Medial luxation of the patella in small breed dogs. Medial luxation of the patella in dogs

In veterinary practice, joint dislocation in a dog is understood as an anatomical displacement of bone structures with damage to tissue integrity. The injury is accompanied by destruction of cartilaginous structures, blood vessels. IN pathological process tendons and ligaments of the joint are involved.

According to its etiology, the disease can be congenital, for example, due to improper development of the fetus in the womb. With the development of atrophic processes in muscle tissue The dog develops paralytic dislocation. The owner usually encounters a pathological type of injury against the background of the development of musculoskeletal diseases in the pet (rickets, osteomalacia).

Causes

falling from height;

car accident;

injuries that occur at high speed.

The term dislocation of the knee joint refers to a change in the position of one bone in the joint in relation to another. Associated with this are ligament ruptures and damage to the capsule, leading to swelling, deformation of the limb and decreased mobility of the leg.

The structure of the knee joint involves the combination of two cartilages, one of which is located between the bones of the leg and thigh, and the second - between the thigh and the cup. These components are susceptible to various kinds damage and are easily injured.

The function of the patella is to move the lower leg through the femoral muscles. The cup is most subject to stress during braking, as well as flexion or extension of the knee. The combination of external and internal ligaments securely holds this bone in the center in the sliding groove, which allows it to function fully.

class="tieicon-boxicon">If this function does not work properly, the joint experiences severe strain, leading to instability of the patella and its dislocation.

Experienced dog breeders and veterinary surgeons note two main reasons for the development of the disease in four-legged pets - congenital and traumatic. Congenital dislocations are most typical for representatives dwarf breeds due to genetic hereditary predisposition, genetic marriage. In some cases, pathology is detected at the age of 6-8 months.

Veterinary surgeons often diagnose congenital dislocation of the patella in small breed dogs, incomplete dislocation hip joint. Wherein genetic predisposition to pathology have such miniature breeds, like toy terriers, chihuahuas, lap dogs.

Clinical picture

As a rule, owners of dogs that are initially predisposed to the disease quickly realize that something is wrong with their pets, since the symptoms are quite characteristic. The animal begins to limp from time to time without any visible reasons, his gait becomes unstable, “wobbly.”

The dog falls on his sore paw from time to time, tries to sit less, preferring to lie down more often, he gets up with difficulty, very carefully.

Chronic cases can lead to erosion of the cartilage on the femur (due to constant mechanical pressure) and eventually osteoarthritis. It’s easy to find out about this - if the animal simply has some kind of “wrong” with the kneecap, he does not feel pain. If osteoarthritis is involved in the process, everything becomes much worse.

In rare cases, a dislocated kneecap leads to a very serious consequence - a cruciate ligament rupture. However, in the veterinary literature, many authors agree that this phenomenon is not too rare - in the chronic course of the pathology, it was recorded in 15-20% of sick animals. There are two main predisposing factors that lead to worsening of the disease:

  • As a result of constant dislocations and improper weight distribution, the load on the kneecap area increases dramatically.
  • If osteoporosis develops as a result of constant mechanical pressure, there is a high risk that inflammatory process will go to the cruciate ligament. As a result, the risk of its rupture also increases significantly.

With diagnosis, everything is quite simple, since the pathology is easily determined by simple palpation. The disease is divided into four types.

In the case of the first type, the dislocated cup easily snaps back into place. At the fourth stage, it is no longer possible to put it in its place.

Regardless of the stage of the pathology, ultrasound and x-ray examinations are performed. It is important for the veterinarian to determine whether there are signs of osteoarthritis and lesions cruciate ligament.

Classification

There are several classifications of dislocations, which depend on many factors.

Traumatologists distinguish 2 large groups of dislocations:

  • Congenital;
  • Traumatic or acquired.

There are several types of this injury. Depending on the violation of congruence of the articular surfaces, dislocations are distinguished:

  • complete – congruence is completely lost;
  • incomplete (subluxation) – when there is partial contact between the surfaces of the articulation.

Symptoms

Almost all forms of knee damage will be characterized by the following symptoms:

  • severe pain;
  • change in the shape of the knee joint;
  • immobilization of the joint;
  • incorrect position of the sore leg.

First the patient will feel severe pain in the knee, swelling and signs of balloting (floating kneecap). In this case, the deformation of the leg will be step-like, and movements will be limited.

If the patient can passively move his knee, then active movements are simply impossible. Often, with a dislocation, hemarthrosis develops - a disease in which internal hemorrhage occurs in the joint area. In this case, both diseases need to be treated.

You can understand that a displacement has occurred in the knee joint by the following signs:

  • sharp pain which increases when you try to move the kneecap into place;
  • knee deformity with swelling outside;
  • inability to move the joint;
  • swelling;
  • hyperemia of the skin (if hemorrhage occurs);
  • numbness of the injured leg below the knee.

In the case of a knee dislocation, symptoms may appear depending on the location, strength and area of ​​damage, as well as the reasons that led to the knee injury varying intensity.

It is also important to understand that many of the symptoms of dislocations, sprains and fractures of the knees at the initial stage are similar.

Characteristic clinical signs that are diagnosed in all forms of injury include:

  • sharp, severe pain in the joint area, which is especially severe when moving;
  • severe swelling, swelling;
  • tissue hyperemia in the knee joint;
  • deformation, change in the shape of the knee;
  • numbness, feeling of coldness in the leg, loss of sensation below the injury site;
  • absence of pulsation below the injured area;
  • reduction or complete absence joint mobility;
  • temperature increase.

A knee injury is a fairly complex injury that can, over time, if not properly treated, result in limited mobility and chronic pain. Injuries such as joint dislocations are a persistent displacement of the articular ends of articulating bones beyond their limits. physiological mobility, disruptive fixation of the joint and integrity of the joint capsule.

