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How To Fix A Luxating Patella (Trick Knee) In A Dog Without Surgery

Updated on November 18, 2016
DrMark1961 profile image

Dr Mark is a veterinarian in Brazil. He has been working with dogs more than 40 years.

Surgical repair of a luxating patella is not possible for some dogs.
Surgical repair of a luxating patella is not possible for some dogs. | Source

What Is A Trick Knee?

What Is A Trick Knee?

A trick knee in your dog is caused by 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. A trick knee shows up occasionally, though, often inherited in small dogs or larger breeds that have hip dysplasia.

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.

Your new puppy may have been diagnosed with a trick knee during his first exam. 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 is some breeds but can happen in any size dog, and at any age.

If a luxating patella is ignored, the dog will develop arthritis.
If a luxating patella is ignored, the dog will develop arthritis. | Source

How Are Knees Graded? 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 even need surgery.

1. 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.

2. 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 may develop arthritis and pain in the knee, and will sometimes need surgery.

3. 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.

4. 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.

A luxating patella usually needs to be fixed surgically.
A luxating patella usually needs to be fixed surgically. | Source

How Can A Trick Knee Be Fixed Without Surgery?

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 move it back into place during his exam. For more permanent results, however, you need to consider all of the following alternatives:

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. Acupuncture: Consult a veterinarian who specializes in treating conditions of the knee.

Dogs with bad knees usually need restricted activity.
Dogs with bad knees usually need restricted activity. | Source

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.

When the knee is okay, anything is possible.
When the knee is okay, anything is possible. | Source

© 2012 DrMark1961

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    • DrMark1961 profile image
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      DrMark1961 3 days ago from The Beach of Brazil

      Wow Siddesh I am sorry to hear that. Surgery is not a good option in the region I live in either. Physiotherapy does not help much, unlike with arthritis of the hips, but with a Lab weight control is very important. You should also look into glucomsamine/chondroitin (especially natural, like chicken legs), and ask your vet if he gives adequan or some other injection forchondroitin. Hope it works out for her since a young dog like her does not need to suffer so much.

    • Siddhesh mavkar 3 days ago

      Hi doc I have a nine months old Labrador she has suffering from patellar luxation grade 3 surgery can't be done. As our vet group is not so good to perform surgery. Can I get it corrected by physiotherapy please help.

    • DrMark1961 profile image
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      DrMark1961 2 weeks ago from The Beach of Brazil

      Lauren, I buy my chicken legs and raw beef trachea from a butcher every week, feed my dogs all natural (no commercial food). There are very small bones in feet, no problems eating them whole (but they should never be given cooked) and beef tracheas are only cartilage, so if you have access anywhere and do not feel good about the feet that is a good option. Do not give up! Let me know how things are going for them.

    • Lauren 2 weeks ago

      Dr. Mark,

      Thank you so much for your feedback! My vet told me her weight was perfect and I pride myself on feeding my dogs a high quality dog food in two measured servings a day. So I'm confident she will never become obese! :) But I appreciate your comments because it's good to have that decision reinforced.

      As far as the beef trachea or chicken legs, do you mean for me to serve that to her raw, (bones included) chopped up with a little mixed in her food? My vet is telling me that surgery is likely the only options to correct it but I would really prefer to go the natural route if possible. She is still not putting weight on her leg, however, and it's now been around 2 weeks. While she isn't in pain, I obviously can't stand to watch her hobbling around on 3 legs when she has 4! I will begin the beef/chicken and vitamin C today.

      Thank you again for your input!

    • DrMark1961 profile image
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      DrMark1961 3 weeks ago from The Beach of Brazil

      Lauren, she is at the age where you can do a lot to help her. Do not let her get overweight as she ages, and make sure she gets at least a few walks per day to keep in shape. Please consider giving her a natural glucosamine source, like chicken legs or beef trachea, and also look into giving her vitamin C (which has not been proven to help but will definitely not hurt.)

