In some instances, comminution may be present on the medial or lateral aspect of the patella, but the patellar mechanism remains intact. For these patients, the removal of these small comminuted fragments will suffice.
The stifle joint is protected and partially immobilized if deemed necessary for approximately 14 days.
Cryotherapy and passive range of motion are indicated but not possible if immobilization is used.
Activity is limited to leash walks until bone healing is radiographically evident.
Phase 1: 1-3 days after surgery
The aim is to reduce the edema, inflammation and pain using cryotherapy anti-inflammatory and analgesic medications.
Gentle passive range of motion of the hip and stifle joint can be initiated to promote mobility and joint health.
Phase 2: 4-14 days after surgery
The aim is to resolve the hematoma, edema, control pain and prevent muscle contracture.
Anti-inflammatory and analgesic medications may still be needed.
If the dog is not starting to use the limb within a few days after surgery, re-evaluation is recommended.
Phase 3: 14 days-8 weeks after surgery
Rehabilitation therapy is continued.
10-14 days after surgery the sutures are removed.
Radiographic assessment is performed every 4-8 weeks until bone healing is confirmed.
6. Case example
Ventrodorsal radiograph of a 6 months-old female whippet. An ill-defined bone opacity is visible on the lateral aspect of the left patella. That bone opacity is not visible on the mediolateral radiographic view.
On this distoproximal oblique radiographic projection of the dog the comminution is visible on the lateral aspect of the patella.
A lateral parapatellar approach has been performed. Intraoperative picture showing the comminution on the lateral aspect of the patella.
Picture showing the patella after comminuted fragments removal.