C.M. Lemos; C.D.B. Fischer; K.G. Baja; V.M. Pinto; J. Maia
Av. Farroupilha, Canoas, RS, Brazil
Patella is the largest sesamoid bone in the body and it is located inside of the insertion tendon of the quadriceps muscles. It is part of the knee extensor mechanism, that is compound by the quadriceps muscles, the trochlear sulci, the patella, the patella ligaments and by tibial tuberosity (Chierichetti & Pedro 2006). Although the patella luxation can be of traumatic origin, it is in the most part of the cases related to conformational abnormalities of pelvic limbs. According to Souza et al. (2006), the instability process is progressive involving breeds, feedings and environmental components. According to Filho et al. (2005) the most affected breeds are poodle, Yorkshire terrier, Chihuahua and Pomeranian dog and considering all races, the medial luxation are more frequent than the lateral ones (Davidson et al. 2008). To Piermattei & Flo (1997), the clinical signs can be absent until the functional impotence of the affected limb. The patella luxation is classified into 4 grades that according to Souza et al. (2006) are based on the severity of the clinical signs, on the facility of luxate and reduction of the patella, as well as in the severity of the bone alterations. Clinically patients with grade I and II present a discreet atrophy of quadriceps and the animals which present grade III and IV show moderate to severe atrophy in all pelvic region, even though with weight deviation to the thoracic limbs (Chierichetti & Pedro 2006). According to Piemattei & Flo (1999), the diagnosis is performed by physical examination that must be done with the animal in standing position and in lateral decumbent. To Morgan & Leighton (1995), the radiographic exam is important to evaluate the severity of the bone deformity, the trochlear sulcus depth and the degenerative alterations. According to Davidson et al. (2008), the patient's rehabilitation with patella luxation varies according to joint instability grade, to the chosen way of treatment and the joint affected. To Chierichetti & Pedro (2006), every animal which has patella luxation and presents lameness must be treated surgically. The aim of the surgical treatment is to realign the quadriceps mechanism and keep the patella in the trochlear sulcus. The postoperative physiotherapy is performed through cryotherapy and through passive mobilization of femoro-tibial patellar joint, avoiding patella adherence or joint capsule and the extent diminished of the movement (Millis, 2008). It is possible to use a transcutaneous electrical nerve stimulation (TENS) to analgesia thus making the joint mobilization easy (Joaquim 2007, Steinss & Levine 2008). To Davidson et al. (2008), from the fifth day of postoperative period the patient must be encouraged to use the limb taking short-distance walking and stretching the quadriceps daily, as well as moving the hips and the coxofemoral, femoro-tibial-patella and tibiotarsal joints.
According to Steiss & Levine (2008), the patient's rehabilitation with patella luxation till third grade is fast. In some cases in which the atrophy is bigger, it can be used a functional electrical stimulation (FES) to muscle strength or an anklet in the animals which have already presented a partial discharge of the limb. To Amaral (2006), the active exercise promotes a strengthen when comparing to electrical stimulation devices. In the treatment of the patient with grade IV luxation, because they suffer from osteotomy, it is necessary a relaxing period to osteo-consolidation (Chierichetti & Pedro 2006). According to Steiss & Levine (2008), during this period the muscle strength is done only with the FES use and the mobilization must be performed in a tender way, preserving the fracture focus. Laser use activates the microcirculation and stimulates the bone cicatrization, accelerating the rehabilitation (Mikail 2006a).
Chierichetti & Pedro (2006), affirm that the prognostic to patella luxation is, in most cases, good to excellent. Based on the importance of patella luxation on clinical routine of dogs, the aim of this work was to determine which physiotherapeutic methods were used in the rehabilitation of animals with patella luxation assisted in Veterinarian Hospital of Universidade Luterana do Brasil in the period from January 2007 to November 2008.
