DORSAL PATELLAR FIXATION IN CATTLE: DESMOTOMY
ON LATERAL RECUMBENCY
Luiz Antônio Franco da Silvaa*, Maria Clorinda Soares Fioravanti a,
Duvaldo Euridesb, Ingrid Bueno Ataydec, Carla Afonso Silvad, Olízio
Claudino Silvac and Bruno Rodrigues Trindadee
a DVM, Professor, Department of Veterinary Medicine of Universidade
Federal de Goiás, Brazil.
* address for correspondence: Rua 18-A, 591, apt. 502, ed. Acauã, Setor
Vol. 59 (3) 2004
Aeroporto. 74 070-060 Goiânia - Goiás - Brazil.
b DVM, Professor, Department of Veterinary Medicine of Universidade
Federal de Uberlândia, MG, Brazil.
c Post-graduation student (Doctorate) on Veterinary Medicine at
Universidade Federal de Goiás, Brazil.
d DVM, DNR grantee of CNPq at the Department of Veterinary Medicine
of Universidade Federal de Goiás, Brazil.
e Undergraduate student in Veterinary Medicine at Universidade Federal
de Goiás, Brazil.
Abstract
The efficiency of the medial patellar ligament section technique as a surgical
treatment for dorsal patellar fixation in cattle held in lateral recumbency was
evaluated in this study. A total of 309 animals, of both sexes, from 4 to 6 years of
age, of different breeds, activities and reproductive categories presenting a clinical
diagnosis of patellar fixation were observed. A higher predisposition of females
(94.8%) compared to males (5.2%) was noted and 53.58% of the females had calved
immediately before the observation. There was no breed predisposition and most of
the cases occurred during the dry weather season (75.40%). Three hundred and eight
animals (99.67%) recovered from surgery, proving that the technique employed was
effective and of simple execution for the treatment of dorsal patellar fixation in
bovine. The nutrition of the animals appears to be the most relevant factor in the
pathogenesis of this process.
Introduction
Patellar fixation is one of the main functional disorders of the tibia-femoral-patellar
articulation (knee joint) in cattle (1) characterized by temporary or permanent dislocation of
the patella from its regular position during locomotion (2). Such dislocation may be dorsal,
lateral or medial, causing a dorsal, lateral or medial patellar fixation, respectively (3,4,5).
The major potential factors for patellar fixation in cattle are nutrition deficiency, exploitation
activity, breed and genetic tendency, external traumas, intense contraction of the crural
triceps muscle and morphological changes of the trochlea and medial condyle of the femur (2,
6, 7, 8, 9, 10 ).
Lameness after extended rest is the most typical sign (7). The fixation invokes subtle
extension of the limb, phalangeal flexion so that the animal drags the tip of the hoof (3).
Diagnosis is based upon anamnesis, clinical signs and local palpation (3, 9), radiography may
also be useful (11, 12). Ultrasonography may be employed for studying disorders such as
those of the tibia-femoral-patellar articulation (13).
Medial patellar desmotomy is frequently used in the treatment of dorsal patellar fixation (6 ,
14). The use of exercises and injection of low concentration iodine solution into the femuropatellar articulation as an alternative treatment has also been reported (2,5,9).
This present study is aimed to establish the clinical diagnosis and prevalence of dorsal
patellar fixation in cattle, to evaluate the efficiency of the surgical treatment and to provide
data which may be used to elucidate the etiopathogenesis of this condition.
Materials and Methods
During two seasons of the year, the rainy and dry, 183 rural properties were visited from
1990 to 2002, including approximately 106 300 animals, which 72% were females and 28%
males. Half of them were evaluated in the rainy season, and the other half in the dry season.
Patellar dorsal fixation was clinically diagnosed, in 309 animals of both sexes, 4 to 6 years of
age and of different breeds (Bos indicus, Bos taurus, crossbreds and buffaloes), usage and
reproductive categories. The animals were raised extensively on pastures, and received
supplementary nutrition during the dry season.
