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Grade 4 patella luxation is the worst you can get and most uncommon. Because of his age and size there are so many contributing factors vets have openly admitted they don't know what's best for him. I was going to get a second opinion but it turned out the vets I was going to go to actually is...

I've never heard of a pup so young like this have you? Breeder said that there is no problems at all with any of his dogs or the other pups I have no way of finding out but believe it to be genetics! Vets haven't been very informative at all I've had to push for the minimal answers I do have...

I'm devastated, my nearly 9 month old American Akita puppy has Grade 4 patella luxation in both legs, joint effusion, displastic right hip, tilted hips and is close to tearing his cartilage He is too young for surgery and struggling to get comfortable... I lack knowledge of where to go from...