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A low morbidity surgical approach to the sheep femoral trochlea.

Orth P, Madry H - BMC Musculoskelet Disord (2013)

Bottom Line: The novel approach could be performed easily in all joints and safely exposed the distal two-thirds of the medial and lateral trochlear facet.No signs of lameness, wound infections, or empyema were observed for both approaches.The mini-arthrotomy presented here yields good exposure of the distal ovine femoral trochlea with a lower postoperative morbidity than the classical medial parapatellar approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Saar, Germany.

ABSTRACT

Background: The ovine stifle joint is an important location for investigations on the repair of articular cartilage defects in preclinical large animals. The classical medial parapatellar approach to the femoral trochlea is hazardous because of the high risk of postoperative patellar luxation. Here, we describe a low morbidity surgical exposure of the ovine trochlea without the necessity for intraoperative patellar luxation.

Methods: Bilateral surgical exposure of the femoral trochlea of the sheep stifle joint was performed using the classical medial parapatellar approach with intraoperative lateral patellar luxation and transection of the medial patellar retinaculum in 28 ovine stifle joints. A low morbidity approach was performed bilaterally in 116 joints through a mini-arthrotomy without the need to transect the medial patellar retinaculum or the oblique medial vastus muscle nor surgical patellar luxation. Postoperatively, all 72 animals were monitored to exclude patellar luxations and deep wound infections.

Results: The novel approach could be performed easily in all joints and safely exposed the distal two-thirds of the medial and lateral trochlear facet. No postoperative patellar luxations were observed compared to a postoperative patellar luxation rate of 25% experienced with the classical medial parapatellar approach and a re-luxation rate of 80% following revision surgery. No signs of lameness, wound infections, or empyema were observed for both approaches.

Conclusions: The mini-arthrotomy presented here yields good exposure of the distal ovine femoral trochlea with a lower postoperative morbidity than the classical medial parapatellar approach. It is therefore suitable to create articular cartilage defects on the femoral trochlea without the risk of postoperative patellar luxation.

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Related in: MedlinePlus

Schematic drawing of the surgical anatomy of the novel low morbidity approach. The described less-invasive surgical approach allows for a minimally invasive exposure of the distal two thirds of the medial and lateral trochlear facet in sheep. It preserves the oblique medial vastus muscle as well as the medial patellar retinaculum that would have to be transected using the classical medial parapatellar approach. Especially as no intraoperative patellar luxation is needed, the risk for postoperative patellar luxations is decreased compared to the classical approach. Moreover, flexion of the stifle joint allows for a good exposure of the medial and lateral condyle as well as the anterior third of both menisci. The skin incision is depicted in dark red. F: femur; QT: quadriceps tendon; OMV: oblique medial vastus muscle; MPR: medial patellar retinaculum; P: patella; LT: lateral trochlear facet; MT: medial trochlear facet; LC; lateral femoral condyle; MC: medial femoral condyle; PL: patellar ligament; FI: fibula; T: tibia. For ease of visualization, the remaining parts of the quadriceps muscle as well as other capsular structures and parts of the ovine anatomy are not shown.
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Figure 2: Schematic drawing of the surgical anatomy of the novel low morbidity approach. The described less-invasive surgical approach allows for a minimally invasive exposure of the distal two thirds of the medial and lateral trochlear facet in sheep. It preserves the oblique medial vastus muscle as well as the medial patellar retinaculum that would have to be transected using the classical medial parapatellar approach. Especially as no intraoperative patellar luxation is needed, the risk for postoperative patellar luxations is decreased compared to the classical approach. Moreover, flexion of the stifle joint allows for a good exposure of the medial and lateral condyle as well as the anterior third of both menisci. The skin incision is depicted in dark red. F: femur; QT: quadriceps tendon; OMV: oblique medial vastus muscle; MPR: medial patellar retinaculum; P: patella; LT: lateral trochlear facet; MT: medial trochlear facet; LC; lateral femoral condyle; MC: medial femoral condyle; PL: patellar ligament; FI: fibula; T: tibia. For ease of visualization, the remaining parts of the quadriceps muscle as well as other capsular structures and parts of the ovine anatomy are not shown.

Mentions: Key procedures of the novel less-invasive surgical approach. The sheep were placed in a supine position (A). with linen sheets onto the abdomen to extend the sterile area (B). Full extension of hip and stifle joints by axially pulling both hindlimbs during wrapping is crucial to later avoid a possible shifting of the drapes during intraoperative joint mobilization (B). Fenestrated linen sheets are used to cover the proximal, lateral and medial borders, leaving open a triangular operative site (C). Following the slightly oblique skin incision (length 4–5 cm) and arthrotomy, exposure of the distal two thirds of the lateral and medial facet of the femoral trochlea is achieved (D). This preserves the oblique medial vastus muscle and the medial patellar retinaculum and retains the patella in a proximal position without the need for its intraoperative surgical luxation (Figure 2). Each femoral condyle (E) as well as the anterior third of each meniscus (E; arrow) can also be safely exposed when applying different degrees of stifle joint flexion. For closure of the capsule, non-absorbable sutures were used (F). The surgical wounds (F) were closed in layers by simple interrupted suture patterns. Finally, aluminium bandage spray was applied (G).


