PAPER

Patellar luxation in 70
large breed dogs
OBJECTIVES: To report the signalment, history, clinical features, and INTRODUCTION
outcome in dogs weighing greater than 15 kg, treated surgically and
Patellar luxation is one of the most com-
non-surgically for patellar luxation. Risk factors for the development mon orthopaedic conditions encountered
of patellar luxation, postoperative complications, and outcome were in dogs (Johnson and others 1994, Ness
and others 1996). It is primarily a dev-
evaluated. elopmental condition, with traumatic
METHODS: Details regarding signalment, bodyweight, breed, luxations being less common. The aetio-
pathogenesis of canine patellar luxation
aetiology, unilateral or bilateral luxation, duration of lameness, has been extensively reviewed yet remains
grade of luxation, direction of luxation, grade of lameness at poorly understood (DeAngelis and Hohn
1970, Robins 1990, Hulse 1993, Roush
presentation, concomitant cranial cruciate ligament rupture, 1993, Tomlinson and Constantinescu
method of treatment, surgical technique, surgeon, and 1994, Brinker and others 1997). A herita-
ble basis for the disease has been suggested
complications were obtained from the medical records. Outcome and is supported by the over-represent-
was graded as excellent, good, fair, or poor, according to the ation of certain breeds and the high pre-
valence of bilateral cases (LaFond and
degree of lameness. others 2002).
RESULTS: Seventy dogs (45 males and 25 females) were included. Patellar luxation has traditionally been
recognised in small breed dogs; however,
Thirty-five had bilateral luxations (105 limbs). Mean age was two the prevalence in large breed dogs appears
years, and mean weight was 30 kg. The relative risk for Labrador to be increasing. While Priester (1972)
found that only 48 of 542 (9 per cent) dogs
retrievers was 3
3 (P<0
001). All luxations were developmental. with patellar luxation were large dogs
Luxations were medial in 102 stifles and lateral in three. Fourteen (weighing greater than 18
2 kg), Hayes
and others (1994) showed that 48 of
stifles had concomitant cranial cruciate ligament rupture. As the 124 (39 per cent) dogs with patellar luxa-
grade of patellar luxation increased, so did the grade of lameness tion were large dogs (weighing greater than
18
2 kg). Much of the literature associates
(P<0
001). Surgery was performed in 70 stifles, and outcome was large breed dogs with lateral patellar luxa-
excellent/good in 94 per cent and fair/poor in 6 per cent of stifles. tion (Olmstead 1993, Brinker and others
1997); however, medial patellar luxation
Complications occurred in 29 per cent of stifles, and increasing is more frequently recognised in dogs of
bodyweight was found to be a risk factor (P=0
03). Thirty-five stifles all sizes (Hayes and others 1994).
It has been suggested that medial patel-
were managed non-surgically, and outcome was excellent/good in lar luxation increases the stress on the cra-
86 per cent and fair/poor in 14 per cent of stifles. nial cruciate ligament predisposing to
degeneration and rupture (DeAngelis
CLINICAL SIGNIFICANCE: In view of the potential risk of postoperative and Hohn 1970, DeAngelis 1971, Willa-
complications, all surgically treated cases of patellar luxation in uer and Vasseur 1987). However, Hayes
and others (1994), however, found that
large breed dogs should be managed with a femoral trochleoplasty, the prevalence of cranial cruciate ligament
a tibial tuberosity transposition (stabilised with K-wires and a tension injury in dogs with patellar luxation was
not different when compared with dogs
band wire), and soft tissue releasing and tightening procedures. with other orthopaedic conditions.
Many surgical techniques have been
S. E. GIBBONS, C. MACIAS, described to stabilise the femoropatella
M. A. TONZING, G. L. PINCHBECK* joint (Singleton 1969, DeAngelis 1971,
Willows Referral Service, 78 Tanworth Lane, Trotter 1980, Tomlinson and Constan-
AND W. M. MCKEE Solihull B90 4DF
tinescu 1984, Slocum and Devine Slocum
*Department of Veterinary Clinical Science,
Journal of Small Animal Practice (2006) University of Liverpool, Leahurst, 1998). Secondary osteoarthritis is a com-
47, 3–9 Neston CH64 7TE mon sequelae associated with develop-

Journal of Small Animal Practice
Vol 47
January 2006
ª 2006 British Small Animal Veterinary Association 3

mental patellar luxation (Roy and others
1992). There is no evidence that the devel-
opment and progression of osteoarthritis
are influenced by the method of treatment
(Willauer and Vasseur 1987, Roy and
others 1992).
