Luxating Patella In Dogs: Is Surgery Really Necessary?

Luxating Patella In Dogs

If you’re a dog owner with toy or miniature breed dogs, some day you’ll probably have to deal with a luxating patella. If that happens, most vets will tell you that surgery is the only solution.

But there are lots of natural ways to help your dog with this hereditary problem … without surgery.

What’s Luxating Patella?

Patella means kneecap. Dog kneecaps aren’t as obvious as human ones … but they all have them. Your dog’s patella is almond-shaped. It’s right at the knee joint, where the tendon of the quadriceps muscle group joins the top of the shin (tibia).

The quadriceps muscle, the kneecap and its tendon form the “extensor mechanism.” They’re normally aligned with each other. When your dog flexes or extends his knee joint, the kneecap glides up and down a groove at the front of the knee joint. This groove is called the femoral groove.

To luxate means to put out of joint or dislocate.

So a luxating patella is a dislocated kneecap that moves out of its normal groove. It’s very similar to a “trick knee” in humans. When it happens, your dog can’t move or extend his knee properly. This can cause limping or an abnormal gait. It may also cause pain and eventually, arthritis.

The abnormal movement also causes the tibia to rotate differently from the femur. That can stress the cranial cruciate ligament (CCL) in the knee. It can also lead to chronic inflammation in the joint that causes the ligaments to break down. This means that 10-15% of dogs with luxating patellas will eventually damage the CCL as well.

And the more the kneecap is outside its normal groove, the shallower the groove becomes. So the kneecap then dislocates more easily.

About half of dogs with luxating patella have it in both knees.

RELATED: How to treat cruciate tears without surgery

What Causes Luxating Patella?

Luxating patella can be congenital, genetic or from a traumatic injury.

Most luxating patellas are due to genetic issues. In many cases, the femoral groove where the kneecap travels is too shallow. Luxating patellas can also come from a skeletal defect, such as …

  • Abnormal hip joint, such as hip dysplasia
  • A femur with abnormal angulation and rotation
  • A malformed tibia
  • Tight or atrophied quadriceps muscles (that pull the patella out of its groove)
  • A Patellar ligament that’s loose or too long

Types Of Luxating Patella

Luxating patella can take several forms …

Medial Luxation

Medial luxation is the most common type of patellar luxation. It’s when the kneecap rides on the inner part of the knee. 

Medial luxation is an inherited disease. Puppies may be born with anatomical abnormalities that allow luxation over time. It’s often seen in very young dogs.

One study found that 82% of dogs with luxating patellas had congenital luxations. 98% of the dogs with medial luxation were small breeds. And about half of all dogs with medial luxation had it in both legs. 

Lateral Luxation

Lateral luxation is more common in large and giant breed dogs than small dogs. It’s when the kneecap rides on the outer part of the knee. 

When lateral luxation happens in small breeds, it’s often caused by a breakdown in soft tissue, not skeletal defects. So it happens when dogs are 5 to 8 years old. 

Lateral luxation in giant breeds is often due to other problems like hip dysplasia, which can cause abnormal rotation of the femur. This affects the patellar mechanism.

Sometimes lateral luxation is caused by trauma or over-exertion.

Luxation From Trauma

Traumatic injury to the knee can cause patellar luxation. In that case, severe lameness can occur very suddenly.

Dogs That Are Prone To Luxating Patella 

Miniature and toy dogs are especially prone to luxating patella …

  • Miniature and Toy Poodle
  • Maltese
  • Bichon Frise
  • Jack Russell Terrier
  • Yorkshire Terrier
  • Pomeranian
  • Pekingese
  • Chihuahua
  • Cavalier King Charles Spaniel
  • Papillon
  • Boston Terrier

Large breeds susceptible to the condition include …

  • Labrador Retrievers
  • Golden Retrievers
  • Akitas
  • Malamutes
  • Boxers
  • Huskies
  • St. Bernards
  • Great Danes
  • Irish Wolfhounds

There’s some disagreement about gender susceptibility. But many experts say luxating patella is more common in females.

