

Central 
Bringing Excellence in Open Access
Journal of Veterinary Medicine and Research
Research Article *Corresponding author
Mohamed Wefky El-Sherif, Department of Surgery

New Technique for Medial and Anesthesiology, Faculty of Veterinary Medicine,

New Valley, Egypt, Tel: 201008467944; Email:

Patellar Desmotomy in Cattle Submitted: 08 May 2017

Accepted: 26 June 2017

and Donkeys Published: 28 June 2017

ISSN: 2378-931X
Copyright
Mohamed Wefky El-Sherif*
© 2017 El-Sherif
Department of Animal Surgery, Faculty of Veterinary Medicine, Assiut University, Egypt
OPEN ACCESS

Abstract Keywords
A new medial patellar desmotomy technique in cattle and donkeys (Equus acinus) • Patella
is presented. It has been successfully applied to 20 alive animals. The technique is simple, • Desmotomy
takes few minutes and easily applicable. In contrast to other techniques designed for medial • Donkey
patellar ligament desmotomy; the present technique is less invasive, the skin at the surgical • Cattle
site is not incised, following certain recommendations; the pericapsular fat and joint capsule • Upward fixation
are not invaded and the ligament is fully transected in a one-step procedure. Minimal tissue
invasiveness limits the infection of the surgical site, minimizes bleeding and decreases their
related postoperative consequences. On clinical application; the present approach was
feasible, reliable and less time and tool requiring.

INTRODUCTION ligament splitting under the guidance of ultrasound requires

general anesthesia and animal positioned in dorsal recumbency.
Upward fixation of the patella (UFP) has been reported Classical medial patellar desmotomy, also called open or blind
almost in all domestic animals [1-4] with a high incidence method is performed initially by identifying the tibial tuberosity
rate in equines than in cattle [5]. This condition believed to be as a land mark for identifying the patella and patellar ligaments.
according to the bad conformation of the hind limb [6]. Upward Infiltration of 5-10ml of local anesthetic solution beneath skin
fixation of patella occurs when the medial patellar ligament with and in the space between medial and middle patellar ligaments.
its parapatellar fibrocartilage fails to disengage the notch of A stab incision is made by surgical blade #12 at the skin between
the medial ridge of the femoral trochlea at the commencement the two fore-mentioned ligaments. A sharp tipped surgical knife
of limb flexion [7], the stifle can’t be flexed and the hind limb is introduced through the skin incision and advanced beyond the
remains extended with flexed fetlock. The condition may occur medial patellar ligament. The blade is used to split the ligament
temporarily which may spontaneously recover or permanent in a slow sawing action [16]. Further approaches described a
requiring surgical correction [8]. Affected animals are unable blind splitting of the ligament without performing an initial skin
to protract the leg forward, or flex the affected limb causing the incision [17] and others recommend sharp and blunt dissection
involved hind leg to drag behind (Figure 1) and jerky movement of the skin and sub cutis and exteriorization of the medial patellar
is pronounced during the walk [9]. The condition is economically ligament before splitting [18]. The earlier mentioned surgical
important as it reduces the market value of the affected
animal especially in riding animals like horses and donkeys.
Several treatment attempts of upward fixation of patella were
reported. Conservative treatment comprises conditioning
and rehabilitation exercises with concurrent administration
of nonsteroidal anti-inflammatory [10,9], injection of counter
irritants around the middle and medial patellar ligaments [11,9]
and corrective shoeing [7].
Surgical treatment is decided upon definitive diagnosis in
conservative treatments non-responsive candidates. Medial
patellar desmotomy (MPD) and ultrasound guided medial patellar
ligament splitting (MPLS) are the classical surgical procedures
for this condition [12,10,9,13-15]. Medial patellar desmotomy
is usually performed while animal standing and under the Figure 1 Typical posture of upward fixation of patella in equine.
effect of light sedation and local analgesia. Medial patellar Schematic taken from Lameness, King, C. pg. 885, 1997.

Cite this article: El-Sherif MW (2017) New Technique for Medial Patellar Desmotomy in Cattle and Donkeys. J Vet Med Res 4(6): 1091.
 El-Sherif (2017)
Email:


Central 
Bringing Excellence in Open Access

treatments are invasive techniques that require skin incision.