The preoperative care consisted of a 12 hours fast. The animals were cast in lateral
recumbency, the limbs were extended and held by ropes. The limb to be operated was kept
tractioned, remained at about 1m (3,3 ft) from the ground. A cushion was placed under the
scapular area.
Tranquilization was achieved with 0.1 mg/kg live weight Xylazine hydrochloride1,
intramuscular on 267 animals while the rest tranquilization was not necessary. The tibiafemoral-patellar articulation area was appropriately prepared, and antisepsis was done by a
disinfectant solution containing iodophor2, diluted on water as recommended (15). Local
anesthesia was achieved in all animals by infiltrating approximately 20 ml of lidocaine
hydrochloride3 into the gap located between tibia crest and the medial and intermediate
patellar ligaments.
By placing the thumb and the medium finger respectively at the tibial tuberosity and at the
upper spot of the femoral medial trochleal crest, the medium point between these two
anatomic references was established using the index finger. This procedure facilitated the
identification of the medial patellar ligament. After an incision of about 5 cm on the skin, at the
area indicated by the index finger, the subcutaneous connective tissue was withdrawn, as
well as the fasciae, yielding complete visualization of the medial patellar ligament. Next, a
curved haemostatic clamp was placed between the ligament and the pericapsular connective
tissue, in order to fix the ligament and make its sectioning easier. After the section of the
ligament, was fixed several times to ensure that the problem was completely solved. Closure
was made on two levels. First, the muscle fasciae were brought closer by an X stitch using
simple catgut number 1, and, on the second level, dermorraphy was made using cotton 000
suture using simple separated sutures.
The postoperative antibiotic therapy consisted of penicillin-G-benzathine4 at a dosage of
20 000 IU/ Kg live weight, every 48 hours on five occasions. Daily dressings were made with
healing paste of zinc oxide, pine oil, vitamin A, sulfanilamide and triclorfon5. The removal of
the sutures was recommended 10th to 12th days postoperatively.
The farmers (owners) were given a questionnaire on the affected animals. The questions
concerned information about their age,sex, breed, lactating period, pregnancy, spontaneous
recovery, diet and nutritional supplement, soil characteristics.
For statistical analysis, Chi-square test with continuance correction was employed, so as to
verify any associations of the frequency of dorsal patellar fixation occurrence with dry and
rainy seasons and sex. When the Chi-square value was significant, the association coefficient
was calculated to measure its magnitude (16).
The confidence interval (95%) was calculated for the prevalence of dorsal patellar fixation
during the study period (17).
Results
The prevalence of patellar dorsal fixation was 0.29% +/- 0.032% on the herd. Of the 309
animals used on this study, 308 (99.7%) have recovered. The technique employed did not
require major experience of the surgeon or special instruments.
Two hundred and thirty-three animals (75.4%) presented the clinical signs of dorsal patellar
fixation during the season of lower rainfall, resulting in scarce and lower quality pasture. It
was observed that 226 (73.14%) animals used on this study presented unilateral limb
compromise (Table 1). Furthermore, it was observed, as described on Table 2, that 67
(22.87%) females were pregnant and in lactation, 45 (15.36%) were pregnant, 57 (53.58%)
had just calved and only 24 (8.19%) were not in calf.
Table 1. Cattle with dorsal patellar fixation submitted to medial patellar desmotomy in lateral recumbency, according to
breed, the season in which the condition occurred and number of affected limbs.Breed
Season
Breed
Dry
Affected limb
Rainy
Total
Unilateral
Bilateral
Total
Bos indicus
81
22
103
77
26
103
Bos taurus
66
29
95
63
32
95
Crossbred
85
24
109
84
25
109
Buffalo
Total
1
233
1
76
2
309
2
226
83
2
309
Table 2. Famale cattle effeted with dorsal patellar fixation and treated by medial patellar
desmotomy in lateral recumbency, according to breed and reproductive category.--------------------------------------Breed
Reproductive category
Calved
and
nursing
cattle
Pregnant
Calved
Not
pregnant
Total
Bos indicus
23
11
54
9
97
Bos taurus
19
16
49
4
88
Crossbred
25
18
52
11
106
Buffalo
Total
67
45
2
157
24
2
293
Before having surgery the animals dragged and spasmodically contracted one or both hind
limbs during locomotion, for a period that ranged according to the severity of the condition.
