Patellar Groove Replacement

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1 KYON Symposium 2013 Innovations in Veterinary Orthopedics and Trauma Boston, USA - April Patellar Groove Replacement Clinical Experience Aldo Vezzoni, DVM, Dipl. ECVS, Cremona, Italy alvez@me.com

2 Patellar Groove Replacement Common procedure in human surgery J Arthroplasty Mar;27(3): Epub 2011 Oct 2. Patellofemoral Arthroplasty: 7-year Mean Follow-Up. Mont MA, Johnson AJ, Naziri Q, Kolisek FR, Leadbetter WB. Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, Maryland. CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 436, pp Lippincott Williams & Wilkins Biomechanics of Patellofemoral Joint Prostheses Andrew A. Amis, DSc; Wongwit Senavongse, PhD; and Peter Darcy, MRCS Abstract

3 Case Selection Chronic or severe patellar luxation Severe loss of joint cartilage Severe DJD Severe trochlear malformation Severe comminuted trochlear fractures As an alternative to TKR in femoro-patellar DJD Not used when regular trochleoplasty was feasible

4 Patellar Groove Replacement - Surgical technique Straight osteotomy Frontal plane Inclination to correct femoral torsion From LDE origin to proximal margin of the trochlea M L M L M L MPL LPL

5 Patellar Groove Replacement - Surgical technique Find the coaxial position with the quadriceps mechanism

6 Patellar Groove Replacement - Surgical technique Fix the plate in that position and assemble the prosthesis

7 Patellar Groove Replacement - Surgical technique Final check of patellar matching and stability during ROM

8 Patellar Groove Replacement - Surgical technique Combined with femoral osteotomy when indicated

9 Case # Name Breed Age Sex Weight MPL LPL Previous Surgeries PGR size Adjunctive procedures Followup Outcome 1 Born Toy Poodle 8 mo M 1.4 kg MPL 4 TTT + Sulcoplasty 1 None 2 yrs Excellent 2 Fiamma Mongrel 6 yrs F 29 kg LPL 3 L None 7 None 1.5 yr Excellent 3 Fiamma Mongrel 6 yrs F 29 kg LPL 4 R None 7 TTA 1.5 yr Good 3 Arlong Corso 7 yrs M 48 kg LPL 3 TTT TPLO 10 None 1 yr Good 5 Monet Lagotto 6 yrs M 23 kg LPL 4 None 7 None 9 mo Excellent 6 Frodo Segugio 1 yr M 17 kg LPL 4 L None 8 DFO-PTO 9 mo Good 7 Trudy Mongrel 4 yrs F 54 kg MPL 3 TPLO 9 TPLO 4 mo Loosening Rev. good 8 Penny Lhasa apso 3 yrs F 6.4 kg MPL 3 L TTT 4 None 10 mo. Excellent 9 Patton Dobermann 3 yrs M 40 kg Trochlear Fx None 9 None 9 mo Excellent 10 Lisa Yorkshire T. 2 yrs F 1.9 kg MPL 4 TTT + Trochleoplasty 1 DFO-PTO 7 mo Good 11 Grinza Mongrel 4 yrs F 48 kg MPL 3 None 7 None 2 mo Recurrence Rev + DFO 12 Hero Akita Inu 1.5 yrs M 50 kg MPL 4 TTT 9 None 6 mo Good 13 Penny Lhasa apso 3.5 yrs F 6.5 kg MPL 3 R None 4 TTT 6 mo Excellent 14 Vladimir Toy Poodle 9 yrs M 5 kg MPL 3 + CrCL r. None 3 TPLO 5 mo Excellent 15 Jack Corso 2.5 yrs M 57 kg MPL 3 TTT + Trochleoplasty 9 TTT 4 mo Good 16 Charas Mix-Labr. 4 yrs F 35 kg MPL 3 none 9 TPLO Nilo Mongrel 10 yrs M 5.7 kg MPL 3 Capsulorraphy 3 None - -

10 Clinical cases Previous surgeries None 53% TTT TTT + Trocleoplsty 12% 18% Capsulorraphy TTT + TPLO TPLO 6% 6% 6% Total: 17 knees

11 Clinical cases Adjunctive procedures None 53% DFO+PTO TTT TPLO 12% 12% 18% TTA 6% Total: 17 knees

12 Clinical cases Outcome Excellent 47% Good 40% Poor Revision for recurrance 13% Total: 17 knees (no FU for last 2 cases)

13 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery Flat trochlea Case # 1

14 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery Flat trochlea Case # 1

15 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery Trochlea osteotomy Case # 1

16 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery Trial patellar grooves Case # 1 # 1

17 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery Trial patellar grooves Case # 1

18 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery Fixation of the basement Case # 1

19 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery Assembling the prosthesis Case # 1

