How to Fix a Dog’s Luxating Patella (Bad Knee) Without Surgery
Here are some of the signs your dog has a luxating patella and how you can treat his bad knee.
What Is a Luxating Patella (Trick Knee)?
A "trick knee" in your dog is caused by an inherited deformity in the bones that allow the kneecap to move from side to side (a luxating patella). Patellas (kneecaps) can luxate (move out of place) towards the dog's body (medially) or away (laterally).
The kneecap normally rides in a groove in the femur and works so well that most owners do not even realize that it is there. However, a trick knee does show up occasionally. It's often inherited in small dogs and sometimes develops in larger breeds that have hip dysplasia.
Trick Knees Should Be Taken Seriously
Some dog owners will also say that their dog has a “trick knee” after a cruciate ligament tear, but ruptured ligaments are actually a lot more serious and have to be treated quite differently. If not treated properly, they may even require surgery.
Your new puppy may have been diagnosed with a trick knee during his first visit to the vet. You may have just noticed your puppy running on one back leg or running with both back legs together (bunny hopping). This is more common in some breeds, but it can happen in any size dog (and at any age).
Let's explore some luxating patella treatments without surgery.
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Will My Dog Need Surgery?
When this problem is first noticed and diagnosed, the vet will probably recommend strict confinement. She might try NSAIDs like Rimadyl or aspirin, and may even want to put your dog on a course of steroids. Sometimes these things will work.
Trick knees might respond to confinement or might get worse if not surgically repaired. There are four grades of luxations, however, and not all require surgery.
Four Grades of Luxations
- Grade I: Dogs are not in pain. When the knee moves out of place, it can be massaged back to where it belongs. Since dogs carry most of their weight on their front legs, this dog will probably never need surgery if the problem is taken care of right away.
- Grade II: Dogs have a few more problems with the affected knee. It can still be massaged back, but it usually moves out of place again as soon as the dog starts walking around. A dog with this grade is usually not in pain, but they may develop arthritis and pain in the knee and will sometimes need surgery.
- Grade III: Dogs with this level of luxation are usually already arthritic and in pain by the time they are seen. The knee is out of the groove more than in it.
- Grade IV: Dogs no longer have a groove and the kneecap cannot be put back into place. If this has been going on for a long time, the dog is arthritic and in pain. A dog like this always needs surgery.
Surgical repair of trick knees differs based on how the dog is built, how many changes have already occurred, and what the surgeon will think is going to work. Sometimes, a dog can get by with having the kneecap ligaments strengthened with non-absorbable suture, some will need a deeper groove cut for the kneecap to move in, and some even need surgical changes to the bone where the kneecap attaches. When the bone has changed, a specialist may need to do the surgery and the dog will have less of a chance of recovering.
There are several nutritional, non-surgical alternatives. A non-surgical method is never going to change the anatomy of your dog's leg. You can choose to accept alternative theories or not, but of course, by delaying surgery, the chances of recovery after surgery are lessened.
What a nutritional alternative can do is improve the dog's health and the quality of the joint so that secondary changes are reduced. This is an important issue with knee conditions and a reason that so many dogs develop arthritis in their knees as they become older.
If a luxating patella is ignored, the dog will develop arthritis.
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How Can a Trick Knee Be Fixed Without Surgery?
If your dog's trick knee is very mild, your vet can show you how to pop the knee back into place during his exam. It is easy to do if your dog is calm and not in pain. All you have to do to put the knee back in place is to straighten out the leg, massage gently and move the knee as you are massaging. I find that it helps a lot to talk to the dog and distract him so that he will be even more calm as you are doing this.
For more permanent results, however, you need to consider all of the following alternatives:
- Put your dog on a severe diet so that he is not overweight, and definitely not obese: Besides living a shorter life, obesity will cause extra stress on all of his joints. Overweight dogs with trick knees will have more problems walking, and the arthritic changes to the knee will happen that much faster.
- Walk your dog for a short distance several times a day: Exercise is good to treat many behavioral problems, and in this instance will also keep your dog physically healthier. Besides keeping off his excess weight, the muscles that hold his knee in place will be healthier.
- Improved diet: A raw or homemade organic diet may improve overall cartilage condition and make all joints, including the knee, healthier. A raw diet can even be made with beef traches and chicken legs, which will add glucosamine and improve the condition of the joint.
- Give glucosamine and chondroiton dietary supplements: These supplements improve the quality of the joint. They improve the cartilage and may even improve the fluid available in the knee. Some diets advertise the presence of chondroiton, but adequate amounts are only available in balanced raw diets.