Incomplete displacement is called subluxation of the knee joint

dislocation with external deformity of the kneecap, the knee does not straighten;

the knee joint returns to its place on its own, but the knee is very swollen and painful.

severe acute pain in the knee joint;

loss of sensation;

formation of massive edema;

Sometimes when a knee is dislocated, the pulse below the bruise cannot be felt.

What symptoms of a dislocation require urgent medical attention?

severe unbearable pain;

state of shock body due to a dislocated knee;

large swelling in the knee joint;

sharp increase body temperature due to a dislocated knee;

feeling of deformation of the knee joint;

feeling of coldness or numbness in the leg;

lack of pulse below the knee.

The kneecaps are a wide plate of bone located within the joint itself. The main function of the cup is to protect the joint cartilage from various kinds displacements and deformations.

The owner can suspect a pathological process in the joint by paying attention to the following clinical picture in the pet:

  • Refusal to step on the affected limb. The dog begins to limp, takes an unnatural position, and jumps on three legs.
  • When a forelimb is dislocated, the injury is characterized by the animal pulling its paw under itself. If the dog has hip dislocation, then the owner observes that she has difficulty getting up after sleep or rest.
  • The damaged musculoskeletal organ changes its anatomical configuration due to the development of tissue edema. The owner often observes swelling in the joint area.
  • The mobility of the injured limb is limited. The dog tries to hold the limb, pointing it inward.
  • Any touch, let alone palpation, causes severe pain in the animal. A painful reaction may be accompanied by aggression from the pet. The dog whines, squeals, growls, tries to move away from the owner and even tries to bite.

In some cases, symptoms of dislocation in dogs may include sounds of bone rubbing against the surface of the joint, clicks, and even grinding sounds.

Patellas in small breeds

Owners of Yorkies, toy terriers, and Spitz dogs often contact a veterinarian regarding lameness in their pets. The majority of these calls are for medial patellar luxation in dogs. The pathology is characterized by a displacement in the structure of the knee joint into the organ. Lateral displacement (outward) accounts for only 20-25% of calls.

Veterinarians distinguish 4 degrees of luxating patella in dogs. The most difficult case is grade 4, in which the kneecap cannot be adjusted without assistance.

Clinically, the disease is characterized by periodic lameness. The most informative diagnostic method is an x-ray examination of the joint, which is performed in direct and lateral projections.

Hip

One of the most common injuries in dogs is dislocation of the hip joint, accompanied by displacement of the head of the femur from its anatomical place - the acetabulum. The pathology is often complicated by rupture of the round ligament.

Clinically, hip dislocation in a dog is characterized by severe lameness. She does not step on the sore paw and constantly holds it up. The limb is directed inward. Severe pain leads to loss of appetite, accompanied by lethargy and apathy of the animal.

Hind and front paws

Diagnostics

On prehospital stage You can guess the displacement of the kneecap by appearance limbs and by palpation. When contacting a traumatologist, in the vast majority of cases the patient is sent for an x-ray.

Images are taken simultaneously of both knees to compare the patient with the healthy one. Usually two projections are used (antero-posterior and lateral).

For greater clarity, a tangential projection according to Laurin can be used, when the rays are directed tangentially to the patella. X-ray diagnostics can detect subchondral damage and bone fractures.

Only a traumatologist can make an accurate diagnosis. To do this, you should collect a complete history of the injury:

  • Identification of etiological factors (cause);
  • Subjective complaints. The patient should be carefully interviewed to clarify the intensity and nature of pain syndrome;
  • Inspection data ( visual signs pathology).

Effective treatment can be prescribed only after undergoing comprehensive diagnostics.

Diagnostic methods include:

  • visual inspection;
  • radiography;
  • arteriography (x-ray of arteries);
  • checking the pulse, which allows you to determine the location of damaged areas and whether there is a circulatory disorder.

Diagnosis of the disease is carried out according to the classical system, which is followed in traumatology.

X-ray for a dislocated knee - check the bones for integrity;

Arteriography (X-ray of arteries) - whether there is damage to the arteries;

As an alternative to arteriography - ultrasound or Dopplerography;

Neurological examination - mobility of the foot, does it rotate inward, outward, up, down;

Pulsemetry of the knee joint - checks whether blood circulation is impaired.

Main trauma syndromes

articular,

edematous-infiltrative,

hemodynamic disorders, dystrophy

And functional disorders.

An experienced specialist will be able to immediately install correct diagnosis, but additional examination methods are required to exclude other types of injuries and related disorders.

Examination program:

  • examination by a traumatologist;
  • radiography;
  • MRI or CT;
  • Ultrasound of the joint;
  • Dopplerography of blood vessels to exclude damage;
  • neurological examination to assess the condition of nerve fibers.

In order to confirm traumatic injuries to the bones of the knee joint, it is necessary to perform a thorough diagnosis, which includes the following measures:

  • X-ray. This method is effective for studying pain as well as changes in the knee. X-ray diagnostics can reveal various deformations and fractures with displacements, damage and ruptures of the ligamentous apparatus, dislocations and cracks. In addition, the X-ray image clearly shows changes in the joint due to arthrosis, arthritis, osteoporosis, growth of tumors, etc.
  • CT scan. CT scan can reveal early stage developments such pathological manifestations, like arthrosis, arthritis, malignant neoplasms and joint injuries.
  • Magnetic resonance imaging (MRI). Allows you to most accurately diagnose bruises, fractures, tumors, infectious processes and degenerative changes in bone tissue.
  • Joint puncture. To perform such a study, a sterile needle is inserted into the joint cavity to collect exudate, which is then examined for the number of leukocytes, protein, and microorganisms that indicate the etiology of the development of the inflammatory process.

