My Dog is Diagnosed with Medial Luxating Patella (“Trick Knee”)…Now What?
If you’re like me, you wouldn’t be researching this title unless your little buddy has a limp…or worse.
Their sensitivity could be subtle but persistent, or maybe it’s gotten to the point where your best friend won’t even touch their paw on the ground.
And when you took them to a vet, the good doctor probably told you that the reason is Medial Luxating Patella. I’ll bet like me, you had an overwhelming flood of images and emotions.
(Koda being yellow)
The revelation was HEAVY, right?
Been there, done that!
Help! Get me outta this! Right?
Been there too.
This is my amigo, Koda. At three years old, he was diagnosed with MLP.
My wife and I noticed that he occasionally limped on his right back leg for a dozen or so steps after getting up. He didn’t do it often at first, and the limp wasn’t severe.
We were concerned but not alarmed. I thought it was possibly due to growing pains or maybe he had been laying on it funny which caused his leg to be numb.
I was wrong. The limp got more frequent and more pronounced. It was time to get a professional inspection.
My regular veterinarian performed the initial examination. The diagnosis was old news to him after his many years of service.
He told me that this is something that could happen to anyone’s dog for a couple of different reasons, genetics or trauma.
Genetics is the usual cause of MLP. At about ten months of age, a dog’s bone density is considered mature.
After that, it would take a considerable impact to dislodge the patella (kneecap) from its track.
The vet explained to me that young dogs can be more susceptible to this injury. They sometimes get running around all “squirrelly”, then do something goofy like take a wrong twist or jump in the air and land funny.
Their bones are too immature and weak to cope with certain stresses. The over-exertion can sometimes cause damage to the ligaments.
I do recall hollering at Koda a few times, “Hey Dirtbag, knock it off! You’re gonna hurt yourself!” after watching him spaz out (trying to run in six directions at once as fast as possible).
If you’ve ever seen a puppy in action…you know what I’m talking about!
Small dogs are always susceptible to this injury. Their bones aren’t as thick as bigger dogs and can snap from the force of just jumping on the couch.
I learned that they can produce up to 700 percent of their body weight with thrust. That’s WILD!
So here I am. My dog’s been diagnosed with something or other, and I can sense that this is significant serious news. My reaction…
First of all, keep your scalpels far away from my child’s furry yellow leg, and second, I don’t recall adding an expensive surgery to my budgeting plans.
(Baby Koda)
It was a gut punch.
Thanks a lot, fate!
So now what’s a person to do?
Research, investigate, and get educated. That’s why you’ve stumbled across this article right?
It’s what I did to get a clearer picture of what lay ahead. Here’s hoping what I found helps you too.
Top 27 Questions for a Pet Owner’s MLP Problem
1. What is Medial Luxating Patella (MLP)?
2. What does this mean for my four-legged child?
5. What are the best preventions?
6. Are there alternatives to surgery?
DIAGNOSIS
SURGERY
10. What are they doing inside the knee to fix it?
11. What are the most common complications?
12. Will my dog need surgery again?
13. How strong will the leg be after surgery?
14. How will his knee be long-term
16. Does waiting for surgery cause more damage?
AFTERCARE
18. Will my dog need a lift harness/sling to assist with walking during rehab?
20. What other kinds of post-opo rehab and care will my dog need?
EXERCISE:
22. How soon can my dog play with other dogs?
23. How long do I need to keep my dog on a leash?
24. What’s the best type of exercise?
NUTRITION:
25. How do weight and diet affect recovery?
(Dream time Image) (Please note: this article was done on spec and all images can be replaced.)
1. What is Medial Luxating Patella (MLP)?
What this means in English is, middle, dislocating, kneecap. Medical Professionals use “middle” because that is the direction the kneecap and tendons slide toward. The middle of the dog.
If it was a “lateral” luxating patella, the kneecap and tendons would slide to the outside (Medial is much more common.) Luxating is a medical verb meaning the dislocation of an anatomical part.
And kneecap is kneecap what else can I say? I’m sure you’ve heard of them.
MLP grading system?
Grade I: The kneecap can be manipulated out of its groove but returns to the normal position on its own.
Grade II: The kneecap slides out of its groove occasionally but can be placed back in the groove manually.
Grade III: The kneecap rides mostly out of the groove and doesn’t stay in the groove after manual placement.