The signalment, history, clinical signs,
surgical repair, complications, and outcome
of patellar luxation in small breed dogs
(Hodgman 1963, Priester 1972, Willauer
and Vasseur 1987, Hayes and others
1994) are well documented. Data pertain-
ing to the management and outcome of
patellar luxations in large breed dogs are
limited to one series (Remedios and others
1992). The extrapolation of the results from
small breeds may be erroneous. Remedios
and others (1992) reported 16 large breed
dogs with 22 patellar luxations and con-
comitant cranial cruciate ligament rupture
was present in one. Surgery was performed
on 21 stifles, and postoperative complica-
tions occurred in three of them.
The purpose of the current study is
to report the signalment, history, clinical
features, and outcome in 70 dogs weighing
more than 15 kg, treated surgically and
non-surgically for patellar luxation. Risk
factors for the development of patellar
luxation, postoperative complications, and
outcome were evaluated.
MATERIALS AND METHODS
Population data
The clinical records of 70 large ($15 kg)
dogs presented to Willows Referral Service
with patellar luxation between May 1999
and August 2003 were retrospectively
reviewed. Details regarding sex, age, body-
weight, breed, aetiology (developmental or
traumatic), unilateral or bilateral luxation,
duration of lameness, grade of luxation, dir-
ection of luxation (medial or lateral), grade
of lameness at presentation, concomitant
cranial cruciate ligament rupture, method
of treatment (non-surgical or surgical), sur-
gical technique, surgeon (experienced or
surgeon in training) and complications were
obtained from the medical records.
Grade of patellar luxation
Patellar luxations were graded as
follows.
4 Journal of Small Animal Practice
S. E. Gibbons and others
Grade 1: The patella was easily luxated
with manual pressure but returned to
the femoral trochlea when released.
Grade 2: The patellar luxation occurred
with rotation of the paw and flexion of
the stifle, and returned to the femoral
trochlea.
Grade 3: The patella was permanently lux-
ated but could be reduced with manual
pressure.
Grade 4: The patella was permanently lux-
ated and could not be reduced manually.
Lameness score
Lameness at presentation and follow-up
was graded as follows.
Grade 0: No lameness.
Grade 1: Mild or intermittent lameness.
Grade 2: Moderate lameness.
Grade 3: Severe lameness.
Grade 4: Non-weightbearing lameness.
For cases where the degree of lameness
varied, the worse scenario was recorded.
Surgical details
Surgical techniques were retrospectively
divided into four categories.
ST1: Femoral trochleoplasty, tibial tuber-
osity transposition, and soft tissue
procedures.
ST2: Tibial tuberosity transposition and
soft tissue procedures (no femoral troch-
leoplasty).
ST3: Femoral trochleoplasty and soft
tissue procedures (no tibial tuberosity
transposition).
ST4: Soft tissue procedures (no fem-
oral trochleoplasty or tibial tuberosity
transposition).
A stifle arthrotomy was performed
using a parapatellar approach in all cases.
The femoral trochlea, cranial cruciate
ligament, and menisci were inspected. If
the trochlear depth was considered to be
inadequate, a femoral trochleoplasty was
performed using a wedge recession
(Slocum and Devine 1985) or a rectangular
recession technique (Talcott and others
2000). The remnants of the cranial cruciate
ligament were debrided if the ligament
was ruptured. A partial menisectomy
was performed when meniscal injury was
found.

