TPLO - Tibial Plateau Leveling Osteotomy For the Treatment of Dog Cruciate Ligament Injury
Tibial plateau leveling osteotomy (TPLO) is a very commonly performed surgery to treat dog cruciate ligament injury.
Cruciate ligament tears in dogs are by far the most common orthopedic injury that veterinarians see.
There are many different ways of treating cruciate ligament injury in the dog and there is, unfortunately, no "right" way of treating it.
Below I am describing the TPLO, what it is, how it works, complications, and recovery.
The tibial plateau leveling osteotomy is a procedure that involves cutting the top part of the weight-bearing surface of the tibia, rotating or turning it to remove the slant or angle to it, then allowing it to heal in this abnormal position.
The end result of this process is that it puts the knee in a neutral position during weight-bearing and effectively eliminates the need for the dog to have a cruciate ligament.
To understand how this works, you need to understand the dog's anatomy within the knee or stifle.
The tibial plateau is the top part of the tibia which comes in contact with the condyles of the femur.
The plateau is where both cruciate ligaments orginate from and is also where the two menisci sit.
It is technically the "weight-bearing surface" of the tibia.
In people, the tibial plateau is a flat surface.
In dogs, however, because they don't walk upright, their tibial plateau is at an angle, usually slanted downwards at about 25 degrees.
What research has found is that when the muscles around the dogs knee contract, such as during any weight-bearing activity like walking or running, the effect of the muscles working against this slant in the tibial plateau, causes the femur to want to slide back and down the slant in the plateau, thus making the femur and tibia want to shift compared to one another.
This process has been termed cranial tibial translation in our field.
In the dogs knee, the thing that prevents this shifting of the two bones from happening is the cranial cruciate ligament.
Therefore, every time the dog takes a step, it is stressing its cruciate ligament.
We suspect that this leads to early degeneration of the ligament over time and is why a majority of dogs get cruciate ligament tears without having a traumatic injury to the joint like people require.
The TPLO procedure involves cutting straight across the top part of the tibia with a semi-circular or biradial saw blade to free up the tibial plateau then turning the plateau so that the slant goes from around 25 degrees on average to 5 degrees.
The plateau is then stabilized in this new position with a specially designed bone plate and bone screws while it heals back together in this abnormal position.
By doing this, when the muscles around the knee contract against the now almost flat tibial plateau, the two bones are neutral and there is no desire for the femur to shift on the tibia.
Effectively, this eliminates the need for the dog to have its cruciate ligament.
This does sound like a very radical approach to fixing a torn ligament, but it has been shown over many years and hundreds of thousands of dogs to be very effective.
Complications with the TPLO can occur and range from 10-20% depending on what you read.
The most common complications involve the bone plate and screws that are placed to hold the bone still while it heals.
Breakage of the bone screws holding the plate in place occurs more frequently than breakage of the plate.
Fortunately, both of these are rare.
Breakage of screws holding the plate can result in delayed bone healing or the bone not healing at all.
Plate infection can occur and if it does, can be very difficult to completely eliminate.
This will require long term antibiotic treatment and may ultimately require that the plate and screws be removed once the bone has healed, usually around 3 months.
Fracture of the tibia or fibula can occur but is also rare.
Subsequent meniscal damage after the surgery can occur which would require a second surgery to remove the damaged meniscus.
This is a complication of every procedure that is done to repair cruciate ligament tears and occurs in about 10% of dogs.
Inflammation of the patellar tendon can occur during the recovery leading to pain.
This is usually a temporary problem that resolves over a few weeks on its own.
Finally, the most common complication is infection or opening of the skin incision, both of which can be treated relatively easily.
Recovery from TPLO surgeries varies depending on the veterinarian performing the surgery.
In general, dogs are limited for 3 months to on-leash activity only.
This is to prevent running, jumping, twisting and turning motions that could damage the repair or the other hind leg.
Dogs are encouraged to use the leg when they are willing so once they are putting it down with each step and no longer holding it up, they can start leash walks.
These leash walks should be gradually increased over the full three months.
After 3 months, if the bone has healed radiographically and the dog has not had any set-backs, they can return to normal, off-leash activity.
Other things during the recovery like physical therapy are also sometimes advocated to speed up the recovery.
With the TPLO surgery, the outcome in a majority of cases (90%+) is good to excellent function on the leg.
This means the dog returns to normal or near-normal performance with the affected leg.
So, which dogs require TPLO surgeries? Unfortunately, there are no hard and fast rules when it comes to cruciate ligament repair in dogs.
TPLO surgeries tend to be reserved for the medium, large, and giant breed dogs and the very active dogs.
TPLO surgeries can be performed on any size dog except maybe the very tiny, teacup-size dogs like Teacup Poodles and Chihuahuas.
