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Natural Canine Health Symposium


Treatment Options For The Luxating Patella

By: Julie Mayer DVM
September/October 2011 Issue

A luxating patella occurs when the knee cap moves out of its natural position. The patella (knee cap) lies in a cartilaginous groove at the end of the femur at the stifle. The patella in dogs is shaped like an almond and its purpose is to assist in knee extension. The patella resides in the tendon of the quadriceps muscle group which attaches to the bone below the femur, the tibia. When this muscle group contracts, it pulls on the tendon and the knee cap, thereby extending the stifle. If the patella is pulled out of its normal groove with knee extension, this is called a luxating patella.

The causes of this condition can be congenital, genetic and/or traumatic. Breeds with a predisposition for luxating patellae are Miniature and Toy Poodles, Maltese, Jack Russell Terriers, Yorkshire Terriers, Pomeranians, Pekingese, Chihuahuas, Cavalier King Charles Spaniels, Papillons and Boston Terriers. Large breed dogs prone to this condition include Labrador Retrievers, Golden Retrievers, Akitas, Malamutes, Boxers, Huskies and St. Bernards. Apart from breed predilection, if a dog has poor conformation, such as no angulation in the hock, then this can also cause luxating patellae.

This condition is usually diagnosed early on. The initial symptoms include occasional limping, an intermittent skip in the gait, sudden loss of support on the limb, abnormal sitting posture with the knee placed outward; all of which are usually intermittent. Sometimes, chronic cases can lead to erosion of the cartilage on the femur from the constant friction, and eventually, to osteoarthritis. In this case, pain is usually involved and lameness is more constant and severe.

Occasionally, a luxating patella can lead to a ruptured cranial cruciate ligament. The literature states that at least 15% to 20% of dogs with patellar luxation will eventually rupture their cranial cruciate ligament. Two main reasons why this scenario may follow are:

  1. a luxating patella will change the biomechanics of the knee and subject the cranial cruciate ligament to more stress and strain, and
  2. if the luxating patella is chronic with arthritic changes, the inflamed environment inside the joint will cause a breakdown of the ligaments (especially cruciate ligaments).

A luxating patella is usually diagnosed by feel and is assigned a grade based on the severity of the condition. Grade 1 is the least severe and the knee cap easily slips back into place on its own whereas Grade 4 means the knee cap is actually stuck and fixed outside its normal resting position in the groove of the femur. A radiograph of the stifles can be performed to see if there is osteoarthritis present or any sign of cranial cruciate ligament damage.

Surgery is not always necessary for this condition. Many small dogs live their entire life with luxating patellae and it never results in arthritis or pain, nor does it interfere with the dog’s life. Grade 3 or 4 luxations normally require surgery as greater pain or discomfort will be involved, along with reduced function of the leg or associated damage such as a cranial cruciate ligament rupture. Every situation is different.

The surgical procedure usually involves carving out a deeper groove in the end of the femur so the patella will remain in the groove with move- ment. If a ruptured cranial cruciate ligament is present, it can be cor- rected at the same time.

If your dog suffers from this condition, you can’t change his DNA but you can help him with supportive nutrients and exercise.

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38 Responses to Treatment Options For The Luxating Patella

  1. Phil V.

    I’m a first time dog owner of a beautiful, sweet blue nose Pitt, and I noticed he came up limping one day on his back right leg. It lasted for about 48 hours so I took him to the Vets. They did blood work which came back negative, and did some movement and joint tests and determined that he has patellar luxation as well as some development of arthritis. He is at. Perfect weight, and is only two years old. They told me eventually he may need surgery but prescribed rest and one week of Rimadyl, followed up by Glucosamine supplements.

    He did well after the Rimadyl but I still here a clicking noise sometimes when he walks. He runs, jumps on the couch like normal and can jump in and out of the car when we go for rides. However when we jog together, I notice he rarely ours pressure on that leg and when I do range of motion stretches, I can feel something popping in and out. I want his quality of life to be great since he was rescued after being abused and neglected, but I’m looking for the best possible treatment to make him feel “young” again.

