Patella dislocation – when the kneecap gets stuck

This condition of the knee joint, in which the kneecap (patella) pops out of its natural position to the side, is one of the most common causes of lameness in dogs. This dislocation occurs mainly in growing and older dogs of small breeds. Several of these breeds have a particular genetic predisposition to patella luxation.

INHALT
Causes and development Symptoms Diagnosis Treatment Forecast Prophylaxis
Causes and development

In most cases, a slight misalignment of the upper and lower leg bones or a groove that is too shallow is the cause of a dislocated kneecap. In very rare cases, accidents can also lead to patellar dislocation.

To better understand the condition, it is important to know where the kneecap is normally located and what its function is. A long tendon, known as the patellar ligament or patellar tendon, runs from the front of the thigh bone, across the knee joint, to the upper end of the lower leg bone. The kneecap is a small flat bone that is embedded in this ligament in a groove in the thigh bone and, as part of the knee joint, is involved in the smooth bending and straightening of the knee.

If there is a deviation in the bone axis between the upper and lower leg, the straight patellar ligament no longer runs centrally across the knee joint, allowing the kneecap to slip either inward or outward out of its intended groove. In most cases, the kneecap slips inward. The joint can no longer be straightened properly and the natural movement is disrupted. Depending on the severity of the misalignment and the surrounding muscle tension, the kneecap may shift either occasionally or permanently.

If the condition persists for a long time and the kneecap jumps back and forth frequently, the surrounding soft tissue structures and the knee joint can be damaged. If left untreated, osteoarthritis can develop as a result of the incorrect loading.

Schematic diagram of patellar luxation in dogs
1 Tendon of the quadriceps muscle | 2 Patella | 3 Medial collateral ligament | 4 Patellar tendon | 5 Anterior (red) and posterior (blue) cruciate ligaments | 6 Femur | 7 Patellar groove | 8 Lateral femoropatellar retinaculum | 9 Lateral collateral ligament | 10 Shinbone (left) and fibula (right)
Symptoms

Patella luxation usually manifests itself in a very typical form of lameness. Affected dogs suddenly stop putting weight on the affected leg for a few steps, even though their gait appears otherwise normal, and then bend it sharply before continuing to walk normally. If the kneecap is permanently displaced, the dog will show signs of significant pain and persistent lameness in the affected leg.

Diagnosis

If you suspect that your dog is suffering from patella luxation, you should have it examined by a veterinarian as soon as possible. Your veterinarian will first examine the affected knee joint as part of a general examination and then check the mobility of the kneecap using specific tests. If necessary, they will then take X-rays to determine the severity of the dislocation and any joint damage.

  • Grade 1: The kneecap can be pushed out of the groove manually, but springs back on its own; otherwise, the knee joint shows no changes
  • Grade 2: The kneecap occasionally jumps out of its groove but slides back on its own or by straightening the leg
  • Grade 3: The kneecap is frequently displaced and cannot be moved back by stretching. It can be pushed back manually, but quickly pops out again
  • Grade 4: The kneecap is permanently displaced and cannot be put back into place by hand

Treatment

Milder forms of patella luxation can usually be treated successfully with splints or bandages. Physiotherapy and special dietary supplements can be used to strengthen the surrounding connective tissue and muscles. Your veterinarian will be happy to advise you on the right product.

In severe cases of constant or permanent patella luxation with sometimes considerable pain, surgery may be necessary to stabilize the patella in its original position and prevent the development or progression of osteoarthritis of the knee joint. Depending on the severity of the misalignment and dislocation, your veterinarian has a variety of surgical techniques to choose from. During these procedures, the groove can be deepened, the attachment point of the patellar ligament can be moved, and the soft tissue structures can be tightened, among other things. Since every general anesthetic and surgery carries certain risks, your veterinarian will weigh up the pros and cons in each individual case and advise you in detail on whether surgery is advisable.

Forecast

The prognosis depends on the severity of the patella luxation and the size of the dog. Small dogs generally have a better prognosis than large dogs due to their lower weight. With appropriate treatment, dogs with grade 1 to 3 luxations have a good chance of becoming symptom-free. Dogs with permanent patella luxation have a slightly poorer prognosis. Early treatment is crucial here to prevent secondary damage.

Prophylaxis

Since it is largely a hereditary condition, patella luxation cannot be directly prevented. However, many breeding associations for endangered breeds already require a certified examination for patella luxation before breeding approval is granted. In this way, they are helping to reduce the spread of the disease.