Decisions about which surgery is the best for your dog should be made in consultation with your veterinarian who will give you their recommendations.
Cruciate ligament tears in dogs are by far the most common orthopedic injury that veterinarians see.
There are many different ways of treating cruciate ligament injury in the dog and there is, unfortunately, no "right" way of treating it.
Below I am describing the TPLO, what it is, how it works, complications, and recovery.
The tibial plateau leveling osteotomy is a procedure that involves cutting the top part of the weight-bearing surface of the tibia, rotating or turning it to remove the slant or angle to it, then allowing it to heal in this abnormal position.
The end result of this process is that it puts the knee in a neutral position during weight-bearing and effectively eliminates the need for the dog to have a cruciate ligament.
To understand how this works, you need to understand the dog's anatomy within the knee or stifle.
The tibial plateau is the top part of the tibia which comes in contact with the condyles of the femur.
The plateau is where both cruciate ligaments orginate from and is also where the two menisci sit.
It is technically the "weight-bearing surface" of the tibia.
In people, the tibial plateau is a flat surface.
In dogs, however, because they don't walk upright, their tibial plateau is at an angle, usually slanted downwards at about 25 degrees.
What research has found is that when the muscles around the dogs knee contract, such as during any weight-bearing activity like walking or running, the effect of the muscles working against this slant in the tibial plateau, causes the femur to want to slide back and down the slant in the plateau, thus making the femur and tibia want to shift compared to one another.
This process has been termed cranial tibial translation in our field.
In the dogs knee, the thing that prevents this shifting of the two bones from happening is the cranial cruciate ligament.
Therefore, every time the dog takes a step, it is stressing its cruciate ligament.
We suspect that this leads to early degeneration of the ligament over time and is why a majority of dogs get cruciate ligament tears without having a traumatic injury to the joint like people require.
The TPLO procedure involves cutting straight across the top part of the tibia with a semi-circular or biradial saw blade to free up the tibial plateau then turning the plateau so that the slant goes from around 25 degrees on average to 5 degrees.
The plateau is then stabilized in this new position with a specially designed bone plate and bone screws while it heals back together in this abnormal position.
By doing this, when the muscles around the knee contract against the now almost flat tibial plateau, the two bones are neutral and there is no desire for the femur to shift on the tibia.
Effectively, this eliminates the need for the dog to have its cruciate ligament.
This does sound like a very radical approach to fixing a torn ligament, but it has been shown over many years and hundreds of thousands of dogs to be very effective.
Complications with the TPLO can occur and range from 10-20% depending on what you read.
The most common complications involve the bone plate and screws that are placed to hold the bone still while it heals.
Breakage of the bone screws holding the plate in place occurs more frequently than breakage of the plate.
Fortunately, both of these are rare.
Breakage of screws holding the plate can result in delayed bone healing or the bone not healing at all.
Plate infection can occur and if it does, can be very difficult to completely eliminate.
This will require long term antibiotic treatment and may ultimately require that the plate and screws be removed once the bone has healed, usually around 3 months.
Fracture of the tibia or fibula can occur but is also rare.
Subsequent meniscal damage after the surgery can occur which would require a second surgery to remove the damaged meniscus.
This is a complication of every procedure that is done to repair cruciate ligament tears and occurs in about 10% of dogs.
Inflammation of the patellar tendon can occur during the recovery leading to pain.
This is usually a temporary problem that resolves over a few weeks on its own.
Finally, the most common complication is infection or opening of the skin incision, both of which can be treated relatively easily.
Recovery from TPLO surgeries varies depending on the veterinarian performing the surgery.
In general, dogs are limited for 3 months to on-leash activity only.
This is to prevent running, jumping, twisting and turning motions that could damage the repair or the other hind leg.
Dogs are encouraged to use the leg when they are willing so once they are putting it down with each step and no longer holding it up, they can start leash walks.
These leash walks should be gradually increased over the full three months.
After 3 months, if the bone has healed radiographically and the dog has not had any set-backs, they can return to normal, off-leash activity.
Other things during the recovery like physical therapy are also sometimes advocated to speed up the recovery.
With the TPLO surgery, the outcome in a majority of cases (90%+) is good to excellent function on the leg.
This means the dog returns to normal or near-normal performance with the affected leg.
So, which dogs require TPLO surgeries? Unfortunately, there are no hard and fast rules when it comes to cruciate ligament repair in dogs.
TPLO surgeries tend to be reserved for the medium, large, and giant breed dogs and the very active dogs.
TPLO surgeries can be performed on any size dog except maybe the very tiny, teacup-size dogs like Teacup Poodles and Chihuahuas.
Decisions about which surgery is the best for your dog should be made in consultation with your veterinarian who will give you their recommendations.
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