Grade IV: The kneecap stays out of its groove continuously and cannot be properly repositioned.
(Dreamtime image)
2. What does this mean for my four-legged child?
Koda was restricted to leash walks before the surgery to prevent any further damage. He will end up staying overnight at the animal hospital on the day of surgery.
He will wear a “cone of shame” or an Elizabethan collar for a couple of weeks after surgery to prevent him from licking the incision.
When unattended, he will be in a confined space like a large kennel to keep him as inactive as possible for the first few weeks after surgery.
I will need to monitor his wound for infection or tearing of stitches.
I’ll also have to give him pain and anti-inflammatory medicine, ice packs, moist heat, and massages. When he’s ready there’ll be rehab exercises to rebuild muscle in the whole body as well as the damaged limb.
Someone will need to assist him with his bladder and bowel movements. Using a manufactured or homemade sling will help him walk. It could take several weeks before he’s ready to put his full weight on the repaired knee joint.
3. What’s my time Investment?
I’m sure you’ve gathered from the last paragraph that “potty time” alone is going to be a substantial investment.
It’s probably the activity that will consume the most time for the first while. In the beginning, relieving himself is going to be physically painful and mentally awkward. Remember, dogs can’t really be rushed into doing their “business” …who can?
Physical therapy and rehabbing will be a close second to “potty” breaks. Cold/heat packs, massages, and exercise are necessary to return Koda to full strength.
Temperature packs: 5-10 minutes 3-4 times/day
Muscle rubs: 10 minutes 3-4 times/day
Walks: 5-20 minutes 3-4 times/day.
(There are lots of other exercises that are great for strengthening muscles besides walking. They’ll still take time though.)
It all adds up.
Tending to my furry patient with basic nursing duties like administering meds, setting up bedding, and checking in to make sure everything’s ok is time-consuming too. Just ask a nurse.
There are also a handful of vet visits that will add up to a bit of time.
4. How much will this cost me?
I’m going to point out the obvious here: There are many factors wrapped up in this answer, including region and economic climate.
The higher the material and labor cost, the more of it will be passed on to you. The more elite the clinic…, you know the rest of this sentence.
Money for fancy new machines at state-of-the-art facilities needs to come from somewhere.
The surgeon’s education and credentials play their part in this too.
This is a specialized operation service that your regular vet might not offer at their clinic. There’s a good chance you’ll be referred to a surgical hospital.
I was told by one vet that these surgeons would find this procedure almost boring and routine because they do it every day.
Search your area to find the right fit for you and your pooch. Many clinics can provide a payment plan or advise you on where to get help if you find yourself in a financial pickle.
The answer is $1,000-5,000. This doesn’t necessarily cover consultation, x-rays, post-care, or medication costs, but it might.
5. What are the best preventions?
The most common answer is not to breed this lineage of dog. Genetics far outweigh trauma for the cause of this condition.
Certain breeds of dogs are more susceptible to MLP. You can find multiple lists of which breeds are affected by searching online or asking your veterinarian.
I’ve seen golden retrievers second on more than one list of large dogs that are susceptible to MLP. However, these lists don’t account for the popularity of the breed.
Goldens are one of the most common dogs for family pets, so the number of golden retrievers who end up with MLP is naturally high compared to less popular breeds.
The size makes a statistical difference, too. Surprisingly, smaller dogs are more prone to contracting MLP.
Reducing the amount of weight on all their joints is probably the highest on the list of prevention needs and just like us, 80% of it starts in the kitchen. Killing them with kindness totally applies here. I’m guilty too!
Especially when they stare at you with their soul as if you are completely despicable for not sharing.
Vitamins, minerals, and other supplements keep the fluids, tendons, and ligaments around the knee healthy.
(Everything looks YUMMY to your dog)
Strong muscles around joints help to bear the strain of use. You can check with your vet to see what exercises would help your dog build and strengthen their muscles and joints.
Keep in mind that the species has evolved as scavengers. This means they are designed to trot-stop, trot-stop, trot-stop endlessly, but constant hard-core and/or long-distance running can do more damage than good.
6. Are there alternatives to surgery?
If your dog has a Grade III or IV MPL they will need surgery. If they have a Grade II level, surgery is most likely on its way, if not already due. At Grade I, there is hope that through diet, exercise, and supplements, you can avoid the procedure.