Material and Methods
The study was based on the records of Animal Rehabilitation Sector of Veterinarian Hospital of Universidade Luterana do Brasil which referred to clinical cases of assisted dogs with patella luxation diagnosis during the period of January 2007 to November 2008. All animals were submitted to physiotherapy and acupuncture sessions weekly. The physiotherapeutic sessions involved an animal physiotherapeutic evaluation with the establishment of the treatment aims. It was considered the pain clinical evaluation and the inflammatory process as well as the grade of the present muscle atrophy. The physiotherapeutic resources used were electrotherapy (FES, TENS), therapeutic laser, thermotherapy (cryotherapy and therapeutic ultrasound) and also kinesiotherapy.
One Hundred and fifty five (155) animals of the Rehabilitation Sector Veterinarian Hospital of Universidade Luterana do Brasil were assisted during the period from January 2007 to November 2008, and, seven out of those patients, presented a medial patella luxation. From these seven animals, 57.1% were poodles and 28.6% Yorkshire terrier, with average age of 4 years old. The most prevalent grade of patella luxation was grade III with 71.4% of the animals and surgical procedures were performed in 85.7% of the animals, with cryotherapy being used in 42.8% of the animals in postoperative period. The therapeutic laser and the ultrasound were used in 78.6% of the cases, the kinesiotherapy was used in 92.8% of the patients, and the stretching was performed in 100% of the patients, also the strengthening muscle was performed in 76.6% of the animals. The animal clinical improvement was observed from the third physiotherapeutic session, varying from the second and the fifth ones and the treatment average duration was about 5 sessions, varying from 2 and 8 ones.
Discussions and Conclusions
From the total of patients that have been assisted with patella luxation in Animal Rehabilitation Sector of Veterinarian Hospital of Universidade Luterana do Brasil, 57.1% were of poodle race and 28.6% of Yorkshire terrier; thus being in accordance to Filho et al. (2005) that affirm that these breeds are the most affected, besides the Chihuahua breed and Pomeranian dog. The age of the analyzed animals varied from 9 months to eleven years old, being the average age of old 4 years old. Considering all dogs and cats breeds, the medial luxations are more frequent than the lateral ones (Davidson et al. 2008), thus being in accordance to outcome analyses performed which showed that 100% of luxations were medial ones. The most prevalent grade of patella luxation was grade III with 71.4% of the animals. The surgical correction was performed in 85.7% of the analyzed animals, thus being in accordance to Chierichetti & Pedro (2006), that report that every animal which has a patella luxation and presents lameness must be treated surgically. All animals were submitted to physiotherapy and acupuncture sessions weekly and the physiotherapeutic resources used were electrotherapy, therapeutic laser, thermotherapy and kinesiotherapy. The therapeutic laser and the ultrasound were used in 78.6% of the cases, being in accordance to Mikail (2006a), that reports that one of the main indications of the laser is osteoarticular affection treatment and the inflammation and the edema relieve along with the ultrasound. The kinesiotherapy was performed in 92.8% of the patients with the stretching being used in 100% of the patients and the muscle strengthen in 76.6% of the animals. Amaral (2006) reports that the stretching and the muscle strength are important in the rehabilitation of these patients. The cryotherapy was used in 42.8% of the cases, always being indicated in the immediate postoperative period; thus in accordance to Millis (2008). The hydrotherapy was used in only 7.1% of the cases although Mikail (2006b) reports that it is benefic to improve the venial return, to keep muscle tonus and the joint movement extent and to avoid weight discharge upon the structures of locomotor apparatus. The animal clinical improvement was observed from the third physiotherapeutic session, varying between the second and the fifth ones. Steiss & Levine (2008) report that the patients recovering from patella luxation grades I, II and III is fast. The treatment average duration was about five sessions, varying between two and eight sessions, being that 85.7% of the animals were totally rehabilitated. Chierichetti & Pedro (2006), report that the prognostic in most cases is good to excellent. Concluding that, with the physiotherapeutic resources used in the patients affected by patella luxation in the Animal Rehabilitation Sector of the Veterinarian Hospital of Universidade Luterana do Brasil, it was possible to maintain a good life quality of the animals during recovering period.
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