Last week I discussed the pathology and diagnosis of medial patella luxation (MPL), and today I would like to talk about some treatment ideas for these patients. First, let me disclose that if possible you should work closely with a certified canine rehab practitioner. Each case can be very different and a certified professional can develop a program tailored to your pet’s specific needs and recommend any supplements or medications that might help prevent long-term issues such as osteoarthritis. In addition, this is just a general guideline, and as we know rehab is not a one size fits all approach.
Post-op patients
In this case we should first start addressing any pain, inflammation and swelling in the stifle joint after surgery. The owner probably received instructions on icing and PROM upon the patient’s discharge from the surgeon, but it is always a good idea to review those procedures during the initial evaluation. Once that is managed the therapist should follow the same practice guidelines that we do with our human patients keeping in mind the phases of healing and starting with some isometric exercises as tolerated. Then, as tolerated progress through gait training and more advanced strengthening exercises. The goal should be to get the quadriceps muscles as strong as possible. If needed, the therapist can even use some NMES to the quadriceps. Later on, the underwater treadmill can be a great way to gradually increase the patient’s endurance and strength with gait.
Conservative Management
As discussed on the previous post, not every patient is a good candidate for conservative management of MPL. Unfortunately, at least to my knowledge as of today, there is no brace or orthotics that have successfully helped these patients. Also, I have personally tried different taping techniques but have not been successful either. The main issue I have encountered with taping was creating enough torque to keep the patella in place, even more so with small breeds. Even when I was able to tape unfortunately it didn’t stay on for more than a few hours at best. The main focus with conservative rehab is to focus on weight loss if needed and to strengthen the hind muscles as much as possible, especially the quadriceps. NMES to the quadriceps can also be an option but should be done by a professional. Progressing exercises to tolerance without aggravating the patella is key. The underwater treadmill can be really useful, starting with shorter sets and progressing time and speed to tolerance. Some treadmills even allow to set it up on an incline, which places more emphasis on the hind muscles.
Conclusion
If your pet has been diagnosed by your primary vet with a MPL the next step should be to get a consult with a certified rehab practitioner and with an orthopedic surgeon. They will be able to assess your dog’s individual needs and make the appropriate recommendation.