So being diligent in your efforts will help but brace yourself for the possibility of surgery.
7. What causes MLP?
MLP is most often caused by genetics, but an injury can create an MLP. Dogs are active and energetic, and they can hurt themselves. They are most susceptible at a young age.
8. How common is it?
There is limited research on this, but it is estimated that about 1.5 percent of all dogs have a “luxating patella”.
Diagnosis
9. How is MLP diagnosed?
You are the first step in figuring out why your canine companion is limping. Deciding to take them to a professional is an important part of maintaining their health.
A veterinarian will start with a physical examination where they manipulate/move joints in the leg using their experienced hands.
This helps them determine which joint is causing the limp and why it’s painful. They will probably want to take x-rays to have a better look at the problem.
Your next stop might be a specialized surgery hospital where a surgeon will want more x-rays and do the touchy-feely thing again to get their own sense of the problem.
Surgery
10. What are they doing inside the knee to fix it?
Depending on the extent of repairs required, your surgeon may be doing a collection of operating procedures. Here are a few regular terms and approaches they could take:
(Model of a dog’s knee with a good view of the Trochlear groove.)
Trochleoplasty: The wall of the trochlear groove is either heightened or the groove itself is deepened. This is done by adding or subtracting bone and/or cartilage.
Trochlear recession: Approximately 1-2 mm of bone beneath the cartilage in the knee joint is removed to allow the “patella” assembly to drop into the newly created space.
This method protects the smooth cartilage surfaces from damage while making a deeper trough in the trochlear groove.
Medial tibial tuberosity: Tuberosities are raised bones that muscles or tendons are naturally anchored to. The tibial bone helps create the kneecap/tendons/quadriceps lever.
(Dreamtime image) (Image is replaceable)
Tibial tuberosity transposition/transfer (TTT): To help realign the function of the “patella” (kneecap), the small bone that the tendon is naturally attached to on the front of the shin is relocated laterally to a better spot.
This is done with anchors or screws which help stabilize the assembly in its proper channel so the bones can grow back together.
External Femoral Torsion: A genetic condition where one or both knees face more outward. This can be caused by a slightly twisted femur (thigh bone).
The improper alignment pulls the patella, tendons, and muscle mechanics out of a straight line.
This is a big contributor to MLP because the assembly wants to take the shortest route possible like a stretched rubber band. This can make the patella pop out of the trochlear groove.
(Koda’s x-ray right after surgery)
Distal femoral varus: This is when the tibia (large shin bone) is turned inward. The misalignment to the femur causes the knee to turn outward.
Osteotomy: Osteotomies are “bone cutting” procedures that can be done to many parts of a skeletal frame.
Some examples of these are the jaw, shoulder, spine, hips, knees, and feet. Surgeons will sometimes need to realign or reshape the bone’s structure to improve function.
Distal femoral corrective osteotomy: This bone operation involves cutting the distal (furthest from the body’s center) part of the femur and securing it in proper alignment.
Bone reformation is a common practice with an extremely high success rate!
The groove under the kneecap is a lever point for the tendons and muscles to pull from. When the tendons and kneecap are not in their proper place, there’s nothing to hinge off of, so the leg can’t extend.
Another problem with the kneecap sliding in and out of its spot is wearing down the groove's sidewall. Eventually, there is little to nothing holding the kneecap in place.
My regular vet told me that some dogs, especially retrievers would still chase a rabbit down a hole even if they had two broken legs.
11. What are the most common complications?
There are two:
Reluxation (the kneecap slips out again)
Implant problems (the implant becomes loose or breaks)
There seem to be no conclusive studies on complication rates. Most surveys are based on a small test group and a limited number of clinics studied for each article.
Also, there are other factors that aren’t specifically discussed in most surveys. Healthy body weight, size of the dog, and grade of MLP aren’t addressed.
What has been noted is that the more advanced the facility, the higher the success rate, which in turn lowers the chance of complications.
12. Will my dog need surgery again?
The statistical information available suggests there is about a 5 percent chance the initial operation will need to be revisited.
13. How strong will the leg be after surgery?
Two main factors will determine the height of recovery.
The first is the Grade of patella luxation. A dog at level I should have a better recovery than one at level IV.
