Combined ACL & Patella Luxation Repair

When diagnostic imaging and orthopedic examination confirm both conditions are present and clinically significant, combined repair is generally preferred over staged surgeries. Leaving one problem untreated while the other heals prolongs the period of abnormal mechanics, increases arthritis progression, and often means the pet is taken back to the operating table weeks later. In smaller dogs the lateral fabellar suture technique for the cruciate is commonly paired with trochleoplasty and tibial tuberosity transposition for the patella — all performed through the same surgical approach to minimize tissue disruption. The exact technique combination is determined at the surgical consultation.

The combined repair is performed under general anesthesia with full monitoring. The sequence typically follows:

• The knee is entered and the joint is inspected — the extent of cruciate tearing and any meniscal (cartilage) damage is documented and addressed
• The cruciate repair is completed first (lateral fabellar suture or a tibial osteotomy technique based on the dog's size and slope), stabilizing the joint against front-to-back shift
• The trochlear groove is deepened (trochleoplasty) to provide a proper track for the kneecap
• The tibial tuberosity (the attachment point of the patellar tendon) is repositioned and secured with pins and wire to realign the quadriceps pull
• Soft-tissue capsule adjustments balance medial and lateral forces around the knee

The surgical plan is prepared in advance based on X-rays so the two repairs are coordinated efficiently.

Pre-operative X-rays of the stifle (knee) assess cruciate status, the degree of patellar groove shallowness, and the alignment of the tibial tuberosity. Pre-anesthetic bloodwork screens organ function before anesthesia. If your dog is overweight, even modest weight loss before surgery reduces intraoperative and recovery-period stress on the joint. Fast your pet from food the evening before (water is usually fine up to a few hours prior), and the surgical team will confirm which medications to continue or pause. Setting up a small, non-slip recovery area at home in advance means one less thing to scramble for on discharge day.

Because two repairs heal simultaneously, adherence to the activity plan is especially important — cutting corners risks compromising both. A typical recovery timeline:

• Weeks 1–2: strict confinement; short leashed outings for bathroom only; cold packing the knee to reduce swelling; pain and anti-inflammatory medication as directed
• Weeks 3–6: controlled leash walks with gradual distance increases; no jumping, running, or stairs; follow-up exam to assess healing progress
• Weeks 6–10: recheck appointment evaluates stability and kneecap tracking; graduated return to normal activity as cleared by the surgeon

Weight management during and after recovery is one of the most impactful things owners can do — extra body weight substantially increases stress on small knee structures and slows healing.

Combined repair carries the surgical risks of both individual procedures — infection, implant-related complications, re-luxation of the patella, and potential late meniscal injury. Because more steps are performed in one sitting, the anesthesia time is somewhat longer, which is factored into the pre-operative risk assessment. The majority of patients do very well, often recovering more smoothly than expected because both sources of pain are resolved together. Arthritis already present in the joint will not regress, but its progression is typically slower once normal alignment is restored. The surgeon discusses individual risk factors at the consultation so owners can make a fully informed decision.