A low morbidity surgical approach to the sheep femoral trochlea.

Orth P, Madry H - BMC Musculoskelet Disord (2013)

Schematic drawing of the surgical anatomy of the novel low morbidity approach. The described less-invasive surgical approach allows for a minimally invasive exposure of the distal two thirds of the medial and lateral trochlear facet in sheep. It preserves the oblique medial vastus muscle as well as the medial patellar retinaculum that would have to be transected using the classical medial parapatellar approach. Especially as no intraoperative patellar luxation is needed, the risk for postoperative patellar luxations is decreased compared to the classical approach. Moreover, flexion of the stifle joint allows for a good exposure of the medial and lateral condyle as well as the anterior third of both menisci. The skin incision is depicted in dark red. F: femur; QT: quadriceps tendon; OMV: oblique medial vastus muscle; MPR: medial patellar retinaculum; P: patella; LT: lateral trochlear facet; MT: medial trochlear facet; LC; lateral femoral condyle; MC: medial femoral condyle; PL: patellar ligament; FI: fibula; T: tibia. For ease of visualization, the remaining parts of the quadriceps muscle as well as other capsular structures and parts of the ovine anatomy are not shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539878&req=5

Figure 2: Schematic drawing of the surgical anatomy of the novel low morbidity approach. The described less-invasive surgical approach allows for a minimally invasive exposure of the distal two thirds of the medial and lateral trochlear facet in sheep. It preserves the oblique medial vastus muscle as well as the medial patellar retinaculum that would have to be transected using the classical medial parapatellar approach. Especially as no intraoperative patellar luxation is needed, the risk for postoperative patellar luxations is decreased compared to the classical approach. Moreover, flexion of the stifle joint allows for a good exposure of the medial and lateral condyle as well as the anterior third of both menisci. The skin incision is depicted in dark red. F: femur; QT: quadriceps tendon; OMV: oblique medial vastus muscle; MPR: medial patellar retinaculum; P: patella; LT: lateral trochlear facet; MT: medial trochlear facet; LC; lateral femoral condyle; MC: medial femoral condyle; PL: patellar ligament; FI: fibula; T: tibia. For ease of visualization, the remaining parts of the quadriceps muscle as well as other capsular structures and parts of the ovine anatomy are not shown.
Mentions: Key procedures of the novel less-invasive surgical approach. The sheep were placed in a supine position (A). with linen sheets onto the abdomen to extend the sterile area (B). Full extension of hip and stifle joints by axially pulling both hindlimbs during wrapping is crucial to later avoid a possible shifting of the drapes during intraoperative joint mobilization (B). Fenestrated linen sheets are used to cover the proximal, lateral and medial borders, leaving open a triangular operative site (C). Following the slightly oblique skin incision (length 4–5 cm) and arthrotomy, exposure of the distal two thirds of the lateral and medial facet of the femoral trochlea is achieved (D). This preserves the oblique medial vastus muscle and the medial patellar retinaculum and retains the patella in a proximal position without the need for its intraoperative surgical luxation (Figure 2). Each femoral condyle (E) as well as the anterior third of each meniscus (E; arrow) can also be safely exposed when applying different degrees of stifle joint flexion. For closure of the capsule, non-absorbable sutures were used (F). The surgical wounds (F) were closed in layers by simple interrupted suture patterns. Finally, aluminium bandage spray was applied (G).

Bottom Line: The novel approach could be performed easily in all joints and safely exposed the distal two-thirds of the medial and lateral trochlear facet.No signs of lameness, wound infections, or empyema were observed for both approaches.The mini-arthrotomy presented here yields good exposure of the distal ovine femoral trochlea with a lower postoperative morbidity than the classical medial parapatellar approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Saar, Germany.

ABSTRACT

Background: The ovine stifle joint is an important location for investigations on the repair of articular cartilage defects in preclinical large animals. The classical medial parapatellar approach to the femoral trochlea is hazardous because of the high risk of postoperative patellar luxation. Here, we describe a low morbidity surgical exposure of the ovine trochlea without the necessity for intraoperative patellar luxation.

Methods: Bilateral surgical exposure of the femoral trochlea of the sheep stifle joint was performed using the classical medial parapatellar approach with intraoperative lateral patellar luxation and transection of the medial patellar retinaculum in 28 ovine stifle joints. A low morbidity approach was performed bilaterally in 116 joints through a mini-arthrotomy without the need to transect the medial patellar retinaculum or the oblique medial vastus muscle nor surgical patellar luxation. Postoperatively, all 72 animals were monitored to exclude patellar luxations and deep wound infections.

Results: The novel approach could be performed easily in all joints and safely exposed the distal two-thirds of the medial and lateral trochlear facet. No postoperative patellar luxations were observed compared to a postoperative patellar luxation rate of 25% experienced with the classical medial parapatellar approach and a re-luxation rate of 80% following revision surgery. No signs of lameness, wound infections, or empyema were observed for both approaches.

Conclusions: The mini-arthrotomy presented here yields good exposure of the distal ovine femoral trochlea with a lower postoperative morbidity than the classical medial parapatellar approach. It is therefore suitable to create articular cartilage defects on the femoral trochlea without the risk of postoperative patellar luxation.

Show MeSH
Related in: MedlinePlus