For smaller displaced fractures arthroscopic removal is recommended. Larger displaced fragments can be removed using a combination of arthroscopy and arthrotomy. Arthroscopy is used to examine the joint and identify the fracture boundaries. Arthrotomy is then typically needed to remove these large fragments. It is important to note that attachments of the lateral and middle patellar ligaments to the parent bone should be intact and ideally identified before removal of large parasagittal fragments. Ultrasonographic examination can help determine whether these ligaments are intact.
The arthroscope is placed in the cranial aspect of the femora-patellar joint.
Examination of the medial articular surface of the patella reveals the fragment. The fragments are usually attached to the medial patellar fibrocartilage.
Appropriate instrument portal(s) are made in the femoropatellar joint.
An arthroscopic scalpel is used to sharply dissect the soft tissues off the fragment. The fragment is removed using Ferris-Smith rongeurs. Motorized equipment can be used to disrupt the soft-tissue attachments to these fragments.
The fragment bed is debrided as needed and the joint lavaged to remove debris.
4. Overview of rehabilitation
The horse is held in box stall rest for 4 weeks with hand-walking during weeks 3-4 followed by pasture turn out for 4-8 weeks. After 12 weeks return to training is recommended if all clinical signs have resolved.