Re: [SPAM]Re: patellar tendinitis post TTA

[Guest guest]

Hi All,

I have been doing TTA for going on 4 years now. It is quite common for

me to see enlargement (hypertrophy?) of the patellar tendon, but

usually only the distal half within a few weeks of performing TTA. It

usually decreases by about 12 weeks, but never goes back to the size of

the pre-op level. I do not think you can take a saggital saw and cut

the tibial tuberosity loose, advance it and not expect to get some

inflammation (reaction?) around the distal aspect of the tendon. I

have also seen this with tibial crest transposition for MPL. However,

there is no lameness associated with it and no discomfort on joint

manipulation. Based on this, I can't make a diagnosis of patellar

tendonitis on the size of the tendon alone, but if other signs of pain

on flexion and digital palpation are present then I would consider it.

Additionally, if the post-op effusion was decreasing and the fat pad

was re-establishing on radiographs at 5 weeks, AND then the knee

developed an effusion, I would be suspicious of something other than

PTitis. I don't typically see a significant joint effusion with

PTitis. I do see significant effusion and pain with meniscal injury or

a septic joint, both of which cause significant lameness. My advice:

get a joint aspirate and culture done. If positive culture, send back

to the surgeon for treatment. If negative culture, then treat as

PTitis and if not significantly better in 2 weeks on

anti-inflammatories, then send back to surgeon for meniscal evaluation

(scope or explore). I agree with in that I see hardly any cases

of what might be PTitis with TTA. I don't know why for sure. I used

to see more with TPLO. I am sure some researcher in time will sort out

the biomechanics of the difference but I have always wondered if

leveling the plateau vs moving the tuberosity (leaving the slope to the

plateau) facilitates internal rotation and stress on the PT, and hence

contributes to more pivot shift and PTitis. I also do not see pivot

shifts of any significance with TTA. My humble opinion for what it is

worth!!! Anyone else out there have an opinion on some of the above

points???

Mark B. Parchman, DVM, CVA, DACVS

Bend Veterinary Specialists

rfreedman wrote:

very interesting!

-----

Original Message -----

From:

tomlinson

To:

VetRehab

Sent:

Friday, September 05, 2008 10:12 AM

Subject:

RE: patellar tendinitis post TTA

I have had two TTAs

with patellar tendonitis – both from an experienced surgeon who has

done many TTAs

They were self

limiting as with the TPLO ones. PT was 3 x the size it was immed post

op

Tomlinson BVSc

MS PhD DACVS CCRP

Certified Canine

Rehabilitation Practitioner

Twin Cities Animal

Rehabilitation Clinic

12010 Riverwood Dr,

Burnsville MN 55337

www.tcrehab.com

From: VetRehab

[mailto:VetRehab ] On Behalf Of rfreedman

Sent: Friday, September 05, 2008 8:55 AM

To: VetRehab

Subject: Re: patellar tendinitis post TTA

Actually, TTA

prevents patellar tendonitis, and in fact, is on eo fht reasons it is

gaining favor. I'll bet against that being the problem-also, the joint

effusion will stay around for up to 10-12 weeks postop. Not uncommon at

all.

So i don't buy

PT yet!

-----

Original Message -----

From:

renee1rvt

To: VetRehab

Sent: Friday, September 05, 2008 9:08 AM

Subject: patellar tendinitis post TTA

I have been treating a 4 yr old G. Dane that has had bilateral

TTA's.

The most recent was 5 wks ago. The dog was progressing well, until 2

wks ago became increasingly lame (toe-touch WB w/occas. NWB). I was

away at the conference when this occurred. No fractures were found on

radiographs with very minimal OA. The joint is swollen, warm to

touch, with increased joint effusion. The flexion of the stifle is

WNLs. The surgeon believes he may have patellar tendinitis. We have

never seen a case in a TTA. I know that it is very common in TPLO's,

but does anyone have experience with this in TTA's.

The treatment has been strict confinement, ice, massage, very gentle

PROM, US (3 x wk). Any other suggestions on Tx, and an idea of

aproximate healing time for the patellar tendinitis.

Thank you,

[Guest guest]

Mark

one reason for not seeing PTnitis si if you allow for 5-10 mm proximal shift ti the TT, as described by Montavan, then the pT shouldn't be under any duress. At least, that is my understanding

patellar tendinitis post TTA

I have been treating a 4 yr old G. Dane that has had bilateral TTA's. The most recent was 5 wks ago. The dog was progressing well, until 2 wks ago became increasingly lame (toe-touch WB w/occas. NWB). I was away at the conference when this occurred. No fractures were found on radiographs with very minimal OA. The joint is swollen, warm to touch, with increased joint effusion. The flexion of the stifle is WNLs. The surgeon believes he may have patellar tendinitis. We have never seen a case in a TTA. I know that it is very common in TPLO's, but does anyone have experience with this in TTA's.The treatment has been strict confinement, ice, massage, very gentle PROM, US (3 x wk). Any other suggestions on Tx, and an idea of aproximate healing time for the patellar tendinitis. Thank you,