A painting of a dog with patellar luxation.

What is Medial Luxating Patella in Dogs?

ByPhil Good, DVM Pet Health Plus

What is it?

Medial patellar luxation in dogs is a condition that affects the normal alignment of the kneecap, causing it to shift out of place. This can lead to discomfort, pain, and difficulty walking or running. Medial patellar luxation can affect dogs of any age or size and may be caused by a variety of factors, including genetics and trauma.

How is it Treated?

The treatment of medial patellar luxation in dogs depends on the severity of the condition and its impact on the dog’s mobility and quality of life. In mild cases, rest and physical therapy may be recommended to strengthen the muscles and stabilize the joint. More severe cases may require surgical intervention to realign the patella and repair any damage to the joint. 

Breed Predispositions

Chihuahuas Pomeranians Toy Poodles Yorkshire Terriers Boston Terriers Cavalier King Charles Spaniels French Bulldogs Jack Russell Terriers Miniature Pinschers Shih Tzus

Introduction

As Tom watched his spirited Jack Russell Terrier, Daisy, frolic around the park, he couldn’t help but notice her occasional skipping and limping on one of her hind legs. Concerned about his beloved pet’s well-being, he decided to consult his veterinarian for a thorough examination. After evaluating Daisy, the vet diagnosed her with a medial luxating patella, a common orthopedic condition in small breed dogs.

A medial luxating patella, or patellar luxation, is a frequent orthopedic issue in dogs where the kneecap (patella) dislocates or shifts from its usual position within the femur’s (thigh bone) groove. This results in discomfort, limping and diminished mobility in the dogs affected. Medial patellar luxations are commonly observed in small and toy-breed dogs, mainly due to genetic predisposition, trauma, or developmental abnormalities. Notably, almost half of the dogs affected by this condition experience knee damage.

The patella, connected by the patellar ligament to the shin bone, plays a crucial role in the functioning of the quadriceps muscle. Any dislocation, whether medial (towards the body’s midline) or lateral patella luxation (away from the body’s midline), can significantly impact a dog’s mobility. This condition can sometimes be related to other knee issues, such as damage to the cranial cruciate ligament. Small-breed dogs, in particular, are often more prone to this condition.

Classifications of Patellar Luxation in Dogs

Dogs with patellar luxation can be categorized into four grades, depending on the severity of the condition:

  • Grade I: Once released, the kneecap (patella) can be manually dislocated, but it spontaneously returns to its normal position within the trochlear or femoral groove. The dog might not exhibit noticeable signs or may display occasional mild lameness.
  • Grade II: The patella may also spontaneously luxate occasionally, leading to intermittent lameness in the dog. While it can be manually returned to its position, it may spontaneously luxate again.
  • Grade III: The kneecap remains perpetually dislocated but can be manually repositioned, although it will luxate again once released. Consequently, the dog will endure consistent lameness and may struggle with walking.
  • Grade IV: The patella is permanently dislocated and cannot be manually repositioned. The dog will exhibit constant lameness, and its leg might be held in a bent position. This stage is severe and generally necessitates surgical intervention.

Furthermore, it’s essential to recognize that patellar luxation can be either medial or lateral, depending on the kneecap’s dislocation direction. Medial patellar luxation is more prevalent when the kneecap dislocates towards the leg’s inside. Conversely, lateral patellar luxation transpires when the kneecap dislocates towards the leg’s outside.

Certain breeds, including small dogs like the Yorkshire Terrier and Boston Terrier, are more prone to this condition, particularly medial luxation. The patellar tendon, connected to the femur (thigh bone), plays a crucial role in knee stability, and any dislocation can significantly affect the dog’s mobility.

Two Categories of Patellar Luxation

In addition to the classifications based on severity and direction of dislocation, patellar luxation can also be categorized as congenital or acquired.

Congenital Patellar Luxation

Congenital patellar luxation is present at birth or develops shortly after that. Genetic factors often cause it, and certain breeds like Toy and Miniature Poodles, Chihuahuas, Yorkshire Terriers, and Pomeranians are more prone to this condition. In congenital cases, structural abnormalities in the bones, muscles, and connective tissues contribute to the development of patellar luxation.