    Other possible things I thought of were giving him senior type of dog food for the Glucosamine factor. I feed him Blue Buffalo Wilderness now. Any advice would be greatly appreciated. Giving him meds is not my first choice.

      • Aditya

        Hi, I have seen that the homeopathy from Hampl Australia for OCD / HOD / Legg Perthes and Arthro-Ionx for the pain has turned around my 1 year old Rottie who was almost paralysed with severe weakness and immobility to now 90% cured after 3 months of extreme love and patience. He is the runt of the litter from a breeder (India) where they have no safe practices. He also has Vit-C, MSM, and canine pre-probiotics along with a Vit-B complex liquid supplement.

  2. Brenda

    My toy fox terrier is almost 10. She was diagnosed with luxated a yells years ago, level 2, but they wanted to operate. For a number if reasons we did not; she is close to 8 pounds. Just this morning she started totally not using one hind leg ; she hops like a three legged dog. I have read the information provided and would live to get her a brace, ( along with doggie pain med tabs I have from a long time ago). Can anyone tell me where I can get a brace for an 8lb toy fox terrier, ASAP ? I hate to see her in pain but cannot put her through surgery now even if I did think it was a good idea. Thank you in advance. Brenda, mom of Pie

    • Dogs Naturally Magazine

      Animal Rehab Services in Newmarket Ontario makes very nice braces and they will ship.

    • Melissa Meeka

      Hi Brenda, can I ask why you can’t do the surgery? I feel like I’m in the exact boat as you. Please respond, maybe we can exchange emails. -Melissa

    • Lucille

      I am a vet nurse, and please believe me all dogs with bone changes must be seen by the vet, no homeopathy or natural therapies help when they are problems with the bones involved. Bones are not skin – you cant use herbs or cleaning masks to regenerate their structure. It may support dog for short period of time, seek vet’s advice, vets spend years on studying these things therefore they have knowledge and experience that we have to paid for, if we want our dogs to live longer with no pain.

      • Dogs Naturally Magazine

        Noted veterinary homeopathy, Dr Glen Dupree, never had to cut a stifle in his 30 years of homeopathic practice with both large and companion animals. These Homeopathic Vets are colleagues not of yours, but your employer. They are experienced vets and their experience says otherwise. Conventional practitioners have no grasp of homeopathy and what it can and can’t do – so I implore you to understand a lot more about the fastest growing form of medicine in the world before commenting. To reiterate, these homeopaths you, as a veterinary nurse, are calling out are VETS. Surely you’re not so biased that you are calling out veterinary practitioners??? ~ Respectfully, Dana

        • Lucille

          Dana,
          Good luck, I wanna see you using homeopathy on yourself when you experience degeneration of bones or other osteo related problems. I hope it will take your gigantic pain away
          Regards,

          • Dm

            The irresponsibility & $$$$ motive, tells the real story. When a vet hands me a sample of Purina dog chow, along with a bottle of prednisone, ordering an ignorant uneducated fool like me to come back every week , for CBC, then tells me prednisone is a lifetime therapy, you know what I do. See ya! After 1 year trial and error, I replaced prednisone with Vitamin k for itp. I was treated as a pariah. Told I would kill her……Then a month later another hospital sent me a vaccine overdue list. 12 vaccinations, were due her, according to vca hospital…..I think most of you are fos. Its been 16 mths. No pred. 50 MCG vitamin k a day. No visible sign of purpura or blood in stool. No insane behavior from prednisone either…..You talk how vets care. I had to hide the fact that she wasn’t on pred, or I couldn’t get a CBC. When was the last time you had a canine bleed out with a blood test? I’m sure it happens Everyday. This was simply control that I witness in your industry. Go have a bowl of Purina or science diet yourself. The ignorance in the vet community, is amazing and sad. This is to the G.P.s. your solutions are derived from materials handed down from pharmaceutical co. Where lies abound and profits over fact rule the day. Holistic medicines are time immortal, each individual learning what he can from each case. Your day goes like this? science diet and a bottle of prednisone. Next! Ad nauseum The vets now know to watch for the ignorant fool, that kills canines with fresh chicken, human grade herbs, apple,banana,broccoli salmon, and nauseating conversation that gets them all smiling. Enjoy your prednisone and write us all in 2 weeks and tell us how great you feel. Best regards and bon apetit’