Joint puncture is widely used not only in diagnostic purposes, but also for administering medications directly into the joint cavity

Analyzes

To clarify the diagnosis, a number of tests are prescribed, including great importance has common and biochemical analysis blood, indicating one or another reason for the development of pathology.

When performing diagnostics, the possibility of physical stress on the knee joint should be taken into account. Most often, displacement is observed during training, but professional athletes with minor injuries do not pay much attention to this, which is fundamentally wrong.

Even small displacements, after which the patella independently returned to its place, require mandatory X-ray diagnostics. This will allow you to assess the severity of the damage and the required degree therapeutic intervention.

Treatment

Only a doctor can correct a dislocation. At home, any such attempts can be fraught with fracture of the ends of the joints. Only in rare situations, if a normal dislocation of the knee joint has occurred, is the patient, already having the required experience and skills, able to treat himself at home.

First aid for a dislocated kneecap is to apply cold, as for a bruise. Read more about a bruise in a child in the article “What to do if a child bruises his knee: ways quick fix pain and swelling."

If the knee displacement occurs for the first time, and it is not complicated by ligament damage or fracture, treatment with conservative methods is indicated. In case of habitual dislocation of the patella or in the presence of complications (fracture, intra-articular bodies, hypermobility of the patella after reduction), only surgery can provide an effect.

Conservative

If the kneecap is still displaced before visiting a traumatologist, the doctor will realign it under anesthesia. In this case, the patient sits so that the hip joint is bent at a right angle (this reduces the tension of the tendons), and the knee should be straightened.

To prevent re-displacement of the kneecap, treatment should include immobilization for 4-6 weeks. To do this, use plaster splints or a brace (retaining elastic bandage). The advantage of a brace over a cast is that it can be removed at any time for physical therapy or the use of ointments. More information about what ointments can be used to treat knee injuries can be found in the article

Active sports while wearing the bandage are excluded to sprained ligaments managed to recover. After removing the fixing material, they gradually begin to develop the limb, doing exercises for the quadriceps muscle, which straightens the leg at the knee.

At first, moving your knee may cause pain. To learn how to cope with it, read the article: “Methods of treating pain after a fracture: eliminating discomfort when the knee joint and ankle are destroyed.”

Surgical

Types of injury treatment:

  • Conservative;
  • Surgical.

In all cases of primary knee dislocation, conservative treatment is prescribed. The healing method is as follows:

  • applying cold compresses to the sore spot to help relieve pain and reduce swelling;
  • a direct injection is performed under the kneecap with an anastatic effect;
  • the knee joint is realigned and the damaged cartilage is aligned;
  • then apply a plaster cast or other fixatives;
  • physiotherapeutic procedures (UHF, electrophoresis).

The course of treatment should be carried out under the strict supervision of doctors, and even after removing the plaster cast, the patient is monitored by the treating traumatologist for 2 months. For patients with repeated dislocations, it is prescribed surgery.

Treatment for luxating patella in dogs depends on what causes it. In any case, the treatment will be surgery, since the problem is a mechanical defect and over time causes a series of accompanying pathologies. Therefore, it is necessary to treat luxating patella in dogs.

We perform a number of operations on dwarf dog breeds, and also combine surgical treatment methods for the best outcome of the operation. The range of operations performed is very diverse and depends on the causes of luxation of the patella in a dog:

  • in case of a shallow depression in the femur with a poorly developed medial edge, wedge-shaped groove plasty is performed.
  • at traumatic dislocation In the case of the patella in dogs, duplication of the joint capsule can be performed.
  • if the roughness is incorrectly attached tibia, an operation such as transposition of the tibial roughness is performed.
  • in case of deformation of the femur or tibia, depending on the degree, a corrective osteotomy is performed.

Sometimes these reasons can be combined, for example, the roughness is incorrectly attached and the gutter is shallow. In this case, we are talking about combining surgical treatment methods.

The traumatologist decides how to treat the injury. A dislocated knee joint cannot be treated at home. The first emergency aid may be ice. Next, a doctor should take care of the knee dislocation.

Stages in the treatment of knee dislocation

reallocation (reduction) – returning the damaged knee joint to its place;

immobilization - fixation of the sore knee using an immobilizer or splint.

Ligament restoration is a difficult stage. Sometimes surgery is initially necessary.

Then rehabilitation of the knee joint under the supervision of an orthopedic doctor.

Treatment methods for knee dislocation

Treatment methods for knee dislocation are reduction followed by immobilization (from 1 to 6 weeks depending on the damaged joint) with plaster or soft bandages and subsequent functional therapy, including exercise therapy, massage and physiotherapy, the duration of which is also determined by the anatomical and physiological characteristics of the knee joint, the type of injury , age of the patient.

decrease traumatic edema(lymphatic drainage methods for treating knee dislocation),

resorption of hematomas, effusions and infiltrates (anti-inflammatory treatment methods),

pain relief (analgesic methods).

After removing the immobilizing bandages, the main tasks are to restore blood circulation to damaged tissues (vasodilator methods for the treatment of knee dislocation),

improvement of joint tissue trophism (reparative and regenerative methods for treating knee dislocation)

and muscles (myostimulating methods for treating knee dislocation),

full restoration of joint function.

Rehabilitation after a knee dislocation

physiotherapy;

therapeutic exercises for the knee joint;

knee joint massage;

proper nutrition;

vitamin therapy.

How to treat a dislocation at home?

Milk compresses will help treat a dislocated knee joint. Gauze is soaked in hot milk and applied to the problem area;

Porridge with onions in the treatment of a dislocated knee - grate the onion or in a blender, add granulated sugar in a ratio of 1-10. Apply as a compress (6 hours each);

Apply porridge made from wormwood leaves to the sore knee. This is beautiful antiseptic.

