What is a TPLO?

TPLO stands for Tibial Plateau Leveling Osteotomy. It is performed on dogs suffering from rupture of the cranial cruciate ligament (analogous to the human ACL). Since the ligament degenerates and is so small, procedures were developed to change the geometry of the joint such that the ligament is no longer necessary.

What is cranial cruciate ligament (CCL) disease?

The CCL connects the back of the thigh bone to the front of the shin bone, preventing the shin from sliding forward relative to the thigh during normal walking. In dogs, the CCLs degenerate, weakening them so that they rupture during normal activity. This abnormal joint movement creates irritation, which leads to the development of arthritis.

How is CCL disease diagnosed?

It is primarily a physical examination diagnosis: we feel for the shin moving forward relative to the thigh during certain manipulations. Radiographs (x-rays) cannot show a ruptured CCL. They are, however, useful to exclude other causes of lameness (such as fractures and bone tumors) and to demonstrate secondary changes such as the presence of joint effusion or arthritis. MRI is required to image the CCL, but this is rarely necessary.

What are the treatment options?

Non-surgical options involve use of a brace to help stabilize the knee, decreased activity to avoid pain, and physical rehabilitation to maintain muscle mass and joint flexibility. This is a reasonable option for older, debilitated, or high anesthetic risk patients. Surgery is necessary to minimize the development of arthritis, and the TPLO procedure has the best success rate for this in larger dogs. Alternatives include the lateral suture technique, which is best reserved for smaller patients; the TTA, which results in less stability than the TPLO; and the CBLO, which is which is a new technique still being refined.

What does post-operative recovery entail?

8-12 weeks of exercise restrictions: no running, jumping, rough-housing, furniture, or stairs. Physical therapy is a good option, especially for patients with pronounced muscle atrophy/weakness. Some dogs benefit from the use of a sling to help support the weight in the hind end.

What about the other leg?!

50-90% of dogs who rupture 1 CCL go on to rupture the other. There are only 2 in the body, 1 in each knee.