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Cornell Hoops Team Under Investigation

Cornell’s run in the Sweet 16 may be tarnished after reports surfaced today that all 13 players on the roster have been given elite educations that all but guarantee high-paying jobs after they leave the school.  “It’s important to remember that right now these are only allegations—allegations that we are looking into,” said NCAA president James Isch. “But, obviously, if true, this would be very disappointing. The NCAA has certain expectations and standards. It’s not fair for players at one school to be given expensive educations while athletes at other member schools receive basic, remedial instruction that is worth essentially nothing.”  According to documents seized from the school’s registrar’s office, Big Red players have received an education worth $39,450 per year—or $52,316 including room and board—totaling more than $200,000 over a four-year career.

Compare that to a player at a school like Kentucky, where tuition is set at $4,051—but with an actual value far below that.  “I don’t want to say too much until these reports are confirmed,” said Calipari. “But we’re talking about more than a $150,000 difference in education per player—and that’s even if my players stayed four years or graduated, which many of them do not. Then these Cornell players are reportedly stepping into six-figure jobs after graduation while my kids if they don’t make the NBA, have absolutely no job prospects or life skills. It’s far from a balanced playing field. They are buying the best players by giving them a high-priced education.”  In addition to the allegations that they were given an expensive education, many Cornell players have been spotted around campus holding books, studying and engaging in interesting conversations. Others have been seen with people who are known to not be tutors.  Cornell point guard Louis Dale, who is reportedly enrolled in the College of Human Ecology, denied allegations that the Big Red program is cheating. “The discourse on this matter is fatuous and inane,” he said, only implicating his program further….

Animal Rights is NOT the Answer

On the surface, the decision by the city of West Hollywood to classify pet owners as pet guardians seems reasonable and harmless.  So does the decision to pass city ordinances limiting or banning cat de-clawing, debarking, and tail and/or ear cropping.  Unfortunately, these seemingly innocuous and well-intentioned ordinances are indicative of a trend for the government to intrude upon the medical decision making that has always been within the domain of the doctor-patient relationship. In addition, these ordinances are only the first salvo being fired by the animal rights activists in an attempt to destroy organized agriculture, the utilization of animals for food and fiber, and the ownership of pets by the general public. Make no mistake about it, these decisions, under the guise of being politically correct, are being advanced by the animal rights groups to limit personal choice and animal ownership in general.

Before I delve into this subject any further, I should take this time to point out that I do not believe in routine de-claw, debark, or cosmetic surgery for its own sake. I just do not believe that governmental agencies should intrude upon the veterinarian-client relationship and criminalize certain medical or surgical procedures. In the 23 years, I have been a board-certified veterinary surgeon, I have witnessed innumerable instances where these types of “inhumane” procedures have resulted in an increased quality and quantity of life for both the pet and pet owner. I would agree that the performance of these procedures is controversial and should be limited in their application. I believe that the way to successfully reduce or eliminate the number of unnecessary procedures requested by pet owners is by educating the pet owner, not by a governmental mandate which would require a variance to be obtained by a pet owner before they could proceed. The key point here is that ethical veterinarians do not request that their patients be de-clawed, debarked, or otherwise subjected to unnecessary elective surgical procedures. It is the client that initiates the request 100% of the time.

The broader concern is where do you draw the line regarding the government’s ability to dictate what is acceptable medically and surgically in the veterinary community?  It seems reasonable that cats should not be de-clawed. I would agree that the client that wants their cat to be de-clawed because they are afraid of their drapes being shredded should have thought about this before owning a cat. It doesn’t take a brain surgeon to know cats like to use their claws. But what if the owner is geriatric and has recently been placed on cardiac medications which thin their blood. A cat scratch now becomes a valid medical concern. What is the lesser of two evils? Forcing the owner to give up their pet because it is illegal to perform a de-claw? What is the chance of a middle aged cat getting adopted from the shelter or from a rescue group? Are these people now forced to live without cats? Or is a safe, properly performed surgical procedure carried out which allows the human-animal bond to continue uninterrupted? What about a gay couple where one partner has recently been diagnosed with AIDS? A cat scratch in an immuno-compromised patient is a serious issue.  What is a veterinarian to do? Refuse to perform a surgical procedure that would allow the owner to more safely handle their pet? These may seem like extreme examples to the casual reader, but these types of scenarios play out in veterinary facilities on a daily basis. It should not be the role of local government to interfere with the veterinary-client relationship and dictate which procedures should be performed and which should not. This is but one of the reasons that each state has a Veterinary Medical Board. The American Veterinary Medical Association, together with the individual State Board of Veterinary Medical Examiners is in a much more logical position to propose guidelines for the practice of veterinary medicine.