Research Your Breeder To Avoid Luxating Patella

If you plan to buy a puppy from a breeder … ask whether their breeding adults are certified by OFA (Orthopedic Foundation for Animals). Dogs with congenital luxating patella shouldn’t be bred.

You can also do your own research in the OFA’s Records Search feature. Search for your potential puppy’s parents and relatives by dog name, part of name, breed, and disease type. You can also search by kennel name. This can give you some insight into the kennel’s history of the disease.

All dogs with normal results on an OFA screening test are in the searchable online database.

Dogs with abnormal results are only in the database if the owner authorized it. So, if a dog isn’t in the database, you can assume they haven’t had OFA screening … or that they had abnormal results.

OFA clearance doesn’t guarantee your puppy won’t develop the condition. But it does mean a better chance of avoiding it.

If you adopt or already own a breed prone to luxating patella, you can take steps to avoid it. Follow the guidelines below under How To Manage Luxating Patella Without Surgery.

Grades Of Luxating Patella

There are several grades of the disease.

Grade I – the kneecap can be manually moved out of its groove when the knee is extended. But it goes back to its position on its own.

Grade II – the kneecap rides out of its groove occasionally, but can be manipulated back into place.

Grade III – the kneecap rides out of its groove permanently. It can be manually moved back into place but will pop back out again.

Grade IV ­– the kneecap is permanently out of its groove and can’t be manipulated back into place.

Signs of Luxating Patella

Look at your dog from behind when he’s standing. Does he have a bow-legged stance? This could mean he’s likely to develop luxating patella. 

The most common symptom of luxating patella, especially in small breeds, is a “skipping.” You may see your dog hop along for a few steps, then go back to normal movement. You might even hear a clicking sound as the kneecap pops out of alignment.

You may also see your dog sitting with his knee pointing outward.

If your dog has luxating patella in both knees, you might see him walk stiffly or awkwardly. His knees may not extend fully.

Some dogs learn how to kick their leg to the side to pop the kneecap back into its groove.

When Luxating Patella Symptoms Start

Some puppies show abnormal hind-leg movement as soon as they start walking. These are often more severe grade III and IV cases.

Some young or adult dogs show abnormal gaits all their lives. The lameness may be intermittent or constant. These are often grade II or III luxations.

Older dogs may show sudden signs of lameness as tissues breakdown over time. Or luxation may be due to injury or worsening joint disease. These are usually grade I and II luxations.

Is Luxating Patella Painful?

Luxating patella isn’t always painful for your dog. Grade I luxating patella usually doesn’t hurt. And if you manage your dog’s Grade I condition with diet and exercise, it may not develop into more painful stages.

Higher grade luxating patellas can be painful as the kneecap slides out of the groove. Over time, there may be cartilage damage or structural changes due to frequent luxation. This can create more constant pain for your dog.

How Vets Diagnose Luxating Patella

Dogs with grade I luxating patella usually don’t have visible symptoms. So your vet may find it incidentally during a regular exam.

If you spot your dog showing any luxating patella symptoms, ask your vet to examine him. It’s usually diagnosed by a manual exam. Your vet will assess what grade of luxating patella your dog has.

Sometimes your vet will take x-rays to assess any limb deformity. X-rays will also show if there’s any osteoarthritis.

Luxating Patella Treatment

Once your vet assesses what grade your dog’s luxating patella is, she’ll recommend treatment options. And for Grades II to IV, surgery will likely be the only option she’ll propose.

But you may be able to avoid surgery … which you’ll learn about in a bit. First let’s look at the different types of surgery. 

Types Of Luxating Patella Surgery

The main goal of surgery is to get the quadriceps muscle realigned normally with the rest of the leg. It’s done by reshaping the bones and reconstructing soft tissues. These are some of the techniques. Your surgeon may use more than one.

