NYVSC Logo

New York
Veterinary Specialty
and Emergency Center

Educational Handouts

Click below for PDF educational materials, and forms.

Your pets stay at nyvsc

HERE IS WHAT TO EXPECT

So your pet is going to be staying with us (admitted to the hospital): Whether it is for an elective surgery or a life-threatening emergency, when your pet is admitted to the hospital, it can be frightening and leave you full of anxiety. It can be stressful, both emotionally and financially, so we hope this video will help take away a little of the unknown. If your pet will be having surgery, after you watch this video we suggest you watch the next one, which goes over surgery visits in more detail.Make sure you have our contact information on hand. There is a print version of this document from the front desk, or on our website under the 'Client Education' tab. 

Our Contact information:

Phone: 631-694-3400
Fax: 631-694-3401
Email (doctors): vets@nyvsc.com
Email (office): office@nyvsc.com
Website: www.nyvsc.com

Our Hours:

 We are here 24 hours a day, 7 days a week, including all holidays. Call during weekdays to set an appointment with one of our specialists. Non-Emergency Admission Hours: 8am – 9am. You may drop-off earlier, or even the night before, at no additional cost.

Visiting hours: 

4pm – 7pm. Any visits outside of these hours are at the discretion of the doctor on duty. Orthopedic surgery patients may not have visitors for the first 24 hours. The safety and medical care of all of our patients, clients, and staff is vital to us. As such, if visitors will inhibit our ability to care for any patient or anyone’s safety, we will restrict visitation. Visits are always at the discretion of the doctor on duty.

Discharge hours:

3pm – 6pm. Pick-ups outside of these hours are possible, but may take longer. Please call ahead. We never can anticipate emergencies coming in. Even if you are told it is a good time to visit or pick up your pet, things can change in minutes. Please be patient, as our primary concern is our patient’s care.

Shift Changes:

8am & 8pm. Doctors and technicians are in “rounds” discussing all hospitalized patients. This can take up to an hour. Emergencies, of course, will be seen at any time, but all other visits and calls should be avoided during these times. If you must come in at that time, please try and let us know and anticipate a longer wait time.

Communications:
  • Calling to check on your pet. You can call anytime day or night, but if you are calling in the morning to check on a pet that was here overnight, you should call after 10am.
  • We will only discuss your pet’s records or care with an authorized person. If you are granting permission for us to discuss care with a person not listed in our records, you must tell us who and for how long we can do so.
  • If there is more than one person responsible for care, please contact us together so that information can be consistent and decrease changes of miscommunication.At the time you admit your pet, you will be required to leave a deposit of 75% of the low end of the estimate.
Finances:
  • At the time you admit your pet, you will be required to leave a deposit of 75% of the low end of the estimate.
  • If you pet stays longer or requires additional care that was not on the original estimate, you will need to come in to sign a new estimate. At that time, you will need to pay for services performed up to that time, plus leave another deposit of 75% of the low end of the new estimate.
  • Payment is due in full at discharge. When you pick up your pet, you are required to pay the full balance. There are no payment plans currently available.
  • You must determine payment methods when your pet is admitted.
  • We will help you apply for a CareCredit credit card if you wish.
  • Payment arrangements must be made prior to pick up.
  • When you drop off your pet with us, you need to leave:
  • Any medications they are currently taking
  • A completed Admit Form
  • Any special foods or treats (which is optional)

We recommend that you NOT leave: Any leashes, collars, carriers, or any other personal items, as we cannot guarantee their safe return.

We will place an ID band on your pet in place of their collar at the time of admission.

Be sure you have completely filled out all paperwork. Double check that we have any phone numbers needed to be able to reach you! Answer all questions marked as “* required”. Let us know if it is okay to take pictures to share with others. 

Ask questions if anything is unclear.

When you sign the “Release and Authorization”, you are verifying:
  • You are over 18 years of age and are the owner or owner’s authorized agent for the animal listed on the next page.
  • You have the authority to execute this consent.
  • You have read and understand the above information.
  • You understand that all fees are due in full at discharge.
  • You understand and have answered all questions to the best of your abilities.
  • You understand there is a risk of post-operative infection, and that you are responsible for the cost of it’s treatment.
  • You understand that no guarantee or warranty can ethically or professionally be made regarding results or cure.
  • You understand that NYVSC cannot guarantee the return of any personal items left with your pet.
  • You understand that unforeseen conditions may be discovered that necessitate altering medical care.
  • You understand that the services you are consenting to have inherent risks.
  • You consent to the hospitalization of your pet, and authorize the doctors and staff of NYVSC to administer any tests, medications, anesthesia, or surgical procedures deemed necessary for the health, safety, and well-being of your pet.
  • You have read and understand this “Release and Authorization”, and are aware that it will apply to all future admittance.

