A perfect fit: The RAPID LUXATION Plating System and TTA RAPID® CCL System can be seamlessly implanted together in a challenging case of a cruciate ligament rupture and a concomitant patella luxation.
Cruciate Ligament Rupture and Patella Luxation
Patella luxation refers to the dislocation of the kneecap (patella) from its normal position within the femoral groove. The cruciate ligament, specifically the cranial cruciate ligament, is a crucial structure in the knee joint that helps stabilize it and prevents excessive forward movement of the tibia relative to the femur.
Relationship between Patella Luxation and Cruciate Ligament
Approximately 20% of small patients (likely referring to small breed dogs or cats) may have both patella luxation and a cruciate ligament tear concurrently. These two conditions are related because the cranial cruciate ligament helps limit internal rotation of the tibia. When the cranial cruciate ligament ruptures, there is a loss of stability in the knee joint, leading to cranial subluxation (partial dislocation) of the tibia. Additionally, there is increased internal rotation of the tibia within the joint.
Aggravation of Patella Luxation
The increased internal rotation of the tibia resulting from the cruciate ligament rupture can exacerbate (worsen) a pre-existing medial patella luxation. In other words, the increased rotational instability in the knee joint can aggravate the displacement of the kneecap, particularly in cases where the luxation was previously mild (Grade 1 or 2).
Clinical Implications
Initially, a patient with a Grade 1 or 2 Patella Luxation may not show significant clinical signs or symptoms. However, if this patient also experiences a cruciate ligament rupture, the aggravated patella luxation can worsen to a Grade 3 luxation. A Grade 3 luxation is clinically relevant and may manifest with noticeable lameness, pain, and functional impairment.
Need for Addressing Both Pathologies
In cases where a patient has both a cruciate ligament rupture and an aggravated patella luxation, it is essential to address both conditions simultaneously. Treatment involves surgical intervention to repair or stabilize the cranial cruciate ligament and correct the patella luxation.
TTTA - One procedure that addresses both
TTT + TTA RAPID®
Both patholgies can be addressed with a modified TTA RAPID® procedure and is done by simply adding a RAPID LUXATION Spacer to the TTA RAPID® Cage.
Trochleoplasty Consideration
Before proceeding with the TTA RAPID® surgery, it is important to assess whether the dog would benefit from a trochleoplasty. Trochleoplasty is a surgical procedure that involves reshaping the groove at the end of the femur (trochlea) to improve patellar tracking and reduce the risk of patella luxation. If the assessment indicates that trochleoplasty would be beneficial, it should be performed before the TTA RAPID® procedure.
Tibial Tuberosity Transposition (TTT)
The osteotomy (bone cut) used for the TTA RAPID® procedure can also be utilized to achieve a medial or lateral tibial tuberosity transposition, depending on the type of patellar luxation present. Tibial tuberosity transposition involves repositioning the attachment point of the patellar ligament on the tibia to improve patellar alignment and stability within the femoral groove. The direction of the transposition (medial or lateral) depends on the specific characteristics of the patella luxation, such as whether it is medial or lateral.
Comprehensive Treatment Approach
TTTA offers a comprehensive treatment approach for dogs with concurrent cruciate ligament tears and patella luxation. By addressing both pathologies during a single surgical procedure, TTTA aims to restore stability to the knee joint, alleviate pain, and improve the patient's overall function and quality of life.
Watch the video to see how a cruciate ligament rupture and patella luxation can be repaired simultaneously in one surgery:
Essentials for the TTTA Procedure
RAPID Patella Luxation Tibia Tappet and RAPID Patella Luxation Spacers
RAPID Patella Luxation Tibia Tappet
The RAPID Patella Luxation Tibia Tappet is a specialized instrument that facilitates precise and easy tibial tuberosity transposition after the TTA RAPID® cage is inserted into the open partial osteotomy (bone cut). By providing controlled realignment of the tibia crest and enabling accurate measurement, this instrument plays a key role in achieving optimal outcomes in cases of patella luxation correction.
Transposition of Tibial Tuberosity
After the TTA RAPID® cage is inserted into the open partial osteotomy, the TTA RAPID® Tibia Tappet is used to transpose the tibial tuberosity. The Tappet is placed into either the cranial or caudal screw holes of the TTA RAPID® cage, depending on whether there is a medial or lateral patella luxation. The Tappet can then be rotated, and it fixates itself in the screw holes of the cage, allowing for controlled transposition of the tibia crest to the medial or lateral side.
After the TTA RAPID® cage is inserted into the open partial osteotomy, the TTA RAPID® Tibia Tappet is used to transpose the tibial tuberosity. The Tappet is placed into either the cranial or caudal screw holes of the TTA RAPID® cage, depending on whether there is a medial or lateral patella luxation. The Tappet can then be rotated, and it fixates itself in the screw holes of the cage, allowing for controlled transposition of the tibia crest to the medial or lateral side.
Measurement Scale for Precision
The RAPID Patella Luxation Tibia Tappet features a scale (in millimeters) on the top of the instrument, which allows for precise measurement of how far the tibia crest is transposed. This scale ensures accuracy and consistency in the transposition process, enabling the surgeon to achieve the desired degree of realignment.
The RAPID Patella Luxation Tibia Tappet features a scale (in millimeters) on the top of the instrument, which allows for precise measurement of how far the tibia crest is transposed. This scale ensures accuracy and consistency in the transposition process, enabling the surgeon to achieve the desired degree of realignment.