Tibial Tuberosity Transposition

This surgery realigns the insertion of the tendon between the kneecap and shin bone. Bones heal better than tendons, so they cut the bone that the tendon is attached to and move it to a better position. The bone heals over 4 to 8 weeks. The shin may be secured with wire and/or pins. This is to balance the pull of the quadriceps muscle in the opposite direction.

Femoral Varus Osteotomy

If your dog has a severely bowed thigh bone (femur), this technique straightens the femur. This involves removing a wedge of bone and repairing the femur with a plate and screws. This procedure is usually done on larger dogs or dogs with higher grade luxations.

Your vet should do a CT before this surgery so that they can plan the correct reorientation of the bone.

Recession Sulcoplasty

This surgery deepens the groove that the patella glides in if it’s too shallow. Your vet will remove a wedge or block of cartilage and bone, then replace it in a recessed position.

Soft Tissue Reconstruction

When your dog has luxating patella, the soft tissues on either side of the patella are often too tight or too loose. Reconstruction will release tight tissues and tighten loose tissues.

Recovery From Luxating Patella Surgery

In most cases your dog will be hospitalized overnight after surgery. The hospital will give you individualized recovery instructions. This is the general process, lasting up to 3 months …

Weeks 1-2: Restricted activity. Your dog should be crated or in a closed off area, with no access to stairs or steps. He should only have on-leash potty breaks, with no running, jumping or playing.

Day 10-14: Your vet should remove your dog’s stitches or staples around this time.

Weeks 3-6: Continued restricted activity. No running, jumping, playing or stairs. Your dog may be able to do minor activities on-leash, like practicing sit, heel, or down. (Don’t overdo the treats when practicing these cues, to keep your dog’s weight down!)

Week 6-8: Most vets will do a recheck exam, possibly with new x-rays, to monitor your dog’s progress. If your dog is healing well, you’ll move on to the next step.

Weeks 7-12: Less confinement, with longer walks. No jumping on or off couches or in and out of cars; no running or playing hard. This phase may vary depending on what your vet sees at the recheck exam.

Risks Of Luxating Patella Surgery

Most vets and online articles claim luxating patella surgeries are usually successful. The American College of Veterinary Surgeons reports that over 90% of owners are satisfied by the progress of their dog after surgery. They say most dogs go on to live normal, active lives. 

But according to several research papers, luxating patella surgery isn’t always smooth sailing.

One 2019 UK study looked at short and long-term complications of medial patellar luxation surgeries in dogs under 20 kg (44 lbs). They found complications in 37 out of 100 surgeries. There wasn’t a significant difference between the different surgery types.

The complications were quite serious, and included …

  • Patellar reluxation
  • Implant failure or migration
  • Tibial tuberosity fracture
  • Recession wedge displacement
  • Tibial or femoral fractur
  • Lateral trochlear ridge fracture
  • Patellar ligament rupture
  • inability to fully extend the joint
  • Osteomyelitis
  • Wound reopening
  • Septic arthritis (infection in the joint)

Another 2006 study found only an 18% rate of complications. Other research found a 51% rate of complications, with 38% classified as “major.” And that study observed much higher complications in dogs who had both knees repaired at once (bilateral vs unilateral).

The results of those studies are very different. But even the “best” results suggest you should use caution. And that you should only choose patellar luxation surgery for situations where conservative management doesn’t help. The studies also suggest that bilateral procedures should only be done on dogs under 10 kg (22 lbs).

Cost Of Luxating Patella Surgery

Cost is another great reason to avoid luxating patella surgery. Online estimates are from $1,500 to $3,000 per knee. That doesn’t include vet visits for diagnosis and pre-surgery bloodwork. And it assumes no complications.

How To Manage Luxating Patella Without Surgery

Many dogs (especially small breeds) can live their entire life with a grade I or II luxating patella without pain or arthritis. Most vets will tell you that grade III or IV luxations need surgery sooner or later. These more severe luxations can cause increased pain, arthritis and reduced mobility.