Vol 47
January 2006
ª 2006 British Small Animal Veterinary Association
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Tibial tuberosity transpositions were
performed manually using a bone saw
and stabilised with one or two
K-wires, with or without a tension band
wire. An air-driven drill was used to insert
the K-wires. Tracking of the patella within
the femoral trochlea was assessed. Release
of the medial or lateral soft tissues (deep
fascia, retinaculum, joint capsule, tendons
of insertion) to reduce tension was per-
formed as necessary. Tightening of the
medial or lateral soft tissues (joint capsule
and deep fascia) to increase tension was
undertaken when necessary.
Postoperative radiographs were
obtained following tibial tuberosity trans-
position to assess implant positioning. In
some cases with concomitant cranial cru-
ciate ligament rupture, a lateral fabelloti-
bial suture (Anderson 1994) or tibial
plateau levelling using a closing wedge
osteotomy (Slocum and Devine 1984)
was performed.
Outcome
Short-term follow-up was obtained by
clinical examination of surgically treated
limbs four to 12 weeks postoperatively.
Long-term follow-up was obtained by
telephone communication three months or
more following surgery or initial presenta-
tion in non-surgical cases.
Short- and long-term outcomes were
graded as excellent (no lameness), good
(mild or intermittent lameness), fair (mod-
erate lameness) or poor (severe or non-
weightbearing lameness). Surgical compli-
cations were divided into major and minor
categories.
Statistical analysis
Chi-squared test and Fisher’s exact test
were used to test for univariable associa-
tions between categorical variables (breed,
sex, age, bodyweight, aetiology, duration
of lameness, unilateral or bilateral lux-
ation, grade of luxation, direction of lux-
ation, grade of lameness at presentation,
concomitant cranial cruciate ligament
rupture, method of treatment, surgical
technique, surgeon, grade of follow-up
lameness, and complications). Dogs with
bilateral patellar luxations, which had
unilateral surgery, were considered to be
surgical cases for the purpose of statistical
analysis.

Table 1. Breeds of 70 large dogs with unilateral and bilateral patellar luxations
Breed
luxation (n=35)
Labrador retriever*
Staffordshire bull terrier
Japanese akita
Bull dog
Flat coated retriever
Springer spaniel*
Border collie
Golden retriever
Rottweiler
Elkhound
Munsterlander
Crossbreed
Dogue de Bordeaux
English bull terrier
Irish setter
Neopolitan mastiff*
Newfoundland
Sharpei
*Breeds with lateral patellar luxation
yFourteen dogs had the same grade of patellar luxation bilaterally, eighteen dogs had one grade difference between
limbs, one dog had two grades difference between limbs, and two dogs had three grades difference between limbs
For continuous variables, t test or non-
parametric alternatives (Kruskal-Wallis)
was used. Investigation of factors (see list
of variables above) associated with compli-
cations and outcome (classified as good/
excellent or fair/poor for analysis) was per-
formed using logistic regression analysis
on data from all unilateral luxations and
from the limb, with the worst outcome
in dogs with bilateral luxations. The crit-
ical probability throughout was less than
0
05. All the analyses were performed in
Mintab (Mintab 13
2; Mintab).
RESULTS
Population data
Of the 70 dogs, 25 were female (13 neu-
tered) and 45 were male (17 neutered).
Their age ranged from five to 84 months
(median 16
5 months, mean 24 months)
and bodyweight from 15 to 76 kg (median
30 kg, mean 30 kg). The breeds of the
dogs are shown in Table 1.
The patellar luxations were considered
to be developmental in all cases. Thirty-
five dogs had unilateral luxation and 35
had bilateral luxation (105 limbs)
(Table 1). The duration of lameness
before presentation varied from one to
104 weeks (median eight weeks, mean
15 weeks). Right and left luxations were
recorded in 54 (51 per cent) and 51 (49
Journal of Small Animal Practice
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January 2006
ª 2006 British Small Animal Veterinary Association
Patellar luxation in large breed dogs
Unilateral Bilateral
luxationy (n=35)
11 14
8 7
0 4
1 3
1 2
2 1
3 0
1 1
1 1
0 1
0 1
1 0
1 0
1 0
1 0
1 0
1 0
1 0
per cent) cases, respectively. There were
102 (97 per cent) medial luxations and
three (3 per cent) lateral luxations. The
grade of patellar luxation and grade of
lameness at presentation are given in
Tables 2 and 3. Fourteen stifles (11 dogs)
had concomitant cranial cruciate ligament
rupture. The age of these dogs ranged
from nine months to seven years (median
19 months, mean 32 months).