This is especially true when the local government employees responsible for introducing these bills are extraordinarily biased and guilty of promoting an extremist animal rights agenda. It is not a coincidence that the city government first introduced a guardianship, rather than continued ownership for animals. Sounds reasonable. Why should any living thing own another? People should not be able to own animals, plain and simple. We can be their guardians, but not their owners. Sounds simple, but this simple change of wording has huge medical-legal consequences. Ask any lawyer the difference between owning something and being its guardian.

For instance, a client enters a veterinary hospital with a dog with a broken leg. Surgery is indicated to return the dog to at least good if not excellent function. The client declines surgery because of financial constraints. They elect for the limb to be splinted, or worse, elect to euthanize the pet. The standard of practice is surgical reconstruction. If these clients were legal guardians, the veterinarian would be legally bound to perform the standard of practice. Who pays for that? Does the veterinarian give the dog back to a “guardian” that declines the standard of care? A similar instance would be where the client elects for standard of care surgery, but upon being presented with the bill for services exclaims “I’m not the owner, I’m just its’ guardian”. Sounds far-fetched? Not really.

Imagine if an animal guardianship ordinance is passed somewhere in dairy country. In absolutely no time, an animal rights activist and a sympathetic policeman will approach a dairy farmer and claim he is an unfit guardian, in an attempt to shutdown dairy production. It is not a coincidence that these ordinances are first mentioned by the local government with regard to their application with companion animals. If mentioned first with regard to domestic agricultural animals, the intent would be too easily seen. The animal rights groups don’t want to be that obvious. The strategy is to establish “animal guardianship” as accepted legal jargon before moving on to the final solution, which is the destruction of organized agriculture and the abolition of pet ownership.

Why abolish pet ownership? Because pets can be abused by abusive owners. Why abolish organized agriculture and the utilization of animals for food, fiber, education, and recreational purposes? Because domestic animals can be similarly abused. That animals are not to be treated in a cruel and inhumane manner is a common belief among most, if not all, civilized societies. The shift toward greater legal protections for domestic animals is the result of many factors.  The industrialization of animal agriculture resulted in the implementation of large-scale food animal operations designed to efficiently produce large numbers of cattle, swine, and poultry for human consumption. It was a logical response to the legitimate concern for supplying the public with cheap and plentiful food. Animal cruelty was never intended. This agricultural model is now being questioned, and agricultural businesses are being increasingly called upon to make food animal welfare a priority. These businesses need to adjust accordingly to these ethical concerns. This adjustment is long overdue. The implementation of reasonable and ethical animal welfare practices is the answer, not the abolishment of animal agricultural practices and the extinction of domestic animals.

Companion animal welfare is equally important. It is beyond the scope of this article to address the value companion animals play in our lives. I take those truths to be self evident. Pet owners must be educated to accept greater responsibility and greater accountability for the welfare of their pets. The elimination of pet ownership is not the answer. The elimination of abusive pet owners, however, is the answer. The question is who does, as well as, where does one determine what constitutes an abusive situation? It’s obvious that a person who beats their dog is abusive. So is a person who leaves their dog outside unattended for extended periods without food, water, or shelter.  Is a person who declines an MRI for a dog with seizures abusive? Is a person who declines a hip replacement for their dog and relies on buffered aspirin for pain relief abusive? A phenomenal array of advanced diagnostics and treatment options are available now that a higher standard of veterinary care is easily accessible. Are pet owners who do not seek out these options abusive?