Finally, the Life-Sustaining Efforts Directive. If you pet suffers cardiac or respiratory arrest, we will always take action to revive them, but we need to know your wishes of how far to go in the effort. All patients must have this section filled out to be admitted. Choose only one.

CPR: Yes, Resuscitate.

YES! Use any and all medically sound actions to revive my pet as long as hope remains. I understand that the costs of these attempts cannot be predicted, and accept the financial responsibility.

DNR: Do NOT Resuscitate.
  • NO! Let my pet pass as peacefully as possible
  • I accept all risks, including the death of my pet, ad take full responsibility for declining any attempts to resuscitate them.
CPR with restriction: Resuscitate with Financial Limitations.
  • Continue resuscitation as long as hope remains.
  • Attempt to resuscitate, but stop all life-saving efforts when the costs exceed the pre-set amount (resuscitation cost only).

Be aware that when resuscitation (CPR) is attempted, it will likely add a minimum of $600 to any invoice.

Thank you for trusting us with your pet’s care.

SURGERY AT NYVSC

HERE IS WHAT TO EXPECT

.Once you’ve made the emotional decision for your pet to have surgery, the most difficult thing you face is the unknown. This video is meant to try and ease some of the anxiety by helping you to be as informed as possible. That being said, there is nothing more valuable than your conversations with your surgeon. Be sure to let them know when there is anything you’re having difficulty understanding. It also can be helpful to write down your questions beforehand so that you don’t forget anything during your consultation.

Summary:
  • Pre-surgery exam and diagnostics are needed.
  • Be sure your surgeon knows all medications your pet is on
  • Stop food at midnight & pick up water when you wake up
  • Continue all medications as normal unless otherwise directed.
  • Drop off early in the morning or the night before at no extra cost
  • We will be shaving your pet’s fur in various locations
  • Your pet may not be hungry for a couple of days after surgery
  • Post-surgical care will focus on pain management & avoiding infection
  • After care is vital for your pet’s recovery
  • An e-collar can keep them from chewing at their surgery site
  • Ask any questions about your pet’s medications and/or treatments
  • Let us know right away if there are any concerns
Pre-Anesthetic Exam, Blood Work, and X-Rays: 

It is vital that prior to any anesthetic procedure, we have an up-to-date physical examination and blood test results. A pre-surgical physical exam will always take place the same day as the surgery. The blood work will allow the doctor to identify potential concerns and help them make adjustments to provide the safest care possible. How close to the day of surgery this blood work must be performed can vary depending on the patient’s age and health status. Regardless, all pre-operative blood work must be done within one month of the surgery. Your surgeon will let you know how close to the procedure it must be performed. Pre-operative blood work and some x-rays can also be done at your regular veterinarian.

The Night Before the Surgery: 

Any medications that your pet is currently taking should be continued as normal unless specified by your surgeon. Be sure to make a list of what your pet is taking, when and how they are taking it. Food and Water: Feed your pet as normal and then pick up any food or treats at midnight. They can still have some water overnight, and remove the water when you wake up. Patients should not have a full stomach when they arrive.

On the day of surgery: 

The time of surgeries are established after all pets have been admitted that day. The times may be altered in the event that an unexpected emergency arrives. We request an early drop off so that we can begin pre-surgical procedures. Why are we shaving so much of your pet’s fur? We must shave the sites completely in order to be able to properly sterilize the surgical site, as well as for the IV catheter & other locations.

Once they start waking up: 

After the surgery, the surgical technician will transfer your pet to an assigned kennel, and continue to monitor them as they awaken from anesthesia. The breathing tube will be removed during this time. There can be soreness or discomfort for a day or two from the endotracheal tube. That can make some patients reluctant to eat.