Management
Eleven dogs with bilateral patellar luxation
(22 stifles) and 31 dogs with unilateral
patellar luxation had bilateral surgery
(31 stifles). Seven dogs with bilateral patel-
lar luxation (14 stifles) and four dogs with
unilateral patellar luxation were managed
non-surgically (four stifles). Seventeen
dogs with bilateral patellar luxation had
unilateral surgery (17 stifles managed sur-
gically, 17 stifles managed non-surgically).
A total of 70 stifles were managed surgi-
cally, and 35 stifles were managed non-
surgically. In those operated on bilaterally,
the interval between operations varied
from two to seven months.
Surgical details
The 70 stifles (59 dogs) treated surgically
had grade 1 (n=5), grade 2 (n=36), grade 3
(n=19) and grade 4 (n=10) patellar lux-
ations. Experienced surgeons operated on
46 stifles and surgeons in training on 24
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Table 2. Grade of patellar luxation
(n=105) at presentation in 70 large
breed dogs
Grade of luxation Number
1 28
2 47
3 18
4 12
Table 3. Grade of lameness at
presentation in 70 large breed dogs
with 105 patellar luxations
Grade of lameness Number
0 9
1 36
2 35
3 23
4 2
stifles. The surgical techniques performed
are shown in Table 4. Wedge recession
femoral trochleoplasty (n=37) and rect-
angular recession femoral trochleoplasty
(n=14) were performed in 51 stifles. Tibial
tuberosity transpositions (n=68) were
stabilised with one (n=3) or two (n=65)
K-wires, with (n=62) or without (n=6)
a tension band wire. Soft tissue techniques
included medial soft tissue release (n=63),
lateral soft tissue release (n=1), medial soft
tissue tightening (n=1) and lateral soft tis-
sue tightening (n=66). Surgical treatment
methods for dogs with concomitant
cranial cruciate ligament rupture are
shown in Table 5.
Short-term outcome
Sixty-five stifles (54 dogs) treated surgically
were re-examined between four and 12
weeks postoperatively (median six weeks)
(Table 6). Lameness had improved by three
grades in one limb, two grades in 17 limbs,
and one grade in 24 limbs. It was unchanged
Table 4. Surgical technique (n=70)
in 59 large breed dogs with patellar
luxation
Surgical technique Number
of Stifles
ST1 50
ST2 18
ST3 1
ST4 1
5
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S. E. Gibbons and others

Table 5. Surgical techniques for 11 Table 7. Long-term outcome for each grade of patella luxation and surgical
large breed dogs (13 stifles) with technique in 50 stifles (45 dogs)
patellar luxation and concomitant Long-term outcome Grade of patellar luxation at presentation Surgical technique
cranial cruciate ligament rupture 1 2 3 4 ST1 ST2 ST3 ST4
Patellar luxation Cranial cruciate
surgery ligament surgery Excellent/good 4 23 13 7 33 13 1 0
Fair/poor 0 2 0 1 3 0 0 0
ST1 NS 5 (1)
TWO 1
ST2 TWO 2
LFTS 3 (2)
Twenty-nine non-surgically managed No major complications were detected
ST3 LFTS 1 (1)
ST4 LFTS 1 stifles (24 dogs) were followed long term in the 11 dogs operated on bilaterally. No
(Table 8). Lameness had improved by major complications occurred in cases of
NS no surgery, TWO tibial wedge osteotomy,
LFTS lateral fabellotibial suture three grades in four limbs, two grades in grade 1 patellar luxation. Of the 10 dogs
Values in parentheses indicates the number of stifles
with a meniscal injury treated with menisectomy
two limbs, and one grade in 11 limbs. with fair or poor short-term outcomes, five
It was unchanged in nine limbs and had had major complications and four had
worsened in three. One stifle managed minor complications. Five of 21 Labrador
in 15 limbs and had worsened in eight. The non-surgically had concomitant cranial retrievers (24 per cent) had major compli-
grade of patellar luxation at presentation and cruciate ligament rupture. Outcome was cations and six of 21 (29 per cent) had
the surgical technique used did not influence excellent in this case. minor complications. No major complica-
the short-term outcome. tions were recorded in Staffordshire bull
Complications terriers, but two of 11 (18 per cent) had
Long-term outcome Complications were recorded in 20 surgi- minor complications.