Here is why I’m concerned. Many well-intentioned people contribute time and money to well-known groups failing to realize that these groups may not be everything they seem. For example:

  • “Pet ownership is an absolutely abysmal situation brought about by human manipulation.” –Ingrid Newkirk, co-founder, PETA
  • “We have no problem with the extinction of domestic animals.”-Wayne Pacelle, Humane Society of the United States
  • “There is no hidden agenda. Our goal is total animal liberation.”-Ingrid Newkirk
  • “Even if animal research produced a cure for AIDS, we’d be against it.”-Ingrid Newkirk

The recent national exposure of PETA as a hypocritical and biased organization guilty of animal cruelty comes as no surprise to those who are familiar with the way animal rights groups operate. Their websites promote ending the abuse of companion and domestic animals and give numerous alternatives to the utilization of animal products. These are admirable and worthwhile causes and are why many well-intentioned people support these groups financially. The concern is that at animal rights conventions, these groups champion a much more radical and extremist mission statement. It is at these conventions that statements such as those listed above are made. Many financial supporters would in all probability think twice about contributing to these organizations if they were aware of this fact. The sad truth is that the organizations that these people are supporting in an attempt to end animal abuse would rather end animal ownership. It is my firm conviction that the way to end animal abuse is to end the ownership of animals by abusive people. In the United States today, animal ownership should be viewed as more of a privilege than an inherent right. Animal welfare (note: not animal rights) statutes should be vigorously updated and enforced such that those people that abuse companion or domestic animals suffer significant penalties and are prohibited from owning animals in the future. An extremist animal rights agenda is not the answer.

Finally, the media is beginning to shed light on the hypocrisy of these organizations. They enlist the help of prominent celebrities by touting their well-intentioned causes, only to turn on them the instant these celebrities support an organization they oppose. For example, an academy award winning actress and friend of mine and a long time supporter of PETA was chastised by this group for supporting AIDS research because some AIDS research requires animal testing. These organizations publicly lambaste those who do not completely adhere to their stringent animal rights philosophies. If you are wondering why I use the words “these organizations”, instead of mentioning them by name, is because I literally fear for the safety of my hospital and my staff. It is not beyond these organizations to harass, picket, and threaten their critics. This is the same reason why most veterinarians will not speak out against them even though many share my viewpoint.

Why haven’t these organizations publicly defamed other celebrity supporters who wear animal products, eat meat, and utilize products that have been tested on animals? The only answer that I can imagine is that they have not publicly supported organizations that conflict with an animal rights agenda. It would seem that they tolerate a degree of hypocritical behavior by their supporters so long as they do not lend their support to contradictory groups. But then again, I wonder how many celebrity animal rights supporters have also supported The National Milk Mustache “got milk?”® Campaign?  This campaign is jointly funded by America’s milk processors and dairy farmers. “The goal of the multi-faceted campaign is to educate consumers on the benefits of milk and to raise milk consumption.” This is an outright contradiction to the vegan and animal rights philosophies of the groups that have solicited these celebrities to represent their viewpoint. My point here is that there is a huge difference between supporting animal welfare and supporting animal rights. In my mind, this does not make these celebrities hypocrites; it establishes them as moderates who support animal welfare as opposed to animal rights. These celebrities, however, should distance themselves from these extremist organizations and embrace animal welfare now that is has become obvious that these animal rights groups are not what they profess to be. People need to be more aware of the differences between animal welfare and animal rights.

I believe that the mission statement of animal rights extremists is unrealistic and will never be accepted by the mainstream. These organizations have injured people mentally and physically for not strictly adhering to their extremist agenda. I would go so far to say that animal rights extremists are terrorists. They promote a world free from the utilization of animals in any way, shape, or form and want the entire world to support their view. Is it reasonable to believe that the entire planet could become vegan?

Not only is it unreasonable to expect the entire world to become vegan, it is unreasonable for these groups to expect all of their supporters to become vegan. I have attended numerous animal rights banquets where everything on the menu is “eggplant a la eggplant” only to overhear the main luminaries and celebrity hosts, not to mention the mainstream audience, make plans for “a real dinner” following the banquet. My point here is that supporting an animal welfare agenda is not synonymous with the abolishment of the utilization of animals for food and fiber. I do not understand why these groups pick and choose which supporters they allow to be hypocritical, when almost every person who supports animal “rights” issues still utilizes animals in some way, shape, or form.

