Tibial Plateau Leveling Osteotomy (TPLO) 

for Cranial Cruciate Ligament Repair in Dogs 

Summerfields Animal Hospital in Fort Worth, TX offers Tibial Plateau Leveling Osteotomy (TPLO), the preferred surgical treatment for a torn or unstable cranial cruciate ligament in dogs. Unlike other procedures that attempt to repair the ligament, TPLO addresses the root cause of the problem by changing the structure of the knee joint. This surgical technique effectively stabilizes the knee without relying on the ligament.

A dog's knee, or stifle, closely resembles a human knee in structure. It consists of the femur (thigh bone), tibia (shin bone), and patella (kneecap), which connect and move together. Four primary ligaments—cranial cruciate, caudal cruciate, medial collateral, and lateral collateral—stabilize the joint. Additionally, two menisci (cartilage pads) cushion the femur and tibia, enhancing joint fit and stability. Unlike the human knee, a dog's tibia has a more pronounced slope, known as the tibial plateau slope.

The cranial cruciate ligament (CCL) is the canine equivalent of the human ACL. It prevents excessive knee movement and instability. A ruptured CCL (CCLR) is the most common cause of hind leg lameness in dogs.

Unlike human ACL tears, which often result from trauma, CCLR typically develops gradually due to degeneration. Factors contributing to CCLR include genetics, obesity, early neutering, excessive tibial slope, immune issues, and joint infections. Large, middle-aged female dogs are at highest risk, but any dog can be affected.

The unique shape of a dog's knee puts extra stress on the CCL. As the ligament weakens, the knee becomes unstable, causing pain. Over time, cartilage damage and arthritis worsen the condition. Most dogs eventually experience a complete CCL tear.

Early signs of a partial CCL tear often include sudden lameness after exercise, which may improve over time but then recur as intermittent stiffness or mild pain. As the tear worsens, lameness becomes more constant. A complete tear usually causes severe initial lameness, though the dog may gradually put weight on the leg. Meniscus injury, often painful, can also occur due to knee instability and may cause severe lameness.

To diagnose a CCL tear, veterinarians perform several tests. Early on, knee hyperextension can be painful due to ligament stretching. As the tear progresses, the knee becomes unstable, allowing abnormal movement (cranial drawer and tibial thrust). However, many dogs with pain and lameness have partial tears without obvious instability.

Other physical exam findings include muscle loss, joint swelling, and scar tissue (buttress) formation as the body tries to stabilize the knee. This scar tissue can limit knee movement. A clicking sound may indicate meniscus damage.

X-rays cannot directly visualize the CCL but can show indirect signs of a tear, such as joint swelling, arthritis, and abnormal bone positioning. X-rays also help rule out other problems.

Tibial Plateau Leveling Osteotomy (TPLO) is a well-established surgical procedure used to treat cranial cruciate ligament (CCL) injuries in dogs. This condition, similar to a human ACL tear, causes significant pain and lameness.

The TPLO procedure involves making a precise cut in the tibia (shinbone) and rotating a portion of the bone to reduce the angle of the tibial plateau. The TPLO procedure itself involves the use of a curved saw blade to make a curved cut on the inside, or medial, surface of the top of the tibia.  The cut top portion is then rotated to create the desired tibial plateau angle.  A stainless-steel bone plate is then placed on the bone to hold the two pieces in their new alignment. This change in bone alignment stabilizes the knee joint, reducing pain and restoring function.

Benefits of TPLO:

• Rapid recovery: Most dogs can bear weight on the leg within days of surgery.
• Effective for all dog sizes: TPLO has been successfully performed on dogs of all breeds, from small to large.
• Proven results: Extensive research supports the long-term effectiveness of TPLO in improving mobility, reducing pain, and enhancing overall quality of life.
• Reduced need for implants: While implants are used to stabilize the bone during healing, they often remain in place and rarely need removal.

Compared to other surgical options, TPLO consistently demonstrates superior outcomes in terms of pain management, mobility, and long-term joint health. While individual results may vary, TPLO offers a high success rate and is considered the gold standard treatment for CCL injuries in many cases.

Below are some additional reference sites on the TPLO procedures: 

Home - TPLO Info

Evaluation After TPLO: A Guide for the General Practitioner (todaysveterinarypractice.com)

https://veterinarypartner.vin.com/default.aspx?pid=19239&id=6127944

Home care and rehabilitation helps dogs recover safely and successfully after the TPLO surgery. Below is a link to simple "to follow guides" for postoperative care.
These guidelines offer informative step-by-step instructions to recovery and are now internationally recognized as the standard in post-surgery client education.

Here is a link to the home therapy guidelines:

https://topdoghealth.com/rehab_guides/tplo-home-rehab-guide/

Just select the button that says "download free guide".

Take time to sit and review these guidelines. These are recommended to be followed as a week-to-week recovery plan.

Please contact us if you have any questions!