But there’s a lot you can do to avoid surgeries in many dogs. As always, nutrition is the foundation of good health, whatever your dog’s condition. 

1. Nutrition

Focusing on proper nutrition helps to …

  1. Promote healthy, functional connective tissue
  2. Provide building blocks for collagen synthesis
  3. Control inflammation and pain
  4. Supply antioxidants
  5. Prevent osteoarthritis

RELATED: 6 natural joint supplements for dogs …

To make sure your dog gets what he needs, feed your dog a whole food, raw meat-based diet and always avoid kibble. There are also some important nutrients that help protect your dog’s joints and avoid luxating patella.

Important Vitamins

  • Vitamin C helps collagen synthesis and is an antioxidant.
  • Vitamin E stabilizes cell membranes, stimulate proteoglycan, modulate the inflammatory phase of osteoarthritis and is an antioxidant.
  • Vitamins B1 and B6 are needed for collagen synthesis.

RELATED: Why your dog needs more antioxidants …

Important Minerals

  • Manganese is an essential cofactor synthesizing glycosaminoglycans. It’s involved in the synthesis of collagen and proteoglycans to form the organic matrix of bone.
  • Magnesium and sulphur, copper, iron and zinc all support collagen synthesis.
  • Selenium (especially alongside omega-3 fatty acids) may reduce inflammation in the joint. This can help manage osteoarthritis.
  • Calcium is necessary for bone health and muscle contractions.

 Important Supplements

  • Omega-3 fatty acids are anti-inflammatory. They can also help regulate the cells in cartilage and may help protect against cartilage degradation.
  • Glycosaminoglycans have anti-inflammatory properties and are needed for proteoglycan synthesis and collagen formation.
  • Chondroitin sulfate is anti-inflammatory and stimulates glycosaminoglycans and collagen synthesis.
  • Methylsulfonylmethane (MSM) is a source of sulfur which is required for collagen synthesis. It may relieve pain. It has anti-inflammatory effects and helps reduce muscle spasm.
  • Bioflavonoids (flavones, flavonoids, quercetin, rutin, procyanidins) are found in vegetables, fruits, and green tea. They have antioxidant and anti-inflammatory properties.

RELATED: Best sources of glucosamine for dogs …

2. Manage Your Dog’s Weight

Don’t let your dog get overweight. Excess weight puts more pressure on your dog’s joints and he’ll lose mobility quicker. It can also lower joint inflammation caused by fat.

Every vet will recommend reducing your chubby dog’s weight to help with any joint problem. So keep him lean … and a raw diet will help with that! Kibble is very high in starch and offers poor quality nutrition for your dog.

RELATED: Why kibble is never a good option …

3. Regular Walking

You may wonder if you should walk your dog with luxating patellas. The answer is yes … it’ll help keep your dog’s muscles and tendons strong. That helps to support the joints. But don’t do too many long walks. Several shorter walks a day is the best approach.

4. Minimize Vaccinations

Studies show that connective tissue problems are often related to vaccination. That’s because vaccines can create antibodies that destroy your dog’s collagen. And collagen is the tissue that stabilizes your dog’s joints. It’s in more than 70% of your dog’s muscles, tendons, ligaments and other joint tissues.

When joints lack collagen, the muscles and tissues also become brittle. This leads to inflammation, pain and eventually joint disease.

So don’t over-vaccinate by following conventional vet vaccination schedules. The only vaccine required regularly by law is rabies every 3 years. For other core vaccines, your dog is likely protected for life by the puppy shots he had.

So, do your research and only give the minimum vaccines your dog needs to protect him from disease.

RELATED: How vaccines harm joints …

5. Other Hands-On Management

There are several physical therapy options to support your dog’s structural health. And they can help manage luxating patellas. These include …

  • Exercises to increase strength and range of motion
  • Hydrotherapy (swimming or underwater treadmill)
  • Chiropractic
  • Massage or other manual therapy such as myofascial release
  • Laser therapy
  • Acupuncture

Your vet or surgeon should be able to refer you to local veterinary rehab specialists. They’ll recommend the right physical therapy options for your dog.