  3. Micah

    My Boston has not been diagnosed but I am wondering if this is not his problem. He fell on his front right leg as a baby and recovered fine from it. But he is now eight months old and he fell up the steps again.. After his walk.. And playing with ander dog he has been limping for three weeks… I took him to the vet. Had him xrayed and he said his bone had stoped growing and to put him on adult dog food and pain pills. Neither has helped. He’s still limping. I have noticed him stretching alot.. He’s always done that. The meds are making him throw up.. So I took him off that today. Worried he’s going to b lame..

    • Christy De La Montanya

      Luxating Patella only affects the rear legs. Their front legs are like our arms, they have no patella on their front legs.

  4. RE

    my dog is also a little over a year old.

  5. RE

    My louisiana catahola leopard dog/australian shepard/pit bull mix has lately showing signs of a luxating patella and i’m not sure what grade it is. I’m sure that it’s not grade four, but it shows up more often than grade one and a bit more than grade two. though i do realize that grade three will most likely give her pain, she doesn’t seem to show any pain. Can someone please tell me if i need to bring my dog to the vet and grade you think it is?

  6. Julie - confuse and worry

    My female maltese is turning 1year old, she has luxating patella on both legs…one with grade 2 & other grade 3.
    I dont wish to regret not doing anything in years later when she is in deep pain.
    When to 3 vets consultations…all have different opinion…1 said operate on 1leg, 2nd said both, 3rd said leave it till grade 4.

    What are the probability of getting worst in her older age?
    Do you recommend surgery now to give her a better quality of life?

    • Dogs Naturally Magazine

      Before considering surgery, I would try physiotherapy, bracing and consulting with a good homeopath or homeopathic vet.

  7. I fully agree that “acupuncture or homeopathy would be of great value,” as mentioned above. Braces, also mentioned, are invaluable, especially if used primarily when the dog is going to be more active than usual, such as going to the dog park, classes, etc. Therapeutic massage and gentle and regular stretching would also make a huge difference, whether helping prevent things from degenerating, or just alleviating some of the pain and discomfort which can be associated. Hydrotherapy is another option, especially if the dog is unable to exercise normally.

  8. Rabeesh

    when a i meet a vet doctor he suggest physiotherapy and write sppliments Paw up & Roch bone

  9. Sharon

    Ailene:

    Ask about trying medication first. There are several. I had surgery on a little 5 lb poodle and although her knee is better, she still holds it up out of habit. The surgery is hard on your dog and hard on you. It costs $1,800. Anesthetic scares me.

    I have a 12 year old poodle too. She started having a lot of pain in her knee. She has the same thing. The vet and I discussed medication because of her age. She is on three meds. She is still having a hard time, but I don’t want her put out. I’ll try the meds another month. I am also looking in to seeing if there are braces for dogs.

    • Dogs Naturally Magazine

      There are braces for dogs. Contact Molly at Animal Rehab Services – if you do a google search, you’ll find her. As for meds, if they are NSAIDs, they will work against your dog long term. NSAIDs have been discovered to reduce bone density and ligament integrity so they are a very poor long term choice. ZEEL has been found to be just as effective as Carprofen in a recent study.

      • C. Rubini

        What is Zeel?

      • Greg

        The fine folks at Animal Rehab in Ontario Canada DO NOT offer braces for luxating patella.

  10. Aileen

    Hi,

    I have a maltese, 20 month old. She is very active, very fast runner. she love to stand up when she is happy. One week ago, I came home from work, she was standing up and jumping on me, suddenly, she creamed and lift her back-left leg up,her body was shaking, I could tell she was in pain. Since then, everytime when she get excited, like when she see other dogs or run fast or play with others, suddenly she lift that leg, and limping. But when she walk peacefully, she looks fine.

