Medial Desmotomy in Dogs

Medial desmotomy is a surgery in which ligaments are severed and potentially redistributed. Desmotomy is a common surgical practice in both humans and animals, with its most typical utilization being for patellar luxation, or floating kneecap. Veterinarians will suggest desmotomy surgery for dogs experiencing discomfort or disruption of their everyday routines due to patellar luxation. As the surgery is not around or near any major organs, it is a popular procedure with low-risk probability. 

Medial desmotomy is recommended to canine patients suffering from stage three, four, and sometimes two of patellar luxation. The four stages of this complication denote a level of severity. The goal of the treatment is to return the kneecap to its usual function, relieving the dog of their discomfort and inhibited mobility. This is achieved by releasing tension in or tightening the ligaments surrounding the kneecap.

Pre-Operative

The first step to treating patellar luxation by way of medial desmotomy is to visit a veterinarian. Most veterinarians who observe a canine patient in grade one or two of MPL or LPL will not recommend surgery, but prescribe tramadol (for pain) coincided with non-steroidal anti-inflammatory medications. However, if a lesser grade is unsatisfactorily treated with prescription or grades three or four are diagnosed, then medial desmotomy is scheduled. X-rays will show the veterinary surgeon what their likely course of action will be during operation. 

Day of Surgery 

Before surgery, your dog will need to undergo bloodwork and urinalysis; these tests help predict any possible complications in surgery so that veterinarians can anticipate issues and therefore control. Anesthesia is administered and the dog is placed on its side. The ligaments that help keep the kneecap in place and promote proper movement of the leg are either tightened or loosened. 

To successfully treat MPL or LPL, veterinarians may perform more than medial desmotomy during surgery, depending on each individual case. It is not uncommon for tension band wires to be placed or reconstruction of soft tissue to occur during the operation. During surgery, the veterinary surgeon may correct the kneecap by carving and deepening the trochlear groove, a crevice located on top of the femur that the kneecap naturally is cradled in. 

Post-Operative 

After being bandaged up, the dog will undergo a night’s stay with routine observance from veterinary staff. Once it’s established that the pet is on their way to a safe, healthy healing process, they’re released with specific instructions to owners. 

The effectiveness of medial desmotomy depends on pre-existing conditions. Veterinarians will typically discuss the predicted outcome of the operation; for grades two and three, medial desmotomy’s results are good to excellent, with grade four of patellar luxation having a fair outcome. If arthritis or scar tissue began to form pre-operatively, then the dog is likely to see less satisfactory results.

Additional surgical procedures may be necessary to right the wrongs caused by patellar luxation: lateral fabellar suture, fibular head transposition, distal femoral osteotomy, tibial tuberosity transposition. Often these are performed alongside medial desmotomy to ensure the highest rate of success. After surgery, a dog is likely to see their leg(s) return to normal function after six to eight weeks. Medication and physical therapy are sometimes necessary additions for the animal to experience long-term effects. It is rare for dogs to re-injure their kneecaps after surgery, occurring in less than 6% of cases. 

Canine patients are on strict instructions to avoid exercise during the first six weeks following surgery. In most cases, recovery will last at least eight weeks, during which prescribed pain, anti-inflammatory, and sometimes antibacterial medications are administered. Post-operative check-ups will be scheduled typically two to three weeks, as well as six to eight weeks out. 

Physical therapy is key to the recovery process and helps the dog warm up to their leg(s) which is likely to feel foreign to them. Swimming, alongside simple physical therapy tactics, are enough to promote healing and avoid any adversities. A veterinarian will suggest these steps three weeks post-operatively.  

Surgery to correct patellar luxation can cost between $2,200 and $2,800. Other surgeries which may be recommended in addition to or in place of medial desmotomy, such as tibial plateau leveling osteotomy (TPLO), can be a $4,500 expenditure. Each of these costs are per leg, so the amount could be doubled if your pet is experiencing issues with both kneecaps.

These estimates are based on the operation alone and do not include pre-operative exams or post-operative medications or physical therapy. Radiographs or x-rays to obtain images of the abnormal knee(s) are in the $100 to $180 range. Physical therapy rates vary depending on the recommended number of visitations and durations. A pet-owner should expect to pay around $100 to $150 for the first visit and between $50 and $80 per visit thereon afterward. 

Medial desmotomy is a relatively non-invasive procedure and because it does not occur near or around any major organs, it is also relatively low-risk. Postoperative side effects are rare, as well, as long as the recovery process is adhered to. A small percentage of pets may experience adverse effects after surgery, such as:

• Bacterial infections: Signs of improper healing in the knee should be immediately reported to your veterinarian so medications can be prescribed. These will subside this adverse effect within a week or two.
• Pin breakage: If pins were utilized during surgery to help alleviate patellar luxation, it’s possible for them to come loose or break. However, this can be avoided by following aftercare instructions, such as ensuring your dog avoids stairs, running, or slipping on an ungraspable surface. 

Noticing and operating on a floating kneecap(s) is essential to protecting your dog from developing arthritis. Once arthritis takes shape in a dog’s leg, the damage and discomfort they’ll feel is irreparable.

Since patellar luxation is chiefly hereditary, there’s often little a pet owner can do to prevent it. However, promoting a healthy lifestyle can be holistically beneficial for your dog and hopefully keep other medical conditions at bay. Any of the preventative measures listed below may help patellar luxation be avoided.

Manage Weight

Any extra weight on a dog is added pressure to the joins, particularly the knees. To avoid knee surgery, keep your dog on a healthy diet and exercise regimen. 

Consider Supplementation

With the approval of a veterinarian, seek supplements for your dog. Omega-3 fatty acids are a natural anti-inflammatory and can also promote collagen development. Anti-inflammatories will especially help in dogs experiencing grade one or low grade two of patellar luxation as it relieves pain. Dandelion, an anti-inflammatory, and alfalfa, which eases symptoms of arthritis, are other supplementations to discuss with your dog’s veterinarian. 

Commit to Routine Exams

Never miss an annual or bi-annual visit to the veterinarian, and if you have a worry or inkling that your pet may have patellar luxation, request a radiograph or the knee(s) in question. Ask for a diagnosis, as knowing whether the condition is grade one or grade four will help with prognosis and healing.