I just wanted to say thank you so much for fixing Max's leg and for the care and treatment you have given him. Thank you for all the wonderful work you have done...

The patella (knee cap) doesn’t sit in the centre of the groove on the lower femur. This is because three structures are not in a straight line:
When the patella is out of the groove, the groove becomes shallower, or the ridge may be worn away, making the problem worse.
Causes include genetic factors, trauma or ligament problems but often cannot be tracked down precisely in any one dog. May dogs may have a combination of several causes.
The patella rubs on the edge of the ridge or the rough bone to the side of the ridge. This wears away the cartilage, eventually causing pain and arthritis.
If ligament damage is also present, different or additional surgical treatments may be required (see Tibial Tuberosity Transposition Advancement).