KSAH - Cruciate Ligament Repair - Tibial Plateau Levelling Osteotomy (TPLO)
Karrinyup Small Animal Hospital
5/207 Balcatta Road
Balcatta WA 6021 AU
08 9447 4644
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Tibial Plateau Levelling Osteotomy (TPLO)

The TPLO is an orthopaedic surgery performed following the rupture of a cranial cruciate ligament within the knee.

The surgery helps to stabilise a knee so that your pet can use the limb without its cranial cruciate ligament. The surgery changes the angle of the top of the tibia or shin bone, creating a level tibial plateau, which decreases the sliding motion of the joint. It allows the other muscles to support the knee without a cranial cruciate ligament.

While under general anaesthesia, the knee joint is exposed, opened and the joint examined. Any damaged menisci or other injuries are assessed and addressed where relevant. 

A bone plate and screw is attached to the tibia to stabilise the bone and promote healing. 

What To Expect After Surgery

  • Joint/limb swelling may occur for the first week
  • Mild bruising around the surgical site
  • Restricted exercise (no running or jumping) or stairs for the first 2 months
    • Only leash walking is allowed at the start
  • Prevent licking at the surgery site
  • Daily physical therapy sessions at Karrinyup Small Animal Hospital for 3 days immediately after surgery
  • Weekly check-ups with the Vet for 6 weeks
  • Joint support injections for improved joint healing
  • Return for x-rays 8 weeks following surgery

Your pet may require you to use a sling to assist them walking over surfaces to the toilet within the first 2 weeks to prevent them from falling on their leg.

Prognosis

Pets that has had cruciate ligament injury and surgery are still prone to arthritis and other joint problems, but surgery allows them to return to a healthy and active lifestyle. Studies suggest that 93% of pets can resume full normal function within a year after surgery. 

In approximately 50% of dogs with ruptured cranial cruciate ligaments, the other leg will rupture its cruciate ligament within 2 years. 

Potential complications

Complications occur in less than 14.8% of cases and include:

  • Infection
  • Implant failure
  • Late meniscal injury
  • Bleeding

Only 6.6% of cases required repeat surgery or suffer long term lameness.

Long-term management

The long-term recovery success relies on other forms of management:

Weight management Dogs should be kept healthy and lean, and fed commercial diets high in Omega-3 for its inflammatory effects.
Physical rehabilitation May assist in the speed of normal mobility.
Adjunctive therapies

Pain relief in the initial periods will help improve rehabilitation.

References

Conzemius MG, Evans RB, Besancon MF, et al. Effect of surgical technique on limb function after surgery for a rupture of the cranial cruciate ligament in dogs. JAVMA 2005; 226:232-236.

Dupuis J, Harari J, Papageorges M, et al. Evaluation of fibular head transposition for repair of experimental cranial cruciate ligament injury in dogs. Vet Surg 1994; 23:1-12.

Christopher SA, Beetem J, Cook JL. Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Vet Surg 2013; 42:329-334.

Duerr FM, Martin KW, Palmer RH, Selmic LE. Treating cranial cruciate ligament disease: Preliminary data from a survey of ACVS Diplomates. Vet Surg 2013; 42:E89.

Kowaleski MP, Boudrieau RJ, Pozzi A. Stifle joint. In Tobias KM, Johnston SA (eds): Veterinary Surgery Small Animal, Vol I. Philadelphia: Elsevier Saunders, 2012, pp 906-998.

Cook JL, Luther JK, Beetem J, et al. Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs. Vet Surg 2010; 39:315-323.

Raske M, Hulse D. SwiveLock bone anchor stabilization of the cranial cruciate ligament deficient stifle in dogs: Clinical outcome. Open J Vet Med 2013: 3:297-301.

Au K, Gordon-Evans WJ, Dunning D, et al. Comparison of short- and long-term function and radiographic osteoarthrosis in dogs after postoperative physical rehabilitation and tibial plateau leveling osteotomy or lateral fabellar suture stabilization. Vet Surg 2010; 39:173-180.

Nelson SA, Krotscheck U, Rawlinson J, et al. Long-term functional outcome of tibial plateau leveling osteotomy versus extracapsular repair in a heterogeneous population of dogs. Vet Surg 2013; 42:38-50.

