Laurie's Blogs.


May 2012

Patellar Desmitis or Tendinopathy?

‘Patellar desmitis’ has been confirmed by ultrasonic investigation following tibial plateau levelling osteotomy (TPLO) and tibial tubercle advancement (TTA) surgeries.  It is suspected that the thickening is due to the increased stress on the patellar ligament.

 So, firstly my thoughts on the thickening - are quite simply that with both the TPLO and TTA, the patellar tendon must be taking on an extra ’work load’ to accommodate for the new directional pull and forces subsequent to either osteotomy technique.  Some dogs may respond to the new forces (and added work load) by ’thickening’ the tendon. Some of these dogs may not be as resilient or adaptive to the increased stress and may subsequently become painful.  

 THIS is the mechanism of ’injury’ in tendinosis lesions as well... which is why I suggest that tendinosis be utilized as the descriptive term and/or be added to the thought process in regards to the underlying pathology in the dogs with patellar tendons that are thick and painful on palpation.  My main point being, that we cannot ASSUME the pathology to be an ’itis’.  In other words, we cannot assume that inflammation is the root of the tenderness and thickening.  There are many instances in the body and with various pathologies where this is not true!

As to the terminology:  

Tendinopathy encompasses tendinosis, tendinitis, & paratendonitis.

Desmopathy would indeed encompass any pathology of a LIGAMENT.

And so the argument is:  IS the patellar tendon / distal patellar ligament a TENDON or a LIGAMENT?  

 I vote, based on use, function, and structure, that it is a tendon and so I would throw out there that the terms Desmitis, Desmopathy, Desmo-anything (I could not find Desmosis as a definable word in my medical dictionary) would be technically incorrect... and as such would POTENTIALLY lead us down an incorrect path for treatment.  Look up treatment of tendinosis lesions to ‘do the right thing’ with these cases.

Let’s say, I’m just thinking out loud on this one!

Until next time!