╨╧рб▒с>■  (*■   '                                                                                                                                                                                                                                                                                                                                                                                                                                                ье┴ ┐┌ jbjbjкjк ╚╚┌       ]ввввввв╥╥╥╥╥ ▐ ╥│ъЎЎЎЎЎЎЎЎprrrrrr,ЭЇС6ЮвЎЎЎЎЎЮввЎЎЎЎ╛вЎвЎp╢─ввввЎpjpввpъ l│╢╥╥┤RpHypothesis 1: Medial Patellar Luxation due to traumatic injury to lateral supporting soft tissue structures Titan, being a small breed, female, and obese dog possessed predispositions to this condition. As a result, when Titan jumped off of the bed, the mild trauma induced by landing would be enough to cause noteable injury. She may have landed abnormally , thus placing an unusual amount of stress on her right stifle joint. A lateral displacement occurred due to an excessive amount of external rotation, thus damaging the lateral supporting retinacular structures. This would cause the patella to luxate medially in that the counteractive force exerted by the lateral structures on the medial structures would be reduced. Ligaments are composed of regular connective tissue bands that are arranged into bundles. These bands are primarily collagenous in nature with limited elasticity. Thus, they can only be stretched to a limited degree before fiber damage occurs. In this case, the tensile force exerted on the lateral patellar ligament exceeded the ligamentТs elasticity, thus tearing some of the fibers. Consequently, an irreversible elongation occurred that resulted in decreased cross sectional strength of that area. At this acute stage, Titan came up lame with pain as a result of the mild inflammatory response associated with the sprain and possible injury to the other retinacular structures (i.e. joint capsule, fascia lata, aponeuroses of biceps femoris and vastus lateralis muscles). Over the next few months, healing occurred involving the replacement of damaged fibers with fibrous connective tissue. In general, greater distances between intact fibers results in more scar tissue, and a weaker healed ligament. Thus, the joint is predisposed to further similar injury. At this point, TitanТs injury can be considered chronic. Regional soft tissue structures are generally not as painful and inflammatory characteristics are much reduced. The joint capsule becomes thickened, as a result of continuous hyperplastic and hypertrophic processes stimulated by chronic joint instability. This is in accordance with the medial buttressing found on exam. Very minor trauma could have caused aggravation of the already compromised joint, resulting in a recurrence of lameness. The pain response elicited on exam of the left leg may be from continuous compensation for the lame right leg or an artifact of the patientТs disposition. 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