Management Plan:

	Titan has a grade II patellar luxation, characterized by an intermittant non-weight 
bearing lameness, which is best managed with surgery.  The surgical treatment should 
focus on replacing the patella into the trochlear groove and ensuring that it remains in this 
position.  The extensor apparatus should also be realigned.  Two concurrent surgical 
procedures, a release incision and tibial tuberosity transposition, should be recommended 
to the client.  Grade II luxations have the best prognosis when these two surgeries are 
combined.  The release incision relieves the tension on the patella from the joint capsule 
by loosening the joint capsule on the side of the luxation.  Therefore, the joint capsule 
would be loosened on the medial side of the right stifle joint.  The tibial tuberosity 
transposition is performed because a medial patellar luxation causes the tuberosity to 
form abnormally on the inside of the stifle joint.  In this procedure, the tuberosity is 
excised from the tibia then secured in its correct position with a pin.  While the stifle joint 
is exposed during the surgery, care should be taken to examine other structures in the 
area, such as the cruciate ligaments, to look for any signs of degeneration or trauma that 
might need further attention.
	Titan should also not be allowed to jump on and off beds or other high places 
after the surgery since the left patella could also luxate in the future or the repaired right 
stifle could be damaged again.  Her owners should also strive to prevent Titan from 
becoming obese as obesity would put extra stress on her fragile stifle joint.
	We do not recommend postponing the surgery since patellar luxations alter the 
joint mechanics and predispose for the formation of arthritis.