TPLO (Tibial Plateau Leveling Osteotomy)
One of the most common orthopedic problems in dogs is a ruptured cranial cruciate ligament, or CCL, analogous to the human ACL. This ligament is located inside the knee joint and is responsible for maintaining the joint’s stability, along with the caudal cruciate and collateral ligaments.
Unlike in humans, a ruptured CCL in dogs is caused by an anatomical alteration that places more stress on the CCL rather than trauma, and not uncommonly is a gradual process caused by over-stress. Thus, lameness can begin as mild stiffness and become more pronounced as the rupture of the ligament progresses from a partial to complete tear. Conversely, the CCL can rupture abruptly and completely.
The tibial plateau of the dog’s knee is sloped, and the CCL is responsible for preventing the sliding of the femur down the slope of the tibia. When this ligament tears, the tibia thrusts forward as the dog bears weight on the leg, resulting in wear of the joint cartilage and injury to the meniscus, causing pain.
In a surgery called the tibial plateau leveling osteotomy, or TPLO, the surgeon cuts the proximal tibia (called an osteotomy) and rotates it in such a way that the tibial plateau slope is minimized. The tibial plateau segment is reconnected at this reduced slope using a special TPLO plate and screws. This reduced slope prevents sliding of the femur, stabilizing the joint and eliminating pain. During surgery, the surgeon will also remove the torn ends of the ligament, as well as any damaged part of the cartilage pad in the knee, called the meniscus.
Post-operatively, the patient requires strict confinement to prevent damage to the osteotomy site, which can be caused by excessive activity. Larger dogs will require support in the form of a belly-sling when they are walked outside to eliminate. Some surgeons recommend physical therapy to maintain range of motion in the joint and prevent muscle atrophy.
Every patient has a different recovery, but he or she should gradually progress in his/her use of the operated leg. By the two week recheck appointment, most patients are lightly weight-bearing on the leg. Progress radiographs taken at 6 to 8 weeks post-op should reveal early healing of the osteotomy site, and most patients are walking with only mild signs of lameness.
The patient is gradually returned to his/her normal activity as directed by the surgeon. Though complete recovery can take up to 6 months, most patients will eventually regain normal function of the leg.
Post-operatively, the patient requires strict confinement to prevent damage to the osteotomy site, which can be caused by excessive activity. Larger dogs will require support in the form of a belly-sling when they are walked outside to eliminate. Some surgeons recommend physical therapy to maintain range of motion in the joint and prevent muscle atrophy.
Every patient has a different recovery, but he or she should gradually progress in his/her use of the operated leg. By the two week recheck appointment, most patients are lightly weight-bearing on the leg. Progress radiographs taken at 6 to 8 weeks post-op should reveal early healing of the osteotomy site, and most patients are walking with only mild signs of lameness.
The patient is gradually returned to his/her normal activity as directed by the surgeon. Though complete recovery can take up to 6 months, most patients will eventually regain normal function of the leg.