20 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery Checking the stability of the patella Case # 1

21 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery Post-op X-Ray Case # 1

22 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery 2 months FU Case # 1

23 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery 2 months FU Case # 1

24 Born, Toy Poodle, M, 8 mo, 1.4 kg Grade 4 MPL, recurred after conventional surgery 6 months FU Case # 1

25 Frodo, Segugio, M, 1 yr., 17 kg Chronic Grade 4 bilateral LPL Right knee treated with DFO and block trochleoplasty Left knee: distal femoral valgus and internal torsion, proximal tibia varus and internal torsion

26 Frodo, Segugio, M, 1 yr., 17 kg Chronic Grade 4 bilateral LPL Right knee treated with DFO and block trochleoplasty Left knee: distal femoral valgus and internal torsion, proximal tibia varus and internal torsion

27 Frodo, Segugio, M, 1 yr., 17 kg Chronic Grade 4 bilateral LPL Right knee treated with DFO and block trochleoplasty Left knee: distal femoral valgus and internal torsion, proximal tibia varus and internal torsion

28 Proximal tibial detorsional osteotomy

29 Distal femoral medial closing wedge osteotomy

30 Distal femoral medial closing wedge osteotomy PGR

31 Distal femoral medial closing wedge osteotomy PGR

32 Distal femoral medial closing wedge osteotomy PGR Petelloplasty

33 Patellar Groove Replacement: clinical cases

34 FU 2 mo.

35 FU 2 mo.

36 Patton, Dobermann, M, 3 yrs., 40 kg HBC, lateral trochlear ridge comminuted fracture, longitudinal patellar fracture and medial luxation, open fracture type 1, collateral and cruciate ligaments intact

37 Patton, Dobermann, M, 3 yrs., 40 kg HBC, lateral trochlear ridge comminuted fracture, partial longitudinal patellar fracture and medial luxation, open fracture type 2, EDPL avulsion collateral and cruciate ligaments intact.

38 Patton, Dobermann, M, 3 yrs., 40 kg HBC, lateral trochlear ridge comminuted fracture, partial longitudinal patellar fracture and medial luxation, open fracture type 2, EDPL avulsion collateral and cruciate ligaments intact.

39 Patton, Dobermann, M, 3 yrs., 40 kg HBC, lateral trochlear ridge comminuted fracture, partial longitudinal patellar fracture and medial luxation, open fracture type 2, EDPL avulsion collateral and cruciate ligaments intact.

40 Patton, Dobermann, M, 3 yrs., 40 kg HBC, lateral trochlear ridge comminuted fracture, partial longitudinal patellar fracture and medial luxation, open fracture type 2, EDPL avulsion collateral and cruciate ligaments intact.

41 Patton, Dobermann, M, 3 yrs., 40 kg FU 2 months

42 Patton, Dobermann, M, 3 yrs., 40 kg FU 7 months

43 Patellar Groove Replacement: complications Implant loosening 1 case, aseptic, revised successfully with a new PGP Recurrence of luxation 1 case, revised successfully with DFO

44 Patellar Groove Replacement: complications Implant loosening Trudy, cross breed, 4 yrs, 54 kg FU 7 mo

45 Patellar Groove Replacement: complications Implant loosening Trudy, cross breed, 4 yrs, 54 kg

46 Patellar Groove Replacement: complications Implant loosening Trudy, cross breed, 4 yrs, 54 kg

47 Patellar Groove Replacement: complications Implant loosening Trudy, cross breed, 4 yrs, 54 kg

48 Patellar Groove Replacement: complications Implant loosening Trudy, cross breed, 4 yrs, 54 kg

49 Patellar Groove Replacement: complications Implant loosening Trudy, cross breed, 4 yrs, 54 kg FU 2 mo after revision

50 Patellar Groove Replacement: complications Implant loosening Trudy, cross breed, 4 yrs, 54 kg FU 2 mo after revision

51 Patellar Groove Replacement: complications Recurrence of luxation Grinza, cross breed, 4 yrs, 48 kg, III MPL

52 Patellar Groove Replacement: complications Recurrence of luxation Grinza, cross breed, 4 yrs, 48 kg, III MPL postop FU 2 mo

53 Patellar Groove Replacement: complications Recurrence of luxation Grinza, cross breed, 4 yrs, 48 kg, III MPL DFO, medial open wedge

54 Patellar Groove Replacement: complications Recurrence of luxation Grinza, cross breed, 4 yrs, 48 kg, III MPL DFO FU 6 weeks

55 PATELLAR GROOVE REPLACEMENT Conclusions Very promising preliminary results Several potential clinical applications in femoro-patellar joint disorders Absolutely essential surgical tool for complex conditions Mild malalignment can be corrected with PGR Severe malalignment must be addressed with other techniques too I could not do without it!

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