"" Modified Technique for Medial Patellar Desmotomy in Donkey

Research Article

Austin J Anat. 2017; 4(1): 1062.

Modified Technique for Medial Patellar Desmotomy in Donkey

MA Nazih* and MW El-Sherif

Department of Anatomy and Surgery, Faculty of veterinary medicine, Assiut University, Egypt

*Corresponding author: MA Nazih, Department of Anatomy and Surgery, Faculty of veterinary medicine, Assiut University, New valley, Egypt

Received: October 27, 2016; Accepted: January 19, 2017; Published: January 24, 2017

Abstract

In our study, the modified technique of medial patellar desmotomy in donkey was performed on 10 apparently adult healthy alive donkeys of both sexes in addition other, two cadavers. In concern to the upward fixation of patella in donkeys as native animals in Upper Egypt which recorded high incidence of the disease more than found in northern areas. Medial patellar desmotomy is the preferable surgical procedure of choice for treating such problem. Contrary to the standard technique of treatment, the study aimed to introduce a modified easier, less expensive and field applicable desmotomy method. our study give a full detailed applied anatomical description of the patellar ligaments specially the medial one as well as its boundaries; osseous and muscular attachments as well as the extension of the joint capsule. The medial patellar ligament was the longest and the weakest among others on the other hand the middle one was the shortest and of considerable thickness. The best and ideal side for desmotomy was determined in order to avoid massive drawbacks as piercing the joint capsule or even cutting the tendon of the sartorius muscle. Generally nearly similar anatomical results were observed with the most of authors and the donkey was an ideal animal in equine experiment and the study allow the anatomists for further comparative anatomical researches.

Keywords: Donkey; Medial patellar desmotomy; Applied anatomy

Introduction

On reviewing the available literatures among large domestic animals, most of authors described the stifle joint and patella in horse and cattle, rather than that of donkey which is scanty. Concerning the surgical and clinical practices, studying a circumscribed area anatomically was an important to serve the mentioned purposes Getty [1], Dyce et al. [2] and König and Liebich [3] in domestic animals. Topographically the anatomical regions allow surgeons and clinicians to perform perfectly Dyce et al.

Most of anatomists cited that the patella was articulated with the femur to form the femoropatellar joint and the knee cap as recorded by König and Liebich [3] in domestic animals, the patella was attached to the tibial tuberosity by the patellar ligaments and they were lateral, middle and medial Getty [1] and König and Liebich [3] in domestic animals and Uddin et al. [4] in cattle. The knee cap was fixed on its position by patellar retinacula, femoropatellar and patellar ligaments König and Liebich [3] in domestic animals. In addition to the muscular insertions for the surrounding tensor fascia lata and quadriceps femoris muscles were recorded by Getty [1], Dyce et al. [2] in domestic animals, King and Mansmann [5], Riegel and Hakola and Orsini and Sack [6] and Jennifer [7] in horse.

The patellar gliding movement was related to the function and strength of tensor fascia lata and quadriceps femoris muscles Hayes [8] and Jennifer [7] in horse.

The exact measurements of the patellar ligaments in cattle were a significant point of study of Uddin et al. [4]. In this aspect, the anatomists spot on investigating the topographical relations of the patellar ligaments, which were of clinical importance especially among cattle and horse in the medial patellar desmotomy which indicated for the surgical treatment of the upward fixation of patella Ramakrishna [9] in buffalo, Ali &Hashim [10] in cattle and Tyagi & Singh in ruminanrs. Regarding the latter, the donkeys are widely distributed and extensively used in Egypt for agricultural and transporting issues. Upward fixation of patella is a common disorder of donkeys with a high incidence in Upper Egypt than other areas which necessitate performing medial patellar desmotomy under field conditions and with minimal instrumental requirements. The current work spot a light on detailed description of the patella with its fixation and equilibrium as well as determining the safer and exactly successful site of medial patellar desmotomy as a surgical response in upward fixation of patella among donkeys.

Upward fixation of patella is a condition believed to be according to bad conformation of the hind limb or beginning of training in young age Stick [11] in horse. Displacement of patella occurred temporary which may be spontaneously reduced or permanent requiring surgical correction. Symptoms including extension of the fetlock and phalangeal joints cause the animal to drag the affected limb and if the foot rests on the ground when the extremity is not flexed, it is almost impossible for the animal to step backward Lacorix [12] in horse.

Medial patellar ligament splitting is the surgical procedure of choice, which involves, localizing and anesthetizing the patellar ligament and tissue surrounding, 2-3 cm skin incision, introduction of sharp tipped curved tenotome behind the ligament and splitting it. Complications comprises infection of the surgical site, accidental entry into femoro- patellar joint, sever hemorrhage or accidental sectioning of middle patellar ligament which is a disastrous complication Weaver et al. [13] in cattle.

The standard procedure required a detailed thorough knowledge of stifle anatomy and special instruments. As well as evaluate the present technique on the basis of: requirements, feasibility, advantage, precautions and definitive or possible complications.

Materials and Methods

This experimental study was performed on 10 a live adult apparently healthy local breed donkeys and 2 donkey cadavers of both sexes fixed by formalin 10%, at faculty of veterinary medicine, new valley, Assiut University, Egypt.

All represented animals suffer no lameness signs. The same procedure was performed in same sequence by one surgeon in all participated animals.

Anatomical study of the patella

The stifle area of both hind limbs were clipped, skin was excised over the stifle. Sharp and blunt dissection of the fascia was performed till the patella and patellar ligaments were exposed. The anatomical structures and ligament parameters and angulation were recorded.

Surgical procedure

The surgical procedures were performed on both hind limbs of each of the ten donkeys participated in the study. The surgical area of the medial aspect of the stifle was surgically prepared. Clipping and disinfection of the skin with 70% alcohol tissues.

The medial patellar ligament insertion was determined at the level of tibial tuberosity, the groove between the middle and medial patellar ligaments distinguished by hand fingers. Infiltration of 5 ml of lidocaine 2% local anesthetic solution subcutaneously and within the underlying in between the ligaments.

The medial patellar ligament held in between the thumb and index fingers of the left hand [the operator is right handed]. A half circle, sharp tip surgical needle, threaded with doubled USP 1 breaded silk with enough length [about 25cm] was introduced through skin at the proper site in (Figure 5) laterally to the medial patellar ligament and the needle advanced to emerge from the other aspect of the ligament.