Goals of Treating Patellar Luxation
The goals of treating dogs with luxating patellas are to relieve pain and to improve function of the knee joint by physically realigning the pertinent bones and stabilizing the patella in its proper anatomical position. When an owner notices her dog limping, reluctant to rise or showing other signs of hind limb discomfort, she should contact her dog’s veterinarian for a thorough assessment of its condition. There are a number of treatment options if patellar luxation turns out to be the problem.
Non-surgical medical management typically includes administration of nonsteroidal anti-inflammatory drugs (NSAIDs) to minimize pain and reduce inflammation, together with particular physical rehabilitation exercises to strengthen the quadriceps muscles. Weight control is quite important in affected animals to reduce undue stress on the stifle (knee) joint. Other techniques that may or may not be appropriate in addition to medical treatment might include massage therapy to stimulate healing and reduce overall stress, hydrotherapy (swimming and other water exercises), possible application of acupressure techniques and other forms of follow-up supportive care which may help to ease pain, increase circulation, speed healing and otherwise promote wellness and comfort.
Surgical treatment options are also available. These include reconstruction of the soft tissue surrounding the stifle to provide proper support for the patella. There also are a number of surgical techniques to deepen the groove in the femur bone within which the patella normally nestles. Cryotherapy (ice packing) is usually done following surgery, with passive stifle range-of-motion exercises as soon as they can be tolerated. The veterinarian or skilled technician typically shows the owner how to perform these exercises safely.
A common complication of luxating patellas is the development of degenerative joint disease, also called osteoarthritis, in affected stifles. A number of chondroprotective supplements are available, both over the counter and by prescription, to help sooth the signs of arthritis and the pain associated with degenerative joint disorders. These supplements presently include polysulfated glycosaminoglycans, glucosamine, chondroitin sulfate and hyaluronan, among others. Weight control and moderate but regular exercise are also valuable.
In most cases, dogs with luxating patellas have a good prognosis. It is important for owners of dogs with this condition to discuss the possible risks and benefits of NSAIDs and all other forms of medical and supportive therapy with their veterinarian. Some side effects can include gastrointestinal, liver, kidney or other adverse reactions, and more severe and even permanent musculoskeletal damage can occur depending upon the therapy protocol used. There also is an increased risk of recurrence following corrective surgery, so the healing and recovery process should be carefully managed. Generally, however, the prognosis is good to excellent for return to normal or almost-normal hind limb function in mild to moderate cases that are treated surgically with appropriate follow-up care. Unfortunately, as mentioned above, degenerative joint disease usually continues despite treatment, and dogs with luxating patellas tend to be at greater risk of developing cranial cruciate ligament disease down the road.