Acquired Patellar Luxation

Acquired patellar luxation, on the other hand, occurs later in life, typically due to trauma, injury, or gradual degeneration of the joint structures. In addition, overweight dogs are more prone to acquired patellar luxation because the excess weight puts additional stress on the joints, increasing the risk of injury and dislocation.

Causes of Luxating Patella in Dogs

A medial luxating patella, also known as a slipped kneecap, can be caused by various factors. Understanding the root causes of this condition can help dog owners identify risk factors and take preventive measures.

  • Genetics: Genetic predisposition plays a significant role in the development of the medial luxating patella. Certain small and toy breeds, such as Toy and Miniature Poodles, Chihuahuas, Yorkshire Terriers, and Pomeranians, are more prone to this condition due to their genetic makeup. In these cases, structural abnormalities in the bones, muscles, and connective tissues contribute to the development of patellar luxation.
Medial Luxating Patella in Dogs
  • Trauma or Injury: Acquired patellar luxation can occur due to an external force, such as a fall or collision. Injuries to the ligaments and joint structures can lead to instability and dislocation of the kneecap.
  • Degenerative Joint Disease: Over time, wear and tear on the joints can cause the development of a medial luxating patella. This is especially true for older or overweight dogs, where the additional stress on the joints can contribute to joint degeneration and eventual dislocation of the kneecap.
  • Muscle Imbalances: In some cases, uneven muscle development or weakness in the muscles surrounding the knee joint can lead to instability and dislocation of the patella. This may be due to poor nutrition, inadequate exercise, or other underlying health issues.
  • Congenital Abnormalities: Some dogs are born with structural abnormalities predisposing them to a medial luxating patella. These can include misaligned bones, shallow femoral grooves, or lax ligaments that fail to hold the kneecap in place properly.

Prevention and early intervention are crucial in managing medial luxating patella. Identifying and addressing the underlying causes can help reduce the risk of complications and ensure a better quality of life for affected dogs.

Symptoms of Medial Patellar Luxation in Dogs

The severity of medial patellar luxation, characterized by a displaced kneecap, can be gauged through four established grades, each associated with specific symptoms:

Grade 1 Symptoms

The kneecap can be manually dislocated in the most benign form but readily pops back into its rightful position when let go. In addition, the affected dog may show no signs, occasional lameness, skipping, or an abnormal gait.

Grade 2 Symptoms

The kneecap may spontaneously luxate with movement in this stage but can still be manually repositioned. Signs that an affected dog may exhibit include:

  • more frequent limping
  • skipping
  • abnormal gait
  • difficulty jumping, running, or climbing stairs.

Grade 3 Symptoms

The kneecap remains displaced at this more serious level but can be manually relocated. However, it will instantly luxate once released. Dogs may suffer from the following:

  • persistent limping
  • abnormal gait
  • pain
  • reduced activity levels
  • may also have muscle atrophy
  • difficulty bearing weight on the affected leg

Grade 4 Symptoms

This grade represents the most severe form, where the kneecap is permanently luxated and cannot be manually repositioned. Dogs with Grade 4 medial patellar luxation often display:

  • significant lameness
  • pain
  • may be unable to bear weight on the affected leg
  • joint swelling
  • muscle atrophy
  • reduced range of motion in the affected joint.

The intensity of clinical symptoms can fluctuate from one dog to another, even within the same grade, and may escalate over time without appropriate veterinary medicine intervention. Therefore, it is crucial to consult a veterinarian if you suspect your dog may be experiencing intermittent luxation of the patella. This condition can occur particularly in breeds with disproportionate long bones, affecting the alignment and stability of the stifle joint in the affected leg.