Fifty stifles (45 dogs) managed surgically cally treated limbs. Seven (10 per cent) Revision surgery was performed in both
were followed long term (Table 6). Lame- were considered to be major and 13 (19 cases of implant failure and in one with
ness had improved by three grades in one per cent) minor. Major complications patellar reluxation. All that underwent
limb, two grades in five limbs, and one included six with patellar reluxation and revision surgery did not initially have
grade in 24 limbs (the majority of which two with implant failure (loose or broken a trochleoplasty performed, but this was
changed from good to excellent). It was K-wires with proximal displacement of the carried out at the second surgery in two
unchanged in 15 limbs and had worsened tibial tuberosity). cases. The implants were removed from
in five. The grade of patellar luxation at Minor complications included five the tibial tuberosity in one case of implant
presentation and the surgical technique wound-related problems, such as dehis- failure. A tension band wire was not
used did not influence the long-term cence and infection; five implant-related applied in six cases that had tibial tuber-
outcome (Table 7). problems such as discomfort and seroma osity transposition, one of which required
The long-term outcome was assessed in formations; and three miscellaneous com- revision surgery due to loosening of
13 stifles (11 dogs) treated surgically with plications, namely swollen straight patellar the K-wires. Long-term outcome was
concomitant cranial cruciate ligament tendon, hock hyperextension, proximal good for all cases that developed major
rupture. Outcome was excellent in five displacement of tibial tuberosity. complications.
stifles and good in eight. Major complications were recorded in Of the limbs that developed minor
four of 18 (22 per cent) limbs that had complications, the implant was removed
Non-surgical details the ST2 technique compared with three in two stifles. Long-term outcome was
The 35 stifles treated non-surgically had of 50 (6 per cent) that had the ST1 tech- excellent in seven, good in one, fair in
grade 1 (n=20), grade 2 (n=13), grade 3 nique. Of the seven limbs that developed one, and poor in one. Three of these dogs
(n=0) and grade 4 (n=2) patellar luxations. major complications, five (71 per cent) were lost to long-term follow-up.
were from dogs with bilateral patellar
luxations that had unilateral surgery. Statistical analysis
An examination of the proportion of
Table 6. Patellar luxation short- and
Labrador retrievers and the proportion
long-term outcomes for 65 stifles
(54 dogs) and 50 stifles (45 dogs) Table 8. Patellar luxation long-term of all other breeds that had patellar lux-
managed surgically outcome for 29 stifles (24 dogs) ation and presented to Willows Referral
Short-term Long-term
managed non-surgically Service showed a relative risk of 3
3
outcome outcome Long-term outcome for Labrador retrievers (P<0
001). There
Excellent 12 28 Excellent 12
was a positive relationship between the
Good 42 19 Good 13 grade of patellar luxation and the grade
Fair 7 2 Fair 2 of lameness at presentation (P<0
001).
Poor 4 1 Poor 2
Total 65 50 Total 29
Univariable logistic regression analysis
showed that increasing bodyweight was

6 Journal of Small Animal Practice
Vol 47
January 2006
ª 2006 British Small Animal Veterinary Association

associated with increasing risk of major
complications (odds ratio=1
07 per kg
increase, P=0
03).
Major complications occurred in five of
11 (45 per cent) dogs greater than 35 kg
and in two of 43 (5 per cent) dogs less than
35 kg (Fisher’s exact P value=0
05). There
were no significant differences between the
type of surgical technique performed and
the complication rate. In bilateral cases,
there was no evidence that the limb oper-
ated on second was adversely affected by
the delay. Complication rates were calcu-
lated for all breeds, but only Labrador
retrievers and Staffordshire bull terriers
had sufficient numbers to come to conclu-
sions about the results, which showed no
association between breed and complica-
tion rate.
