Another Luxating Patella Topic..

[DogNerd]

Pippin has had a bad right knee since he was little, and we got it checked again at his yearly vaccinations.

The vet recommended surgery as she said it was freely popping in and out. She said there is two different types of surgery to try and fix it and that they'd be taking x rays first and sending them off to the specialist to see which one would be best for him.

Should I find out what specialist or get recommendations (please let me know if you know a good one) for a specialist or just trust who the vet sends the X-rays off to? I take it it's quite a common surgery?

[Rappie]

It's quite a common surgery to be done, and a triple technique is most often used but all the components may not be required in some dogs. The main purpose of radiographs is to determine whether there are a) degenerative changes in the joint and b)to determine whether there are anatomical abnormalities contributing (such as hip deformities or other conformation defects leading to patella luxation.

The triple technique consists of a tibial crest transposition (to move the patella more laterally), deepening of the trochlear groove (in which the patella should sit) and lateral imbrication of the fascia (to tighten the tissues on the lateral side of the joint). The tibial crest transposition is the most important part of the surgery as it directly affects the alignment of the extensor mechanism. Altering the trochlear groove is not always done - depends on the dog.

[minxy]

Where abouts in Qld are you, Dognerd?

[DogNerd]

It's quite a common surgery to be done, and a triple technique is most often used but all the components may not be required in some dogs. The main purpose of radiographs is to determine whether there are a) degenerative changes in the joint and b)to determine whether there are anatomical abnormalities contributing (such as hip deformities or other conformation defects leading to patella luxation.

The triple technique consists of a tibial crest transposition (to move the patella more laterally), deepening of the trochlear groove (in which the patella should sit) and lateral imbrication of the fascia (to tighten the tissues on the lateral side of the joint). The tibial crest transposition is the most important part of the surgery as it directly affects the alignment of the extensor mechanism. Altering the trochlear groove is not always done - depends on the dog.

Thankyou Rappie! That was very informative. The vet seemed to think that the groove one was the most common and one that they could do. I guess if he required the others he'd have to go elsewhere and if it's popping in and out freely it must be pretty bad

Where abouts in Qld are you, Dognerd?

Hey Minxy, Fraser Coast.

If I can find a specialist I think I may ask for his X-rays to be sent to them instead of who they would go with.

[minxy]

Ah bummer, miles away from here. I was going to suggest seeing the specialist we have been seeing with Kyojin's LPs (and who did the surgery on him). Usually deepening of the groove is the most common, but the specialist can't really be certain what they'll do until they can have a good look. We were expecting Kyojin's groove to be deepened, but when the surgeon operated on him decided the best thing to try would be to realign some ligaments to hold everything into place.

[Rappie]

The technique chosen really depends on the individual dog - the trochlear groove will be shallow in the higher grades of luxation (grade 3 and 4) because the proper development of the groove depends on the presence of the patella sitting in it. The reason that the patella doesn't sit in the groove in the first place is varied - may be due to improper angle of the tibial crest, or a low medial trochlear ridge etc etc. The radiographs can go some way to identifying contributing factors but the final decision is often made in surgery. Tibial crest transposition is a more 'benign' correction since it doesn't involve altering the joint surface. There are a few techniques use to deepen the groove - either making a wedge in the cartilage, or lifting the cartilage, removing a wedge, and then replacing it. Either way, the joint is still 'interfered' with.

Edited February 5, 2012 by Rappie

[DogNerd]

Ah bummer, miles away from here. I was going to suggest seeing the specialist we have been seeing with Kyojin's LPs (and who did the surgery on him). Usually deepening of the groove is the most common, but the specialist can't really be certain what they'll do until they can have a good look. We were expecting Kyojin's groove to be deepened, but when the surgeon operated on him decided the best thing to try would be to realign some ligaments to hold everything into place.

Thanks anyway Minxy :). I was thinking of finding out another specialist to get them to send the x-rays off to, I just have to find out who they work with first.

The technique chosen really depends on the individual dog - the trochlear groove will be shallow in the higher grades of luxation (grade 3 and 4) because the proper development of the groove depends on the presence of the patella sitting in it. The reason that the patella doesn't sit in the groove in the first place is varied - may be due to improper angle of the tibial crest, or a low medial trochlear ridge etc etc. The radiographs can go some way to identifying contributing factors but the final decision is often made in surgery. Tibial crest transposition is a more 'benign' correction since it doesn't involve altering the joint surface. There are a few techniques use to deepen the groove - either making a wedge in the cartilage, or lifting the cartilage, removing a wedge, and then replacing it. Either way, the joint is still 'interfered' with.

Thankyou for taking the time to explain it to me Rappie :).

[ness]

So as to not start another thread - my young BC has just been diagnosed by the specialist today as having a Grade 2 Medial Luxating Patella. He mentioned he didn't think her groove felt particularly shallow and that surgery is not urgent but it was strongly recommended. There seems to be conflicting information around as to whether surgery is needed with a grade 2 luxation and while I trust him (and the chiro vet who initially picked up on the problem) any surgery is not something you go into without researching first. There seems to be some literature evidence (and from speaking with a vet friend) that surgery is not something you would consider for anything other than a grade 3 or 4 luxation.

I guess I was a little in denial at the appointment and realize I can email him directly and ask anything I like but thought I might ask on here as well.

[Rappie]

Ness, there isn't necessarily a straight forward answer for you. By definition, in a grade 2 patella luxation the patella is usually in normal position, but can luxate when the limb is extended, then return to normal when the limb is flexed. If this happens only occasionally, then the limb is normal for most of the time and may not require surgery. If it is happening constantly, then it will cause a greater degree of wear on the medial trochlear ridge than higher grades and surgical correction is required to limit the damage done. Grade 3 and 4 are "worse" in terms of the degree of luxation, but in grade 3 the patella spends most of its time being dislocated, and in grade 4 it is always luxated and cannot be reduced. So, although the luxation is more significant, there is less wear and bone-bone contact occurring.

[minxy]

So as to not start another thread - my young BC has just been diagnosed by the specialist today as having a Grade 2 Medial Luxating Patella. He mentioned he didn't think her groove felt particularly shallow and that surgery is not urgent but it was strongly recommended. There seems to be conflicting information around as to whether surgery is needed with a grade 2 luxation and while I trust him (and the chiro vet who initially picked up on the problem) any surgery is not something you go into without researching first. There seems to be some literature evidence (and from speaking with a vet friend) that surgery is not something you would consider for anything other than a grade 3 or 4 luxation.

I guess I was a little in denial at the appointment and realize I can email him directly and ask anything I like but thought I might ask on here as well.

Kyojin was operated on with Grade 1. I still can't understand how it was only classed as a grade 1, when by definition it was far worse than that. It was definitely not something he could live with and meant that without surgery he was only allowed to walk for 15 minutes at a time, no playing with other dogs etc. (His knees would pop out just walking around normally and we could no longer pop them back. Sometimes they would both pop out and he'd fall over). He would grind his teeth in pain. So for us it was pretty important that we did something about it.

[ness]

Thanks looks like my zillion and one questions email to the specialist will be going after all. Kenz is not to bothered by it and is currently on rehab for a shoulder injury anyway.

I should say the specialist was happy enough for continue as we are with regard to her shoulder. She is on progressively increasing leash walks and confinement anyway with some swimming to vary things so I guess we aren't subjecting the knee to anything that is going to cause any additional problems at present.

I was wanting to give her some sort of normal life back after having been already confined for months on end and wasn't sure I could put her in a crate for 6-8 weeks right at this stage.

Edited February 8, 2012 by ness