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Tips for the surgical transposition of a tibial crest

Transposition of the tibial tuberosity is only one part of the surgical repair for a luxating patella. For details of the complete surgery, please see other texts.

  • For cats and small dogs [<10kg], a toggle fixation of the transposed tibial crest offers several advantages over other methods of fixation.

  • Good for anchoring a small tibial crest bone fragment. Only one hole of 1.5mm diameter needed, and drilled while the tibia is intact.

  • No pins to break or migrate out of the bone.

  • No tension band wire to threaten strangulation of the patella ligament

  • No problem holding the tibial crest bone fragment while it is being anchored.

  • A quick, simple technique.

Tips on the surgical technique

  • To perform the osteotomy of the tibial tuberosity, first reflect the cranial tibial muscle to expose the lateral, proximal tibial surface.

  • Drill a 1.5mm hole in the tibial crest starting just below the insertion of the patella ligament and angled slightly distal.

  • The tibial crest is cut, with a hand-held saw, an oscillating saw or chisel and mallet, in a slightly oblique (medial/lateral) direction extending from just cranial to the medial meniscus on the medial tibia to just cranial to the long digital extensor tendon on the lateral side. Try to leave a periosteal attachment to the distal end of the excised crest.

  • Place a loop of strong suture material through the hole in the tibial crest.

  • Judge where you want to place the transposed tibial crest. It should be moved laterally until the patella is centrally located in the trochlea groove. If transposition of the crest to the correct position proves difficult, make a release incision in the medial joint capsule to allow lateral movement of the patella and tibial crest. Then drill a 1.5mm hole through the tibia to align with the drill hole in the crest.

  • Place a loop of suture material through the second hole.

  • Change your surgical gloves, open the Han-de ligature, remove one of the toggles from the ligature and tighten the ligature onto the other toggle.

  • Place the two strands of the ligature through the tibial crest loop and pull the ligature through the hole in the crest. Then place the ligature in the second loop and pull through to the medial surface of the tibia.

  • Place the tibial crest into the transposed position and pull on the ligature strands to lock the toggle onto the tibial crest and the crest into its transposed position.

  • Keep tension on the ligatures, flex and extend the joint while rotating the tibia medially and laterally to check the tracking of the patella in the femoral trochlea. If satisfied, tie the ligature over the second toggle on the medial tibia. If not satisfied, the ligature can be removed from the tibial hole and a second hole drilled in the tibia where required.

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