DISCUSSION
In the present study of patellar luxation in
large breed dogs, Labrador retrievers were
over-represented (36 per cent). This con-
curs with the reported incidence of 10 per
cent (Hayes and others 1994) and 44 per
cent (Remedios and others 1992) in this
breed. In contrast, LaFond and others
(2002) did not find that Labrador
retrievers were susceptible to patellar lux-
ation. The male:female ratio of 1
8:1 in
the present study was consistent with
the sex distribution reported by Remedios
and others (1992) in 16 large breed dogs.
These results contrast with the male:
female ratio of 1:1.5 recorded in small
breed dogs (Priester 1972, Denny and
Minter 1973, Hulse 1993, Hayes and
others 1994). This suggests that patellar
luxation may be more common in male
large breed dogs and female small breed
dogs.
The majority of patellar luxations in the
present study arose in dogs less than two
years old. This was consistent with previ-
ous reports for small and large breed dogs
(DeAngelis and Hohn 1970, Denny and
Minter 1973, Remedios and others
1992, Hayes and others 1994). Half of
the dogs in this study had bilateral patellar
luxations, which supports the findings of
Denny and Minter (1973), Trotter
(1980), Hayes and others (1994) and
Brinker and others (1997). Medial luxa-
Journal of Small Animal Practice
Vol 47
January 2006
ª 2006 British Small Animal Veterinary Association
Patellar luxation in large breed dogs
tions were more common than lateral lux-
ations, a finding documented by others
(Denny and Minter 1973, Rudy 1974,
Remedios and others 1992, Roush
1993, Hayes and others 1994).
The occurrence of concomitant cranial
cruciate ligament rupture in this study was
similar to that in other reports (DeAngelis
and Hohn 1970, DeAngelis 1971,
Willauer and Vasseur 1987, Remedios
and others 1992, Hayes and others 1994).
It has been suggested that dogs with
medial patellar luxation have an increased
risk of developing cranial cruciate ligament
disease due to malalignment of the extensor
mechanism of the stifle and internal rota-
tion of the proximal tibia (Trotter 1980,
Brinker and others 1997). However,
Hayes and others (1994) found no differ-
ence in the prevalence of cranial cruciate
ligament rupture in dogs with patellar
luxation and dogs with other orthopaedic
conditions, bringing this theory into ques-
tion. Brinker and others (1997) and Hayes
and others (1994) considered that con-
current cranial cruciate ligament rupture
is more likely in middle-aged to older dogs,
occurring secondarily to chronic patellar
luxation, but such an age trend was not
observed in the current study.
Surgery was performed on patellar lux-
ations of all grades. In the majority of
cases, the duration and grade of lameness
determined management. For this reason,
fewer dogs with grade 1 luxations under-
went surgery compared with dogs with
grade 2, 3, or 4 luxations. The surgical
techniques performed varied due to pre-
operative evaluation, intraoperative find-
ings, and surgeon preference. Generally,
as the severity of the luxation increased,
so did the degree of corrective procedures
performed.
The surgical techniques used to correct
patellar luxation were similar to those
described in small breed dogs (Tomlinson
and Constantinescu 1994, Brinker and
others 1997, Arnoczky and Tarvin
1998). Tibial tuberosity transposition
may be the most important component
of surgical treatment since quadriceps
malalignment is a key feature in the devel-
opment of all grades of patellar luxation
(Robins 1990). The degree of medial or
lateral transposition of the tibial tuberosity
varies with each case and relies on accurate
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judgement by the surgeon. Over- or
undertransposition of the tibial tuberosity
can result in reluxation of the patella and
may be the most critical factor affecting
the incidence of postoperative reluxation.
It is recommended that flexion and exten-
sion, internal and external rotation of the
stifle tests are carried out to assess patellar
stability following tuberosity transposi-
tion. In cases of patella alta, the tibial
tuberosity can be moved distally in an
attempt to return the patella to the troch-
lea. Adequate fixation of the tuberosity is
extremely important, and variables such as
age, weight, unilateral or bilateral disease,
and activity level should be considered
when choosing the method of fixation.
