Management of severe stifle trauma: 1. Stifle luxation

Combination of TPLO, medial and lateral augmentation techniques for the treatment of traumatic stifle luxation in a cat

Case summary

An 11-year-old female neutered domestic shorthair cat was referred for surgical management of a traumatic right stifle luxation. Orthopaedic examination of the affected stifle under general anaesthesia revealed joint effusion and craniocaudal and rotational instability. Cranial displacement of the tibia with respect to the femur and infrapatellar pad sign were identified on radiography. Intraoperatively, complete rupture of both cruciate ligaments and marked disruption of the mid and caudal poles of the medial and lateral menisci were observed. Both collateral ligaments appeared intact. The remnants of the injured cruciate ligaments were removed, and medial and lateral caudal hemimeniscectomies were performed. A tibial plateau levelling osteotomy (TPLO) was performed to address the craniocaudal stifle instability. Intraoperative assessment of the stifle revealed persistent instability with cranial tibial translation, internal and external rotation, and a positive caudal draw test. A lateral augmentation suture was employed to address the persistent cranial tibial translation and internal rotation. To successfully neutralise caudocranial and external rotational instability secondary to the caudal cruciate ligament deficiency, a medial augmentation suture was placed with the aid of three interference screws. Stifle stability was achieved. A modified Robert-Jones bandage was kept on for 24 h postoperatively. An excellent outcome was achieved, with successful limb function restoration.

Relevance and novel information

This case report represents the first documented instance of feline traumatic stifle luxation repair by combining a corrective tibial osteotomy and extra-articular augmentation. Notably, it introduces the novel technique of implementing a TPLO with medial and lateral augmentation sutures to address multidirectional stifle instability.

Traumatic joint luxations in cats: Reduce, repair, replace, remove

PRACTICAL RELEVANCE

Traumatic joint luxations are usually associated with significant trauma and there may be concomitant systemic injury. Joints are unstable as a result of injury to one or more supporting structures and the clinician should aim to determine which structures are damaged with physical examination, diagnostic imaging and careful assessment under sedation/anaesthesia. The aim is to reduce the joint back to its anatomical position, and then to maintain this through repair of damaged structures. However, where this is not possible, replacement or removal (arthrodesis/excision arthroplasty) of the joint remain viable options.

CLINICAL CHALLENGES

Owing to the small size of feline joints and the severity of damage often seen, surgical management of these cases can be challenging. The first priority is to ensure the patient is systemically well before embarking on any specific surgical treatment of a luxated joint. Cats also present challenges in the postoperative period and a lack of patient and owner compliance can be detrimental to postoperative outcomes.

AIMS

This article aims to help the reader diagnose joint luxations and to assist decision-making with an overview of the management and treatment options available.

EVIDENCE BASE

There are a number of original articles and textbook chapters in the literature covering aspects of different joint luxations, particularly for the more common luxations. This article draws on information from key feline research and, where necessary, extrapolates from relevant canine research. The authors also offer practical guidance based on their own clinical experience.