      Again, let me emphasize that the most important thing for her future is that she does not become obese. Doxies are real chowhounds, and since Chis are small they do not need to be fed much so we humans tend to overfeed them!

    • Lauren 3 weeks ago

      Hi Dr. Mark!

      I have a 2 year old chihuahua/ dachshund mix. She has been a happy, hyper and active dog since I adopted her about 6 months ago. She loves to run around and play with my other dog with no previous or observable health conditions. 6 days ago she was outside in the backyard running around with my other dog when she suddenly became lame. I did not see how it happened, only that she was fine one minute when she ran out the door, and ten minutes later she would not put any weight on her back leg. We inspected it for a bite mark and she screamed out in pain. So I rushed her to the emergency vet clinic and turns out it is a luxating patella. Only just today, 6 days later, she is just starting to use it tentatively, but still mostly lifts her back leg. She received a steroid shot and has been on anti-inflammatory medication the past 5 days. What do you recommend at this point? Can I wait longer to see if it may correct on its own? I took her to my regular vet the day after when he prescribed the anti-inflammitory meds. He told me he can massage it back in place but that it slips right back out. Is it possible that it could get better without surgery? She doesn't seem to be in any kind of pain at all the last 5 days. Any advice would be greatly appreciated.

    • DrMark1961 profile image
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      DrMark1961 7 weeks ago from The Beach of Brazil

      Donna,the foster Yorkie was not lame prior to the accident?If not, I would be more inclined to consider it a Grade 3. I would go ahead and give the pain meds, and in that time the dog will have some time for the swelling to go down. Not sure what to advise you on the shleter situation. Hopefully the dog will not need surgery, but an 11 year old Yorkie is not old, so if that is only option I would try non-surgical first, then maybe surgery if nothing else works.

      How overweight is she? Look into switching her diet to natural /raw instead of commercial, which has a lot of carbs. (That is, if you do adopt her) Good luck with this.

    • Donna 7 weeks ago

      My 11 year old foster Yorkie did a squirrel sprint in the yard a few days ago and immediately came up lame, This is a first in the year I have had her. Shelter vet said he couldnt reduce it so its considered grade 4 luxated patella. plan was 7 days doggie profen & weight reduction diet. No other advice. I'm limiting activity mostly by carrying for stairs adn not taking walks, though she still hobbles around the house on 3 legs more than I would like. I wonder if it is really a #4, maybe just enough swelling from the sudden injury that it won't reduce just yet. I hear there mighta lazer tx option. Shelter vet isn't going to pursue any other measurea due to expense. I could formally adopt her to pursue a repair but wondered if it might be reduced after the week's meds. Not sure he will even be willing to see her again. I am really disappointed in this Vet situation but can't take her elsewhere as long as she's a foster.

    • DrMark1961 profile image
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      DrMark1961 8 weeks ago from The Beach of Brazil

      Gina, there are no exact doses. I would give at least 250 up to 500 mg for a dog that size. The problem with glucosamine is that it is not controlled, so the amount in the capsule may be a lot lower than on the label. I give natural glucosamine, like chicken feet and beef tracheas. One chicken foot is about 450 mg, so two raw feet a day would be a great supplement. (Read more about feeding raw food if you are giving Chibby commercial pellets.) I hope things work out for you both, be sure to leave another message later on and let me know.

    • Gina 8 weeks ago

      How much glucosamine for a 7-9 lb. dog? 10 mo. old puppy starting holding back leg up. Did massage last night and heard a slight popping. Will continue to monitor him, I am a proponate of glucosamine for humans. Hopefully will help my Chibby's situation.

    • DrMark1961 profile image
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      DrMark1961 2 months ago from The Beach of Brazil

      sachin pat--sorry to hear about your little puppy. If you have already had him examined, and his regular vet does not think he will get better, there must be obvious signs of nerve damage. Maybe his toes do not have any feeling? Hard for me to judge without an exam.

