Laurie's Blogs.

In this week’s blog, I want to talk about ‘late onset patellar luxation’.  Now, I bet some of you are thinking, ‘late onset, what the heck is that?’  Well, have you have seen a dog that is aging or who has suffered some rear end or rear limb weakness, who has a concomitant patellar luxation?  I’m betting you have!  Is the patellar luxation a primary problem?  A secondary problem?  Was it there all along?  Let’s discuss!



My first epiphany into this concept is a retired agility patient of mine.  This little dog has been coming to the clinic since she was a pup.  She conditioned on the underwater treadmill.  She had regular physio check-ups and tune-ups.  She was a solid little rock star. 

Then she had puppies.  Then she got soft.  Then new dogs came into the picture.  Then she was retired from sport.  Now, because she wasn’t practicing or trialing, the owner wasn’t bringing her in for conditioning or physio on a regular basis.  I can’t say exactly how long it was after she was retired, but I want to say it was about a year and a half, when I noticed some patellar laxity in one leg.  

It was subtle at first.  Maybe a grade 2 minus.  I went back through her entire chart looking for any indication of patellar luxation in the notes.  Nothing!  I wondered if I had missed it for all these years!  However, it’s been about 3 years since that time, and the patella mobility has worsened a wee bit, more to a grade 2+ or 3-.  It is currently at a point that I KNOW I wouldn’t have missed finding it all of those years before.

So, it made me wonder why.  

The only logical conclusion that I can draw in this case is that she did have ‘loose’ patellae all along – maybe grade 1, but that she was fit and muscled enough that it was not a problem.  However, as she deconditioned, so did the stability at the patellofemoral joint. Had I not known this dog for her entire life, I might not have recognized this phenomenon.

I’ve read comments from other rehab professionals on various Facebook groups eluding to this finding as well. So, I know I’m not the only one that has made note of this.

What makes this significant however, is that it leads to a number of different scenarios that you may need to be aware of as a rehab practitioner.

An older dog comes in with some rear end weakness stemming from the back, the neck, or the hips as examples, but you also find a patellar luxation.  Is the patellar luxation primary?  

A neurologic dog also has a patellar luxation. Will it need patellar surgery?

ANY dog comes in with a patellar luxation and other issues that would affect strength in the rear limbs.  Is the patella primary?  Does it need surgery?

MAYBE NOT.

From a diagnostic perspective, it would be useful to question, “Is the patellar luxation a primary issue or is it the result of weakness caused by some other issue?”

From a treatment perspective, it would be valid to see if the patellar luxation could be treated with strengthening and conditioning or by correcting another related issue (i.e. back pain)?

From a maintenance perspective, there would be justification for continued conditioning of the retired sporting dog as well.

Just more things to think about in your problem solving and treatment planning, and another ‘two for the price of one’ set of conditions!