After the surgery: 

The surgeon will have a personalized treatment plan for your pet after surgery that will consist of instructions for the on-going assessment and care of your pet with the intention of meeting their pain management and treatment needs. Your pet may not defecate after surgery for 1 – 3 days. Do not be concerned unless they are straining to defecate. They should urinate within 24 hours of the surgery. We discourage visiting the night after surgery. It can be very stressful for your pet for you to visit and then leave. It is critical that visitation not interfere with your pet’s recovery, nor with our ability to provide care to other patients, including unforeseen emergencies. We appreciate that you have a busy schedule, and we will try and accommodate you as best we can. Visitation is always at the discretion of the doctor.

When can your pet go home? 

They cannot be discharged until after the morning team has made the final assessment based on the overnight team`s observations.

At home after-care: 

After all surgeries, aftercare will need to be provided at home. It is critical to your pet`s recovery that you understand, and are able to provide this care. At the time of discharge, the technician will go over all medications, treatments, and restrictions. You will be provided with a written discharge instructions sheet. You have made a huge investment in your pet`s health care. It is vital that you are able to continue this care at home, and that you do so consistently. We are here for you to make sure you have the proper tools. If you are unable to give medications or doses are getting missed, please contact us for guidance. If they don`t get all the medications all the times they need it, for ALL the days they need, it may slow down or stop recovery.

What to expect down the road: 

All surgical patients will need to come back for a recheck appointment. The recheck exam is done at no cost. If there is any follow up diagnostics, such as radiographs, blood work, or bandage changes, there may be charges for these services. Any additional medications will usually incur charges. If you have any questions about this, please ask your surgeon. Depending on your pet`s surgery, you may be asked to return with them for more than a standard recheck appointment. This could include physical therapy, hydro-therapy, splint changes, gait analysis, etc. The costs of these anticipated services are usually included in the original estimate.

A critical factor in the success of any surgical procedure is the healing process. It is very important that you follow ALL post-operative physical restrictions and at-home treatments, as this is an extremely vital part of your pet`s healing. It is very important to supervise and use e-collars as necessary, as well as adhere to physical restrictions (play, exercise, jumping, running, stairs, etc.) to avoid any complications such as post-operative infection, re-injury and self-mutilation of the surgical site. Please be aware that any complications would involve additional care and possible charges.

Is the surgery guaranteed to work? 

Unfortunately, no one can guarantee any medical procedure. Like all medical treatments, there is no way to predict with 100% certainty how your pet will respond to medications, how well they will heal, or whether time and activity will result in a full recovery, but we will do everything possible to have a successful outcome. Thank you for trusting us to help you and your pet.

Helping you make an Informed Decision

LET US HELP.

Helping you make an Informed Decision: 

One of the most important things to know about chemotherapy and radiation therapy in dogs and cats, is that it is NOT the same as in people; 90% of the pets we treat handle therapy incredibly well, with little to no toxicity.

In addition, most pets are treated as outpatients, with visits typically lasting 30 – 60 minutes, so the time spent away from you is minimized as much as possible. It’s also important to remember despite what you’re going through, there is always a tremendous amount of hope.

So much has changed in the last 5 years, and there has been a rapid and significant progress in cancer diagnostics and therapies. Because of this, we are partnering here with the Veterinary Cancer Center to provide you with the most up to date information in regards to the treatment options available for your pet’s cancer.

We understand that hearing the word “cancer” stirs up many emotions (fear, anxiety, and depression), and we want to address those feelings by providing important information that will allow you to make the decision that is right for you, as well as for your pet.

Toxicity: 

Chemotherapy and radiation therapy in dogs and cats are very different from these treatments in people. Veterinary oncologists and pet owners have made the conscious choice NOT to put the pets through what people go through. We have designed protocols to maximize BOTH quality and quantity of life.

In addition, there are wonderful ways to prevent side effects of therapy from ever occurring in the first place. When side effects are anticipated, we make sure the right medications are used to alleviate discomfort.

Efficacy:

Cancer is NOT a death sentence. Cancer is much more treatable now than ever before, as we have far more options. New therapies have been developed for the most common types of cancers that have increased life expectancy by over 100% in some cases.

With combination therapy, many animals are living with cancer for years and have a wonderful quality of life. See success stories at: www.vcchope.com/petowners/success-stories.

Cost: 

Cancer therapy does not have to be expensive – in terms of finances or time. With the advent of oral chemotherapies, metronomic chemotherapies, and clinical trials, the cost of treatment is less likely to be a factor for most people.

