... 11

Gambar 1. Kelainan rangka yang berhubungan dengan luksasi patella ........................... 4

Gambar 2. Osteotomy ................................................................................................... 6

Gambar 3. Keadaan sebelum operasi ............................................................................ 7

Gambar 5. K-wire di arahkan cranio lateral dan caudo medial ....................................... 8

Gambar 6. Chuck Jacobs dapat digunakan untuk menggerakan k-wire .......................... 8

Gambar 7. Patela pada posisi yang benar ...................................................................... 9

1.1 Latar Belakang

Luksasi patella pada anjing diklasifikasikan sebagai berikut (gambar 1).

Gambar 1. Kelainan rangka yang berhubungan dengan luksasi patella

Operasi luksasi os patella direkomendasi untuk anjing dengan kepincangan

a. Persiapan Alat dan Bahan

Gambar 3. Keadaan sebelum operasi

Tuberositas tibia harus di pindahkan dari medial ke lateral. Gunakan pengangkat

Gambar 5. K-wire di arahkan cranio lateral dan caudo medial.

American Academy of Orthopaedic Surgeon (2010). Patellar Kneecap Fractures

Sebelum operasi, hewan dipuasakan

Perhatikan posisi kaki anjing lihat kembali orientasi dari ligament

Laporan Kasus: Luksasi Patella Medial pada Miniatur Pinscher

(CASE REPORT: MEDIAL PATELLAR LUXATION IN MINIATURE PINSCHER)

Kata-kata kunci: anjing; miniatur pinscher; luksasi patella medial

Keywords: dog; miniature pinscher; medial patellar luxation

Gambar 1. Gambaran fisik anjing kasus

Penanganan yang diberikan untuk mencegah berkembangnya penyakit sekunder dari

UCAPAN TERIMA KASIH

Academy Step by Step

Patellar Luxation - A Step By Step Guide

Factors that affect quadriceps alignment are:

2. Shallow Femoral Trochlear Sulcus

Too shallow a sulcus or insufficiently high medial

3. Excessively Tight Medial Soft Tissues

a b i.e. retinaculum and joint capsule. If the soft

2. Tibial Tuberosity Transposition i.e. realign

4. Lateral Imbrication i.e. tighten the lateral

Other surgical produces may be used to correct

2 Take orthogonal radiographs of the stifle.

5 Make a lateral para-patellar skin incision over

9 Sharply incise the joint capsule. This incision

6 Dissect the subcutaneous fascia until the