The authors recommend the use of two
K-wires and a tension band wire for fix-
ation of the tibial tuberosity in all large
breed dogs with patellar luxation.
Soft tissue release or tightening proce-
dures in combination with trochleoplasty
and tibial tuberosity transposition play
important roles in the correction of patella
luxation. Achieving a balance between soft
tissue release and soft tissue tightening is
vital to ensure normal tracking of the
patella and avoid reluxation or luxation
on the opposite side of the joint. Soft
tissue procedures are not recommended
as a sole method of treatment for patellar
luxation in large breed dogs because of the
likelihood of failure.
A subjective assessment of trochlear
depth must be made before performing
femoral trochleoplasty. Failure to do so
is likely to increase the risk of reluxation.
Willauer and Vasseur (1987) reported
a 48 per cent incidence of reluxation in
small breed dogs. In view of this potential
complication, a trochleoplasty should be
performed particularly in cases where
there is any doubt regarding trochlear
depth. Two trochleoplasty techniques have
been previously described (Slocum and
Devine 1985, Talcott and others 2000).
It has been suggested that the femoral
sulcus should be recessed sufficiently so
that 50 per cent of the patella is seated
within the trochlear ridges (Slocum and
Devine 1985).
A recent study by Johnson and others
(2001) showed that rectangular recession
trochleoplasty is superior to wedge reces-
sion trochleoplasty in vitro with regard
7

to proximal patella depth, patellar articu-
lation with the proximal trochlea, and
larger recessed trochlear surface area.
Patella alta is suggested to contribute to
the development of patellar luxation
(Brinker and others 1997) and may influ-
ence the method of trochleoplasty chosen.
Radiography and intraoperative assess-
ment of the location of the patella along
the trochlear ridge can be used as a guide
for the most suitable trochleoplasty tech-
nique. In cases where the patella is luxating
proximally or distally in the trochlea,
a rectangular recession may be indicated.
For cases where patellar luxation occurs
mid-way along the trochlea, a wedge reces-
sion may be adequate.
Concurrent orthopaedic disease of the
stifle such as cranial cruciate ligament
rupture or meniscal injury and the method
of surgical treatment did not significantly
affect the outcome. In contrast, DeAngelis
and Hohn (1970) reported a 96 per cent
success rate for uncomplicated patellar
luxations and a 79 per cent success rate
in dogs with cranial cruciate ligament
disease, meniscal injury, and osteoarthritis.
It is difficult to recommend a treatment
protocol for these cases based on such
limited numbers. However, the results
of this study suggest that repair of the
patella luxation is more important than
stabilising the stifle against cranial drawer.
Reluxation occurred in 9 per cent of
dogs in the present study. Willauer and
Vasseur (1987) reported a 48 per cent
incidence of reluxation in small breed
dogs. Five of the reluxations in the present
series were grade 1 and of lesser severity
than the preoperative grade. The remain-
ing case was a grade 3 luxation due to fail-
ure of the implants. Reluxation occurred
in three of 19 stifles in which a trochleo-
plasty was not performed, which may be
indicative of the importance of trochleo-
plasty. The small number of reluxations
encountered is likely to be the result of
the multiple corrective procedures per-
formed at the time of surgery. The major-
ity of dogs underwent a trochleoplasty,
a tibial tuberosity transposition stabilised
with two K-wires and a tension band wire,
and soft tissue releasing and tightening
procedures. In order to prevent reluxation,
an accurate assessment of trochlear depth,
degree of tibial tuberosity transposition,
8 Journal of Small Animal Practice
S. E. Gibbons and others
and extent of soft tissue releasing and
tightening procedures are mandatory.
The use of tension band wire is often
not mentioned in the literature, but the
results here suggest that its use is crucial
in preventing the development of com-
plications in large breed dogs.
The absence of major complications
in dogs that had bilateral patellar lux-
ation could be explained by the fact that
owners may have been reluctant to per-
form surgery on the contralateral limb
after encountering a major complication
on the first limb. Five of the seven
dogs that developed major complications
presented with bilateral patellar luxations;
however, surgery was not performed on
the contralateral limb.