It is also useful to apply compresses from the tincture to bay leaf.

A propolis compress will help treat a dislocated knee joint. Infuse propolis with moonshine or vodka. Moisten gauze or a rag in the resulting tincture and apply to the sore spot;

Grate 2-3 heads of garlic, add apple cider vinegar to it. Let the product sit for 5-6 days. Excellent product for rubbing in bruises and dislocations of the knee;

The patient can adjust a dislocated joint with his own hands if there are no complications. For this manipulation, the patient must have the appropriate skills. If this is another type of dislocation, then you cannot set the knee without the help of a qualified doctor, because this risks breaking the ends of the joint and causing harm to yourself.

Traditional treatment for knee dislocations should only be performed in a hospital. The complex of therapy includes measures to give the cup the correct position, puncture of the joint and ice packs to remove hemarthrosis, as well as the application of a fixing orthosis or plaster cast for approximately 3 weeks.

During treatment, initial loads are placed on the joint from the first days of the disease. Gradually, as soon as the swelling subsides, the load is increased by introducing new movements.

If the dislocation is complicated by ruptures of tendons, ligaments or blood vessels, knee treatment is carried out only surgically. Modern technologies make it possible to perform such operations using an arthroscope, minimizing surgical intervention and shortening the rehabilitation period.

The approach to treating habitual dislocations usually involves physical therapy, which means strengthening the muscles surrounding the kneecap to ensure its stability. Sometimes patients wear a lateral knee splint.

Often this method does not give the expected results. In this case, the joint is stabilized surgically.

During rehabilitation for 4 weeks, the load on the knee is gentle, and then a course is required special gymnastics lasting 90-120 days.

The treatment program depends on the type of injury and associated disorders (ligament tears). Treatment begins with reduction of the dislocation. Make it bloodless closed method or during surgery only under general anesthesia in a specialized trauma hospital.

If blood accumulates in the articular cavity, it is punctured and the contents are evacuated. Hemostatic drugs, anti-inflammatory, antiseptic and antibacterial agents are administered internally to prevent infection.

In case of ligament rupture, treatment is only surgical. It is performed either through a conventional surgical approach or through minimally invasive arthroscopy.

After surgery or conservative reduction, a plaster cast is applied for a period of 3-4 weeks, after which restorative treatment begins.

As a rule, when the patella is displaced, it is used conservative therapy and only in the most severe cases is it recommended to resort to surgery.

Treatment includes the following measures:

  • reduction - this method of treatment is performed only by a highly professional specialist, since if the reduction is incorrect, there is a risk of developing quite serious complications. If a person exhibits similar symptoms and there is no possibility of providing medical assistance, it is recommended to apply an immobilization splint or fixing bandage;
  • cold compress– with the help of cold you can significantly reduce swelling and pain in the knee joint. The effectiveness of compresses can achieve maximum results only at the initial stage of displacement, therefore, 2-3 days after injury, applying a cold compress is not advisable;
  • painkillers - prescribed to eliminate the main symptom of patella displacement (acute pain). Such drugs can be Diclofenac, Voltaren, Spazgan, etc. In addition, it is possible to prescribe anti-inflammatory drugs and antibiotics;
  • dressings - have an analgesic and therapeutic effect, but they should be used only after the main course of therapy. The length of time you wear the bandage depends on the severity of the injury. In addition, in some cases the patient needs a wheelchair or a cane;
  • during recovery period a complex of physical therapy is prescribed, including static exercises. In addition, massage, UHF, magnetic therapy, laser therapy, as well as electrophoresis using novocaine have a positive effect.

After surgery, you can walk on crutches only after 7-10 days. In the first 2-3 weeks it is recommended to use crutches without loads, which ensures the fastest possible restoration of joint functionality

In veterinary practice, conservative and surgical methods. The arsenal of non-surgical therapy includes such manipulation as organ reposition. The return of the joint to its anatomical position is carried out after preliminary anesthesia of the quadruped patient.

After reposition, the joint is fixed for 3 weeks using immobilizing bandages. In some cases, a veterinarian recommends limiting the pet’s mobility for several days by placing it in a small room, box, or cage.

To accelerate the regeneration of damaged tissues, the animal is prescribed anti-inflammatory drugs, chondroprotectors and vitamins. Physiotherapeutic procedures in veterinary practice include massage and heat therapy. During the rehabilitation period, moderate exercise and swimming in a warm pond are prescribed.

Treatment of dislocations in dogs is often complicated by relapse. Repeated dislocation usually occurs within 14 days after the first injury. In such a situation, a veterinarian recommends surgery.

Depending on the type of damage, the surgeon performs restoration of the round ligament (in case of dislocation of the hip joint), repair of the joint capsule if it is damaged, and interarticular fastening. High tech allow veterinary specialists to replace the joint capsule with a biosynthetic prosthesis.

Postoperative period includes immobilization of the injured limb, the use of anti-inflammatory drugs, for example Prednisolone, Dexamethasone. Chondroprotectors, vitamin D, and calcium supplements speed up recovery. Swimming, special exercises, long walks contribute to the rapid return of the pet to duty.

Dislocation in four-legged pets is a common surgical problem. The main cause of the disease is congenital pathology and traumatic factors. A characteristic symptom injury is lameness, the reluctance of the animal to lean on the sore limb.

Note that surgery is not always used to treat this pathology (especially in small breed dogs). Thus, in the first and second stages of the disease (when dislocation of the cup occurs rarely, and it can easily be put back in place), dogs live for years, receiving necessary medications.

In contrast, stages three and four of patellar luxation can only be cured through surgery. Ultimately, the decision about the method of therapy must be made by the veterinarian.