Metronomic chemotherapy is the use of very low dose oral chemotherapy and other medications given daily. This combination of drugs causes almost no side effects, and works to slow down the growth of almost all cancers. Again, remember that over 95% of our patients are treated as outpatients, and your clinic visits typically last less than 60 minutes.

The Median is NOT the Message: Despite what you may have read on the internet or in many scientific papers, the outcome of an individual pet is not known. Statistics are wonderful for comparing groups of either people or animals.

However, they have far less meaning to the individual patient. Every pet, just like every person is an individual patient. Every pet, just like every person, is an individual and may respond far better than the average. We will never treat your pet as a statistic, and always strive for the best outcome.

Quality of life is extremely important to us. We strive to maximize both quality and quantity of life for your pet.

Warning Signs of Cancer

KEEPING YOU INFORMED

Early Detection is Key: 

Pets have become members of our families, and as we take better care of them, they are living happier, longer lives. Despite this, or perhaps because of this, cancer is one of the leading causes of death in dogs and cats. Early detection is key to a better outcome, and this is why we have collaborated with The Veterinary Cancer Center to come up with the 10 warning signs of cancer.

Swollen Lymph Nodes: 

These “glands” are located all throughout the body, but are most easily detected under the jaw or behind the knee. When lymph nodes are enlarged, they can suggest a common form of cancer called lymphoma. A biopsy or cytology of these enlarged lymph nodes can aid in obtaining a diagnosis.

An Enlarging or Changing Lump:

 Any lump on a pet that is rapidly growing or changing in texture or shape should have a biopsy. Lumps belong on biopsy jars, not on pets. Abdominal Distension: When the “stomach” or belly becomes enlarged rapidly, this may suggest a mass or tumor in the abdomen, or indicate bleeding that is occurring in this area. A radiograph or an ultrasound of the abdomen can be very useful in this situation.

Chronic Weight Loss: 

When a pet is losing weight and you have not put them on a diet, you should have your pet checked. This sign is not diagnostic for cancer, but can indicate that something is wrong. Many cancer patients have weight loss.

Chronic Vomiting or Diarrhea: 

Unexplained vomiting or diarrhea should prompt further investigation. Tumors of the gastrointestinal tract can often cause chronic vomiting and/or diarrhea. Radiographs, ultrasound examinations, and endoscopy are useful diagnostic tools when this occurs.

Unexplained Bleeding: 

Bleeding from the mouth, nose, gums, or blood in the urine or stool that is not due to trauma should be examined. Although bleeding disorders do occur in pets, they usually are discovered at a young age. If unexplained bleeding starts in a pet that is old, a thorough search should be undertaken.

Cough: 

A dry, non-productive cough in an older pet should prompt chest radiographs to be taken. This type of cough is the most common sign of lung cancer. Please remember there are many causes for a cough in dogs and cats. Lameness: Unexplained lameness (especially in large or giant breed dogs) is a very common sign of bone cancer. Radiographs of the effective area are useful in detecting cancer of the bone.

Straining to Urinate:

 Straining to urinate and blood in the urine usually indicate a urinary tract infection; however, if the straining and bleeding do not resolve rapidly with antibiotics or are recurrent, cancer of the bladder may be the underlying cause. Cystoscopy or other techniques that allow a veterinarian to take a biopsy of the bladder are useful and sometimes necessary to establish a definitive diagnosis in these cases.

Oral Odor: 

Oral tumors do occur in pets, and can cause a pet to change its food preference (i.e. from hard to soft foods), or cause a pet to change the manner in which he/she chews their food. Many times a foul odor can be detected in pets with oral tumors. A full oral examination with radiographs or CT scan, requiring sedation, is often necessary to determine the underlying cause.

Hip Dysplasia

WHAT IS IT, AND YOUR OPTIONS.

Hip Dysplasia: 

The ball and socket of the hip joint should fit together neatly, allowing the legs to move freely and without pain. Hip Dysplasia is a genetic disorder causing a poor fitting hip joint. Hip dysplasia causes pain, damage to the bone, and can erode the cartilage of the joint. It can lead to arthritis and joint pain as the pet ages. It can effect one or both hips.

Diagnosis: 

Signs of severe hip dysplasia usually appear before the dog turns one year old, and can include rear leg pain, bunny hopping, limping, and/or a wavering/wobbly gait. A common first sign is a dog that has trouble rising from laying down.

