Patellar desmitis following TPLO

Radiographic and ultrasonographic evaluation of the patellar ligament following tibial plateau leveling osteotomy

Mattern, Berry, Peck, De Haan

Background
This study evaluates radiographic and ultrasonographic changes in the patellar ligament following tibial plateau leveling osteotomy (TPLO), a surgical intervention for cranial cruciate ligament (CCL) rupture in dogs. While patellar ligament thickening has been observed anecdotally after TPLO, there is limited objective documentation of these changes. The study hypothesizes no demonstrable changes in the patellar ligament postoperatively.

Methods
Twenty-nine dogs with CCL rupture underwent TPLO. Patellar ligament evaluation was performed using radiographs and ultrasonography at preoperative, 1-month, 2-month, and 6-month intervals. Measurements included ligament thickness and cross-sectional area at proximal, middle, and distal regions. A subjective scoring system assessed ligament changes based on echogenicity, fiber architecture, and periligamentous alterations. Data were analyzed using statistical models to determine correlations with body weight, postoperative tibial plateau angles, and desmitis development.

Results
Patellar ligament thickening was observed postoperatively, especially at the distal region. Radiographic proximal-to-distal ligament thickness ratios decreased significantly by 1 month and persisted through 6 months. Ultrasound measurements confirmed increased ligament thickness and cross-sectional area at all evaluated time points. Subjective scoring revealed desmitis in 16 of 31 stifles at 1 month, with persistence in 3 of 13 stifles at 6 months. Significant risk factors for distal patellar ligament thickening included increased body weight and reduced postoperative tibial plateau angles.

Limitations
Intra- and interoperator variability in ultrasound measurements and the lack of histologic correlation limited precision. Cutaneous markers for measurement standardization were subject to movement, potentially affecting consistency across evaluations. The clinical significance of ligament thickening regarding residual lameness was not assessed.

Conclusions
Patellar ligament desmitis is a common sequela following TPLO, characterized by thickening and fiber disruption detectable via radiography and ultrasound. Increased stress on the ligament, influenced by body weight and postoperative tibial plateau angles, may contribute to these changes. Future studies should correlate these findings with clinical outcomes to determine their significance.

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