Placement of Patella Spacers
Once the tibial tuberosity has been transposed to the appropriate position, Patella Spacers are placed between the screw holes of the cage and the bone. These spacers serve to fill the gap between the cage and the bone, providing additional stability and support to the transposed tibial tuberosity.
Once the tibial tuberosity has been transposed to the appropriate position, Patella Spacers are placed between the screw holes of the cage and the bone. These spacers serve to fill the gap between the cage and the bone, providing additional stability and support to the transposed tibial tuberosity.
Removal of Tibia Tappet
After the Patella Spacers have been placed, the RAPID Patella Luxation Tibia Tappet
After the Patella Spacers have been placed, the RAPID Patella Luxation Tibia Tappet
can be removed from the surgical site. The transposition of the tibial tuberosity is now complete, and the surgical site can be further managed according to the specific requirements of the procedure.
Product Code | Description |
|---|---|
132-4070-00 | RAPID Luxation Tibia Tappet, Standard 2.4 mm |
132-4071-00 | RAPID Luxation Tibia Tappet, Petite / Tiny 2.0 mm |
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RAPID Luxation Spacers
Similar to the TTA RAPID® cages, the RAPID Luxation Spacers are made of purest Titanium for best biocompatibility. The spacers are available in different thicknesses.
Product Code | Specification | For TTA RAPID® Cage Sizes |
|---|---|---|
132-8030-01L | 1 mm height, 2 holes, left | Petite / Tiny |
132-8030-01R | 1 mm height, 2 holes, right | Petite / Tiny |
132-8030-02L | 2 mm height, 2 holes, left | Petite / Tiny |
132-8030-02R | 2 mm height, 2 holes, right | Petite / Tiny |
132-8030-03L | 3 mm height, 2 holes, left | Petite / Tiny |
132-8030-03R | 3 mm height, 2 holes, right | Petite / Tiny |
132-8030-04L | 4 mm height, 2 holes, left | Petite / Tiny |
132-8030-04R | 4 mm height, 2 holes, right | Petite / Tiny |
132-8020-02L | 2 mm height, 2 holes, left | 3 mm - 7.5 mm |
132-8020-02R | 2 mm height, 2 holes, right | 3 mm - 7.5 mm |
132-8020-03L | 3 mm height, 2 holes, left | 3 mm - 7.5 mm |
132-8020-03R | 3 mm height, 2 holes, right | 3 mm - 7.5 mm |
132-8020-04L | 4 mm height, 2 holes, left | 3 mm - 7.5 mm |
132-8020-04R | 4 mm height, 2 holes, right | 3 mm - 7.5 mm |
132-8010-02L | 2 mm height, 3 holes, left | 9 mm - 15 mm |
132-8010-02R | 2 mm height, 3 holes, right | 9 mm - 15 mm |
132-8010-04L | 4 mm height, 3 holes, left | 9 mm - 15 mm |
132-8010-04R | 4 mm height, 3 holes, right | 9 mm - 15 mm |
132-8010-06L | 6 mm height, 3 holes, left | 9 mm - 15 mm |
132-8010-06R | 6 mm height, 3 holes, right | 9 mm - 15 mm |
The TTA RAPID® and Patella Luxation (TTTA) Surgery
A brief guide
Prior to the TTA RAPID® surgery itself, it should be determined if the patient would benefit from a trochleoplasty. If so, it should be performed before the TTA RAPID® procedure.
1. Osteotomy and Cage Insertion
The osteotomy used for the TTA RAPID® procedure can also be used to achieve a medial or lateral tibial tuberosity transposition (TTT), depending on the kind of patellar luxation. The procedure described in the following focuses on a lateralization of the crest, which is needed for the correction of a medial patellar luxation. After performing the osteotomy, the appropriate cage is inserted into the osteotomy and all of the caudal screws are inserted in the tibia.
2. Cage Selection
Ensure the selected cage has a bigger medio-lateral length than measured after the osteotomy to adequately support both cortices of the transposed crest. Usually, the longest cage is advised.
2. Tibial Crest Advancement
Advance the tibial crest slightly to facilitate lateral movement. Be very careful performing this and restrict the advancement to the absolute minimum to avoid crest avulsion. Ideally, perform the advancement above the cage.
We recommend the use of the RAPID LUXATION Tibia Tappet
to facilitate an easy and accurate transposition.
4. Position Maintenance and Spacer Placement
Once the desired position of the tibial crest is achieved, use bone holding forceps or a small Kirschner wire to maintain the position temporarily. Place a corresponding patella spacer between the crista tibiae and the ears of the cage to secure the position.
Using the RAPID LUXATION Tibia Tappet
will eliminate the need for bone holding forceps or K-Wire to temporarily hold the desired position.
5. Screw Insertion and Completion
If the transposition adequately prevents patellar dislocation, insert the remaining screws of the cage. Complete the operation according to standard procedure.
In cases of lateral luxation, shift the tibial crest medially in a similar manner after fixing the cranial part of the cage in the tibial crest.
CAUTION:
Patients undergoing TTA RAPID® surgery frequently experience a subjective sense of greater comfort during their initial post-operative recovery compared to those undergoing alternative osteotomy procedures. Nevertheless, it's crucial to acknowledge that TTA RAPID® involves a substantial and significant osteotomy. Therefore, both meticulous patient selection and comprehensive education for pet owners regarding post-operative management are imperative.
Questions?
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TTA RAPID® & RAPID Patella Luxation
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