During the operation (if a decision has been made to perform it), the condyles and ligamentous apparatus are restored. The most difficult surgical intervention is when you simultaneously have to eliminate the consequences of a cruciate ligament rupture.

When it has been decided that the operation is not advisable for some reason, the animal is prescribed a special diet. It must include a complex the following vitamins:

  • Ascorbic acid(Vitamin C) is a powerful antioxidant that stops inflammatory and degenerative processes in cartilage cells.
  • Tocopherol (Vitamin E). Stimulates regenerative processes, accelerates the deposition of proteoglycan in cartilage tissue, and prevents the development of osteoarthritis.
  • Vitamins B1 and B6 are required for collagen synthesis.

Therapy in a medical institution

Any medical procedures should be carried out and prescribed only by a medical specialist, since independent attempts to realign the joint can worsen the condition and lead to fractures of the articular ends.

Having experience, patients who often experience habitual dislocation.

Conservative treatment for a dislocated knee joint is carried out only in a hospital.

If necessary, a traumatologist performs a puncture of the knee joint, removing accumulated exudate.

All manipulations are carried out under local or general anesthesia. After the knee joint has been realigned and returned to its place, the joint is fixed using an immobilizer or a plaster cast, which ensures immobility of the injured limb.

The next stage of treatment includes a set of therapeutic and therapeutic procedures aimed at restoring the integrity of the ligaments.

In severe cases, if the injury is associated with ruptured ligaments and tendons in the area of ​​the kneecap, surgical intervention is performed. Minimally invasive surgery is performed using an arthroscope.

Exercise therapy is also a method

When treating habitual dislocation, a course is prescribed therapeutic exercises(physical therapy), wearing a lateral knee splint. In severe cases, surgery is performed to stabilize the joint.

Used to treat knee subluxation conservative techniques treatment.

First aid

If you suspect a knee dislocation, it is necessary to immobilize the injured limb as soon as possible using a splint or any available means.

If there is poor circulation in the foot or lower leg, you can try to reduce the displacement of the bones by very carefully pulling the foot along the longitudinal axis of the leg, slightly pushing the lower leg in the direction opposite to its displacement.

All manipulations must be carried out as carefully as possible so as not to accidentally cause another injury.

You can apply ice or a cold compress to the damaged area.

Possible complications

Displacement of the kneecap, the symptoms of which are mild and may remain unnoticed, gradually becomes more complicated

After treatment, patients must undergo a rehabilitation course. Its duration depends on the severity of the injury (from 2 months to 1 year).

It is worth noting that a dislocated knee joint is a fairly serious injury and its consequences can be very serious.

Incorrect treatment and inappropriate therapy can lead to complete limitation of knee mobility and the appearance of constant, aching, chronic pain.

If first aid was not provided on time, and treatment was not prescribed in full, then chronic instability of the knee joint, deforming osteoarthritis, and habitual dislocation may subsequently develop. It is important to remember that the prognosis for this injury depends not only on treatment measures, but also on rehabilitation measures.

Rehabilitation treatment should begin immediately after injury. For this purpose, the following measures are used:

  • physiotherapy;
  • massage;
  • physiotherapeutic procedures;
  • wearing orthoses and bandages.

Remember! A knee dislocation is a complex and dangerous injury. Therefore, if you suspect such damage, you must seek specialized medical help in order to maintain your health and be able to move without pain.

What is a dislocated knee joint?

Let's first find out what is meant by this diagnosis. Knee dislocation is a very common disease. It may occur for the following reasons:

1. Heredity. This is the same case when the dog was not injured in any way, but somehow still got a dislocation. This type of disease begins to appear at 4 months, less often at 2-3 weeks of age, when puppies begin to walk. In order to avoid subsequent cases of the disease in offspring, dogs with such heredity are not allowed to breed.

2. Trauma. The dog jumped unsuccessfully, fell from a height, got into a fight with another dog, etc., resulting in a knee joint injury.

3. Age-related changes. As we age, ligaments and muscles weaken, which can cause the kneecap to become dislocated.

Patella dislocation occurs in dogs with polygenic, recessive heredity and most often affects female dogs.

The picture shows very clearly what is happening to the joint. At incorrect position The patella (ligament) stretches and comes out of the groove, thereby depriving the joint of support. In the normal position, the patella prevents friction between the tendon and the trochlear groove of the femur.

Dislocation of the knee joint can be medial or lateral. At medial in a dislocation, the kneecap moves towards inside limbs. This type of dislocation is more common in small breeds of dogs. It is accompanied by a proximal rotation of the tibia inward. Changes in the hip joint may also occur: osteochondritis of the femoral head, changes in the angle of the hip bone. Lateral Dislocation often affects large breed dogs. In this case, the bones of the hind limb rotate outward.

A dislocated knee joint can be identified by the stance of the dog's hind legs.

The left picture shows the correct position hind limbs dogs, and in the right picture the patella is displaced, which led to a “barrel-shaped” stance of the hind legs.

There is a classification of patella dislocation according to severity, developed by two eminent veterinarians - Putnam and Singleton. This classification is still used to this day when making a diagnosis and prescribing treatment.

Patella dislocation, grade I. The most mild degree defeats. In this situation, the patella comes out of its groove when the dog’s paw is in a relaxed state - the animal sits or lies (sleeping) for some time. When the animal stands up, the patella cannot immediately return to its place. Therefore, for several steps the dog limps or jumps on three legs. Then the patella falls into place and the animal walks, trots and gallops with virtually no lameness. At the moment when the patella returns to its place (with the help of realignment by the owner or the animal itself - you just need to stretch your paw back or stand on your hind legs), no crunching is heard. Those. the patella is not yet rubbing against the femur. With such a lesion, the degree of rotation of the bones of the hind limb is minimal. With such a degree of disease, with proper care(conservative treatment), the dog can feel great and move actively until old age.