Dogs with severe hip dysplasia typically develop lameness by one or two years of age. Dogs with less severe cases may not experience arthritis and the related pain or lameness until 6 – 10 years of age.

The clinical signs of hip dysplasia are similar to other diseases, so X-rays are needed to make a final diagnosis. This requires anesthesia to allow for the proper positioning of the patient to reveal these abnormalities. Veterinarians look for degenerative changes, abnormal shapes of the hip joint, and poorly fitting hip joints. FHO and Penn Hip are two organizations and radiographic positions that are commonly used.

Treatment:

Treatment can include medication and/or surgery depending on the severity of the case.

Medication: 

Drug therapy won`t reverse or cure hip dysplasia, but it can offer pain relief. There are several daily use steroidal and non-steroidal, anti-inflammatory drugs available. For many dogs, these prescriptions can offer tremendous relief, allowing them to return to a more active lifestyle that is free of joint pain.

Recent advances have made surgery a more successful option for treating severe cases of hip dysplasia. Surgeons can alter the shape of the femur or pelvis to improve joint function. Total hip replacement replaces the joint with a stainless steel ball and polyethylene socket.

Lifestyle: 

Dogs with hip dysplasia should not live a sedentary lifestyle that is free of exercise. By carefully allowing your dog to exercise at their own pace, you can help loosen up the stiffness in the joints. You must also pay close attention to your dog`s weight. Just a few extra pounds can cause skeletal stress and increase their joint pain. Limit your dog`s exposure to the cold.

Breeding: 

Pet owners should use extreme caution before breeding their dogs. Large breed dogs that are prone to hip dysplasia should be radiographed by a veterinarian to rule out the condition prior to breeding. Since the signs of hip dysplasia may not be evident until the dog is fully grown, final assessment should not be made until then.

Surgery: 

There are three primary surgical options to treat hip dysplasia.

  • Femoral Head and Neck Excision Arthroplasty
  • Triple Pelvic Osteotomy
  • Total Hip Replacement (THR)

Femoral Head and Neck Excision Arthroplasty (Femoral Head Osteotomy): A safe procedure with many good results regardless of the severity of dysplasia. The femoral head and neck are removed so there is no longer any contact between the hip and the leg bone. The body must form a new “false” joint. Depending on how well this is accomplished dictates how well the patient uses the leg. Early function and exercise is critical to a good outcome. Femoral head and neck are removed. Muscle is placed between the raw edges.

Pros:

  • Relatively simple
  • Few complications
  • Relatively inexpensive
  • A majority of smaller patients return to good function
  • Few patients are not improved after surgery

Cons:

  • Not very effective in very large dogs
  • More likely to have good – fair results than excellent

Recommendations:

  • Can be done at any age
  • Good for severe dysplasia in young dogs
  • Better results in small and toy breeds
Triple Pelvic Osteotomy: 

When successful, very good results especially in young dogs with remodeling potential. First choice in young dogs with moderate dysplasia. The pelvis is cut in 3 places to mobilize the acetabulum (cup) which is rotated to cover the femoral head.

Pros:

  • May prevent or reduce the progression of arthritis
  • When successful, more results in excellent to good range
  • Good long term follow-up
  • Preserves natural hip joint

Cons:

  • Relatively more expensive
  • Restricted patient selection:
  • o Must be done before they have arthritis
  • o Usually must be under 1-year-old
  • o Not successful for severely dysplastic patients
  • More possible complications than femoral head and neck excision
  • Some patients still develop arthritis.

Recommendations:

  • Young dogs (5 months – 1 year)
  • Before arthritic changes occur
Total Hip Replacement (THR): 

This is a good choice for patients where the triple pelvic osteotomy is not indicated and the patient is too large to be comfortable with a femoral head and neck excision. A stainless steel prosthetic femoral component and plastic cup are cemented or press fit to replace the dysplastic hip.