A controversial issue amongst animal rights organizations is the utilization of animals for fur. What is the difference between farmed fish and farmed fur? Most people pride themselves on their choice of farmed seafood because it diminishes the depletion of the ocean’s natural resources. It is an excellent example of sustainable farming practices. Every part of the product is used, none is wasted or discarded. The same could be said for farmed fur. What is the difference between wearing a leather jacket or a mink coat? It may surprise you to know that the practices of the fur industry have changed. Mink, for example, is no longer trapped or hunted. The animals are farm raised and every part of the animal is used, none is wasted or discarded, just like the cattle industry. Do I personally wear mink? No, but a good point was raised by a furrier I met in Aspen. The alternative to natural fur is synthetic or fake fur, which is a product of the petroleum industry. Needless to say, the manufacturing of these synthetic fibers creates toxic pollutants as a by product. Using these petroleum based products causes more damage to our environment than the consumption of animal products.  Furthermore, petroleum is by no means a sustainable, renewable resource.

I wonder how many animal rights advocates own goose down comforters, pillows, or ski jackets, or wear leather or shearing or snakeskin or ostrich hand bags, belts, shoes, boots, or other accessories?  Don’t these so-called animal rights activists realize that these are animal products? While I take issue with the animal rights agencies, such as PETA, I whole heartedly support animal welfare. The differences between the two are distinct. The small, but vociferous group of adherents to the philosophy of animal rights views humans and animals as essential equals and condemns any and all use of animals for human benefit, no matter how humane. When the interests of humans and animals come in conflict, animal rights activists place the animals first. As PETA’s Newkirk explained to my friend “Even if animal research produced a cure for AIDS, we’d be against it.” Animal welfare is fundamentally different from animal rights, as it endorses the responsible use of animals. Animal welfare, as defined by the American Veterinary Medical Association Policy on Animal Welfare and Animal Rights is “the human responsibility that encompasses all aspects of animal well being, including proper housing, management, nutrition, disease prevention and treatment, responsible care, humane handling, and, when necessary, humane euthanasia.”  In endorsing animal welfare and rejecting animal rights, the AVMA takes the following position: “The AVMA’s commitment to animal welfare is unsurpassed. However, animal welfare and animal rights are not the same. The AVMA cannot endorse the philosophical views and personal values of animal rights advocates when they are incompatible with the responsible use of animals for human purposes, such as food and fiber, and for research conducted to benefit both humans and animals.”

In summation, my point is that animal rights and animal welfare are two different and separate approaches to a very grey area. If animal rights organizations like PETA want their message to be taken seriously by the mainstream population concerned about animal welfare issues, they need to relax their extremist agenda. Animal welfare supporters do not have to become vegan or disavow the consumption of animal products to prove their compassion for animals. As we have learned from religion and politics, extremist views walk a fine line between righteousness and terrorism.

The time is long overdue for a member of the veterinary profession to speak out publicly regarding the negative influence animal rights groups have had on animal welfare reform. Animal rights supporters, because they reject any use of animals, have purposefully interfered with the advancement of animal welfare reforms. Their reasoning is that any legislation which would improve the “plight” of animals improves the conditions under which animals would continue to be “exploited,” therefore making it more difficult to stimulate public opposition to animal use. This includes pet ownership. This last statement appears to be a contradiction to PETA’s mission statement, as PETA operates a shelter in its Norfolk, VA headquarters to help adopt abandoned pets. If one looks below the surface, however, PETA’s true mission statement is anything but about helping animals. I believe that the only reason PETA operates an animal shelter is to give the general public the appearance of caring about animal issues. In this way, PETA can reach out to the general public to plead for donations. If PETA actually cared about the animals in its care, it would be a “no-kill” shelter. A number of other shelters throughout the United States are “no-kill”, shelters which handle many more than just the 2000 animals a year that the shelter PETA operates in Virginia handles. Yet PETA admits to killing 80% on a yearly basis and has done so since 1998. In 2000, when interviewed by the Associated Press, Newkirk complained that actually taking care of animals costs more than killing them. She admitted “we could become a no-kill shelter immediately.” Ingrid Newkirk freely admits that this practice of killing is healthy for the animals “because it is better to be euthanized than to be a stray on the street.” I can only thank G-d that Ingrid Newkirk wasn’t around in Nazi Germany in the thirties and forties. I do not know who voted her judge, jury, and executioner but the adoption rate from her facility in Virginia is lower than the adoption rate from the shelters here in Los Angeles. Shelters that animal right’s activists openly describe as being amongst the worst in the nation with regard to the amount of animals killed on a yearly basis. I wonder if Ingrid ever heard the statement “people who live in glass houses shouldn’t throw stones?”  In case anybody missed this newsflash, PETA employees have recently been arrested in Virginia for killing healthy pets that could have been adopted. Not only did they kill them, they dumped their bodies in garbage bins to be picked up and discarded like just so much trash. What did the leader of this country’s most vocal animal right’s group offer? An apology? NO. Instead Newkirk made it clear that animal adoption is not her primary concern with regard to companion animals when she defended her operative actions explaining on CNN that “it is better to be dead than to be exploited by the pet owning public.”

