Expertise

Accurate diagnosis is the foundation of effective orthopedic treatment. Before recommending care, The Sams Clinic identifies the source of pain, lameness, dysfunction, or instability and how it affects the patient’s comfort, mobility, activity, and long-term function.

Evaluation is individualized around the patient’s history, prior diagnostics, prior surgery, response to treatment, clinical findings, owner observations, and referring veterinarian records. When additional information is needed, diagnostic evaluation is organized across four pathways:

• Clinical evaluation: comprehensive and joint-specific orthopedic examination, palpation and pain localization, gait and movement assessment, range-of-motion evaluation, joint stability and limb alignment assessment, weight-bearing and functional mobility assessment, objective gait or force-plate analysis, and orthopedic-versus-neurologic screening
• Imaging: radiographs / X-rays, comparative or stress radiographs, CT imaging, review of prior or outside imaging, preoperative and postoperative imaging assessment, CT-based planning, three-dimensional surgical planning, patient-specific surgical guides, deformity correction, limb-alignment, and fracture-reconstruction planning
• Laboratory testing: pre-procedure and pre-anesthesia testing, CBC and chemistry testing, culture and sensitivity, cytology, synovial fluid analysis, infectious or inflammatory workup, osteomyelitis evaluation, histopathology, and bone or soft-tissue biopsy analysis
• Procedural diagnostics: diagnostic and dynamic musculoskeletal ultrasound; arthroscopic or needle-scope evaluation of the shoulder, elbow, stifle, and tarsus; cartilage, meniscal, synovial, capsular, and intra-articular ligament assessment; joint aspiration; synovial fluid collection; bone, soft-tissue, and musculoskeletal lesion sampling; and ultrasound-guided localization

Treatment planning is individualized around the diagnosis, disease severity, patient age and size, activity level, functional demands, recovery expectations, and short- and long-term goals. When options exist, our specialists discuss surgical, minimally invasive, non-surgical, or combined pathways so owners and referring veterinarians can make informed decisions.

Surgical recommendations are individualized around the diagnosis, disease severity, patient age and size, activity level, functional demands, recovery expectations, and long-term goals. Not every orthopedic condition requires surgery, and not every surgical condition requires the same procedure.

• Cruciate, patellar & joint stabilization: tibial plateau leveling osteotomy (TPLO), tibial tuberosity advancement (TTA), extracapsular cranial cruciate ligament stabilization, medial and lateral patellar luxation repair, tibial tuberosity transposition, distal femoral osteotomy, collateral ligament reconstruction, shoulder stabilization, capsulorrhaphy, fascial imbrication, luxation repair, and revision stabilization procedures. Learn more >
• Arthroscopic, intra-articular & cartilage surgery: shoulder, elbow, stifle, and tarsal arthroscopy; diagnostic arthroscopy; arthroscopic chondroplasty; partial meniscectomy; meniscal release; osteochondritis dissecans lesion debridement; fragmented medial coronoid process debridement; synovial or capsular treatment; arthroscopic radiofrequency treatment; exploratory arthrotomy; open meniscal treatment; osteochondral autograft transfer (OATS); and treatment of cartilage, meniscal, ligament, and intra-articular disease
• Fracture, trauma & skeletal reconstruction: fracture reduction and stabilization; articular, pelvic, scapular, physeal, open, comminuted, and complex fracture repair; arthroscopic-assisted fracture reduction; minimally invasive plate osteosynthesis (MIPO); luxation management; delayed-healing fracture treatment; malunion or nonunion revision with bone grafting; and osteomyelitis debridement with skeletal stabilization
• Limb deformity, alignment & corrective osteotomy: femoral, tibial, radial, and ulnar angular limb deformity correction; tibial or femoral realignment; proximal or distal ulnar osteotomy; ulnar ostectomy; joint incongruity correction; distraction osteogenesis; growth-disturbance correction; limb-length management; and corrective osteotomy using three-dimensional planning or patient-specific surgical guides
• Tendon, ligament & periarticular soft-tissue surgery: Achilles tendon repair, superficial digital flexor tendon repair or luxation correction, biceps tenotomy or tenodesis, tendon and ligament repair, muscle or periarticular soft-tissue repair, and soft-tissue reconstruction around joints
• Arthrodesis & joint-salvage surgery: partial carpal arthrodesis, pancarpal arthrodesis, partial tarsal arthrodesis, pantarsal arthrodesis, stabilization of severe joint instability, and salvage surgery for failed, recurrent, or advanced joint disease
• Hip, pelvis & femoral procedures: femoral head and neck excision, hip luxation management, pelvic fracture reconstruction, and surgical treatment of femoral head, femoral neck, hip, and pelvic orthopedic disease
• Revision, implant, infection, biopsy & mass surgery: revision of failed or complicated orthopedic repair, implant complication management, removal of internal orthopedic implants or external skeletal fixation systems, treatment of postoperative complications or recurrent instability, bone biopsy, soft-tissue biopsy, musculoskeletal mass excision, and debridement of infected orthopedic tissue