Lazar TP, Berry CR, DeHaan JJ, et al. Long-term radiographic comparison of tibial plateau leveling osteotomy versus extracapsular stabilization of cranial cruciate ligament rupture in the dog. Vet Surg 2005; 34:113-141.

Gordon-Evans WJ, Griffon DJ, Bubb C, et al. Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. JAVMA 2013; 243:675-680.

Choate CJ, Lewis DD, Conrad BP, et al. Assessment of the craniocaudal stability of four extracapsular stabilization techniques during two cyclic loading protocols: A cadaver study. Vet Surg 2013; 42:853-859.

Cook JL. Proceedings 3rd World Veterinary Orthopaedic Congress 2010; p 93.

Ballagas AJ, Montgomery RD, Henderson RA, Gilette R. Pre- and postoperative force plate analysis of dogs with experimentally transected cranial cruciate ligaments treated using tibial plateau leveling osteotomy. Vet Surg 2004; 33:187-190.

de Medeiros M, Sanchez Bustinduy M, Radke H, et al. Early kinematic outcome after treatment of cranial cruciate ligament rupture by tibial plateau leveling osteotomy in the dog. Vet Comp Orthop Trauma 2011; 24:178-184.

http://www.fluokin.de/projekte/kbr/index.html; referenced February 18, 2014.

Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39:460-472.

Voss K, Damur DM, Guerrero T, et al. Force plate gait analysis to assess limb function after tibial tuberosity advancement in dogs with cranial cruciate ligament disease. Vet Comp Orthop Trauma 2008; 21:243-249.

Wolf RE, Scavelli TD, Hoelzler MG, et al. Surgical and postoperative complications associated with tibial tuberosity advancement for cranial cruciate ligament rupture in dogs: 458 cases (2007-2009). JAVMA 2012; 240:1481-1487.

Kim SE, Pozzi A, Kowaleski MP, Lewis DD. Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. Vet Surg 2008; 37:111-125.

Hoelzler MG, Millis DL, Francis DA, Weigel JP. Results of arthroscopic versus open arthrotomy for surgical management of cranial cruciate ligament deficiency in dogs. Vet Surg 2004; 33:146-153.

Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New Engl J Med 2002; 347:81-88.

Pozzi A, Hildreth BE, Rajala-Schultz PJ. Comparison of arthroscopy and arthrotomy for diagnosis of medial meniscal pathology: An ex vivo study. Vet Surg 2008; 37:749-755.

Austin B, Montgomery RD, Wright J, et al. Evaluation of three approaches to meniscal release. Vet Comp Orthop Trauma 2007; 20:92-97.

Thieman KM, Tomlinson JL, Fox DB, et al. Effect of meniscal release on rate of subsequent meniscal tears and owner-assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy. Vet Surg 2006; 35:705-710.

Roush JK, Cross AR, Renberg WC, et al. Evaluation of the effects of dietary supplementation with fish oil omega 3 fatty acids on weight bearing in dogs with osteoarthritis. JAVMA 2010; 236:67-73.

Jandi AS, Schulman AJ. Incidence of motion loss of the stifle joint in dogs with naturally occurring cranial cruciate ligament rupture surgically treated with Tibial Plateau Leveling Osteotomy: Longitudinal clinical study of 412 cases. Vet Surg 2007; 36:114-121.

Marsolais GS, Dvorak G, Conzemius MG. Effects of postoperative rehabilitation on limb function after cranial cruciate ligament repair in dogs. JAVMA 2002; 220:1325-1330.

Gordon-Evans WJ, Dunning D, Johnson AL, Knap KE. Effect of the use of carprofen in dogs undergoing intensive rehabilitation after lateral fabellar suture stabilization. JAVMA 2011; 239:75-80.

Gordon-Evans WJ, Dunning D, Johnson AL, Knap KE. Randomized controlled clinical trial for the use of deracoxib during intense rehabilitation exercises after tibial plateau leveling osteotomy. Vet Comp Orthop Trauma 2010; 24:332-335.

Gallagher A, Cross AR, Sepulveda G. The effect of shock wave therapy on patellar ligament desmitis after tibial plateau leveling osteotomy. Vet Surg 2012; 41:482-485.