PETA and other animal right’s organizations are guilty of totally misleading the general public about their true convictions. They strive to appear as warm, fuzzy animal lovers. They will even resort to shameless trickery to fool the unsuspecting public and unwitting celebrity sponsors in an attempt to plead for money to support their programs. It’s a pretty good scam. Set up a shelter to adopt out poor and unfortunate pets. Generate donations. Kill the majority of them, so you decrease your fixed expenses. Rationalize that it was better off for them to be dead anyway. Take the money and support the petrochemical companies. Pollute the planet. Threaten non-vegans with death. What a wonderful bunch of ethics. All to ultimately ensure their vision in vivid detail: a world of starvation and synthetics which never biodegrade. A world without any companion or domesticated animals. And you thought they gave a damn about animals.

Animal Rights and the Gulf Oil Spill: Their Silence is Deafening

It goes without saying that the ongoing oil spill into the Gulf of Mexico is a disaster of major proportions. In addition to the cost in human lives, the ecological impact may very well become one of the worst recorded environmental catastrophes in our nation’s history. While numerous experts, politicians, and agencies continue to debate the exact extent of the potential tragedy, one thing is already abundantly clear: The Humane Society of The United States (HSUS) could obviously care less.  Their silence is deafening.

It has been approximately three weeks since the Deepwater Horizon rig explosion off the Louisiana coast. Has anybody noticed that while numerous scientists, environmental groups, universities, federal agencies, and government officials have weighed in on the delicate coastal ecosystem at risk (including, but not limited to the National Oceanic and Atmospheric Administration, the California Oiled Wildlife Care Network at the University of California, the International Bird Rescue Research Center in California, the National Wildlife Federation, the National Oceanic and Atmospheric Administration, the American Bird Conservancy, the Louisiana Universities Marine Consortium, Texas A&M University’s Harte Research Institute for Gulf of Mexico Studies, Louisiana State University, the Maryland Department of Natural Resources , Texas A&M University’s Sea Turtle and Fisheries Ecology Research Lab, the University of Maryland Center for Environmental Science, the Louisiana Audubon Society, the Institute for Marine Mammal Studies), there had not been one word or reference to the plight of the marine birds, mammals, crustaceans, fish, and ecosystem imperiled by the spill uttered by the HSUS until May 6th? In that one paragraph blog, temporarily posted on its webpage, the CEO and President of the HSUS asked for “patience” in dealing with the spill and its environmental impact.  Not one negative word about the oil industry’s role in causing the problem and devastation was mentioned. In two weeks, that’s the best they could come up with? This coming from an organization that prides itself on going undercover to expose malevolent acts as blatantly as possible in order to garner as much public support to embarrass and shock these groups into changing the way they operate and conduct business?

The Humane Society of the United States considers itself the largest animal advocacy organization in the world. I guess the population of animals living in and around the ocean doesn’t count. Or could it be that the HSUS is allied with the oil industry and would therefore prefer to ignore the oil industry’s role in creating this particular environmental disaster?

Why would the HSUS be politically aligned with the oil industry? Could it have something to do with the fact that every alternative to utilizing animals for food and fiber is dependent upon petroleum products? Where do you think “fake fur” comes from? Could it be that the HSUS is not really an animal advocacy or animal welfare agency, but rather an animal rights organization?

