Canine Luxating Patellas

A luxating patella, also known as a floating kneecap, is a common orthopedic condition that can affect dogs, especially small and toy breeds.

Symptoms of a luxating patella may include limping, intermittent skipping or hopping on the affected leg, difficulty bearing weight, and pain. Some dogs might show signs of lameness only after vigorous exercise or extended periods of activity.

My little Miss Molly Brown has had a skip in her get-a-long for all of her 11 years. I have only treated it with chiropractic adjustments. The patella, or kneecap, is a small, flat bone located in front of the knee joint, its design is very similar to our knee cap. It normally glides up and down in a groove within the femur (thigh bone) when the dog moves its leg. Her groove is most likely shallow as she is only six pounds and considered a toy breed AND as long as adjusted regularly to maintain her pelvis in correct positioning and proper movement in her lumbar spine, she continues to skip but is pain-free. It has minimal to no degeneration over all these years based on symptoms. I contribute that to easy walking on a mostly daily basis, fitness exercises and chiropractic care. She has decided that a massage every once in a while is pretty good too!A luxating patella, also known as a dislocated kneecap, is a common condition in dogs, particularly in small breeds. It occurs when the patella (kneecap) slips out of its normal position in the groove of the thigh bone (femur), usually moving towards the inside of the leg. This condition can range from mild to severe and can affect either one or both knees.

Signs and Symptoms of Luxating Patella in Dogs Include:

1. Intermittent Limping or Lameness: You may notice your dog limping or favoring one leg, especially after exercise or when they first get up from a resting position. This limping can come and go.

2. Sudden Skipping or Hopping: A dog with a luxating patella may skip or hop while walking, using only three legs, and then go back to using all four.

3. Pain: While some dogs may not show obvious signs of pain, others may yelp or whine, especially when the kneecap pops out of place.

4. Stiffness: The affected leg may appear stiff, or your dog may have difficulty in straightening the knee.

5. Abnormal Gait: You may notice an unusual walking pattern or an odd way of moving in your dog.

6. Reluctance to Exercise: Dogs with a painful luxating patella might avoid activities they usually enjoy, like running or jumping.

7. Muscle Wasting: In chronic cases, the muscle in the affected leg may begin to atrophy due to reduced use.

8. Sitting Awkwardly: Some dogs may sit with the affected leg stuck out sideways.

It's important to note that the severity of a luxating patella can vary. In mild cases, the kneecap may only occasionally slip out and quickly return to its normal position. In more severe cases, the kneecap may be permanently dislocated, or it may require manual manipulation or surgery to return it to its proper place. 

If you suspect your dog might have a luxating patella, it's important to consult with a veterinarian for a proper diagnosis and treatment plan. Early intervention can help manage the condition and prevent further joint damage.

This is true in most cases, but I have seen over the years injuries to a knee that the resulting inflammation in the soft tissue in the knee causes a luxating patella that can be resolved with time as the inflammation goes down. And as stated above, even if that groove is on the shallow side, I have found those pet parents that continue with regular chiropractic care (a visit every 4 to 8 weeks) can maintain the knee joint by addressing the pelvic rotation that comes with this type of dysfunction. 

Say what, Dr. Andi? In my experience, the reason the knee cap can luxate on one side more than the other or be worse at times is when the pelvis is rotated toward the side of the more prominent luxating knee. You see, a dog's pelvis is designed like a steering wheel and if rotated towards the luxating knee (we are talking miniscule rotation, so little you cannot see it and technically it is less of a rotation and more of an incongruent firing of motor cells in the nervous system) it puts "slack" in the tendon that controls the knee cap allowing for more motion and thus luxation. Again, a tendon is part of a muscle and bones are stupid, they go where the muscle goes.Conventional veterinary treatment options for a luxating patella depend on the grade and severity of the condition. Mild cases may be managed with pain management and restricted activity. In more severe cases, surgical intervention might be necessary to realign the patella and deepen the groove in which it moves. 

Luxating Patella Grading System

Let's take a look at the grading system and what will be offered by your conventional veterinarian as options. Medial luxating patella is usually graded on a scale from I to IV, depending on the severity:

• Grade I: The patella occasionally slips out of place but returns to its normal position on its own.

• Grade II: The patella frequently slips out of place but can also return to its normal position spontaneously.

• Grade III: The patella is often dislocated and requires manual manipulation to put it back into position. Most times this manual manipulation can be performed by the pet parent.

• Grade IV: The patella is permanently out of place and cannot be manually repositioned.

Pain management is generally always offered and surgery is usually mentioned, but rarely do conventional veterinarians offer options to maintain or limit the impact of a MLP. Of course, pain management aims to alleviate discomfort and improve their overall quality of life. The specific pain management plan can vary depending on the severity of the patellar luxation and any associated conditions. And you may want to try a medication or two to evaluate if your pet is in pain. If the medication does a wonderful job and the limping reduces or even goes away, THAT IS INFORMATION! That means your pet had inflammation in the joint and the med helped to reduce said inflammation. In my world, it does not mean that now the animal stays on this prescription medication for life. The next question I ask is how can I manage this inflammation and condition with other options that are easier on my pet's system?