      I am not sure if he will get better, but if he were my puppy I would put him on a raw diet high in glucosamine, based mostly on chicken legs, which are easy for a little puppy of that age to eat.

      Besides his regular diet, I would also give him vitamin C. You will probably not have a natural C in high enough amounts, so Vit C tablets is your best bet. Not sure how big he is, what breed, etc, so I can not tell you how much to give.

      Good luck with the puppy.

    • sachin pat 2 months ago

      my 2 months old puppy was attacked by some pigs his back legs knee is dislocated doctor says this can't be fixed what should I do now he is just walking on 3 legs he doesn't feel pain in that leg

      is there anything I can do to fix it

    • DrMark1961 profile image
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      DrMark1961 4 months ago from The Beach of Brazil

      David, just take hold of your dogs foot and extend the leg all the way. The patella often pops back in when the leg is extended all of the way, if not just massage it and gently push it towards the center of the dog´s body. If she cries a lot she might need to be sedated, but this almost always works.

    • David 4 months ago

      How do you massage the patella back in place, I have a chihuahua she owns the house we just live their.

    • Sally 4 months ago

      My 14 year old Bichons was just diagnosed with this. We are doing acupunture along with total body massage with lavender oil from Young Living Essential Oils ...only therapeutic essential oil on the market. I've learned how to move her knee cap back into place and she lets me do it. Our vet is trained in Chinesse herbs and acupunture. She is also on an herb for inflammation along with a lot of rest and being carried up and down the steps and doing very well. Vet is AMAZED at how well she is responding!! GLORY!!

    • jm 5 months ago

      my 5 years old pekingese with congenital patellar luxation worsen, from grade 2 became grade 4, we did the surgery, he is recovy right now, and rehab program after 2 weeks.

    • Yvone 7 months ago

      All of this information was very helpful my puppy's leg literally just started acting up and I was so scared

    • Sherry Resnick 7 months ago

      Devasted right now! Our almost 3 year old 80# pit was just dignosed with luxating patella in both knees!! We are beside ourselves he is our baby!! I will not do the surgery! Has anyone had any luck with holistic vets?

    • Cindy 9 months ago

      Hi we have a boerbull. At 10 months he started limping. We took him to the vet and first opinion was an ACL. We took him to a second vet and exrays showed a luxating patella. We had the op done which was not completely successfull. They redid the op a few days later to tighten the knee as it was still popping out. A month and a half into recovery his second leg started showing signs of discomfort and this was now also putting weight on his leg that had been operated on. We then had the other leg operated on a couple of months later which was a huge success but because the first leg was not done correctly the first time and because of the added weight during healing he needed a third op on the 1st leg. We noted our concerns that something was not right when we took Rocky to have his stitches out. He has a follow up soon but I realized his leg was popping out again. The heart break. What now. The ops are exhausting not just to Rocky but us as well. He is confined to a cage most of the day and knight but as a very active strong willed dog he is throwing tantrums and he is totally oblivious to pain he really cares less about his sore legs. So the delema He wants to run and jump and as a huge dog he loves to throw his weight around. His had a bit of obedience training but the cage is taxing on him. Surgery on the leg does not seem as if its going to work on the leg that has had three ops already. I'm at my wits end what else can we do to stabilize the knee because i dont think Rocky would survive being confined all his life.

    • jacqueline 10 months ago

      My 15 month old baby girl Sopie as just diagnosed with this she is a pom. I am trying a brace and glucosamine with chronditan and omega 369

    • Beth 10 months ago

      Thank you for all this information. I just found out my dog has this.

    • DrMark1961 profile image
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      DrMark1961 4 years ago from The Beach of Brazil

      Thanks Michelle this is not a popular subject, and not one people want to hear about. I hope your Westie never needs this information.

    • midget38 profile image

      Michelle Liew 4 years ago from Singapore

      This is awesome, Mark. I would think especially so as the dog grows older. Thanks for sharing!

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