Patella I dislocation I degree. The displacement of the patella becomes almost constant. With this degree of damage, the rotation of the bone can be no more than 30 degrees, the head of the hip bone in the joint can be slightly deviated. The patella moves medially, and the tibia joint begins to rotate outward. The dog periodically does not step on his foot. When realigned, a distinct crunching sound is heard. This patella rubs against the knee joint. A crunching sound may also be heard when walking. Constant friction of the patella can lead to its erosion and irreversible changes in the knee joint. In this condition, a dog can live well for several years. But then, due to irreversible changes in the knee joint, surgery is inevitable.

III degree patella dislocation. The patella is constantly displaced. The rotation of the hip bone is 30-50 degrees. The hock joint is no longer in the same vertical line with the stifle joint. When moving, it is either to the right or to the left. The groove in which the patella should be located narrows and becomes almost flat. At the same time, the dog manages to adapt and step on the paw. True, she often spares the sore paw and does not load it, or keeps it in a relaxed state.

IV degree patella dislocation. The kneecap is constantly displaced. The hip bone is rotated inward and the angle of deviation from the vertical (at the joint) can be 50-90 degrees. With this degree of damage, the patella is located on the inside of the knee joint (it can be felt with your fingers). The groove atrophies or bulges, filling with bone tissue. The dog is limping badly and cannot stand on its affected paw.

Diagnostic methods

Visually, the hind limbs are not positioned correctly (even if the dog is not limping yet); recurrent lameness; Jumping on three legs after getting up from a sitting or lying position.

On palpation, abnormal position of the joint, exit of the patella from the groove, and swelling of the joint are noted.

To clarify the diagnosis, it is necessary to take an x-ray in frontal and lateral projections. And preferably not only the knee, but also the hip joints. On x-rays the degree of damage and destruction of the joint, the degree of rotation of the bones, and the condition of the groove on the knee joint will be visible.

Macroscopy will show the degree of wear of articular cartilage, osteophytes, sprain joint capsule, fibrosis or contractures.

Microscopic examination shows synovitis, fiber disintegration articular cartilage etc.

Never rely simply on results when making a diagnosis. general examination and unfounded assurances that your dog has a luxated patella. Lameness and joint swelling can be caused by completely different orthopedic diseases. A true diagnosis can only be shown by a thorough X-ray examination of not just one knee joint, but two joints - both the knee and the hip.

Conservative treatment methods

For grade I and some types of stage II lesions, conservative treatment can be used, which consists of the use of anti-inflammatory, chondroprotective and painkillers.

I must say right away that you should pay great attention to the presence of analgesic components in chondroprotective drugs. Often, this component is MSM - methylsulfanylmethane. The fact is that similar drugs will have an analgesic effect. The dog, without feeling pain, will not spare the damaged joint and lean on it with all its strength. And you will see a rosy picture of your pet’s recovery - the dog is not limping! But in fact, the joint will deteriorate more and more.

Why are chondroprotectors and anti-inflammatory drugs needed? The fact is that when the patella is dislocated, due to incorrect position, the joint gradually wears out and degenerative arthritis develops. In order to prevent this and prolong the active life of the pet, it is necessary to periodically carry out maintenance therapy with chondroprotectors. These substances are glucosamine and chondroitin. For complete absorption of substances, it is recommended to give them in combination with drugs that stimulate the production of collagen in the dog’s body.

Now there are a lot vitamin complexes or specialized preparations that contain glucosamine, chondroitin and collagen hydrolysate. It is recommended to select several (2-3) drugs that suit your pet well and give them in courses, alternating periodically. This is done so as not to cause addiction. These chondroprotectors not only restore joint tissues and ligaments, but also perform an anti-inflammatory function.

Surgical treatment methods

Some types of II degree, as well as III and IV degrees of patella dislocation are treated with surgery. There are two methods of surgical treatment - trochleoplasty and trochlear chondroplasty.

The essence of trochleoplasty is to deepen the groove where the patella should be located. To do this, a section of cancellous bone is removed. Subsequently, fibrocartilage grows again and lines the femur block.

Trochlear chondroplasty is performed on young dogs under 6 months of age. During the operation they peel off cartilage tissue, deepen the subchondral area of ​​the bone, graft cartilaginous tissue so that it lines the newly created groove.

It should be remembered that even after a successful operation, relapses of knee joint dislocation are possible in 48% of cases.

Testing for habitual patellar luxation in dogs. Dislocation of the kneecap.

about patella from Baltic dog handlers
"Patella is a big problem for small dogs (based on materials from Amber Dog, Latvia).

Patella luxation: a big problem for small dogs
Necessity mandatory checks– in the subsequent healthy population of our dogs.
At exhibitions we really meet beautiful dogs. It would seem that everything is fine about them. But it also happens differently: dogs hide behind their beauty hereditary diseases. The goal of any breeder is to monitor the health of their pet. And in the case of luxation of the patella, check your dog in time and treat the results obtained as responsibly as possible, because the health and future of the breed as a whole depends on this.

Luxation of patella in a scientific way.
Patella luxation (patellas luksacija, luxating patella) is a condition in which the patella (patella) comes out of normal position, that is, it shifts.
Luxation of the patella, or luxation of the patella, is a fairly common disease of the musculoskeletal system in dogs. Patella luxation can be medial (i.e., located on the inside of the knee joint) or lateral (located on the outside). Patella is most common in dogs ornamental breeds, although it is also recorded in almost all other dog breeds.
This disease is hereditary, although there are cases of patella dislocation as a result of injury to the knee joint.
The severity of the dislocation is expressed by numbers 1, 2, 3, and 4 in accordance with the degree of the disease.
Assessment of the severity of patellar dislocation according to Putman (1968)

Grade 1: intermittent dislocation. It is possible to perform forced manual displacement of the kneecap with full extension of the knee joint, followed by its spontaneous reposition.
Grade 2: Frequent dislocation of the kneecap during joint flexion or manual manipulation, but spontaneous reduction does not occur.
Grade 3: persistent dislocation in which manual reduction is possible, but then spontaneous redislocation occurs.
Grade 4: persistent dislocation in which manual reduction is not possible.