Short and long term post-operative complications associated
with classic surgical treatments includes swelling, pain, sever
bleeding, wound infection, persistent low grade lameness and
persistence of signs due to the incomplete transaction of the
medial patellar ligament [19-21,7]. The present study presents a
new surgical technique for upward fixation of the patella in cattle
and donkeys which is thought to be minimal invasive, easy and
more suitable for field conditions.
Figure 2 The preliminary study on cadaver. (A) superficial anatomy of
MATERIALS AND METHODS stifle (1, patella, 2, parapatellar cartilage, 3, medial patellar ligament,
4, patellar retinacula, 5, insertion of the common tendon of sertorous
Experimental preliminary study (S) and gracillis (G) muscles and Tt, tibial tuberosity), (B) insertion of
silk beneath the medial patellar ligament, (C) dissection to assess the
A topographical anatomical preliminary study was course of the silk strand.
performed on three donkey cadavers at the faculty of veterinary
medicine morgue and five cattle carcasses at the city abattoir.
The anatomical features of the medial patellar ligaments and
their relation were recorded. Regarding the collected data, the
medial patellar ligament (MPL) was located in one donkey and
one cattle and the new surgical technique to transect the MPL
was performed.
The medial patellar ligament was located and hold with the
index and thumb fingers, a half circle cutting surgical needle
threaded with silk (USP 1) was passed through the skin, advanced
inward distal to the ligament then emerged through skin at the
opposite side.
Dissection of skin and subcutaneous facia was performed to Figure 3 Schematic showing steps of the procedure (A) insertion of
needle with silk beneath medial patellar ligament, (B) sawing action
expose the medial patellar ligament and to assist the course of
and ligament transection.
the silk suture around the ligament (Figure 2 ,3).

Clinical case study the other finger) at the space between the middle and medial
The study was approved by the animal welfare committee of patellar ligaments. The two ends of the silk strand were grasped
the faculty of veterinary medicine, New Valley (August, 2016). with both hands and was used to transect the ligament with
sawing action movements. Sawing stops when the “POP” sound
The new technique was performed on five donkeys and eight indicating the completion of ligament transection heard. The silk
cows. Participated animals were local breed adults. They were strand removed and surgical site disinfected again. Antibiotic,
of variable sexes, ages (7-13 years for donkeys and 2-5 years anti-inflammatory and anti-tetanic prophylaxis remedies were
for cattle) and weights (120- 160 kg for donkeys and 350-420 administered.
kg for cattles). Animals were sedated with xylazine Hcl (Xylaject,
ADWIA pharma, Egypt), (1mg/kg and 0.1mg/kg) administered RESULTS
intravenously in donkeys and cattle respectively.
The anatomical study revealed the optimal site for the needle
Donkeys were secured with ropes and kept in standing insertion at the cranial aspect of the stifle three fingers breadth
position while cows were positioned in lateral recumbency with above the point of tibial tuberosity. This site is safe due to presence
the affected limb upward. Stifle region of the affected limb was of pericapsular fat while, above this point, danger to traumatize
clipped and disinfected with absolute alcohol wipes followed superficial branch of the saphenous nerve or penetration of the
by application of povidone iodine solution (Betadine, Mondio, medial extension of femuro-patellar capsule presents.
Switzerland). Ten milliliters of lidocaine Hcl 2% (Depocaine,
The surgical procedure was feasible, time and money saving
Depiky pharma, Egypt) was injected at the surgical site beneath
and not required special instruments. The mean operative time
the skin and deep between the middle and medial patellar
calculated between the needle insertion and removal of silk
ligaments. Further disinfection was performed with alcohol
strand from the surgical site was 3 ± 1 minutes.
wipes and Betadine solution. The medial patellar ligament was
located with its insertion to the tibial tuberosity then held with Skin was not incised. Instrument needed are half circle
the tips of thumb and index fingers of the left hand (the operator reverse cutting needle, needle driver and silk strand (USP 1) in an
is right handed). With the opposite hand, a sterile strand of silk appropriate length. Minute bleeding at points of needle insertion
(USP 1) mounted on a half circle cutting needle is advanced and exit which stopped spontaneously. A hearable “POP”
through skin at the medial aspect of the medial patellar ligament sound indicated complete transection of tensed medial patellar
(at the tip of finger) to the subcutaneous fascia and directed ligament. All participated animals retained normal posture and
beneath the ligament to emerge the opposite side (at the tip of be able to walk normal immediately after the procedure.

J Vet Med Res 4(6): 1091 (2017) 2/3

 El-Sherif (2017)
Email:


Central 
Bringing Excellence in Open Access

No intra or post-operative complications were recorded over REFERENCES

two weeks after the procedures.
1. Shettko DL, Trostle SS. Diagnosis and surgical repair of patellar
DISCUSSION luxation in a flock of sheep. J Vet Med Asso. 2000; 216: 564-566.