The other factor is how soon the operation is performed before the onset of arthritis.
Many surgeries result in a full recovery. Most reach at least a 90-95 percent return to normal.
14. How will his knee be long-term?
Having good long-term health is greatly impacted by owner care.
One important key to knee joint health as the dog ages is how much arthritis has developed pre-surgery.
Supplement, mineral, and vitamin consumption pre- and post-operation for the duration of the animal’s life have big implications, too.
Physical inputs like exercise, massage, and “passive range of motion” (PROM) during the healing process are instrumental to better life-long function in the dog’s leg.
Your dog can have an enjoyable, normal life.
15. What’s the success rate?
As I mentioned before, the data is inconclusive due to the limited accuracy of the research. The consensus is that MLP surgery has about a 95 percent success rate.
Variables include the grade of MLP, the dog’s overall health, and post-care.
16. Does waiting for surgery cause more damage?
The longer surgery is postponed the greater the chance for the development or growth of arthritis.
The healthy legs will become more susceptible to injury due to fatigue compensating for the weakened team member.
17. What about the other leg?
The longer the healthy leg carries the bulk of the workload, the greater the chance of damage.
The healthy leg should get proper attention like supplements, general or targeted exercise, massage while there’s a weight distribution imbalance, and a good diet to decrease its chances of needing surgery.
Koda’s MLP leg is genetically bowed out, but his good leg grew straight and shouldn’t be a problem.
(The day after surgery)
Aftercare
Koda’s first day home from surgery was fairly quiet because the sedation medicine hadn’t worn off yet. It was mostly sleepy time.
It was also challenging getting him to pee or poop when he was in pain and groggy. The surgeon told me this is all typical in the first twenty-four hours. Something else to expect is a shaved, red, and swollen leg with a long incision.
(2 days after surgery)
Once the ice pack treatments bring the swelling down, it is expected that gravity will pull the baggy skin down to the hock (ankle area) making it much larger than normal.
Cold packs or moist heat and massage help shrink the loose skin back to normal. The surgeon told me the redness should subside with the swelling eventually. I was to contact him within a few days if it didn’t.
(3 days after surgery)
Vets usually prefer the incision be left alone. They say creams and ointments keep it from drying out and scabbing over.
Surprisingly most dogs are in good spirits when they arrive home.
They’re just so happy to be back to their normal environment that they don’t seem to care too much about their leg.
Some dogs are able to put weight on the repaired leg shortly after surgery, but some aren’t.
Either way, they’re going to need assistance holding themselves up to avoid accidents for the following few weeks.
18. Will my dog need a lift harness or sling to assist with walking during rehab?
You can purchase lift harnesses or lifting slings online for about $25-55. There are a few in the hundreds of dollars. Many clinics sell them, as well.
Or you can make your own out of a towel or cloth grocery bag by cutting the ends out or just use a towel. It will be needed to help your hairy patient go “number one and number two”, at the very least.
19. Will we need a leg brace?
Braces are often intended to be an alternative to surgery. Many reports suggest they can be effective for lower Grade MLP.
There are two main kinds of braces: soft and rigid. The rigid ones are significantly more expensive. You can find them online in the $200-300 range. The soft ones will cost $100.
Some theories suggest that they don’t help at all. If the patella is out of its groove, it can’t leverage the leg to extend, with or without a brace.
20. What other kinds of post-op rehab and care will my dog need?
(10 days after surgery)
Before bringing your little buddy home from surgery, you’re going to want a confined space set up for when nobody can tend to them.
They could be spending a big chunk of the next few weeks in a kennel or box.
Limiting their ability to move around too much is crucial to a proper, speedy recovery.
Here are some other items you may want to consider purchasing when getting prepared for nursing duties:
(14 days after surgery)
A sling to help your dog get around, especially for potty time.
The “Cone of shame” to keep them from licking their wound.
Rubber-backed rugs or yoga mats on slippery floors to decrease the chance of injury.
Cold/ice packs to apply 3-4 times a day to reduce swelling, soothe pain, and help speed up recovery time for a couple of weeks (check with your vet to see what is appropriate for your situation).
Moist heat starts about a week after surgery to help increase blood flow. A warm cloth with a hot water bottle worked well for us. (Check with your vet to see what is appropriate for your situation).
