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Is Surgery Necessary for Medial Patellar Luxation in Dogs?

Is Surgery Necessary for Medial Patellar Luxation in Dogs?

Medial Patellar Luxation

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Learn when surgery is necessary for medial patellar luxation in dogs, what to expect, and when non-surgical treatment may be enough

By 

Sustainable Vet Group

Updated on

June 21, 2025

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What Is Medial Patellar Luxation (MPL)?

Medial Patellar Luxation (MPL) is a condition where a dog’s kneecap (patella) slips out of its normal groove and moves toward the inside of the leg. This misalignment causes the knee joint to become unstable and painful.

  • Knee and mobility impact: When the patella moves out of place, it interferes with the smooth motion of the leg. This makes walking, running, and standing more difficult. Over time, the joint may develop inflammation, arthritis, or muscle loss if left untreated.
  • Signs and symptoms: Most owners notice limping, skipping steps, or the dog holding one leg up. Some dogs may show a hopping gait or reluctance to run, climb stairs, or jump. The signs may come and go in mild cases or become more constant as the condition worsens.

Recognizing these symptoms early helps ensure your dog receives proper care before long-term damage sets in. A veterinary exam is needed to confirm MPL and determine its severity.

Understanding MPL Grades and Why They Matter

Veterinarians classify Medial Patellar Luxation (MPL) into four grades based on how easily the kneecap moves out of place and how often it stays there. These grades help guide treatment decisions and predict outcomes.

  • Grade I: The kneecap can be manually moved out of place but returns on its own. Dogs may not show clear symptoms and often walk normally.
  • Grade II: The patella dislocates on its own but can return manually or with movement. Dogs may show occasional limping or skipping.
  • Grade III: The kneecap is out most of the time but can be pushed back into place. Dogs often have lameness or abnormal gait.
  • Grade IV: The kneecap is permanently out of place and cannot be returned. Dogs have trouble walking and may show pain or severe limb deformity.

Grades I and some Grade II cases may be managed without surgery. Grades III and IV almost always require surgical correction to prevent long-term joint damage and restore function.

Can Mild Cases Be Managed Without Surgery?

Yes, surgery is not always necessary for every case of Medial Patellar Luxation. Mild cases—especially Grade I and some Grade II—can often be managed successfully with conservative treatment, especially when symptoms are minimal.

  • Good candidates for non-surgical care: Small breed dogs under 20–25 pounds, dogs with occasional limping but no consistent pain, or older pets with lower activity levels.
  • When surgery may not be needed: If your dog moves normally most of the time, does not show signs of chronic pain, and maintains good muscle strength in the leg.
  • Monitoring is key: Dogs with mild MPL should be checked regularly to make sure the condition isn’t getting worse.

Managing mild MPL early can delay or even avoid the need for surgery. However, owners must stay alert for signs of progression, such as frequent limping or reduced activity. Your veterinarian can help determine if surgery is needed later based on your dog’s symptoms and lifestyle.

Non-Surgical Management Options

For dogs with mild MPL or those not ready for surgery, there are several non-surgical options that help reduce pain and support joint function.

  • Weight control: Keeping your dog at a healthy weight reduces stress on the knees and slows joint wear.
  • Exercise restrictions: Avoid jumping, fast running, or slippery surfaces. Controlled walks and low-impact movement are safer.
  • Joint supplements: Products containing glucosamine, chondroitin, or omega-3 fatty acids support cartilage health and reduce inflammation.
  • Anti-inflammatory medications: Vets may prescribe NSAIDs to relieve pain and improve movement in flare-up periods.
  • Physical therapy: Gentle stretching, strength-building exercises, or laser therapy help maintain muscle tone and balance.
  • Hydrotherapy: Swimming or underwater treadmill therapy allows your dog to exercise without putting weight on the joint.

These approaches do not cure MPL, but they often keep symptoms under control, especially in mild or early-stage cases. Regular follow-ups are important to monitor changes in mobility or comfort.

When Surgery Becomes Necessary

Surgery becomes necessary when non-surgical treatments no longer manage symptoms or when the patellar luxation is more severe (Grades III–IV). Early surgery can prevent joint damage, chronic pain, and loss of mobility.

  • Signs conservative care isn’t working: Frequent limping, pain during movement, decreased activity, or worsening gait even with rest and medications.
  • When surgery is recommended right away: Grade III or IV MPL, kneecap always dislocated, clear signs of pain, or limb deformity. Puppies with severe signs may need early correction to avoid growth issues.
  • Risks of delaying surgery: Untreated MPL can lead to arthritis, muscle loss, and worsening joint misalignment. Long-term damage may make surgery and recovery more difficult later.

If your dog struggles to walk or play comfortably, it’s time to discuss surgery. Procedures are generally safe and have a high success rate, especially when done early. Your vet will guide you through the options based on your dog’s condition, age, and lifestyle.

What Happens If MPL Is Left Untreated?

Leaving Medial Patellar Luxation (MPL) untreated can lead to long-term problems in the knee joint. Even if symptoms seem mild at first, the condition often worsens over time.

  • Joint degeneration and arthritis: Repeated luxation wears down cartilage, leading to joint inflammation and permanent damage.
  • Pain and worsening lameness: As the kneecap slips more often, your dog may limp more, avoid activity, or show signs of constant discomfort.
  • Cranial cruciate ligament (CCL) tears: Long-term instability puts added strain on other structures, especially the CCL, increasing the risk of rupture and more serious surgery.