Signs of the disease vary in animals with varying degrees of severity. Thus, with a mild degree of development of the disease in dogs, lameness is observed, followed by a normal gait. A “bouncing” gait is also characteristic.
In severe cases of the disease, the affected limb can be bent at the knee joint and brought under the stomach.

Painless and necessary.
Despite the fact that such a disease of the musculoskeletal system as patella luxation was previously unknown to many dog ​​owners, in the practice of veterinarian Inga Berzini (clinic “B. Reinika un Ko”), this disease was encountered even before mandatory checks. The only difference was that the owners brought their pets with obvious signs of the disease, for example, with severe lameness. Indeed, as Dr. Berzynia notes, patella luxation contributes to complete or partial rupture of the cruciate ligaments in dogs, thus causing lameness.
Testing for detection of patella luxation is carried out in animals when they are physiologically mature and the dog’s skeleton is formed. For small dogs this is 6-8 months of age, and for representatives of large breeds the test is carried out at 12-14 months.
I. Berzinya reminds that this test is completely painless for the dog and does not require anesthesia. The veterinarian performs the check manually, feeling the knee joint and the position of the kneecap in it. The doctor also evaluates the animal's gait. If a severe degree of patella luxation is detected, X-ray examination and, possibly, even surgery are also necessary. But since the introduction of mandatory checks in Dr. Berzini’s practice, such severe cases did not have.

Prevention comes first.
For those dogs that do not have congenital defects of the knee joints, during heavy physical activity, games with very large four-legged friend or a bad fall, there should be no problems with a dislocated kneecap. A different situation arises for those animals in which, from birth, the patella, due to the congenital depth of the intertrochlear groove, is not where it should be in a normal position. This condition of the knee joint contributes to the occurrence of injuries in the dog in certain situations listed above. Therefore, those owners whose dogs are at risk should be especially careful with their pets. Unfortunately, we cannot influence what the dog has already inherited, but we can create the most favorable living conditions for our pets so as not to provoke injury. As I. Berzinya says, the owners of dogs with mild degree disease, it is possible to avoid unpleasant consequences for your pets as follows:
1) by controlling the weight of your dog, because, as you know, when overweight it is easier to get injured by making an awkward movement;
2) avoiding heavy physical activity, again to prevent injuries.

If the dog has a severe degree of the disease, surgery may be required. During the operation, an artificial intertrochlear groove is created for dogs, that is, the void is filled due to which the kneecap is out of place. However, even after surgery, no surgeon can guarantee that the dog will stop limping. Often, after surgery, dogs’ ability to withstand physical activity is significantly reduced, not to mention the period itself. postoperative recovery rated as very heavy. For dogs, this recovery period means weeks, sometimes even months, spent in a crate. Therefore, Dr. Berziņa regards the test for patella luxation introduced by the Latvian Canine Federation as a very important and simply necessary measure for prevention of this disease. “By checking dogs, we can not only avoid unpleasant consequences, but also help improve the health of future livestock,” notes I. Berzinya.

Help improve the health of our dogs.
As Baiba Rumba, head of the LKF breeding commission, admitted, since the Latvian canine federation is a member of the FCI, it must adhere to a uniform policy in the field of dog health, i.e. raise as healthy animals as possible, and in the case of luxury patella, carry out appropriate health checks. So far, testing for patella luxation is only mandatory for certain breeds of dogs, and it is not a prerequisite, for example, for using a dog for breeding. But checking for the possibility of a dislocated kneecap is still necessary, and first of all, for the breeder or dog owner. After all, as you know, this disease progresses and causes obvious discomfort to the animal. As B. Rumba notes, Latvian breeders are very concerned about the manifestation of patella luxation in their dogs. If an animal is diagnosed with a severe degree of disease, the breeder is inclined to take the use of such a dog in breeding work very seriously. More and more breeders are checking for patellar luxation because it is in their own interests and also directly affects future puppy owners.
According to Marina Zarina, head of the breeding book of the LKF, checking the luxation of the patella was introduced in Latvia relatively recently - from June 1 last year. Now this check must be done for the following dog breeds: decorative dogs all breeds of FCI group IX (except for large poodles), all retrievers, American and English cocker spaniels, Yorkshire and West Highland white terriers, as well as small and dwarf Spitz dogs.
For now the main objective checks – to find out the situation that has developed in Latvia in connection with this disease. To do this, it is necessary to check as many animals as possible in order to obtain the necessary data on the health status of our dogs and further develop the necessary program to reduce the spread of this disease - for example, by culling seriously ill animals. Testing is important in part because many dog ​​owners from other countries require our breeders to test for patella luxation before using our dogs for breeding.
According to M. Zarina, what is now known is that the most severe (grade 4) luxation of the patella was not found in any (!) tested dog, and also that all tested West Highland White Terriers and Labrador Retrievers turned out to be absolutely healthy. All the results obtained on dog breeds will still be analyzed, and it is too early to draw any conclusions.
Despite the popular belief that the breeder is able to notice the luxation of patella in a dog himself, one should not delude himself: this is a disease that, like any other, can only be diagnosed by a veterinarian, starting from 6 months of age in dogs.
The testing procedure itself is much simpler than, say, testing for dysplasia, and it can be done in two clinics with which LKF has entered into the necessary agreements. These are the clinic “B.Reinika un Ko” (Kalnciema St., 7) and the clinic “Dzivnieku veselibas centrs” (F. Tsandera St., 4). All that is needed for verification is a referral from the LKF and, of course, a desire to help improve the health of our dogs!