- Give added Vitamin C: This still needs a lot more evidence. Dogs produce vitamin C but the amounts are probably not enough to help with strengthening the ligament when your dog is affected by a trick knee. Doses have not been worked out but you should probably give your dog 1000mg a day (500 mg for a smaller dog), and preferably use natural sources like acerola.
- Acupuncture: Consult a veterinarian who specializes in treating conditions of the knee.
A luxating patella usually needs to be fixed surgically.
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Do What's Best for Your Dog
If your dog has been diagnosed with a luxating patella, it is not the end of the world. You can find alternative treatments, and if nothing works find a good surgeon to repair the knee so that your dog can live normally.
If your dog has a trick knee, however, she should not be bred! Bad knees are sometimes a sign of hip problems, which are inherited. Even if only the knee is affected, this condition is genetic—it will be passed on to her puppies.
There is still a lot of controversy in this subject so I cannot definitely state which method is best and which method will succeed or fail. In 2011, a report came out that stated the method used by most vets was not even successful. If you choose the surgical alternative for your dog please research this subject carefully. Find the best orthopedic surgeon you can afford, and take care of this problem as soon as you can.
Dogs with bad knees usually need restricted activity.
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More About Your Dog
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Here is how to figure out why your dog is lame and what you can do about it. - 7 Ways to Help Your Dog Lose Weight
Need to know how to start? Great exercise routines and estimated calorie burn for each exercise are included to help you work with your obese dog. Easy steps you can follow to get your dog in shape and prevent the diseases associated with obesity.
Questions and Answers to Help Your Dog
Here are some common questions about treating your dog.
Question: Our dog has been in for multiple surgeries and the knee still keeps popping out. What happens if the knee is not fixable?
Answer: If it is not possible for him to fix the kneecap, eventually the dog will develop arthritis in the joint and will either walk with three legs or may even have to drag her end. You might look into a wheeled cart that supports the hind end, similar to that which is used when Dachshunds undergo back surgery and are no longer able to walk.
I have seen some dogs that no one is able to repair. As long as they are small breeds, the owner just has to make adjustments. It is very difficult when the dog is large and not able to be carried around.
Q: My dog is old and has another problem. She cannot have surgery for her knees due to medical issues. Would leg braces be any good?
A: Some people claim they delay the onset of arthritis by keeping the patellas in place. (If that is true then the braces are well worth the cost.) Of course, if the patellas are not in place when the brace is put on, they also keep the patellas from moving back into a normal position.
I would suggest carrying your dog up and down the stairs to reduce stress, put her up on the bed if she sleeps with you, etc. She may benefit from massage.
Q: How much does it cost for a patella surgery on a small dog?
A: The cost of the surgery depends on the severity of the knee and how many degenerative changes have taken place, by the location, by the skill of the surgeon, etc. It does not depend on whether the dog is a Yorkie or Maltese.
If you are in NY it will cost several thousand, half of that in Kansas, and about $1500 for a small dog in Chicago.
Q: What kind of brace is used while a luxating patella is healing?
A: There is a temporary brace that you can use. Instructions on how to make it are on YouTube. A brace is not always needed, and if your dog is very small and you can control her movements, then it will probably not be needed at all.
Q: Will walking help my dog get his dislocated knee back in?
A: Keeping your dog in good shape through walking is going to prevent rapid degeneration of the knee. Walking alone, however, is not going to allow the knee to pop back into place. If it is very early in the course of the disease, you can massage the knee gently when the leg is extended and it might go back in by itself.
Q: What kind of care does my dog need after patellar surgery?
A: If your dog has undergone a surgical procedure you should discuss this with your vet. He may have your dog taking anti-inflammatory drugs, antibiotics, or other medications to deal with the pain and swelling.
Most dogs also benefit from rest. When you take the dog out do not let him run, and in the evening lift your dog up onto the bed (if he normally sleeps in the bed).
Q: Can any vet pop the knee back in place for my tiny dog (she has a luxating patella) Or do I have to take her to a surgeon?
A: Your local vet can do this, but unless the knee is very bad, you can do it yourself. You might need someone to help you hold your dog on their lap, belly up, and then take the leg and extend it, holding on to the toes.
When the leg is straight, fully extended, just put your fingers on the kneecap and gently massage. Talk to your dog to get her to relax. Usually, it is easier to move it back into place at home where the dog is not so stressed out.
If this does not work, your vet may need to sedate your dog.
Other Questions?
If you have any questions about this article of other health problems with your dog or other pets you can contact me at my Ask a Vet column at Pethelpful.com.