Wound dehiscence and wound infec-
tion may occur following any orthopaedic
procedure. Complications necessitating
implant removal were so few that routine
implant removal is not recommended.
One case had a swollen straight patellar
tendon six weeks postoperatively. Friction
between the tension band wire and the
K-wires may have caused irritation or even
tearing of the straight patellar tendon.
Accurate positioning of the K-wires and
tension band wire with respect to the
straight patellar tendon is essential. When
K-wires are driven into the proximal
aspect of the tibial tuberosity, the tension
band wire should be placed caudal to the
straight patellar tendon to prevent it being
severed by the wire. If the K-wires are
placed more distally in the tibial tuberos-
ity, the wire can safely be placed cranial to
the straight patellar tendon. Slocum and
Devine (1985) postulated that the straight
patellar tendon may be predisposed to
rupture following wedge recession troch-
leoplasty.
Short-term outcome was excellent/
good in 83 per cent, and long-term out-
come was excellent/good in 94 per cent
of surgically treated dogs. Similar out-
comes have been reported in large and
small breed dogs with patellar luxations
(Willauer and Vasseur 1987, Remedios
and others 1992). The reasons why five
dogs deteriorated between short- and
long-term follow-up were not determined,
but implant-related complications, osteo-
arthritis, cranial cruciate ligament disease,
and hip dysplasia may be implicated.

Vol 47
January 2006
ª 2006 British Small Animal Veterinary Association
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The long-term outcome for dogs with
grade 1 and 2 patellar luxations treated
non-surgically was less favourable than
that for dogs treated surgically. Further
studies would be necessary to determine
the long-term outcome for dogs with
grade 3 and 4 luxations treated non-
surgically. Reasons for non-surgical man-
agement included owner reluctance to
perform surgery, minimal or no lameness,
and severe osteoarthritis affecting the stifle.
It has been suggested that sound dogs
with patellar luxation may not be surgical
candidates since osteoarthritis is progres-
sive, despite reduction of the luxation
(Willauer and Vasseur 1987, Roy and
others 1992). Despite severe anatomical
abnormalities, some dogs with patellar
luxation have good clinical function.
The two dogs with grade 4 patellar lux-
ations treated non-surgically were sound
or mildly lame.
Predictors of outcome were investi-
gated, but, probably due to the small num-
bers of dogs with fair/poor outcomes, no
significant factors were identified. In small
breed dogs, the results of surgical correc-
tion vary with the severity of the anatom-
ical deformities (Roush 1993). It is
generally accepted that a successful out-
come is likely for luxation grades 1, 2
and 3, and a guarded to poor prognosis
should be given for grade 4 luxations
(DeAngelis and Hohn 1970, DeAngelis
1971, Slocum and Devine 1985, Willauer
and Vasseur 1987). The grade of patellar
luxation did not significantly affect long-
term outcome in the present study. It
is possible that the degree of skeletal
abnormalities is not as severe in large breed
dogs as they are in the small breeds. None
of the 10 dogs in this study with grade 4
luxations required femoral or tibial correc-
tive osteotomies.
There were inherent limitations associ-
ated with this retrospective study. Varia-
tions in evaluation of lameness, degree
of luxation, and surgical treatment tech-
niques were unavoidable with the
number of surgeons involved. Owner
assessment of limb function and hence
long-term outcome may have been incon-
sistent. Concurrent orthopaedic condi-
tions that could affect long-term
outcome may not have been identified
at initial presentation.

Conclusions
Surgically treated cases had a better out-
come than those managed non-surgically.
In view of the potential risk of postoper-
ative complications, it is recommended
that all cases of patellar luxation in large
breed dogs should be treated with femoral
trochleoplasty, tibial tuberosity transpos-
ition (stabilised with K-wires and a tension
band wire) and soft tissue releasing and
tightening procedures.
Acknowledgements
The authors would like to thank the vet-
erinary surgeons who referred these cases
and the nurses at Willows Referral Service
for postoperative care.
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