Moscow Veterinary clinic "Alisavet"

Key Points of Patella Dislocation

A luxated kneecap is usually painful and results in lameness.

Restoring limb function may be recommended, especially in large breed dogs. To recommend the need for any intervention to eliminate a dislocation, you need to know what the frequency of dislocation is over time.

Concurrent cruciate ligament injuries may be present in dogs that have an unstable patella, so this should also be assessed.

The kneecap moves inward (medially) or outward (laterally) relative to normal. As a rule, pathology occurs on both sides (left and right limbs). About 80% of dislocations occur inward (medially). The pathology is transmitted genetically, dogs of dwarf breeds suffer more often than others (Yorkshire terrier, toy terrier, Spitz, Chihuahua, toy poodle, pug, etc.) Trauma, unplanned nutrition, deformation of the axis of the pelvic limbs (X-shaped and V- Figurative curvatures of the pelvic limbs) can also serve as a cause for this pathology. But in large breeds of dogs, on the contrary, a lateral (external) dislocation is more often present and, as a rule, there is an X-shaped curvature of the pelvic limbs.

Ligamentous apparatus

X-shaped and O-shaped curvatures of the pelvic limbs.

The term luxating patella (patellas luksacija, luxating patella) is also often used - this is a condition in which the patella (kneecap) moves out of its normal position, that is, it moves.

Norm and pathology (dislocation)

How to diagnose a luxated kneecap?

The kneecap moves in a groove at the bottom of the femur at the level of the knee joint called the trochlear groove.

Trochleoplasty

Trochleoplasty and transposition of the tibial tuberosity

Knee surgery

Trochleoplasty

Patellar luxation is often caused by congenital pathology. Usually at the level of the hip joint and leads to an abnormal distribution of forces acting on the kneecap, which ultimately begins to move out of the groove. If patellar luxation occurs in young animals, then the tibial and femur become twisted.

In dwarf breeds of dogs, lameness is not regular, periodic, usually a dislocation of 2-3 degrees. If your dog suddenly stands up or jumps off the couch, there may be pain and lameness, which then goes away. If this is not a habitual dislocation, but a traumatic one, then the pain and lameness do not go away on their own.

To clarify the diagnosis, a physical examination by an orthopedic surgeon and a series of x-rays are required. Very often, a dislocation of the kneecap can be combined with other pathologies of the joints and ligaments. For example, Perthes disease requires an additional image of the hip joint. Osteophytes may be present in the joint. Damage or rupture cruciate ligaments and etc.

Classification of patellar dislocation

Assessment of the severity of patellar dislocation according to Putman (1968)

I - degree. After forced dislocation, the kneecap returns to its position.

II - degree. The arm dislocates when bent and sometimes returns to its correct position.

III - degree. Flexion and extension leads to dislocation.

IV - degree. The kneecap is constantly in a dislocated position and cannot be adjusted.

Clinical signs

1. Lameness

2. Periodic skipping of gait, jumping to the other limb.

4. Hind limb stiffness

5. Dogs with this condition typically show only one sign, while other orthopedic problems show many other signs.

6. Failure to comply with the treatment requirements for this disease can lead to progressive arthritis of the knee joint.

Surgery

If the groove where the kneecap moves is not deep enough or is severely deformed, and therapeutic treatment does not give results, then we can deepen the groove surgically. We typically use an advanced technique to perform this procedure called a trochlear osteotomy, V-socket, or trochleoplasty. There are also other options for stabilization, suturing the capsule, creating stability using a ligament with sesamoid bone. As a rule, a combination of several surgical techniques is used simultaneously. This gives a more durable result to prevent re-dislocation.

After surgery 2 weeks

The patella ligament attaches to the crest of the tibia, and if it is in the wrong position, it also requires surgery. If the bone has more than 14 degrees varus deviation, it is necessary this operation. The operation is done by displacing the crest of the tibia and reattaching it to the tibia so that the kneecap slides smoothly in the groove and does not have an abnormal angle to the dislocation. Wires and cortical screws are used to attach to the bone in the new location. Pins are usually not removed unless they migrate out of position or unless a fluid bubble (seroma) may develop at the end of the pin.

A support bandage is not usually used after surgery, so rehabilitation therapy can be started soon after surgery.

Caring for a recovering dog.

Analgesics and nonsteroidal anti-inflammatory drugs as directed by your pet's surgeon.

Excessive activity should be limited for approximately 2 to 3 months

Rehabilitation therapy is a very important tool for limb rehabilitation.

Recovery

10-14 days after surgery, your pet should touch the ground with its toes while walking.

By 2 to 3 months after surgery, your pet should be using the limb satisfactorily.

If your pet is not feathering normally on a limb after 2-3 months, you should see your doctor again.

Surgery has an approximately 90% success rate. Success is defined as return of good limb function

Unfortunately, surgery will not remove arthritis that may already be present in the knee. As a result, your pet may have some limb stiffness in the morning. In such cases, modern allopathic drugs and homeopathy give good results. Additionally, your pet may have some lameness after strenuous exercise.

Large breed dogs that have patellar luxation are susceptible to increased risk to loosen the patella if corrective femoral osteotomy has not been performed.

Possible complications

Anesthesia during surgery can cause the death of a dog.

Infection of the surgical site, although not common, can occur.

Migration of the pin or fracture of the displaced bone.

Formation of seroma at the ends of the pins.

If the dog is actively moving during the first 8 weeks after surgery, displacement of the reduction may occur, followed by reoperation.

Veterinary clinic "Alisavet", Moscow

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