Tibial Plateau Leveling Osteotomy

Has your pet been diagnosed with a ruptured cranial cruciate ligament (CCL)? Your veterinarian may have told you that a TPLO is the only solution to this problem. TPLO is a surgical procedure that alters the way the knee functions by changing the angle between the quadriceps muscle and the top of the tibia so that it pulls backwards on the bone the way the broken ligament used to function.If you have a big dog (over 50 pounds) TPLO (or TTA) are usually better options, resulting in better clinical outcomes and return to function of the limb when compared with the lateral suture techniques many veterinarians perform. We also offer current methods of lateral suture repair that work well for smaller breeds.

“TPLO” was first invented and described by Dr. Barclay Slocum in 1993. At the time, the procedure was patented, as was the equipment, and there was a long waiting list of people wanting to take the course. TPLO is one of the best and most proven methods of repairing a torn cranial cruciate ligament in the knee of a dog, particularly large and active breed dogs. The procedure has also been performed successfully on smaller dogs, as well as cats. A lot of research has been completed on the procedure to either prove or disprove the theory that it works. Nonetheless, it remains the current “gold standard” for repair of the cranial cruciate ligament in dogs, and is the technique of choice for many surgeons, as well as the one to which others are compared.

The objective of traditional surgeries, based on the passive model, is the elimination of cranial drawer. This procedure, commonly called the “modified-retinacular imbrication” technique, simply involves placing a large gauge nylon suture from the lateral fabella of the knee into the tibial tuberosity. Although this procedure commonly works, most dogs have some degree of arthritis a few years later, and this procedure can fail. If one simply considers the biomechanics of the stifle joint, with the high tendency of the tibia to rotate inwards during flexion of the knee, it seems obvious that the amount of stress placed on the suture should force it to break eventually, resulting in failure.

Cranial tibial thrust is a force created in the knee of the dog when the dog bears weight on the leg. Clinically, we see this when the tibial moves forward relative to the femur when a force is applied to the foot of the dog much in the way the dog bears weight on the leg. This cranial tibial thrust creates pain, damages the meniscus, and leads to the development of muscle atrophy and arthritis in the leg. Further, this pain causes the dog to shift the weight to the good leg, in a sense doubling the weight load on that limb, resulting in potential damage to the good leg if the injured one is not repaired soon.

TPLO Animated Video

Cruciate Ligament Surgery Post-Operative Care

1. Absolutely NO OFF LEASH exercise for 20weeks. Your dog should be ON A LEASH at all times when outside, even if only in the backyard. The in house activity should be kept to a minimum.

2. See your veterinarian in 14 days for suture removal.

3. Follow the physical therapy instructions, given to you by your veterinarian.

4. See you veterinarian in 4 weeks so he/she can check the healing progress. You can expect your dog to still be lame but weight bearing at this point. If your veterinarian feels that the healing process is advancing as expected, then be sure to continue with the physical therapy instructions.

5. Cruciate ligaments can tear in any type of animal, because of a misstep. However, in the large breed dogs(Labradors, Golden Retrievers, Rottweilers, Akita’s, Mastiffs) the cruciate ligaments may simply degenerate(deteriorate). 30% of these dogs will have the same problem with the other knee. Therefore monitor your dog especially during the healing process because of the extra weight carrier by the other leg (ask your veterinarian about “towel walking” ). These dogs are also more likely to develop arthritis. The arthritis may or may not cause problems later in life but it is a good idea to keep your dog as lean as possible because obesity will greatly accentuate the arthritic pain.

The first 10 days after surgery:

1. Apply cold compress to the knee, 3-4 times per day for 15 minutes for the first 3 days. Apply 2-3 times per day for 15 minutes for the next 7 days. This will help decrease inflammation.

2. Passive Range Of Motion(PROM): This activity involves moving all the joints of the limbs through a comfortable range of motion. This will promote cartilage and joint health, prevent contraction of the muscles and stimulate blood and lymphatic flow. Do be careful as this may cause discomfort in the early stages. You may wish to place a muzzle on your pet to protect yourself and to get the work done efficiently and safely. Your pet should lie on his/her side with the affected limb up. Gently and slowly extend and flex each joint (ankle,knee and hip) 10 times 2-3 times per day. If you are unsure, ask your veterinarian to demonstrate.

3. Massage the quadriceps and hamstring muscles (large muscle groups at the front and back of the thigh respectively). Best to massage for 2-3 minutes before and after PROM. Massaging will help stimulate blood and lymphatic flow and break down scar tissue within the muscles. Start by applying light pressure and gradually increase it over the coarse of the massage. Try to keep a steady rhythm. Start close to the knee and move up the muscle toward the hip.

4. Assist your dog over slippery surfaces by placing a towel under the belly and supporting your dog (commonly referred to as towel walking). Days 10-28 1. Multiple short,slow, controlled, short leashed (NO FLEXI-LEADS PLEASE!) walks. Start with 5 minute walks 2 times per day.

After 7 days, increase the frequency and length of walks gradually so that you are eventually walking for 20 minutes 2 times per day by day 28. Monitor your pet’s performance; do not exceed his/her limit.

2. Continue with the massages and PROM (Before and after the walks).

Over the next two months 1. Continue to increase the muscling by using the figure 8 technique and sit-to-stand exercise. Do the figure 8 at a slow trot (no sharp turns).

2. Up hill walks (slowly) will be very helpful as well.