Tuesday 22nd Jan, 2019
While the original cause of the growth abnormality was unknown, a neonatal traumatic injury was felt to be most likely.
The radiographic changes included the misshapen proximal tibia, with a proximally and laterally displaced tibial tuberosity. The misshapen tibial plateau had mild sclerotic change, and there was mild calcification of intra-articular structures.
While diagnosis was important, the challenge was to manage the clinical problems present: the lateral patella luxation and also the patella alta (a proximally placed patella) which was believed to be playing apart in the patella luxating.
To resolve these issues, we performed a modification of the techniques used to commonly manage patella luxation: a block recession sulcoplasty, and medial soft tissue imbrication, and also a tibial crest transposition.
This tibial crest transposition was however a bit different. We wished to move the tibial tuberosity distally to treat the patella alta, medialise it to treat the lateral patella luxation but take care to not reduce the range of motion of the stifle: a risk if the tibial tuberosity was transposed too distally.
After a good bit of planning (see image), we performed the surgery to remove a thin wedge of the tibia, whilst also moving the tibial tuberosity as planned. This resulted in a good recovery and clinical outcome.
If you encounter a surgical case like this…. or more something more common…. and would like our help, please get in touch!