There are also some exercises you can easily do at home, with just a few minutes of effort daily.

Exercises To Help Luxating Patella

Canine rehabilitation veterinarian Dr Julie Mayer recommends these exercises. They’ll help strengthen the muscles and improve knee stability. A strong quadriceps muscle with a taut tendon means the patella is less likely to slip out of position.

  1. Have your dog move from a sit to a stand several times in a row.
  2. If you have stairs (preferably carpeted), have your dog go up and down stairs three to five times, several times a day. You can also find a steep hill and have him walk up and down and zig-zag across the face of the hill.
  3. Teach your dog to army crawl. Have him get into a down position and slowly lure him forward with some food. Encourage him to keep his rear end down.
  4. Walking over cavalettis (a series of raised bars set up in a row) encourages flexion and extension of the stifles.
  5. You can use leg weights above the hock and take your dog for a walk or do his exercises with them on to provide resistance and improve muscle strength.
  6. Underwater treadmills or swimming can also strengthen the surrounding knee structures. Water resistance helps build muscle strength and the buoyancy makes it a safer workout.

Follow these guidelines to prevent luxating patellas in your dog. And if he’s already showing signs, you may be able to avoid surgery.

References

Roush JK. Canine patellar luxation. Vet Clin North Am Small Anim Pract. 1993 Jul;23(4):855-68. 

Di Dona F, Della Valle G, Fatone G. Patellar luxation in dogs. Vet Med (Auckl). 2018 May 31;9:23-32.

Hayes AG, Boudrieau RJ, Hungerford LL. Frequency and distribution of medial and lateral patellar luxation in dogs: 124 cases (1982-1992). Journal of the American Veterinary Medical Association. 1994 Sep;205(5):716-720.

Kalff S et al. Lateral patellar luxation in dogs: a retrospective study of 65 dogs. Vet Comp Orthop Traumatol. 2014;27(2):130-4. 

SE Gibbons et al. Patellar luxation in 70 large breed dogs. Journal of Small Animal Practice. 2006 Jan 16.

CC Willhauer VMD et al. Clinical results of surgical correction of medial luxation of the patella in dogs. Veterinary Surgery. 1987 Jan;16(1).

Gareth L Arthurs MA VetMB CertVR CertSAS MRCVS et al. Complications associated with corrective surgery for patellar luxation in 109 dogs. Veterinary Surgery. 2006 Aug;35(6).

Harasen G. Patellar luxation: pathogenesis and surgical correction. Can Vet J. 2006;47(10):1037-1039.

Lavrijsen, I. C. M. et al. Phenotypic and genetic trends of patellar luxation in dutch flat-coated retrievers. Animal Genetics, 44. 2013(6), 736–741.

Lavrijsen, Ineke C M,et al. Genome-wide survey indicates involvement of loci on canine chromosomes 7 and 31 in patellar luxation in flat-coated retrievers. BMC Genetics. 2014 May 28;15(1):64.

Priester WA. Sex, size, and breed as risk factors in canine patellar dislocation. J Am Vet Med Assoc. 1972;160:740-742.

Chase K, Jones P, Martin A, Ostrander EA, Lark KG. Genetic mapping of fixed phenotypes: disease frequency as a breed characteristic. J Hered. 2009 Aug;100(1):S37-S41.

van Grevenhof EM et al. Breeding implications resulting from classification of patellae luxation in dogs. J Anim Breed Genet. 2016 Aug;133(4):316-22. 

Matteo Rossanese et al. Complications following surgical correction of medial patellar luxation in small-to-medium-size dogs. Vet Comp Orthop Traumatol. 2019;32(04):332-340

Arthurs GI, Langley-Hobbs SJ. Complications associated with corrective surgery for patellar luxation in 109 dogs. Vet Surg. 2006 Aug;35(6):559-66. 

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