On his daily blog, the President and CEO of the HSUS, Wayne Pacelle, exhorts “If you care about animals, you should care about the environment. To live and be healthy, animals need a healthy environment. And that’s one major reason why The HSUS celebrates Earth Day. Today, as you celebrate Earth Day and explore the many ways to lessen your impact on the planet, consider these actions to help animals and the environment.” This appeared on April 27th, 7 days after the oil-rig explosion in the gulf. Not one mention of this catastrophic event and its effects on the animals or the environment had appeared. Not one. Until one week later when he recommends “patience”.

The blog goes on to promote the HSUS’s wildlife care centers that purportedly rescue and rehabilitate wild animals, urges Congress to pass the International Whale Conservation and Protection Act, lists tips on how to help injured or orphaned animals, recommends visitors to the site to support the Disney nature documentary “Oceans” and to do your part to help save the oceans, and to watch the “Genesis Awards” which raise awareness of animal protection and environmental issues. Unless of course, the environmental issues raised are caused by the oil industry.

A true animal welfare and/or advocacy organization would not have an issue lambasting the oil industry for its less than stellar global record of polluting the planet. A true animal welfare organization concerned with animal protection and environmental issues would have joined the list mentioned above in expressing their concern for the plight of this endangered ecosystem. Unless of course, once again, you are not truly an animal welfare organization but rather an animal rights organization pursuing a veganism agenda, which is reliant on petroleum based products as an alternative to the utilization of animals for food and fiber. It’s never a palatable strategy to bite the hand that feed you.

Perhaps the Humane Society is humane in name only. Despite its public claim to ensure that animals are treated humanely and the environment is respected, the group’s values appear tilted towards an animal rights philosophy. There is no other reasonable explanation as to why the HSUS would remain totally silent while one of the worst potential ecological disasters threatens the largest coastal wetlands area of the United States. Hundreds of species of fish, birds, marine, and other wildlife are imperiled by this spill. Has the HSUS held the oil industry accountable in any way, shape or form?  No. Thank G-d Hurricane Katrina wasn’t caused by the oil industry. What will happen next with the oil spill? No one knows for sure, but even the most optimistic scenarios provide little hope that the coastal marshes and wetlands and the animals that inhabit them will escape unscathed. One thing is for sure, however. Because the oil industry caused it, the HSUS will be conspicuously absent in its criticism.

Management of Medial Patella Luxation in the Dog & Cat

Medial patella luxation (MPL) is one of the most common stifle problems encountered in veterinary medicine.

It is a more common orthopedic problem in the dog, but has been reported frequently in the cat.  MPL may be caused by trauma or congenital malformations (with the latter being far more common) or may occur secondary to fracture disease and/or surgical intervention. Congenital MPL is most commonly observed in the toy and miniature breeds of dogs and also in the Abyssinian and Burmese cats and causes minimal, if any, to severe gait abnormalities.  The degree of deformity and, therefore, subsequent dysfunction varies markedly within the affected population and within the approximately 50% of the patients with bilateral involvement. Many affected animals are presented at approximately six months of age with the owner describing a skipping or hopping type of gait or an animal that is intermittently non-weight bearing on one limb or the other. The problem is usually transient with the dog or the cat returning to apparently normal function within a short period of time. Although medial patella luxation may be present in cases with acute severe lameness, it is usually a chronic problem, and therefore, other causes of acute onset of stifle pain (i.e. cruciate ligament injury) should be carefully ruled out. Other animals are presented as adults with a history of acute onset of lameness with minimal trauma or with the frequently severe and complicated secondary stifle changes due to chronic abnormal stress.  There are also a certain portion of the affected population that present for routine physical examination with severe grades of MPL, to which the owner responds, “What do you mean he has bad knees, he’s never limped a day in his life.”