Every procedure is selected for the individual patient, expected recovery, long-term function, and quality of life.

The Sams Clinic emphasizes arthroscopic and minimally invasive treatment when advanced visualization, image guidance, or limited-access technique can diagnose or treat an orthopedic condition while preserving healthy tissue and supporting recovery.

• Arthroscopy & needle-scope procedures: diagnostic and therapeutic shoulder, elbow, stifle, and tarsal arthroscopy; needle-scope evaluation and treatment; arthroscopic chondroplasty; partial meniscectomy; meniscal release; osteochondritis dissecans lesion debridement; fragmented medial coronoid process debridement; synovial and capsular treatment; arthroscopic radiofrequency treatment; and arthroscopic treatment of cartilage, meniscal, ligament, and intra-articular disease
• Musculoskeletal ultrasound-guided procedures: dynamic soft-tissue evaluation, precision localization, targeted injections, and image-guided treatment of tendons, ligaments, muscles, joints, and periarticular soft tissues
• Orthobiologic & regenerative treatment: platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), adipose-derived cellular therapy, intra-articular orthobiologic therapy, tendon, ligament, muscle, and soft-tissue treatment, cartilage and osteoarthritis treatment, surgical-recovery support, nonoperative treatment, and biologic banking
• Less-invasive orthopedic techniques: arthroscopic-assisted fracture reduction and stabilization, arthroscopic-assisted intra-articular treatment, minimally invasive plate osteosynthesis (MIPO), percutaneous and limited-incision procedures, and minimally invasive diagnostic-to-treatment pathways

The goal is to select the least invasive medically appropriate pathway that can accurately address the patient’s condition while supporting durable comfort, mobility, recovery, and long-term function.

The Sams Clinic provides advanced evaluation and treatment for cranial cruciate ligament (CCL) disease -- often described by pet owners as a torn ACL in dogs -- for patients throughout the San Francisco Bay Area. When TPLO surgery is the most appropriate treatment, our specialists plan the procedure around each dog’s anatomy, degree of knee instability, meniscal and other joint findings, activity demands, overall health, and long-term functional goals.

Our specialists have performed thousands of TPLO surgeries and managed primary, complex, revision, and second-opinion cases. Members of our specialist team have also designed TPLO plates and implant systems used by veterinary surgeons. Treatment may incorporate arthroscopic joint and meniscal evaluation, rehabilitation, and a progressive return to activity.

TPLO is not automatically recommended for every dog with CCL disease. The complete orthopedic evaluation determines whether TPLO, another surgical procedure, or nonsurgical management offers the most appropriate path.

Explore TPLO surgery and cranial cruciate ligament treatment >

Consider orthopedic evaluation if your pet is experiencing:

• Difficulty with daily function: trouble rising, lying down, sitting, climbing stairs, jumping, walking, getting into the car, or performing normal activities
• Lameness, stiffness or gait change: limping, uneven weight-bearing, altered stride, stiffness after rest or exercise, or changes in movement quality
• Pain, swelling or structural change: sensitivity, joint enlargement, limb deformity, abnormal limb position, guarding, or visible physical change affecting a limb or joint
• Sudden injury or loss of function: trauma, suspected fracture, luxation, ligament injury, non-weight-bearing lameness, or rapid change in limb use
• Incomplete recovery: persistent symptoms, stalled progress, recurrent lameness, poor limb use, or limited improvement after previous treatment, surgery, or rehabilitation
• Growth or alignment concerns: lameness in a young or growing animal, abnormal limb position, progressive deformity, uneven weight-bearing, or suspected developmental orthopedic disease
• Sport, work or activity changes: reduced speed, power, endurance, confidence, jumping ability, turning ability, workload tolerance, or performance under training, sport, work, or active daily life

Orthopedic consultation is also appropriate when the diagnosis remains uncertain, treatment options are unclear, or owners and referring veterinarians want specialist guidance before major decisions about surgery, minimally invasive treatment, non-surgical care, or long-term management.