    I took her to the Vet. They did X-ray and told me she has patella luxation and she need to get surgery as soon as possible.

    I am wondering if there is a natural cure other than surgery. Could anyone please tell me if there is any other sulutions?

    Thank you very much!

    Aileen

    • Daphne

      Aileen, this happened to my Boston this week. He is five. He jumped straight up, screamed in pain, and now if he jumps up to a higher surface I see he holds his back leg up.

      He could have injured one of the ligaments in the injury, but I think this is almost better than having the chronic condition from birth, in which the groove in which the patella sits is too narrow. The later-in-life injury can be fixed, and even if it does require surgery, there is an end to the issue.

      Our Boston will get surgery if he needs it. There is only a six-week recovery time, and Care Credit cards allow for a no-interest payback time of six months. Please get the surgery if your vet suggests it, because your dog deserves a pain-free life. In the meantime, vitamin C and Dasuquin will help your dog’s ability to fix herself. I wish you the best of luck!

  11. Susan

    Our nearly 7-year-old Toy Fox Terrier was diagnosed today with Luxating Patella; he has only had one episode. What are some of the exercises and nutrient support you reference in this article? Thanks!

  12. Valerie Hoff

    It is my understanding that skipping is very natural in many of the terrier breeds, including Jack Russells, and is really not a problem or health issue. I’m surprised the breeder of your dog did not mention this trait. In this case, I could be wrong, but have seen many skipping terriers over the years.

    • hello
      been breeding JRT for 14 years and I imported her form US and its the first time I have a dog skipping, but will look into that what you are saying to see, she was x-ray twice, she skips from both legs somtime alot somtime not at all.
      I really tought it was a neurological reaction to a vaccine.
      thanks for your response :)

  13. is the symptoms for pattella the dog skips steps?

  14. ok thanks
    she was x-ray for hips and knees, will try to find a physiotherapist.
    have to say she never complains for pain, she can catch a frisbee at 5′ in the air.
    thanks againg

  15. and want to say Im french, so is the pattella the same as leg perthe?

    • Dogs Naturally
      Dogs Naturally

      Legg Calve Perthes disease is an erosion of bone in the hip – it is completely unrelated to luxating patallea. Because x-rays are very good at detecting bone, it would show up very easily on film. Luxating patella however are a soft tissue issue and this would not be picked up on x-ray unless there were associated arthritic changes. In the case of the luxating patella, the quadriceps muscle in which the patella is embedded is too loose and this allows the patella, or kneecap, to slide around laterally against the stifle, instead of just gliding up and down with movement. When the patella slides laterally, it ‘catches’ and this causes the hitch in the dog’s gait. A good physiotherapist would be better able to identify and correct this issue than most vets because this is an issue they deal with every day. It is caused by muscular imbalance which may be the result of poor conformation, but there are corrective exercises that can be done. In humans, we can simply use tape to hold the kneecap in the right position and prevent the lateral movement – or a brace.

  16. I have a jack russell that skips steps on both sides alot, she was X-ray at 9 mounts and 1 years ans 1/2 and the x-ray were ok and checked by a orthopedist, so we think that its the rabies vaccine that caused a neurological reaction to her :(
    what to you think.
    thanks xx

    • Dogs Naturally
      Dogs Naturally

      In a previous life, I was a kinesiologist and specialized in biomechanics and sports injuries. I would say that a subluxating patella will not show up on film if the severity is mild, and it could be missed by an orthopedic vet also. Regardless of the diagnosis or the cause, acupuncture or homeopathy would be of great value!

      • thanks for your fast response, I did acuponcture and osthéopathie with her with no results, all my dogs have Vit C-E, kelp, luzerne, leveure de biere, moule verte and eat raw food, the thing is that she skips alot, about every steps she takes, I told her breeder since I imported her from US for breeding, and sent her the ortho report,
        here is the breeder’s response
        ”I believe this is a misdiagnosis. Legg Perthes is EASY to identify on an x-ray. There is no such thing as a “minor” case of Legg Perthes. The entire ball joint just plain dissolves with Legg Perthes.”

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