Understanding Tibial Plateau Leveling Osteotomy (TPLO)
The tibial plateau leveling osteotomy (TPLO) was among the first osteotomy (bone cutting) techniques for the treatment of CrCL tears in dogs. Veterinarians have used it in practice for over 35 years, with nearly 200 research articles published on the topic. Most board-certified specialists consider TPLO the “gold standard” for managing CrCL tears in dogs.
This surgery requires making a curved, crescentic bone cut at the top of the tibia, which includes the weight-bearing part of the bone known as the tibial plateau. Following osteotomy, we rotate this small section of bone to reduce the tibial plateau angle (TPA). While the average canine TPA is between about 22-30°, we aim to get it to about 2-5°. We stabilize the two segments of bone using a bone plate and screws. Over time, the tibial bone heals where surgeons made the original bone cut. A newly leveled tibial plateau makes for an immediate change in weight bearing mechanics of the knee and prevents the femur from sliding down the slope of the tibia, all of which results in a more stable and less painful knee.
The lateral suture can be an effective technique for dogs weighing under 30 pounds. However, research supports the use of TPLO in small breed dogs, and many surgeons prefer this technique over the lateral extracapsular suture for this population. When comparing TPLO against a less invasive repair known as lateral imbrication, TPLO returned dogs to weight-bearing faster and with a higher level of physical function.
In medium and large breed dogs weighing more than 30-pounds, increasing evidence shows improved outcomes with TPLO over other commonly performed methods.
Prognosis
Despite the perceived invasiveness of TPLO, dogs are generally comfortable enough to begin weight-bearing on the limb within days of surgery. This rapid leg use is one reason we prefer the TPLO over the lateral suture technique.
TPLO has a 90-95% good to excellent outcome. An excellent outcome is when your pet can jump, play and run as though never injured. With a good outcome, heavy activity may cause your pet soreness requiring a short course of anti-inflammatory medication/s. For one reason or another, 5-10% of patients will not return to an optimal level of function.
Recovery
For the first 6-8 weeks after surgery, we rely entirely on implants (plate and screws) to stabilize the tibia bone and knee joint. Once the bone has healed, the plate and screws are no longer necessary, though they’re left in place in most cases unless there’s a problem such as infection or irritation. Approximately 1-2% of ACOSM patients who have a TPLO procedure will need the plate removed.
Full recovery takes about 12-14 weeks. After knee arthroscopy and TPLO surgery, dogs typically use the operated limb within days. Dogs generally take longer to weight-bear after extracapsular repairs, such as lateral suture stabilization.
The Arizona Canine Orthopedics & Sports Medicine approach is exceptional because:
- Stifle arthroscopy avoids excessive tissue trauma, so we don’t need to make large incisions.
- Arthroscopy provides high magnification and bright illumination allowing for improved visualization and more precise joint manipulations.
- Arthroscopy decreases trauma to the joint and muscle tissue compared to arthrotomy.
- We exclusively use the highest quality orthopedic implants – the Synthes Vet and Arthrex Vet Systems locking bone plates and cortex screws.
- Surgeons successfully perform TPLO on dogs from 10-pounds up to 200-pounds or more.
- Our experienced ACVS board-certified surgeons have performed over 5000 successful TPLO procedures.
- TPLO is associated with an early return to weight-bearing function with fewer complications.
- We notice earlier postoperative bone healing (around 45-50 days) compared to the published national experience.
