References
Surgical treatment of a bilateral superficial flexor tendon luxation
Abstract
A two-year-old, male, neutered, crossbreed dog was presented to Anderson Moores Veterinary Specialists with a history of bilateral pelvic limb lameness. Right pelvic limb lameness was first noted 3 months prior to presentation. Right superficial digital flexor tendon tendinopathy and associated bursitis were diagnosed based on computed tomography scans performed by the referring veterinarian. Conservative management, consisting of analgesia and exercise restriction, did not resolve the clinical signs and referral was sought. At the time of presentation, left pelvic limb lameness of 1 week's duration was reported additionally by the owner. Clinical examination and imaging findings were consistent with bilateral superficial digital flexor tendon luxation. Surgical management consisting of relocation of the superficial digital flexor tendon into the central position of the calcaneal groove alongside a retinaculoplasty and calcaneoplasty was performed bilaterally. Half-cast dressings were placed on both pelvic limbs and were removed after 3 weeks due to mild soft tissue complications. The patient was cage rested for 5 weeks in total. The re-examination 8 weeks after surgical treatment revealed that the tendons remained stable and could not be manually luxated.
The superficial digital flexor tendon originates on the lateral femoral head and lateral sesamoid. It forms both medial and lateral retinacular attachments at the tuber calcanei, coursing distally over the plantar aspect of metatarsals II to V before inserting on the middle phalanges. It forms the most superficial part of the Achilles tendon (Fossum, 2019). Superficial digital flexor tendon luxation is an uncommon condition in dogs, with Collie breeds and Shetland sheepdogs overrepresented (Bernard, 1977; Mauterer et al, 1993; Solanti et al, 2002). Luxation is typically caused by a rupture of the medial or lateral retinacular insertion on the calcaneal tuberosity, with the former, which leads to lateral luxation, being most common.
The clinical presentation of dogs with superficial digital flexor tendon luxation ranges from mild to severe lameness, and gait abnormalities can be intermittent (Slatter, 2003). Associated effusion is palpable at the tuber calcis on orthopaedic examination in most cases (Johnston and Tobias, 2018). Superficial digital flexor tendon luxation in acute cases can be achieved by manual manipulation of the tendon towards the medial or lateral direction. In chronic cases it can be more challenging to manipulate the tendon, because of it becoming adhered to soft tissue in the luxated location. Such cases present with swelling at the level of the tuber calcanei. Conservative management, with or without external coaptation, has been shown to result in chronic lameness and incomplete return to function (Mauterer et al, 1993), so surgical treatment is usually recommended.
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