Question:
Our 3-1/2-year-old Havanese recently jumped off my bed, landed peculiarly on her hind leg, and started limping around. We took her to the veterinarian, and he gave Sadie a full exam, with blood work and an X-ray. The diagnosis reads as follows: "Left Medial Patellar Luxation -- Grade 3. (Sadie) has had a degree of this condition for most of her life, but at this point it has become unstable and gave her an episode of pain. Her other knee is much more stable in comparison. Our usual recommendation, as we discussed on the phone, is orthopedic surgery to correct the MPL problem and stabilize the knee."For the moment, we've decided (with our doctor's consent) to put off surgery and see how the knee responds to short walks -- I think she is the best indicator. She'll walk normally for the first three to four strides, perform a little hop-step with her left back leg to take momentary stress off the knee, and then go back to normal. After a few cycles, she repeats the pattern. After walking for a while, she seems to settle into a routine of walking on all four legs for the rest of the time outside. Please let us know your thoughts. They will be much appreciated.
E.B.S., New York, NY May 16, 2010
Answer:
One would think that your dog is too young to be suffering from a joint disorder, but one or two loose kneecaps or a trick knee is a condition in a class of its own, most commonly seen early in life in small breeds. Contributing factors include her genetic susceptibility, owing to hereditary developmental anomalies -- and how her immune system reacted to vaccinations and caused an autoimmune destruction of tendons/ligaments and connective tissue. Of course, the nutrition of her mother and the food she grew up eating plays a part, too.
Smaller dogs usually self-heal from cruciate-ligament rupture, developing a mild inflammatory response followed by a stabilizing arthritis, which is not particularly incapacitating. But with luxating/dislocating kneecaps, corrective surgery is usually the only solution. Without corrective surgery, dogs develop an abnormal skip-hop gait, throwing the rest of their bodies out of alignment and putting stress on other limbs and their spines. On occasion, the two knee problems are concurrent, and experienced veterinarians also check for cruciate-ligament rupture after making the easier diagnosis of dislocated or loose kneecap/patella. Restricted physical activity for 10 to 12 weeks is called for -- no running, jumping or flights of stairs. Try graduated hydrotherapy, massage therapy, acupuncture and nutraceutical supplements, including turmeric, horsetail (for silica), chondroitin, glucosamine, MSM and hyaluronic acid. Watch her weight -- a low-calorie, lean-meat-and-vegetable diet is best. The torn kneecap ligament may self-repair, but more likely than not surgical correction to stabilize the patella will be needed if time and rest do not help.
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