Interesting patella lesion

[KKelly]

6 yo huntaway who first presented with lameness of LH 1 year ago. We suspected stifle injury and CCL ds but were unable to get cr draw nor effusion on radiographs although some swelling around the stifle was suspected clinically. Mild enlargement of the distal patella was noted and considered indication of early DJD. She was managed with laser treatment NSAIDS and careful exercise management and was doing well until this morning. With an incident at the beach with another dog she went 10/10 lame and there is clinical swelling just proximal to the stifle, pain in that area and still no cr draw, no joint effusion on the radiographs but the patella has further enlarged with well marginated new bone formation distally.
Specialist referral came back as - It seems you have a patellar enthesiopathy. Whether this is the cause of the lameness is another thing as this patient may simply have cruciate disease and the enthesiopathy is secondary.

Would like your thoughts on causes and treatment. I was thinking of conservative ccl protocol and was hesitant about laser on the lesion but radiologists consensus is non-aggressive nature.

I have not got my hands on the dog yet as I have been on maternity leave - have been sent her notes and will see her this week. Would love to go in armed with your input.

Radiograph attached.

Thank you - and love these forums Laurie!

[lehughes]

Hi There,

Sorry for taking so long to answer this question or really, just provide some thoughts!

Okay... so I am of the opinion that you need to have cruciate injury in the back of your head at most times when dealing with a stifle. However, no swelling on radiographs is promising. Clinically, I have seen mild CCL tears that are treated with rehab therapies to look & feel totally NORMAL by the following week... but I KNOW what I saw and felt the previous week! So, just a story to say, "Keep 'CCL' in the back of your mind for a bit longer.

HOWEVER, this case does seem to point directly towards a patellar tendon enthesiopathy. So why not treat it as such... which will also help the stifle anyways.
So for tendon injuries, you want CONTROLLED loading of the tendon:
[*]Sit to stand exercises
[*]Hill walking or stair climbing / descending
[*]Even simple cavalletti's
I would feel comfortable with modalities as well:
[*]Laser!!!
[*]Shockwave
[*]Ultrasound
[*]PEMF
Owner education:
[*]No dog park, play, wild running, beach escapades, etc
[*]Tendons can take a months to heal. Brace them for an 8 - 9 week recovery until the tendon is strong.
[*]Find new games to play. (i.e. Tug of war, or tracking to find treats hidden in the back yard or house)
Check the back and pelvis:
[*]Perhaps not the primary issues (although human literature tells us that sporting injuries in the legs often correlates with an issue in the back or pelvis), but compensations could exist or a pre-existing condition that caused the dog to off-load one limb and overload the other (thus leading to the patellar injury)

Good luck and keep us posted!!

Laurie