And you will need to make time in your schedule for the following during the recovery period.
(22 days after surgery)
Daily massaging for your pup for at least a few weeks after surgery to help benefit physical/mental stress. Massage increases blood flow. (It’s good bonding time, too.) (Check with your vet to see what is appropriate for your situation).
Gentle stretches and moving the limb around can help avoid too much stiffening up (check with your vet to see what is appropriate for your situation).
Controlled exercises that progress week by week will help get Rover back to full strength on all fours as soon as possible (check with your vet to see what is appropriate for your situation).
Scheduled check-ups will ensure there are no setbacks in the recovery.
Expect your dog to hit weekly milestones.
21. How long is recovery?
Some reports state that the recovery will take 6-8 weeks, but most say 8-12 weeks. Keep in mind that everyone heals at a different rate.
Recovering all the muscle lost due to limited use will likely take 6-9 months.
EXERCISE
22. How soon can my dog play with other dogs?
You will probably be waiting for about 10-12 weeks before letting them horse around with their buddies. To be safe, it’s probably best to wait for your vet to give you the go-ahead.
23. How long do I have to keep my dog on a leash?
Part of the rehab journey is monitored off-leash exercise, but that doesn't start until about week ten depending on healing progression. Jumping and playing around is still considered a no-no before this point.
24. What’s the best type of exercise?
There are a lot of different exercises that can help your dog regain strength. Walking is a simple but effective way to get them back to normal.
You can do some really good muscle training indoors too.
Stair climbing (when ready), sitting to standing, and figure 8’s can all be done indoors, and are very good for your dog.
NUTRITION
25. How do weight and diet affect recovery?
As much as we all want to ease the distress of our recovering pups, giving them unhealthy food or too many treats will add weight and extra strain on the injured and healthy knee joints.
26. What minerals, supplements, and vitamins will help?
Vitamins C, E, B1, and B6 help collagen growth and cartilage repair and have strong antioxidant abilities.
Glucosamine and chondroitin are structural parts of cartilage and can slow or stop joint degradation.
Omega 3 fatty acids are anti-inflammatory and can reduce swelling, relieve pain, and improve overall joint mobility.
Hyaluronic acid is a lubricant that cushions and hydrates joints. It aids in tissue repair as well.
Selenium helps regenerate cartilaginous tissue for overall stronger joints.
Tumeric combats arthritis, inflammation, inflexibility, swelling, and pain.
Manganese helps form connective tissue and bones and has blood clotting factors. It is also necessary for brain and nerve function.
Zinc aids in creating DNA, growing cells, building protein, healing tissue, and promoting a healthy immune system.
(Guess what? …Check with your vet for recommendations tailor-made for your dog’s needs.)
(Koda will do anything for treats!)
27. What treats are good?
This list of options is all good, but moderation is key. Bananas for example are high in sugar, and seeds or rinds are NOT good for your pet.
There are many good, manufactured dog treats, so ask your veterinarian what they recommend and do some research too.
Here are a few goodies they can eat that you might not have heard of before:
· Apples
· Bananas
· Blueberries
· Broccoli: Koda will eat anything offered to him, but I’ve never seen him swallow broccoli. I have seen him carry a piece outside once the shocked look on his face wore off though …what happened after that, who knows?
· Carrots: About the only fruit or vegetable Ember (our other dog) will eat…but only if Koda has one first.
· Green beans
· Green peas
· Cooked squash
· Strawberries
· Cooked sweet potatoes: Any kind of potato needs to be cooked, never raw for your dog.
· Watermelon: No seeds or rinds.
(No grapes or raisins)
Whew! I’m exhausted. Sorry for making this so long, but there was a boatload of helpful information I found for you, me, your patient, and mine.
At three months post-surgery, Koda has moments when you don’t even notice a limp. He’s usually stiff after he’s been inactive for an hour or more or has been to the dog park to run free though. (He travels approximately four times as far as I do on those walks).
When he looks like he’s getting too tired or stiff, we ease up on the exercise to give him a break. We don’t really push his exercise too hard, but he does get a solid amount of strength training.
He still gets massages, but not every day anymore.
There you go. I hope this sheds the light you need to move forward more confidently!
(Koda is back to his favorite spot!)
GOOD LUCK!!
(It’s not as daunting as it might sound.)