Diagnosing Medial Luxating Patella in Dogs

Diagnosing medial luxating patella in dogs calls for an integrative approach that includes a comprehensive physical examination, palpation of the joint in question, and additional diagnostic tests to verify the diagnosis and gauge the condition’s severity. Here is the methodology vets employ to diagnose medial luxating patella in dogs:

  • Physical examination: The vet’s first step involves scrutinizing the dog’s walking style and noting any indications of limping, skipping, or abnormal gait patterns that may hint at patellar luxation.
  • Palpation: The vet carefully palpates the dog’s knee joint to discern whether the kneecap is displaced or can be manually luxated. This crucial step can assist in determining the grade of patellar luxation and identifying any associated discomfort or pain.
  • Radiographs (X-rays): X-rays of the leg affected by the condition may be conducted to examine the overall bone structure, gauge the level of joint deformity, and exclude other potential causes of the dog’s symptoms, such as fractures or joint infections. The position of the tibial crest can be particularly informative.
  • Orthopedic evaluation: In some instances, a more in-depth orthopedic evaluation may be required, which could involve referral to a specialist at an animal hospital. This can provide a more detailed assessment of the extent of the luxation and any associated joint or ligament damage and inform the most suitable treatment plan, especially in cases of lateral patellar luxation.
  • Additional diagnostic tests: Depending on the individual case, the vet may recommend further tests like blood work, CT scans, or MRI. These can give a more holistic understanding of the dog’s overall health and spot any underlying health issues contributing to the repeated luxation of the patella.

Accurate diagnosis of a medial luxating patella is vital in determining the correct treatment strategy and effectively managing the condition. This can significantly enhance the dog’s quality of life and reduce the risk of enduring complications.

Treatment Options for Medial Luxating Patella in Dogs

Treating medial luxating patella in dogs is tailored to the severity of the condition, the dog’s overall health, and any associated complications. Here’s how vets treat medial luxating patella in dogs:

medial luxating patellar in dogs

Conservative Management

Conservative management may be recommended for mild cases (Grade I or II). Conservative management for medial luxating patella in dogs typically includes the following components:

  • Weight management
  • Physical therapy
  • Controlled exercise
  • Anti-inflammatory medications
  • Joint supplements

Conservative management aims to control the symptoms of the medial luxating patella without resorting to surgical intervention. However, surgical treatment may be necessary if conservative measures don’t provide sufficient relief or worsen the condition.

Surgical Intervention

Surgery may be necessary to correct the patellar luxation in more severe cases (Grade III or IV) or when conservative management is unsuccessful.  There are several surgical techniques veterinarians may use to treat medial luxating patella in dogs, depending on the severity of the condition and the specific needs of the individual dog.

Some of the most common surgeries for medial luxating patella include:

  1. Trochleoplasty: This orthopedic surgery deepens the groove (trochlear groove) where the patella typically sits, providing better stability and preventing the patella from slipping out of place.
  2. Tibial Tuberosity Transposition: In this surgery, the attachment of the patellar ligament to the tibia (tibial tuberosity) is repositioned to realign the forces acting on the patella, helping to keep it in the correct position.
  3. Soft Tissue Reconstruction: This surgery involves tightening or loosening the soft tissues around the knee joint, such as the joint capsule and ligaments, to help stabilize the patella and prevent luxation.
  4. Wedge recession Trochleoplasty: In this technique, a wedge-shaped trochlear groove is removed, allowing the surgeon to deepen the groove and improve patellar stability.
  5. Combination surgeries: In some cases, combining the above surgical techniques may be necessary to effectively address the dog’s medial luxating patella and provide the best possible outcome.

Medial luxating patellar surgeries in dogs can significantly improve a dog’s quality of life, especially when conservative management is unsuccessful. However, it’s essential to consider the pros and cons of these surgeries before deciding on a treatment plan.

Pros of medial luxating patellar surgeries:

  • Pain relief: Surgery can help alleviate the pain and discomfort associated with medial luxating patella by stabilizing the patella and correcting any underlying deformities.
  • Improved mobility: Dogs with severe patellar luxation may have difficulty walking or running. Surgical correction can restore normal joint function, allowing the dog to move more comfortably and confidently.
  • Prevention of further joint damage: If left untreated, the medial luxating patella can lead to progressive joint damage, including osteoarthritis. Surgery can help prevent or slow down the development of these complications.
  • Customized treatment: Various surgical techniques are available to address each patient’s specific needs, allowing for tailored treatment based on the severity of the condition and the individual dog’s anatomy.