Although some animals presented difficulties on moving, no case of permanent extension was
observed. Wearing off the tip of the hoof in 41 (13.2%), from the 309 bovine observed, no
cases of hemorrhage were seen.
The age of the cattle ranged from 4 to 6 years, 16 (5.18%) males and 293 (94.82%)
females (Table 3).
Of the males, 5 (31.25%) were used for traction and 11 (68.75%) for reproduction. For
diagnosing of dorsal patellar fixation it was considered tha only clinical observations,
anamnesis and local palpation, were necessary without the need for radiography or
ultrasonography.
Maintaining the animals in lateral recumbency, with the limbs extended and the limb to be
operated held higher, proved to be a safe method, facilitating the execution of the technique
and diminishing the risks of accidents during the operation. The only disadvantage was the
positional discomfort for the surgeon. The lateral recumbency position, allied to pulpation
using the thumb, index and medium fingers helped to localize the medial patellar ligament,
which facilitated the surgical technique.
During the postoperative period, complications occurred in 23 (6.80%) animals, 11 (3.55%)
presented partial dehiscence of the wound and seven (2.26%) presented total dehiscence.
From the seven cattle with total dehiscence, one was used for traction and was put back to
work within less than one week of surgery. Abscesses were present in two animals (0.60%).
In one animal (0.32%) clinical signs persisted.
Of the total number with unilateral fixation, 13 (4.20%) presented the problem in the other
limb later, and were operated once more.
According to the questionnaire, the condition was most prevalent during the dry season, in
pregnant, calved and lactating cows, mostly in crossbreds and Bos indicus animals aged 5.7
to 6.15 years. Also the condition was observed more in animals of low body condition grazing
on less fertile pasture.
Table 3. Cattle with dorsal patellar fixation, submitted to medial patellar desmotomy in lateral
recumbency and classified according to breed, age (in years) and gender
Breed
Average
age
Gender
Total
Male
Female
Percentage
(%)
(years)
Bos indicus
6.15
6
97
103
33.33
Bos taurus
4.65
7
88
95
30.75
Crossbred
5.70
3
106
109
35.28
Buffalo
Total
5.80
-
16
2
293
2
309
0.64
100
Table 4. Contingency table (Chi-Square) relating the incidence of dorsal patellar fixation according to
the season (rainy or dry), observed from 1990 to 2002.
Dorsal
Season
Patellar Fixation
Dry
Rainy
Present
233 (154,5)
76 (154,5)
309
Absent
52917
(52995,5)
53074 (52995,5)
105991
Total
53150 (53150)
53150 (53150)
106300
P<0.001
Total
Table 5. Contingency table (Chi-Square) relating the incidence of dorsal patellar fixation
according to gender, observed from 1990 to 2002.
Dorsal
Gender
Total
Patellar Fixation
Female
Male
Present
293 (222,48)
16 (86,52)
309
Absent
76243 (76313,52)
29748 (29677,48)
105991
Total
76536 (76536)
29764 (29764)
106300
P<0.001
Discussion
The surgical treatment employed in this study, according to literature recommendation (6,
9, 14), was proved efficient and of easy execution, as opposed to the desmotomy technique
with the animals standing (18). The latter procedure was disregarded on this study due to
difficulty of employment on aggressive animals and for demanding more experience of the
surgeon in locating the medial tibial-patellar ligament.
Due to the success of this method and lack of experience with alternative treatments, nonsurgical treatments were not considered. The option for surgery as the first and only treatment
is also indicated by literature (10). Spontaneous healing (19) was not observed in any of
these cases, however, it was reported that some of the animals presented a reduction of the
fixation signs during the rainy season.