The present technique is a new technique designed to transect 2. Takahashi N, Kishimoto T, Nemoto T, Kadowaki T, Kasai H. Fusion
pore dynamics and insulin granule exocytosis in the pancreatic islet.
the medial patellar ligament which indicated for treatment of
Science. 2002; 297: 1349-1352.
upward fixation of patella in cattle and donkeys. The classical
closed surgical medial patellar desmotomy procedure requires 3. Duzgun O. A retrospective study: Evaluation of patellar luxation cases
skin incision to introduce a sharp fixed scalpel blade beneath the of cats. Turk J Vet Anim Sci. 2005; 20: 279-283.
medial patellar ligament in order to sever it [19-21,12,7]. Unlike 4. Araujo JAS, B Curcio, J Alda, RMT Medeiros, F Riet-Correa. String halt
the classical procedures, the present technique didn’t require in Brazilian horses caused by Hypochaeris radicata. Toxicon. 2008;
special instruments or to incise skin at the surgical site. Intra 52: 190-193.
and post-operative complications arise from open wound and 5. Hanson RR, Peyton LC. Surgical correction of intermittent upward
using sharp instrument in this vital region are avoided and the fixation of patella in a Barhman cow. Can Vet J. 1987; 28: 675-677.
subsequent hazards are prevented.
6. Stick AA. Stifle, in Aur and Stick editors, Equine surgery. 2006. 1325-
The alternate therapeutic surgical procedure is the ultrasound 1326, 3rd ed., Saunders Elsevier.
guided medial patellar ligament splitting [7]. This technique 7. Tnibar MA. Medial patellar ligament splitting for treatment of upward
is more sophisticated which requires the patient generally fixation of the patella in 7 equines. Vet Surg. 2002; 31: 462-467.
anesthetized, special layout and positioning, ultrasound machine
8. Lacorix JV. Lauxation of patella. In, Lacorix J.V. editor, Lameness of the
and involves skin incision and suturing. The present technique
horse. 2005. 186-171. Kashvet E-learning.
seems to have alike accuracy but with little tools. It is easily
achievable in the field, could be performed in standing or lateral 9. Brooks JH. Intermittent Upward Fixation of Patella in the Horse: A
recumbent positions with minimal physical or chemical securing, Literature Review. 2007.
doesn’t require expensive instruments and performed under 10. Stashak TS. Upward patellar fixation. In: Adam’s lameness in horse,
local anesthesia. 737-741, 5th ed. Lippincott, Williams and Wilkins. 2002.

The present technique is highly accurate and involves 11. Van Hoogmoed LM, Snyder JR, Harmon FA. In vitro investigation of
complete transection of the medial patellar ligament in a single the effects of cyclooxygenase-2 inhibitors on contractile activity of the
equine dorsal and ventral colon. Am J Vet Res. 2002; 63: 1496-1500.
step. Incomplete severing of the ligament had been reported as
a common intra-operative complication of the blind or closed 12. Turner AS, Mcllwraith CW. Medial patellar desmotomy. In: techniques
technique [19], which necessitates several attempts to completely in large animal surgery, 2nd ed. 1989. Pp 133-135, Lea and Febiger.
sever the ligament. A single step transection completely resolves 13. Chandrapurial VP, Bhadauria P, Jadoun YS. Upward Fixation of Patella
the problem without further inflammatory reactions. Bleeding, and its Clinical Management in Large Ruminants. Intas Polivet. 2012.
infection and swelling are other common post-operative 13: 259-261.
complications referred to skin incision and tissue invasion [5,1,6].
14. Madhu1 DN, Monsang SW, Singh J, Pawde AM. Bilateral Medial Patellar
Unlike this, the present is minimal tissue invasive. Probability of Desmotomy in a Colt. Intas Polivet. 2012; 13: 264-266.
bleeding, infection and subsequent swelling is minimal.
15. Singh AK, Gangwar AK, Kh Sangeeta Devi, Singh HN. Studies on
Several advantages of the present approach over the classical incidence and evaluation of the closed medial patellar desmotomy in
techniques were noticed. Profit of the blind technique described lateral recumbency in bovines. Vet World. 2015; 8: 221-224.
by [17] was obtained, no skin incision was necessary, unlikely, 16. Alfars AA. Surgical treatment of upward patellar fixation in buffaloes
the present approaches overcome the using of a sharp surgical of basrah province. Bas J Vet Res. 2007; 6: 25-29.
blade which may cause further tissue damage. Present approach
17. Mondal S, Karnam SS, Baranwal AK, Das P. Medial patellar desmotomy
contest a more accurate result. Unlike the open approach
by blind method in large ruminants during upward patellar fixation.
reported by [16,18], the present technique was minimal tissue
Exploratory Ani Med Res. 2013; 3: 183-185.
invasive and didn’t required exteriorization of the ligament. This
method showed high accuracy without the need to exteriorize 18. Ahmed HA, Ali A, Akbar Ali, Abid SA, Umar S. Surgical Correction of
the ligament. Contrasting almost all the classical and ultrasound Intermittent UnilateralHind Limb Extension in Buffalo and Cattle.
Pakistan J Zool. 2017; 49: 717-719.
guided techniques described by) [5,1,6,7] current approach uses
nominal surgical tools which makes it achievable at the field 19. Ramakrishna O. Comparative studies on treatment of chronic
conditions. subluxation of the patella in buffaloes. Indian Vet J. 1972; 49: 1150-
1153.
The presented technique is thought to be easy, time
20. Sharma SP. Medial patellar desmotomy as treatment of stringhalt in
and money saving, field applicable, accurate and minimal
ponies. Indian Vet J. 1980; 57: 684-685.
complications associated procedure for a common problem of
cattle and donkeys. 21. Ali MA, Hashim MA. Upward fixation of patella in cattle. Bangladesh
Vet J. 1984; 18: 69-70.

Cite this article

El-Sherif MW (2017) New Technique for Medial Patellar Desmotomy in Cattle and Donkeys. J Vet Med Res 4(6): 1091.

J Vet Med Res 4(6): 1091 (2017) 3/3