Cons of medial luxating patellar surgeries:

  • Anesthesia risks: As with any surgery, there are risks associated with anesthesia, including allergic reactions, difficulty breathing, or even death, although these risks are generally low.
  • Postoperative complications: Potential complications from surgery include infection, excessive bleeding, nerve damage, or recurrence of patellar luxation.
  • Recovery and rehabilitation: The recovery period after surgery can be lengthy, often requiring several weeks or months of limited activity, physical therapy, and close monitoring. This can be challenging for both the dog and the owner.
  • Cost: Surgical treatment for medial luxating patella can be expensive, with prices varying depending on the complexity of the surgery, the surgeon’s expertise, and the geographical location.
  • No guarantee of success: While many dogs experience significant improvements following surgery, there is no guarantee that the surgery will ultimately succeed or that the condition will not recur.

In conclusion, medial luxating patellar surgeries can offer numerous benefits for dogs suffering from the condition, but it is crucial to weigh the pros and cons carefully. Consulting with your veterinarian and potentially seeking a second opinion from a veterinary orthopedic specialist can help guide your decision-making process.

Postoperative Care

After surgery, the dog will require a period of rest and restricted activity to allow the joint to heal. Physical therapy and a gradual return to exercise will help regain strength and flexibility in the affected leg. Pain management and anti-inflammatory medications may also be prescribed during the recovery period.

Ongoing Monitoring

Regular follow-up appointments with the vet will be necessary to monitor the dog’s progress and ensure the treatment plan is effective. In some cases, adjustments to the treatment plan may be required, such as changes in medication or the addition of supportive therapies like hydrotherapy or acupuncture.

Prompt and appropriate treatment of medial luxating patella can significantly improve the dog’s quality of life, reduce pain and discomfort, and minimize the risk of long-term joint damage and arthritis.

Prevention of Medial Luxating Patella in Dogs

Preventing medial luxating patella in dogs is not always possible, as the condition can have genetic and developmental components. However, some steps can be taken to minimize the risk and manage potential factors that contribute to the development of the condition:

  1. Responsible breeding practices: Choosing dogs from reputable breeders who prioritize health, temperament, and conformation can help reduce the risk of passing on genetic predispositions to the medial luxating patella. Breeders should screen their breeding dogs for this condition and avoid breeding those with a history of patellar luxation.
  2. Proper nutrition and weight management: Providing your dog with a balanced diet and maintaining a healthy weight can help reduce the stress on their joints, including the patella. Obesity can exacerbate joint problems, so monitoring your dog’s weight and adjusting their food intake and exercise is essential.
  3. Regular exercise: Regular, moderate exercise can help maintain muscle strength and joint flexibility, which may help support the patella and reduce the risk of luxation. However, avoiding excessive or high-impact activities that could injure the knee joint is crucial.
  4. Routine veterinary care: Regular check-ups with your veterinarian can help identify any signs of medial luxating patella early on. Early detection and intervention can lead to better management of the condition and may reduce the risk of complications.
  5. Joint supplements: Some veterinarians may recommend joint supplements containing glucosamine, chondroitin, or other joint-supporting ingredients to promote joint health and help maintain the stability of the patella.

While it may not be possible to completely prevent medial luxating patella in dogs, following these guidelines can help minimize the risk and ensure your dog has the best chance at a healthy, happy life.

Frequently Asked Questions

Treating luxating patella in dogs without surgery depends on the severity of the condition and the level of discomfort it causes the dog. In mild cases, where the patella (kneecap) only occasionally slips out of place and does not cause significant pain or lameness, non-surgical management may be an option. Here are some approaches that can be considered:

  1. Weight management: Maintaining a healthy body weight reduces joint stress. Excess weight can exacerbate luxating patella and contribute to discomfort.
  2. Exercise moderation: Avoid activities that strain the joints, such as jumping or rough play. Engage in controlled and low-impact exercise, such as leash walks or swimming, to help maintain muscle tone and joint flexibility.
  3. Physical therapy: Therapeutic exercises, such as range-of-motion, controlled swimming, and balance exercises, can help improve muscle strength, joint stability, and overall mobility. Physical therapy may be done under the guidance of a professional rehabilitation therapist.
  4. Joint supplements: Supplements containing glucosamine, chondroitin, and omega-3 fatty acids may help support joint health and reduce inflammation. Consult with a veterinarian for appropriate supplement recommendations and dosages.
  5. Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) or other pain medications may be prescribed by a veterinarian to manage pain and inflammation associated with luxating patella.