The technique of lateral recumbency, proved to be safer for both the animals and the
surgeon. In contrast some authors (1,7) indicate lateral recumbency with the affected limb in
contact with the soil. This position, however, makes it harder to localize the ligament and is
even more uncomfortable for the surgeon. On the other hand, the quadrupedal position
described by some authors (14,18) was not employed since we believe it offers greater risk
for both the surgeon and the animal.
The combination of the lateral recumbency position with placement of the thumb, index and
medium finger helped to localize the medial patellar ligament and facilitated the execution of
the surgical technique, despite a previous report (9).
Most of the dorsal patellar fixation cases happened during the dry season, when pasture is
usually scarce and of lower quality. It was also observed that the majority of the affected
animals were females, which were expecting and/or lactating calves or had just calved. This
was probably due to the higher nutritional needs of these categories. An association between
dorsal patellar fixation and the season was observed (p<0.001), with a greater frequency of
cases during the dry season (75.4%) (20,21), as well as between the condition and gender
(p<0.001), with a greater frequency of females (94.8%) being affected. However the
association degree found for both cases was of less than 0.1 indicating a weak association
between the considered variables, which leads us to believe that it is a multifactorial
condition.
Despite the findings of a greater number of affected Bos indicus, there seems to be a
tendency of rising on the occurrence on crossbred and Bos taurus, which may be due to its
precocity and higher nutritional needs (21). Due to the low numbers of affected animals in
each breed, it was not possible, on this study, to conclude about breed predispostion. Poor
soil quality was also associated with its occurrence. Several causes have been proposed for
dorsal patellar fixation on bovine (2,10), however, such causes are hypothetical and
controversial (18). Several studies (1,22) reported cases of patellar fixation throughout the
year, with apreponderance during the colder season, at the end of pregnancyand right after
calving. These factors indicate that feed restriction, as well as higher reproductive demand,
seem to be relevant factors in triggering the process.
Several reports refer to unilateral compromise of the limb, presented by most of the
animals (2,21,23). Although some animals presented difficulty in locomotion, no case of
permanent extension of the limb was reported (3), however the majority of the clinical signs
observed were similar to those described in other studies (1, 9,18). The hoof tip erosion
described previously (1) was also observed in this study, but was not accompanied by
hemorrhage.
All of the studied animals were 4 to 6 years old, and most were females (Table 3). Of the
males, most were used for reproduction. These observations contradict other data (1,2, 24)
which report higher frequency in traction animals, than in bulls, cows and heifers.
For diagnosing the dorsal patellar fixation it was considered the clinical observations,
anamnesis, and local palpation, as others have recommended (3,9). It was not possible to
use radiography ( 11,12) or ultrasonography for evaluating structures of soft and bony tissues
of the knee joint (13) in this study, for all the animals were treated on farms of origin.
Moreover, those procedures were considered as unnecessary means of diagnosis, because
the clinical signs were characteristic.
The complications observed postoperatively by some animals resulting from abscesses or
wound dehiscence were blamed upon contamination during surgery or failures
postoperatively. The persistence of lameness observed by one animal, was probably due to
incomplete desmotomy of the ligament or to the tension of the aponeurosis of the gracilis and
sartorius muscles, (19).
Of all the animals treated with patellar fixation, 13 (4.20%) presented the problem later in
other limb, and for that reason, were operated once more (25). The appearance of dorsal
patellar fixation signs on the opposite limb was probably due to individual predisposition allied
to feed shortage, pregnancy, calving or some other factor, as observed by other authors
(12,14).
Conclusions
These results demonstrate that the surgical technique of medial patellar desmotomy, with
the animal extended in lateral recumbency was effective and performed easily. As for the
possible triggering factors, breed predisposition was not observed. Females were more
susceptible, especially those which had just calved. Finally, nutritional deficiency seems to be
the most important factor affecting its pathogenesis.
LINKS TO OTHER ARTICLES IN THIS ISSUE
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