Objective To assess the role of the proximodistal and caudocranial relative position of the patellar ligament insertion on the tibia and patellar ligament length-to-patellar length ratio (PLL:PL) in small-breed dogs with and without grade II medial patellar luxation (MPL). Study Design Retrospective study. Sample Population Dogs weighing ≤15 kg, including 43 stifles with MPL and 34 control stifles. Methods The proximodistal and caudocranial relative position of the patellar ligament insertion was determined as a ratio using the vertical (VTT) and horizontal distance (HTT) between the tibial tuberosity insertion and the tibial plateau divided by the tibial plateau length (TPL). In addition, PLL:PL and tibial plateau angle (TPA) were determined. Results The VTT:TPL ratio was lower in affected stifles (95% CI: 0.86–0.94) than in the control group (0.93–1.01; p = .01). No other difference was identified between affected and normal stifles. Conclusion The only difference identified in this study consisted of a more proximal position of the patellar ligament insertion in the stifles of small-breed dogs with grade II MPL. Clinical Significance The more proximal position of the patellar ligament insertion will result in a more proximal position of the patella in the trochlear groove and may contribute to the development of MPL. Potentially, this will also affect the risk of recurrence of MPL after surgical treatment.