2. © TANUVAS, 2011 MEDIAL PATELLLAR DESMOTOMY FOR CLP

3. © TANUVAS, 2011 INTRODUCTION; The patella is a large sesamoid bone which develops in the tendon of quadriceps femoris muscle.it is connected to the femur by collateral ligament and to the cranial tibial tuberosity by patellar ligaments. The patellar ligaments are medial,middle and lateral.

4. © TANUVAS, 2011 LUXATION OF PATELLA; Laxity of the patellar ligaments predisposes the animal to upward fixation of the patella.relaxed ligament allow the patella to glide freely on the articular surface of the trochlea.e.g due to muscular cramps or a conformatory defect,the patellar apex may get jammed between the trochlearridges by hooking the medial fibrocartilage over the medial trochlear ridge. This wouldlead to complete extension of the limb in bovines.

5. © TANUVAS, 2011 CLINICAL SIGNS; In bovines the posture of the animal is normal while at rest but every attempt to move the animal backwards is resisted. The affected limb is brought forward with a jerky flexion on every step.these signs disappear after few step but reappear after prolonged rest.

6. © TANUVAS, 2011 Some animals keep the limb in extension during progression,raise the hindquaters on the affected side. Some animals the symptoms are so severe due to complete extension of the limbs,that they are unable even to move.

7. © TANUVAS, 2011 TREATMENT; In bovine the subcutaneous division of the medial patellar ligament is the common surgical treatment to correct upward fixation of patella. Two types 1.open method 2.closed method

8. © TANUVAS, 2011 OPEN METHOD: A small incision is made in the skin directly over the medial ligament, in front of the medial tuberosity,towards the cranial tibial tuberosity.index finger is passed into the wound and the skin separated from the fascia all around the site. The fascia is dissected to expose white glistenimg medial patellar ligament.the ligament is exteriorized by passinga curved scissors

9. © TANUVAS, 2011 The ligament is then sectioned near its insertion using a knife. The cutaneous wound is sutured with one or two interrupted sutures which are removed on 7th or 8th post operative day. Protrusion of the adipose tissue through the gape created by the cut ends of ligament,cessation of cruntching sound is a indications of a successful mpd.

10. © TANUVAS, 2011 CLOSE METHOD: A stab incision made in to the skin with the B.p blade in front of the medial tibial tuberosity. Through the incision,the abscess knife,curved probe ponited knife is passed flat wise,with its tip fixed in a V shaped groove between the medial and middle patellar ligament and the sharp edge of the instrument is directed towards the ligament.

11. © TANUVAS, 2011 The ligament is then transected by withdrawing the knife towards the operator. In bovine a piece of the ligament is removed to prevent the reunion of cut the ends of the ligament CLOSED METHOD cont..,