The Sams Clinic frequently receives cases with complex histories, unresolved clinical questions, or previous treatment that has not produced the expected result. Consultation is often sought when the diagnosis remains uncertain, recovery has stalled, performance has not returned, or surgery, rehabilitation, or prior treatment has failed to restore the desired outcome.

Common referrals include persistent lameness, recurrent injury, unresolved pain, suspected missed diagnoses, failed orthopedic repair, postoperative complications, revision surgery candidates, and patients requiring a second opinion before major treatment decisions.

Rehabilitation planning begins with the diagnosis, treatment performed, healing stage, pain, strength, muscle mass, range of motion, weight-bearing, gait, mobility, and the patient's functional demands.

Assessment identifies the factors limiting recovery and determines whether rehabilitation should be incorporated into postoperative recovery, nonoperative treatment, chronic-condition management, or return-to-performance planning. Treatment plans, home care, activity progression, and reassessment are individualized as healing and function change.

Rehabilitation combines active treatment, physical modalities, mechanical support, and home care to restore strength, mobility, limb use, movement quality, endurance, and neuromuscular control through:

• Therapeutic exercise & conditioning: strengthening, endurance development, controlled loading, progressive weight-bearing, flexibility, range-of-motion care, and joint-function restoration
• Gait & movement retraining: correction of altered gait, reduced limb use, compensation, and movement patterns that limit recovery or performance
• Balance & neuromuscular recovery: balance, coordination, proprioception, postural control, and task-specific movement progression
• Manual therapy & soft-tissue care: joint mobilization, manual therapy, and soft-tissue mobilization to address restriction, pain with movement, and soft-tissue dysfunction
• Physical modalities: therapeutic laser and extracorporeal shockwave therapy selected to support pain management, inflammation control, and tissue healing
• Orthotics & mobility support: orthotics, bracing, assistive devices, environmental modification, and activity adaptation for stability, protection, load management, and functional mobility
• Home rehabilitation: structured exercise, activity guidance, and progression between clinic visits

Rehabilitation may be recommended for patients recovering from injury, surgery, arthroscopy, orthobiologic treatment, or immobilization; managing orthopedic disease without surgery; experiencing delayed or incomplete recovery; or preparing to return to normal activity, sport, or work.

• Recovery after injury or treatment: rehabilitation following orthopedic surgery, arthroscopy, fracture repair, tendon or ligament treatment, orthobiologic therapy, and periods of restricted activity or immobilization
• Nonoperative orthopedic care: osteoarthritis, degenerative joint disease, and joint, tendon, ligament, muscle, or soft-tissue conditions managed without surgery
• Pain, weakness & loss of function: pain, stiffness, muscle loss, reduced range of motion, poor weight-bearing, altered gait, compensation, limited mobility, and reduced limb use
• Delayed recovery & chronic mobility decline: recovery that has stalled or regressed, persistent lameness, incomplete return of function, and progressive loss of strength or mobility
• Performance & workload-related needs: recurrent injury, repetitive-stress dysfunction, conditioning deficits, workload intolerance, and preparation for return to training, sport, work, or duty

Return to activity is guided by healing, pain control, strength, mobility, limb use, movement quality, conditioning, objective assessment when indicated, and readiness for the physical demands the patient must resume.

• Daily activity: progression toward comfortable walking, stairs, jumping, play, household mobility, and normal routines
• Sport & performance: graduated return to running, acceleration, braking, turning, jumping, endurance, competition, and sport-specific tasks
• Work & duty: progression toward service, field, hunting, detection, protection, and job-specific physical demands
• Long-term mobility & performance: workload progression, recurrence monitoring, reinjury-risk reduction, compensation management, and preservation of mobility or performance as age, workload, and goals change

Reassessment determines when activity can safely progress and whether the rehabilitation plan, workload, or broader treatment strategy should change.