Page 82 - Manual of Equine Field Surgery

78 LrMB SURGERIES

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11i I case selection. Fragmentation of the patella or
. I middle patellar ligament desmitis may occur in

I , 1
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I: i some horses. If associated with lameness> frag-
I mentation of the patella may require arthroscopic

treatment. 6'7

COMPLICATIONS

Surgical errors are rare but include e11trance into

the femoropatellar joint capsule> severance of the

medial femorotibial or middle patellar ligament>

and incomplete transection of the medial patellar

ligament. If a blade is used for transection and is

not securely attached to the handle> it may detach

when being turned 90 degrees against the liga-

ment. Medial patellar ligament desmotomy may

predispose horses to distal fragmentation of the

patella from increased stress 011 the middle patel-

lar ligament. 6'7 A case of apical fracture has also

been reported.8 Extensive fibrosis or surgical site

swelling may also develop and usually resolves

with extended rest but rarely results in lameness

or recurrent upward patellar fixation.9

ALTERNATIVE PROCEDURES

A modification of the procedure performed under

Figure 12-6 Transection of the medial patellar liga- general anesthesia that involves transection of the

ment with a bistoury knife.
aponeurosis of the gracilis and sartorius in addi-

tion to the medial patellar ligament transection

has been described.'? This procedure may mini-
.

Postoperative Care mize the risk of recurrent fixation .

Medial patellar ligament splitting has been
... <:cc;,., -,,; - .
Bandaging: None is practice] or required in this described as an alternative to medial patellar lig-
.
region. The procedure induces a

Exercise R~stridions: Stall rest with handwalk- ament desmotomy.11

ing for 2 weeks followed by small paddock turnout localized desmitis and thickening of the ligament

for a minimum of 90 days after the surgery. that theoretically makes locking the patella more

· Medications: Phenylbutazone is administered at difficult. Using ultrasound guidance, percuta-
1-, neous .splitting of the proximal third of the medial
4.4 mg/kg BID for 24 hours.

Suture removal: Skin sutures are removed 12 patellar ligament is performed. Advantages of the

days postoperatively. procedure include a reported high success rate

with early return to work after surgery> and

reduced incidence of fragmentation of the patella

and middle patellar ligament desmitis.11
EXPECTED OUTCOME Injections of counterirritants into the medial

and middle patellar ligaments have been used as

If rested extensively after surgery, most horses a treatment for intermittent upward patellar

have an uneventful recovery and return to their fixation and may work by creating fibrous tissue

intended use. A retrospective study supports a that restricts stretching of the medial patellar

high return to athletic activity with appropriate ligament.":"