Pros:

  • Can be used in any patient older than 8 months of age
  • Not restricted by the degree of dysplasia or degeneration
  • 80 – 90% of cases report good or excellent results
  • Normal function usually returns within 2 – 3 months
  • Prosthesis should last for the life of most dogs

Cons:

  • Expensive implants and precise surgery necessary
  • Complications – although low incidence, can be significant (10 – 20%)
  • May require additional surgery
Total hip replacement systems include:
  • Traditional stainless steel or titanium stem and polyethylene cup: either bone cement or press fit with bone ingrowth to lock the implant in place (the quality and shape of the dog’s bone dictates which is used.
  • Helica System: similar to resurfacing technique in people, preserves the dog’s femoral neck, therefor preserving more of the patient’s own bone. This system maintains a more normal anatomy and more normal forces across the joint, and more bone in case a revision surgery becomes necessary in the future. Special structured surfaces for optimal osteointegration.
Recommendations:
  • This is a good procedure for medium & large dogs with degenerative changes.
  • Good options for younger dogs with degenerative changes.
  • Good option for younger dogs with less than 10% femoral head coverage

Patella Luxation

WHAT IS IT, AND YOUR OPTIONS.

The dog’s kneecap, or patella, can be dislocated either to the inside (medial) or outside (lateral). The more common is medial. This is an inherited problem, and usually shows up around 6 – 7 months of age. The luxations are graded 1 – 4, 1 being the least severe, and 4 being the most:

Grade 1: 

The kneecap can be dislocated manually, but rarely dislocates on it’s own, and usually there is no lameness. It is usually an incidental finding, and rarely is treatment necessary.

Grade 2: 

The kneecap dislocates on it’s own, but returns to it’s normal position on it’s own. This grade can be subdivided into Grade 2 and Grade 2+ depending on the frequency and ease of luxation. Lameness varies from occasionally holding the leg up, but normally in between, to a steady mild lameness. Often, both knees are affected, and the dogs are reluctant or unable to jump up on objects or chairs. They often appear bow-legged.

a. Plain Grade 2 MPL’s are often not lame, and may not require surgery, while Grade 2+ are usually lame and surgery is the only corrective treatment. Some surgeons will recommend surgery for all Grade 2 luxations to prevent damage to the cartilage on the patella leading to arthritis later on. Some dogs never become lame.

Grade 3: 

The kneecap is luxated all the time, but still can be replaced or reduced manually. If left untreated, the cartilage will be eroded from rubbing on the bone of the femur. Treatment is surgery, and is recommended.

Grade 4: 

The kneecap is permanently dislocated and cannot be reduced without surgery. Some Grade 4 MPL’s are just Grade 3 that has been out too long, but there is a group of severe dislocations that occur in young dogs, where the knee joint (stifle) is distorted and the muscles foreshortened. Often, these dogs cannot straighten their leg at all. These cases are difficult to correct and the prognosis is not as good for a normally functioning leg, even after surgery.

The underlying cause of a dislocating patella is a malalignment of the knee joint. The kneecap is attached to 4 muscles called the quadriceps on top, and the shin bone or tibia via the patella ligament on the bottom. When the muscle contracts, tension is placed on the patella, and its attachment to the tibia causes the leg to straighten. If a line drawn from the beginning of the muscle to the point of attachment to the tibia does not go through the groove that the patella rides in, it will tend to dislocate.

This can be caused by curving of the bones (bowlegged) or rotation of the point of attachment. Also, some dogs stand with a very straight leg, and the kneecap rides above the groove (Patella Alta) and is very unstable.

Surgical Procedures: 

Surgeries should be aimed at correcting the malalignment. The most common case is the tibial crest rotated to the inside. In this case, the crest is detached and moved to the outside, and reattached there with pins or wires, or both. If the luxation is lateral (to the outside), then the crest is moved to the inside. For those dogs where the patella rides above the groove, often the crest is also moved down, as well as to outside to pull the kneecap into the groove.

Often, the groove is not completely formed, and is deepened as part of the repair. This can be accomplished by removing the cartilage and bone to make a rectangular slot, which fills in with fibrocartilage. Or, a wedge or section of cartilage and bone is lifted, and the bed below is deepened, and then the bone/cartilage piece is replaced. This preserves the cartilage, and is called a wedge or block trochleoplasty.

If the bones of the leg (femur and tibia) are curved or twisted, then it is necessary to cut the bones and straighten them out. Bone plates are used to hold them together until the bones heal.

In some more complicated cases, a bone graft is harvested from the pelvis and used to build up the side of the groove where it has been worn down by the luxating patella. In some cases of Patella Alta where the tibial crest cannot be advanced, this graft can be used to extend the groove.

Finally, the tissues on the side of the luxation are loosened with relief incisions, and the tissue on the opposite side are tightened or imbricated.