Delaying treatment can turn a manageable condition into a much more complex problem. While mild cases can be monitored, dogs with moderate or severe MPL often benefit from early surgical correction to avoid joint breakdown and pain. Regular vet check-ups help track changes and guide timely intervention.

Surgical Treatment Options for MPL

Several surgical options are available to correct Medial Patellar Luxation, depending on the grade of the condition and your dog’s unique anatomy.

  • Trochlear sulcoplasty: The surgeon deepens the groove where the kneecap sits, helping it stay in place during movement.
  • Tibial tuberosity transposition (TTT): This procedure moves the bony attachment of the patellar tendon to better align the kneecap with the groove.
  • Soft tissue techniques: Tight or loose tissues around the knee are either released or tightened to improve stability.
  • Bone corrections (osteotomy): In severe cases with limb deformities, cutting and realigning bones is needed to restore proper function.

These procedures are often combined during surgery to give the best results. The goal is to keep the kneecap stable, reduce pain, and prevent further joint damage. Your vet or surgeon will select the right combination based on X-rays, gait analysis, and physical exam findings.

Recovery and Long-Term Outlook After Surgery

Recovery after MPL surgery involves several weeks of rest, careful monitoring, and gradual return to activity. Most dogs do very well when owners follow post-operative care closely.

  • Initial recovery: The first 2 weeks require crate rest and strict activity restriction. Pain medications and anti-inflammatories are typically prescribed.
  • Gradual rehab: Controlled leash walks and home exercises start in weeks 3–6. Jumping, running, and stairs are limited until the vet gives clearance.
  • Physical therapy: Many dogs benefit from structured rehab, including underwater treadmill, stretching, and muscle-strengthening to rebuild leg function.

Most dogs return to normal or near-normal activity within 8–12 weeks. Long-term outcomes are excellent for most cases, especially if the surgery is done before severe joint damage sets in. With successful surgery and proper care, your dog can enjoy a pain-free, active life again.

Does Breed or Size Affect Surgical Decisions?

Yes, breed and size play a major role in how veterinarians approach MPL treatment. While MPL is most common in small breeds, it can affect larger dogs too.

  • Smaller breeds: Dogs like Pomeranians, Chihuahuas, and Yorkies commonly develop MPL and often respond very well to surgical correction.
  • Large breeds: Surgery can be more complex due to body weight and bone structure. Outcomes are still good but may require more rehab and monitoring.
  • Age and activity level: Younger dogs recover faster and may benefit more from early surgery. Active dogs are often treated sooner to prevent injury to other joints.

Your vet will consider breed, weight, limb alignment, and lifestyle when recommending surgery. Even large dogs can do well with the right surgical plan and consistent follow-up care.

Is Surgery Worth It? Cost vs Outcome

For many dogs, MPL surgery is a long-term investment in comfort and mobility. While the upfront cost can be significant, the benefits are often life-changing.

  • Typical cost: MPL surgery ranges from $1,500 to $4,000 per knee depending on location, surgeon experience, and complexity.
  • Early intervention saves money: Addressing MPL before it worsens reduces the chance of arthritis or ligament injuries, which require more costly treatment.
  • Satisfaction and results: Most owners report high satisfaction. Dogs often return to walking, running, and playing with no pain and minimal limp.

While not every case requires surgery, it’s highly effective in moderate to severe cases or when quality of life is reduced. Discussing options with your vet can help you make a confident decision based on your dog’s needs and your budget.

FAQs

How do I know if my dog needs surgery for MPL?

Your vet will assess the severity (Grade I–IV), signs like limping, pain, or kneecap dislocation, and how much it affects your dog’s daily life. Surgery is usually needed for Grade III or IV, or if conservative care fails. A full exam, gait observation, and X-rays help decide if surgery is necessary.

Is surgery the only option for a Grade II luxating patella?

Not always. Some Grade II cases can be managed with rest, weight control, joint supplements, and physical therapy. But if your dog shows worsening pain or lameness, or the condition doesn't improve, surgery may still be recommended. Your vet will guide the best option based on how your dog responds.

Can a dog live a normal life without MPL surgery?

Mild cases (like Grade I) often don’t need surgery and dogs can live comfortably with conservative care. But moderate or severe cases may get worse without surgery, leading to pain, arthritis, or ligament injuries. A dog’s quality of life depends on how well symptoms are managed over time.

How successful is MPL surgery in dogs?

MPL surgery has a high success rate, especially when done early. Most dogs recover well, with reduced pain and improved mobility. Success depends on the dog’s size, the grade of luxation, and how well post-surgical rehab is followed. Reluxation or complications are rare but possible if care is inconsistent.

How much does MPL surgery cost on average?

The cost of MPL surgery typically ranges from $1,500 to $4,000 per knee, depending on your location, surgeon, and whether one or both knees are affected. Additional costs may include diagnostics, follow-up visits, and physical therapy. Some clinics offer financing or package plans to help manage expenses.

Is MPL surgery more risky in large breed dogs?

Surgery in large breeds may involve more challenges due to body weight and joint structure. While the risk of complications is slightly higher, outcomes are still good with proper surgical technique and rehab. Large dogs may need longer recovery and physical therapy, but many return to normal activity.

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