It’s important to note that non-surgical management may not be effective or suitable for all cases of a luxating patella. Severe or persistent cases that cause significant pain or lameness may require surgical intervention to correct the anatomical abnormalities and provide long-term relief.

The average cost of a patella luxation surgery varies depending on several factors, such as the type of surgery, the number of operations needed, the size of the animal, and the location of the surgery. For example, a large dog undergoing two surgeries could cost up to $3,000. On the other hand, a smaller dog who undergoes only one surgery might cost around $1,500.

A grade 4 luxating patella is the most severe condition, where the kneecap is constantly dislocated and cannot be manually repositioned. Dogs with a grade 4 luxating patella typically experience significant pain, lameness, and difficulty walking. Without surgical intervention, it can be challenging for a dog to live comfortably and maintain a good quality of life.

Surgical correction is usually recommended to realign the patella and stabilize the joint, improving the dog’s comfort, mobility, and long-term prognosis. It is essential to consult with a veterinarian experienced in orthopedic conditions for appropriate guidance and treatment options.

In some cases, a luxating patella in dogs may improve or resolve independently, particularly in mild cases. This can happen as the dog grows and develops and the musculature and supporting structures around the knee joint strengthen. However, it is essential to note that not all cases of the luxating patella will self-resolve, and the likelihood of spontaneous healing depends on the severity of the condition.

In more severe cases or instances where the luxation is causing significant pain, lameness, or joint damage, it is unlikely that the luxating patella will heal without intervention. Severe or persistent cases often require surgical correction to realign the patella and stabilize the joint.

A knee brace or orthotic device may be considered for a dog with a mild luxating patella, as it can provide additional stability and support to the joint. However, its effectiveness depends on the individual dog and the severity of the luxation.

 In more severe cases or when the luxating patella causes significant pain or joint damage, a knee brace alone is insufficient, and surgical intervention may be necessary. It is essential to consult with a veterinarian experienced in orthopedic conditions to assess the situation and determine the most appropriate treatment plan for your dog’s well-being.

The life expectancy of a dog with luxating patella depends on factors such as the severity of the condition, the presence of other joint abnormalities, overall health, and the effectiveness of treatment. In mild cases, where the luxation is infrequent and doesn’t cause significant issues, dogs can live an average lifespan with proper management. 

However, the dog’s quality of life may be affected in more severe cases or when complications arise, such as chronic pain or joint degeneration. Timely intervention, including surgical correction when necessary, can improve the long-term outlook. Working closely with a veterinarian experienced in orthopedic conditions and providing regular care and monitoring are essential for maximizing the dog’s well-being and lifespan.

If a luxating patella is left untreated, it can lead to various complications and negatively impact a dog’s quality of life. Over time, the constant misalignment of the kneecap can cause progressive joint degeneration, inflammation, and chronic pain. The affected leg may weaken, leading to fatigue, difficulty walking or running, and reduced mobility. Additionally, the persistent instability in the joint can contribute to developing secondary orthopedic issues, such as ligament tears or arthritis. Prompt intervention is crucial to prevent further joint damage and give the dog a better chance for improved comfort, mobility, and long-term prognosis.

The severity of luxating patella in dogs can vary depending on the case. Therefore, it is graded on a scale from 1 to 4, with grade 1 being the mildest and grade 4 being the most severe. In mild cases (grades 1-2), the patella may occasionally slip out of place but can usually be manually repositioned. 

Dogs may experience minimal to no pain or lameness. The patella frequently dislocates in moderate cases (grade 3) and may not quickly go back into place. Dogs may exhibit lameness, discomfort, and difficulty with mobility. 