Various etiologies have been suggested for congenital medial patella luxation; however, it is generally agreed that MPL is a multi-factorial disorder of pelvic limb conformation.  Depending upon the severity of the individual case, various combinations and degrees of the following features may be observed: (1)intermittent or permanent medial patella luxation, (2)medial displacement of the quadricep’s group with or without muscular contraction, (3)limited extension of the hip and stifle, (4)decreased antiversion, (5)coxa vara, (6)external rotation and/or torsion of the distal femur, (7)internal rotational laxity of the tibia and/or medial torsion of proximal tibia and lateral torsion of the distal tibia, (8)medial displacement of the tibial tuberosity and crest, (9)real or artifactual lateral bowing of the distal femur with increased caudal and medial concavity, (10)lateral angulation or tilting of the femurotibial joint space, (11)shallow or absent trochlear groove, (12)femoral and tibial condylar asymmetry, (13)genu varum, (14)redundant or stretched lateral joint capsule, (15)contracted or inadequate medial joint capsule, (16)cartilage fibrillation or erosion on the articular surface of the patella, (17)erosion on the medial aspect of the dysplastic medial femoral condyle, (18)meniscal, cranial cruciate and lateral collateral ligament changes, and lastly, (19)degenerative joint disease.

While these derangements are common in cases of MPL in the dog, abnormal shape of the femur, tibia, or both has not been observed in cats with MPL.  Some cats, however, do exhibit shallow trochlear grooves and medial deviation of the tibial tubercle.  Because of the broad range of clinical lameness and degree of deformity present in this syndrome, no one surgical procedure is appropriate for all affected patients.  Numerous surgical procedures have been described for the repair of medial patella luxation, and determining the most effective combination of procedures to utilize is quite a challenge. The goal of surgery is to realign the quadricep’s extensor apparatus and to, therefore, stabilize the patella in the trochlear groove and return the animal to at least good, if not excellent function. A grading system, based on the severity and types of deformity present provides the basis for a rational surgical approach.  For each grade of malformation, the following discussion will present the surgical techniques and treatment rationale recommended for the treatment of MPL in the dog and cat at the current time.

Grade 1 MPL – The anatomy of the stifle joint is almost normal and the patella luxates only when the joint is extended and lateral digital pressure is applied; the patella reduces spontaneously.  Because these patients have a normal to near normal stifle joint, minimal if any clinical signs are observed when the animal is presented. It is difficult to recommend a surgical intervention on a clinically normal animal based on the assumption that these animals may be prone to future abnormalities and injuries, and it is my opinion that they are not operated unless they become clinically symptomatic.  In most, if not all, cases of Grade 1 medial patella luxation, all that is needed is the creation of a lateral restraint to prevent medial displacement of the patella.  This is accomplished by either lateral imbrication of the joint capsule or placement of an antirotational suture around the lateral fabelle and through a tunnel drilled in the tibial tuberosity.  In a small number of cases, a medial retinacular release may also be required.

Grade 2 MPL – The patella usually resides within the trochlear groove; however, it will luxate upon flexion of the joint (or digital pressure) and remains luxated until relocated by digital pressure or active flexion and extension of the joint. These animals usually present with some degree of gait abnormality because of the presence of some angular and torsional deformity, and degenerative changes are more likely to develop over time. In these cases, soft tissue procedures alone are usually not capable of restoration of function. A trochleoplasty, medial retinacular release, and lateral imbrication are usually sufficient to overcome the problem; however, if the tibial tuberosity is deviated medially, a tibial crest transplant is also indicated.

Grade 3 MPL – The patella is luxated most of the time, but may be reduced temporarily while the limb is extended.  The angular rotational and torsional deformities are more severe than in Grade 2 MPL, and a corresponding increase in clinical signs of lameness are observed.  All of the previously mentioned procedures will probably be necessary to correct Grade 3 MPL; however, the rotational instability of the tibia will still need to be addressed.  Placement of an antirotational suture around the lateral fabelle and through a tunnel drilled in the tibial tuberosity is usually indicated to help correct a Grade 3 MPL.

