Patella luxation in dogs is most commonly to the medial (inside) of the knee. We have a grading system that helps us record how the patella is moving relative to the femur. It also helps us gauge improvement and decide if surgery is appropriate.
Grade 0- The patella is always in a normal position and does not ever move out of the correct position even when being manipulated. THIS IS NORMAL AND WHAT WE AIM FOR!
Grade 1- The patella generally sits in the correct place, but can be moved out of place. As soon as it is released the patella then moves back into the correct location.
Grade 2- The patella occasionally moves out of place. The animal must either move their leg a specific way or it must be put back in place for them.
Grade 3- The patella is usually out of position. It is possible to place it back in the groove however it pops back out when the dog moves.
Grade 4- The patella is never in position and it is not possible to replace it.
Our primary goal is to have your dog running, leaping and bounding confidently with their patella remaining in the correct place.
Managing the reflexes of the quadricep and hamstring groups balances the forces through the patella tendon. This reduces the abnormal tension across the direction of movement and reduces the likely hood of the patella being pulled out of its groove.
Minimising tightness in hip flexors through active stretching and massage often caused by your dog trying to prevent its patella luxating. This can cause significant additional pain and is counter productive to management of this problem.
Maintaining normal range of motion in the hip, stifle and hock is important to returning your dog back to full function.
Identifying the underlying pathology, appropriate grading of the luxation is vital to determining the appropriate treatment. Primal Paws can help you to identify the right solution for your dog.
Patella luxation is a sign of underlying biomechanics abnormalities. Just like you wouldn't treat a chicken pox rash the same way you would treat a rash caused by an allergic reaction you can't treat the different underlying causes of patella luxation the same way.
In many cases rehabilitation including manual therapies and therapeutic exercise will make a huge difference to your dogs grade of luxation. It is typically the first step to setting your dog up for success.
In cases where the structure of the knee is the underlying cause and driving the problem it is important to set up the muscles to allow the surgery to succeed. Tight quadriceps pulling against the recent surgery and delayed hamstring reflex can weaken the knee and potentate future problems.
Why does this disease process occur, can we prevent it?
A significant proportion of these cases are seen in young small breed dogs. It is often multifactorial with the crest of the tibia sitting in the incorrect location. Instead of sitting in the middle of the tibia it is sitting toward the inside of the tibia, anchoring the patella tendon in a location that will pull the patella out of the trough. The ridge is created by weight bearing on the rear leg. Small dogs do not have as much weight to push on the femur and cause the grove to form, they often also enjoy being picked up and carried!
With these little guys we are relying on genetics to control the location of the tibial crest. We can however encourage safe weight bearing activities to develop the groove.
Less commonly there can be traumatic incidents that damage the ligaments supporting the patella. These ligaments help hold and guide the patella, assisting in keeping it in alignment. We aim to protect these structures through physical conditioning and body awareness exercises that ensure your dog's reflexes to changes in the environment are fast and appropriate to the challenge.
Early intervention if a traumatic luxation does occur is important to give the tissues time to recover to avoid injury, similar to resting your ankle after you have sprained it. Pain management is also important to maintain normal range of motion and muscle activation to support the joint.
If you dog suffers from a locating patella, or you suspect they might be, get in touch for a chat about how we can help them.