Maltese Patellar Luxation: A Guide to Symptoms by Stage (1–4) and Surgical Timing

JointBreed HealthMeongsiljang Veterinary Advisory Board

The Maltese is one of the small-breed dogs most commonly affected by patellar luxation. Here’s a comprehensive overview of the symptoms and management strategies for each stage (1–4), as well as the criteria for surgical intervention.

Why Are Maltese Prone to Patellar Luxation?

Maltese dogs are a small breed particularly prone to patellar luxation, a condition where the kneecap slips out of place. The key is to adjust care habits at the earliest stages. Because Maltese have a shallow groove at the end of the thigh bone and a slight inward bowing of the leg bones, if you notice your dog walking with a skipping gait or lifting its hind legs, suspect patellar luxation stage 2 or higher. With early detection and proper weight and muscle management, it’s possible to maintain symptoms without surgery.

Anatomical Factors That Put Maltese at Higher Risk

According to veterinary internal medicine textbooks, patellar luxation results from a combination of factors, including femoral varus (an inward angulation of the thigh bone), a shallow trochlear groove (the track the kneecap slides in), an inwardly tilted tibial tuberosity, and imbalances in the tension of surrounding muscles and ligaments. Maltese dogs tend to exhibit these structural weaknesses more prominently due to their slender bones and lower muscle mass relative to their body weight. Because patellar luxation can occur bilaterally, it is important to evaluate the opposite knee as well when one side is diagnosed.

Symptom Checklist by Stage

You can get a general idea of your Maltese’s patellar condition by observing their behavior at home.

Stage 1: The knee appears normal during everyday activities, but the patella slips out of place when pressure is applied and returns to its proper position on its own.

Stage 2: Your dog occasionally lifts a hind leg and hops for a few steps before resuming normal walking.

Stage 3: The patella frequently dislocates and requires manual manipulation to be pushed back into place. Your dog may walk with an O-shaped stance, splaying their legs outward.

Stage 4: The patella is permanently dislocated, leading to bowed legs and an abnormal sitting posture.

Comparison of Patellar Luxation Stages 1–4

Comparison of Management and Treatment Guidelines by Stage

Item	Grade 1	Grade 2	Grade 3	Grade 4
Representative symptoms	Asymptomatic	Occasional skipping gait	Frequent luxation/bow-legged gait	Constant luxation/limb deformity
Pain	Usually none	Usually painless intermittent lameness	May be present	May be present
Basic management	Weight/muscle management	Slip prevention/exercise control	Activity restriction/veterinary consultation	Immediate veterinary consultation
Surgery recommendation	Usually not needed	Consider if painful/recurrent	Strongly consider	Strongly recommended

The actual assessment is determined by the veterinarian based on a combination of radiographs and gait evaluation.

Signs That Require Immediate Veterinary Attention

If your dog is unable to bear weight on its hind legs, cries out when sitting or standing, or shows weakness in both hind legs simultaneously, the condition may have progressed to stage 3 or 4, or another joint disease may be present. In particular, Maltese dogs often experience cranial cruciate ligament rupture alongside patellar luxation, and studies report that 15–20% of dogs with patellar luxation ultimately develop cranial cruciate ligament rupture. If sudden lameness occurs, it is important to seek an orthopedic examination as soon as possible.

Indications for Surgery and Surgical Approaches

Orthopedic surgery textbooks consider dogs with clear pain and functional impairment in stage 2 or later, or those in stages 3 and 4, as candidates for surgery. For Maltese dogs, the commonly used approach combines trochleoplasty, which deepens the shallow trochlear groove to stabilize the patella; tibial tuberosity transposition, which moves the inwardly displaced tibial tuberosity outward (in some cases); and soft tissue realignment, which tightens the stretched joint capsule and lengthens the opposite side. Combining these techniques results in a lower recurrence rate than using a single method alone.

A veterinarian examining a Maltese dog's knee

Home Management Strategies to Prevent Recurrence

Regardless of whether surgery is performed, Maltises require lifelong management.

Weight management: Maintain a standard weight range. Excess weight increases the load on the knee joints and can worsen symptoms.

Floor management: Place anti-slip mats on hardwood or tile floors to prevent sudden stops and slipping.

Jumping restrictions: Install steps to prevent jumping off sofas or beds.

Muscle strengthening: Regular walks on flat ground are recommended, and hydrotherapy can be used as a supplementary exercise to reduce joint stress.

Nail and paw hair trimming: Trim every 2–3 weeks to maintain proper traction.

Key Points for Maltese Owners to Note

In addition to patellar luxation, Maltese dogs can also suffer from small-breed-specific conditions such as Legg-Calvé-Perthes disease (avascular necrosis of the femoral head) and tracheal stenosis. If your dog shows persistent hind limb lameness, don’t focus solely on the kneecap—make sure to also get hip X-rays. In young Maltese, if one hind leg is consistently limping, Legg-Calvé-Perthes disease should not be ruled out.

Reviewed by a veterinarian

Dr. Tony — Punnawat Phongkittirak

Veterinarian

A veterinarian who majored in veterinary medicine at Khon Kaen University, Thailand, and completed the IVSA program at North Carolina State University in the United States. Drawing on clinical experience at animal hospitals, he works in the pet healthcare field and is dedicated to building a digital care environment that connects pet parents with veterinarians.

Frequently Asked Questions

Does stage 1 mean surgery isn’t necessary?

Stage 1 is mostly managed through weight, muscle, and environmental care. However, it’s a good idea to regularly check with your veterinarian to monitor whether the condition is progressing bilaterally.

Can supplements help?

Ingredients like glucosamine, chondroitin, and omega-3 fatty acids, which support cartilage health and help reduce inflammation, are sometimes used as complementary aids. Since they are not standalone treatments, we recommend consulting with your veterinarian before using them.

Will surgery cure the condition?

The recurrence rate varies depending on the surgical technique, surgeon’s expertise, and postoperative care. Even after surgery, lifelong weight and muscle management is essential, and you should continue to monitor the opposite leg for any signs of the same condition.

My puppy only lifts and lowers its leg. Should I take it to the vet?

If you repeatedly notice a skipping gait, there’s a possibility of stage 2. I recommend having an orthopedic palpation exam done, even if there are no signs of pain.

At what age do symptoms typically appear?

Maltese dogs can show signs of patellar luxation at a relatively young age. Be sure to have your vet check their knees during regular growth-stage checkups.

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References

[1] Textbook of Veterinary Orthopaedic Surgery, Chapter 11: Patellar Luxation

[2] Clinical Medicine of the Dog and Cat, 4th Ed — Patellar Luxation Pathophysiology

[3] 100 Top Consultations in Small Animal General Practice, Ch.45