Medial Patella Luxation (MPL)

Medial patella luxation (MPL) is a common orthopedic condition seen in the canine population. It happens when their patella (knee cap) does not stay in the groove along the femur. This can prevent the knee from bending and straightening appropriately. The patella can luxate laterally but it is far less common, so MPLs will be discussed here, however lateral luxation treatments are not much different.

 

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Signs and Symptoms

The hallmark of MPL is an intermittent skipping gait, meaning when the patella luxates, the dog will likely kick their leg back into extension to relocate the patella and can proceed walking as normal. Sometimes this can happen very frequently leading to a constant lameness, however more commonly it occurs 50% of the time or less while walking. Typically there will be a long history of the intermittent lameness, and these dogs are middle to older age.

How is it diagnosed?

A veterinarian will make the diagnosis of MPL through physical examination, and may take x-rays to assess the bone and their alignment. The severity of the MPL is classified from Grades 1 to 4:

I: the patella can be manually dislocated, but goes back into place once it is released

II: the patella remains luxated until it is manually put back into place, or until the dog extends the knee themselves

III: the patella remains luxated most of the time but it can be manually reduced with the leg extended, it will pop out when the knee is flexed

IV: the patella is permanently luxated and cannot be put in, the femoral groove is too shallow or absent and the thigh muscle is pushed to an abnormal position.

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Surgery, Rehabilitation or Both?

Surgery will be primarily dependent on the severity grade of patella luxation, commonly grade I and asymptomatic grade II typically respond very successfully to conservative management with rehab; however grade III-IV likely require surgery to address the anatomical structures and provide stability for the patella. There are a few different surgical procedures and they should be discussed with your vet to discuss which is best for your dog and their presentation. With or without surgery, a program developed with and supervised by a certified canine rehabilitation therapist can make a meaningful difference in your dog's recovery.

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How will rehab help?

No matter the treatment route your dog is going through, canine rehab can help promote tissue healing, provide a progressive strengthening program, and assist in normalizing gait (walking) mechanics. Pain management is typically the first goal with or without surgery, then normalizing range of motion of the limb. Typically there is a tightness in muscles along the front of the thigh, and because of compensation some decrease in spine, hip and stifle mobility that needs to be restored. Continuing to strengthen the muscles of the limb through a progressive program without aggravating the patella is important. This may initially require shorter exercise bouts, that will increase over time as your dog's endurance increases.

During our evaluation, we determine what exercises should be done and walk you through the exercises. Within 48 hours of the evaluation, we will send you a link to a portal that has the prescribed pictures and videos for you to continue to do exercises at home. THE HOME EXERCISE PROGRAM IS THE BIGGEST COMPONENT OF SUCCESS. CARRYOVER IS ESSENTIAL.

Every case and situation is different, and rehab is expensive. We encourage you to do an evaluation and determine what you’re able to do at home and what is financially feasible.

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