Evaluation and Diagnostic Process

Here are some facts you should know about the evaluation and diagnostic process before scheduling an appointment with us.

At the Canine Cruciate Center of New England, we do hundreds of cruciate surgeries every year. We see clients/patients from every corner of New England every day and from all over the United States on a regular basis. For each and every case we see, we have a rigorous screening process that enables us to not only confirm (or rule out) the diagnosis of a cranial cruciate ligament (CCL) tear, but identify any and all co-pathologies (co-injuries or associated injuries) that may be present in any given case, such as meniscal injuries, muscle atrophy and/or osteoarthritis. Our screening process may also identify unrelated pre-existing orthopedic issues such as hip dysplasia, fractures or neoplastic (cancerous) diseases of the bone and/or soft tissues that may impact the patient’s recovery and ultimate level of function.

The objective of our screening process is to obtain and confirm an accurate, complete, and definitive diagnosis for each patient. While our doctors will review and take into consideration diagnostic results provided by other hospitals and opinions offered by other veterinarians, ultimately it is our own evaluations, results, and opinions we must rely on in each case and is what constitutes the basis for which we make our recommendations for surgery and/or other forms of treatment.

Please Note:

1. It is the client’s responsibility to ensure that the transfer of all medical records is completed. It is your responsibility as the client to ensure by whatever means necessary that any and all prior medical records (from both your regular veterinarian and any specialists), diagnostic test results, radiographs (x-rays) and other imaging, radiology consultation reports or reports from any other specialists you have consulted are forwarded to and received by our hospital. Our reception staff will do their utmost to assist you in whatever way they can and allocate appropriate and reasonable time and resources to help you with this information gathering process, but ultimately it is the client’s responsibility to follow up with the doctors and facilities you are asking to provide this information to us and to follow up with us to confirm that we have in fact received all of the requested information.

2. All radiographs (X-rays) taken at other facilities must be reviewed by our radiologist. All radiographs (X-rays) taken at other facilities that are submitted for use in a given patient’s case must be of diagnostic quality (in terms of included anatomy, positioning, and exposure) and be reviewed by our own board-certified radiologist.

  • The screening process typically starts with an initial patient examination and review of all relevant medical records and diagnostic findings provided by your regular veterinarian and/or any specialists that may have evaluated the patient. You should know that typically in about two-thirds of our initial patient examinations of patients who have a CCL tear, the degree of the CCL injury and the level of patient cooperation (relaxation) is sufficient to allow us to confirm the diagnosis of a CCL tear. In approximately one-third of our initial patient examinations of patients who have a CCL tear, the degree of the CCL injury and/or the level of patient cooperation (relaxation) is not sufficient to perform an effective and meaningful examination and so we cannot confirm or rule out the diagnosis of a CCL tear on an exam without sedation. If your dog is typically very nervous or anxious on trips to your veterinarian, consider requesting a sedative from your regular veterinarian for this initial patient examination to increase the likelihood of our ability to perform an effective and meaningful examination. Confirming the diagnosis of a CCL tear must be done prior to scheduling surgery to repair a CCL tear.
  • Alternatively, to confirm the diagnosis of a CCL tear, you may schedule an orthopedic evaluation under sedation (OEUS) either directly with us or with a qualified specialist in your area. The standard within the veterinary profession for confirming or ruling out a CCL tear is an orthopedic evaluation under sedation (OEUS). In about a third of our patients the OEUS is necessary to confirm or rule out the diagnosis of a CCL tear prior to scheduling surgery. Our standard protocol is to re-evaluate and perform an OEUS preoperatively for every patient (often a reassessment) on the day of CCL surgery after the preoperative sedatives have been administered. Under sedation, when the mind, body and muscles are completely relaxed, one can get a true and accurate assessment as to the extent of any CCL injury in a given patient.
  • Advanced Imaging is an alternative option for assessing possible CCL injuries. You should be aware that advanced imaging (MRI or CT scan) is also available for assessing CCL injuries but is usually cost-prohibitive for most people. Advanced imaging must be done under general anesthesia (no dog is going to lie perfectly still for 20 to 40 minutes) and the costs of general anesthesia and the imaging itself typically cost thousands of dollars. Most people prefer to allocate those financial resources for the surgical repair of the CCL tear itself.
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