Pain Management Strategies

1. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to reduce pain and inflammation associated with patellar luxation. These medications help relieve pain and improve joint mobility by reducing inflammation. However, long-term use of NSAIDs should NOT be prescribed to avoid potential side effects. 

Side note, and is only my opinion, do not use Gabapentin in this case. As previously stated, the neurology is NOT functioning at an optimal state and adding in a medication that dampens the nervous system will only allow for possible further injury.

Don't forget, you can always try other supplements/homeopathics before or in conjunction with the prescribed medications. These can include and not limited to, Arnica, CBD, Formula 303, White Willow Bark, Chinese Herbs.

2. Joint Supplements: Veterinarians may recommend joint supplements containing glucosamine, chondroitin, and other ingredients that support joint health. These supplements can help maintain cartilage integrity and reduce joint inflammation. 

Again as I see it, synthetic joint supplementation as mentioned above, is age dependent. The body is inherently lazy and if you replace these joint compounds artificially the body will stop making its own. I save these joint protective supplements for older animals that really do need help supporting the body in its support of the joints. But adding in whole food support is recommended at any age like feeding trachea, real raw bone, and organs.

3. Weight Management: Maintaining a healthy weight is crucial for dogs with patellar luxation, as excess weight can put additional stress on the affected joint and exacerbate the pain. A raw dog food diet can help manage weight and reduce inflammation effectively.

4. Therapeutic Modalities: Including chiropractic care, controlled fitness exercises, massage, laser, PEMF, etc can be beneficial in improving muscle strength, joint flexibility, and overall mobility.

5. Environmental Adaptations: Making adjustments to the dog's living environment can help reduce pain and strain on the affected joint. Providing comfortable bedding and minimizing the need to navigate stairs or high jumps can be helpful.

6. Activity Management: Careful management of the dog's activity levels is essential. Avoiding excessive exercise and high-impact activities can prevent further irritation and pain in the affected knee joint.

7. Cold or Warm Compresses: Applying cold or warm compresses to the affected joint can help reduce inflammation and alleviate discomfort. Ideally, this means contrast therapy, heat the area first and then use ice/cold. Repeat. A few minutes at best for a dog Molly's size to 20 minutes each for a giant, furry dog. You will have to play with it with your animal.

8. Pain Monitoring: You are the CEO of your pets health, you are in charge of monitoring their pain level and if anything changes. Get your experienced pet provider team together and check in with them as needed to maintain your pet's awesome health status.

It's important to note that pain management alone may not be sufficient for severe cases of patellar luxation. In such cases, surgical intervention will be advised to correct the luxation and provide lasting relief from pain and discomfort. It is true, surgery will be advised by a conventional veterinarian and is the very last option you should consider from my point of view. I have not seen this surgery be very successful. In most cases, the additional trauma from surgery has caused more issues that then require all the options listed above, but let's take a look at what is involved in a luxating patella surgery.

Luxating patella surgery in dogs, also known as patellar luxation surgery, is a common orthopedic procedure performed to correct the misalignment of the kneecap (patella) in dogs with severe or persistent luxating patella.

The surgical procedure aims to stabilize the patella by realigning it within the groove of the femur (thigh bone) and deepening the groove if necessary. The surgery is typically performed under general anesthesia and involves the following steps:

1. Incision: The veterinarian makes an incision over the knee joint to access the patella and surrounding structures.

2. Evaluation: The surgeon assesses the degree of patellar luxation and any associated damage to the joint, such as cartilage wear or ligament abnormalities.

3. Realignment: The patella is carefully manipulated and repositioned within the femoral groove. In some cases, the groove is deepened to provide better stability for the kneecap.

4. Stabilization: To maintain the correct alignment, various techniques can be used, including the use of sutures, implants (screws), or a combination of both.

5. Repair of associated issues: If there are any additional joint problems, such as torn ligaments or damaged cartilage, they may be addressed during the surgery.

6. Closure: The incision is sutured closed, and the surgical site is bandaged.

After the surgery, the dog will need to undergo a period of post-operative recovery and rehabilitation, usually 8 weeks. This typically includes restricted activity, controlled exercise, and physical therapy to help regain strength and mobility in the affected leg. And don’t forget chiropractic care as soon as your dog is released to regular activity. Your dog’s nervous system needs the support after the trauma of surgery (any surgery).

Complications from luxating patella surgery are generally rare but can include infection, implant-related issues, or recurrent patellar luxation. I personally find, the complication of "recurrent patellar luxation" IS COMMON. I believe there is a time and place for everything, but this surgery is generally a hard no for my dogs. You have to do your own research, in person with practitioners, try some things and know your dog before jumping into any surgery, especially this one. Of course, the success of the surgery and the dog's overall prognosis depends on the severity of the condition, the surgeon and surgical technique used, and the dedication of the owner to follow post-operative care instructions.

It's essential to work closely with a qualified, experienced animal practitioner team, including a dog chiropractor, to determine the most practical treatment plan for a dog with a luxating patella and to ensure a successful outcome!

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