The CESKY TERRIER CLUB Patella Subluxation Testing Form for Cesky Terriers over 12 months of age


Registered name of Dog: _____________________________________________

__________________________________________ KC Reg. No. __________

Sex _________ Date of Birth ___________Microchip No. ___________________

Sire ______________________________________ KC Reg No. ___________

Dam _____________________________________ KC Reg No. ___________

Owner’s Name _____________________________________________________

Address __________________________________________________________

_________________________________________________________________

I hereby declare that the dog I have submitted for examination is the one described above.
I agree that the result may be published by the Cesky Terrier Club—YES/NO


Signed __________________________________ Date _________________


Veterinary Surgeon’s Declaration
I confirm that I have checked the microchip number of the dog and the information above with the Kennel Club registration document. At the time of examination I was unable to
detect any evidence of surgical interference/intervention in either stifle.

The above dog was checked for patella luxation using the Putnam 1968 scoring method.


Score: LEFT _______ (Range 0-4) RIGHT _______(Range 0-4)


Any relevant comments ______________________________________________

Name ____________________________________

Address __________________________________________________________

_________________________________________________________________


Signature ________________________________ Date __________________


PUTNAM 1968 SCORING SYSTEM
Grade 0 Normal
Grade 1 The patella luxates manually but
spontaneously returns to the trochlea when released
Grade 2 The patella luxates spontaneously or on manipulation and remains luxated at a certain angle of the stifle joint. It is either spontaneously reduced on active flexion or extension or can be manually reduced by the examiner
Grade 3 The patella remains luxated most of the time but can be manually reduced. However, reluxation occurs
spontaneously
Grade 4 The patella is permanently luxated and cannot be manually repositioned