Treatment – College of Veterinary Medicine

Treatment of patellar luxation depends on the severity of the condition and a dog’s individual clinical signs. 

Most mild cases without clinical signs do not require any treatment. Conservative medical management for dogs with intermittent or infrequent lameness, or for those who have developed arthritis secondary to patellar luxation, treatment may include the following: 

• Maintaining an ideal weight
• Joint supplements
• Pain medications (e.g., nonsteroidal anti-inflammatories or NSAIDs)
• Exercise restriction
• Physical rehabilitation

Your veterinarian may recommend surgery if your dog has more advanced patellar luxation or persistent lameness.

• If you choose to move forward with an operation, there are a few different surgical approaches, and your veterinarian will help determine which is best for your dog.

Treatment Options For Luxating Patella in Dogs – AKC

A luxating patella is something that needs veterinary attention. “Although the displacement may be intermittent, a luxating patella in dogs is not going to improve on its own,” says Dr. Klein.

• “In some cases, especially in Grade I conditions, the dog may be able to tolerate the condition if exercise is restricted, and anti-inflammatory medications help.
  • But as those dogs age, they’re likely to develop arthritis in the knee joint, which will decrease mobility and increase pain.”
• A dog with a luxating patella is also predisposed to suffer other knee and leg injuries, like torn cruciate ligaments and degenerative joint disease in the hip.
• “Depending on the grade or severity of the luxation, the surgeon may give you various options, from waiting to see if the luxation worsens to performing surgery sooner rather than later,” says Dr. Klein.
• “Over time, and if the luxation worsens, the kneecap will slip more out of its groove, eroding cartilage and eventually leading to an arthritic joint that causes significant pain.
• Surrounding structures can also become strained as their use increases to properly stabilize a joint.”

Conservative Management – TVP

Nonsurgical management is typically elected for patients with grade I PL and subclinical cases (asymptomatic grade II). All cases that are to be conservatively managed require thorough client education and an active surveillance plan.

Recommendations for conservative management are as follows:

• Provide pain management, if indicated, such as nonsteroidal anti-inflammatory drugs with or without neuropathic pain medications (e.g., gabapentin, amantadine given preemptively to avoid windup).
• Achieve and maintain a lean body weight.
• Develop a lifestyle of regular but moderate activity.
• Provide physical therapy to strengthen the quadriceps muscle and lateral thigh musculature. Targeted strengthening exercises can include sit-to-stand exercises, step ups, hill walking, physio ball core stability, and swimming/underwater treadmill.

The PL grade (i.e., severity) is a single snapshot in time for each patient.

• For example, a patient with grade II medial PL may be asymptomatic at a visit, but as the patella luxates medially, it can wear down the medial trochlear ridge, which can lead to cartilage loss and clinical signs.
• As the luxation continues, the same patient can exhibit a grade III medial PL, conformational changes, and more advanced soft tissue alterations months to years later.
• Intervention for that patient as soon as clinical signs develop and before more advanced changes develop is preferred. Thus, serial evaluations and client education, which allow for prompt surgical intervention when indicated, are recommended.
• The timeline for when to reevaluate patients should be decided on a case-by-case basis.

A rough outline of the author’s recheck preferences for nonsurgical PL cases is as follows:

• Incidental grade I : Educate clients on signs of lameness that may develop and encourage them to take videos for evaluation by the veterinary team.
  • After the patient’s first diagnosis, schedule a recheck visit in 6 months, or sooner if clinical signs develop.
  • If static in 6 months, then recheck at annual wellness examinations, documenting PL grade, direction, and feel (smooth or crepitant).
• Occult grade II : Educate clients and recheck the patient in 3 to 6 months, or sooner if signs of lameness develop.
  • If clinical signs are static after 6 months, then recheck at annual wellness examinations, documenting PL grade, direction, and feel (smooth or crepitant).