Grade 4 MPL – The patella is luxated period, and no amount of manual pressure of full limb extension will result in reduction.  Thankfully, this grade is the least commonly encountered, as the bony and soft tissue derangements are terribly severe and the previously mentioned techniques are inadequate to correct the problem. These cases usually require tibial and/or femoral corrective osteotomies to restore alignment of the stifle joint.  In the majority of cases, only a derotational proximal tibial osteotomy is required to correct the malalignment of the distal tibia and paw, which results from derotation of the proximal tibia by imbrication suture.  In some severe cases, however, a cuneiform osteotomy of the distal femur may be necessary to help further align the quadricep’s extensor apparatus.  As mentioned previously, as Grade 4 MPL is not encountered frequently; these corrective osteotomies are not usually necessary and should be used reluctantly, only in severe cases, and in my opinion, as a salvage procedure. These procedures should not be performed if there is the presence of permanent interarticular change (i.e. meniscal remodeling and/or cruciate or collateral ligament changes) as surgical intervention in an attempt to return the animal to more normal function may, in fact, make it worse, which brings us to another important point, namely, timing of the surgical procedure in order to achieve the best functional results.

Once clinical lameness has been recognized, surgical intervention is warranted. In cases where severe bone distortion is not a component of the problem, surgery should be performed early to prevent the continued degeneration of the joint, which normally occurs, and to prevent excessive strain and stresses from developing on the cranial and caudal cruciate ligaments, which will result in their further deterioration.  In those cases with evidence of bone distortion, early surgical intervention is a necessity, as the effects of continual growth distortion cannot be ignored.  In regard to specific surgical technique, the aforementioned procedures are relatively straightforward with the exception of the corrective osteotomies.  The only real choice to be made is how to perform the trochleoplasty.  The older, more standard procedure requires excision of trochlear cartilage and some subchondral bone to achieve proper trochlear depth and maintenance of patella alignment.  As hyaline cartilage does not regenerate, the exposed bone which results is fast covered by granulation tissue which undergoes metaplasia to fibrous tissue and finally fibrocartilage, which is frequently thin, incomplete and of variable quality. With the advent of the more advanced techniques currently available, this approach can no longer be recommended.

A second technique relies on elevation of the trochlear cartilage and removal of subchondral bone with subsequent replacement of the hyaline cartilage. This technique is applicable to dogs under 5 months of age, as cartilage elevation becomes more difficult as the animal ages, as the articular cartilage adheres more tightly to the underlying subchondral bone.  In the trochlear recession wedge technique, the femoral trochlea is depressed while maintaining the normal hyaline cartilage surface, and has provided excellent results in dogs of all ages.  An advantage of the recession wedge technique is that trochlear patella articular cartilage contact is maintained, accounting for a quicker return to full function of the limb.

Most recently, trochlear block recession (TBR) has been described in the veterinary literature as an alternative to trochlear wedge recession (TWR). In this technique, the surface of the recessed osteochondral block is rectangular, rather than a wedge which tapers to a point proximally and distally. The rectangular shape preserves a larger area of hyaline articular cartilage as well as a greater width to the trochlear recession proximally. Therefore, the value of this procedure is its ability to increase proximal pafuctellar depth, increase patellar articular contact with the recessed proximal trochlea, recess a larger percentage of the trochlear surface area, and to better resist patellar luxation in an extended position as compared with TWR.

The TBR was proposed as an alternative to the TWR as a method to increase recession of the proximal trochlea, which is important in the clinical treatment of patellar luxation. With the limb in a flexed position, there are no significant differences between TWR and TBR. As the patella most easily luxates when the stifle is extended and the patella is in a more proximal location within the trochea, performance of a TBR will increase proximal patellar depth and therefore increase patellar articular contact with the recessed proximal trochlea to better resist patellar luxation with the limb in an extended position as compared with TWR.

In conclusion, a variety of surgical techniques are available for correction of the various grades of medial patella luxation and a combination of procedures is usually necessary to optimize return to function.  Once clinical lameness is observed, rapid surgical intervention should be considered to help prevent the often-severe debilitating soft tissue and orthopedic changes, which result in premature development of degenerative joint disease.

The utilization of medical therapy in conjunction with surgical intervention affords the best clinical response. Medical therapy should include but not be limited to the administration of pain management medications (opiods and opiod transdermal patches, non-steroidal anti-inflammatories), neutraceutical supplements (glucosamine, chondroitin, msm, etc), polysulfated glycosaminoglycans (Adequan), acupuncture, physical therapy, Class IV laser therapy, and platelet rich plasma administration. With proper medical and surgical intervention, the majority of animals with patella luxation tendencies can be returned to at least good if not excellent, normal function.

Management of Medial Patella Luxation in the Dog & Cat