In severe cases (grade 4), the patella is constantly dislocated and cannot be manually repositioned. As a result, dogs experience significant pain, lameness, and difficulty walking. Surgical intervention is often necessary to correct the condition and provide relief. The severity of the luxating patella determines the appropriate treatment approach and prognosis for the affected dog.

While injury can potentially contribute to developing or worsening a luxating patella in dogs, it is not typically the primary cause. Luxating patella is often considered a congenital or hereditary condition, meaning it is present from birth or has a genetic component. Structural abnormalities in the bones, tendons, ligaments, or muscles around the knee joint can predispose a dog to the luxating patella. However, trauma or injury to the knee joint can sometimes lead to a luxating patella by causing additional damage or instability to the structures supporting the patella.

In such cases, the injury can exacerbate or accelerate the progression of the luxation. It is important to note that luxating patella is usually a result of underlying anatomical abnormalities rather than a direct consequence of injury. Suppose a dog experiences an injury to the knee or shows signs of a luxating patella. Consulting with a veterinarian for a proper diagnosis and appropriate treatment options is essential.

To prevent the luxating patella from worsening in dogs, focus on maintaining a healthy weight through proper diet and exercise to reduce stress on the knee joint. Regular low-impact exercise, such as walking or swimming, helps strengthen the surrounding muscles. Avoid activities involving excessive jumping or rough play to minimize joint strain. Make necessary modifications to your dog’s environment to prevent accidents or falls.

Regular veterinary check-ups will ensure proper condition monitoring and allow for timely intervention if needed. Consulting with your veterinarian is essential to develop a tailored plan for managing the luxating patella based on your dog’s needs.

In general, walking can be beneficial for dogs with a luxating patella. Still, it is essential to consult with your veterinarian to determine the appropriate exercise routine for your dog’s specific condition. Walking is a low-impact exercise that helps maintain muscle tone, joint mobility, and mental stimulation.

Start with shorter walks on softer surfaces, monitor your dog for signs of discomfort, provide regular breaks, and keep them on a leash for control. Each dog’s needs may differ, so it’s essential to tailor the walking routine to their condition and consult your veterinarian for guidance.

A luxating patella can cause long-term problems for a dog if left untreated or not effectively managed. The constant displacement of the patella can lead to joint degeneration, arthritis, and secondary orthopedic issues over time. Muscle weakness, atrophy, reduced activity, and decreased quality of life can also result from chronic discomfort and limited mobility. Timely intervention, appropriate treatment, and ongoing management are crucial to minimizing the long-term impact of a luxating patella.

Working closely with a veterinarian experienced in orthopedic conditions, regular monitoring, and follow-up care is essential for addressing any changes or complications and providing the best possible support for your dog’s well-being.

The recovery from a luxated patella in dogs depends on the severity of the condition and the chosen treatment approach. In mild cases, conservative management measures like weight control, exercise moderation, and joint supplements may allow dogs to recover fully. However, surgical intervention to realign the patella and stabilize the joint is often necessary in more severe cases. 

With successful surgery and proper post-operative care, dogs can recover and regain normal function, experiencing improved comfort and mobility. Rehabilitation and physical therapy can also aid in the recovery process. However, each dog’s recovery may vary, and ongoing management and regular veterinary check-ups may be required to prevent recurrence and maintain long-term recovery. 

Disclaimer: The information provided on this veterinary website is intended for general educational purposes only and should not be considered as a substitute for professional veterinary advice, diagnosis, or treatment. Always consult a licensed veterinarian for any concerns or questions regarding the health and well-being of your pet. This website does not claim to cover every possible situation or provide exhaustive knowledge on the subjects presented. The owners and contributors of this website are not responsible for any harm or loss that may result from the use or misuse of the information provided herein.

Dr. Phil Good, owner of Beyond Pets Animal Hospital, received his Bachelor of Science with highest honors in Chemical Engineering from Georgia Tech in 2006. Phil finally came to his senses, realizing he’d much rather work with animals than in a chemical plant. Dr. Good obtained his doctorate in veterinary medicine from UGA in 2011.

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