Tibial Plateau Leveling Osteotomy (TPLO)
Dr. Carl Koehler, Diplomate, ACVS
We have a board-certified veterinary surgeon come to do this procedure at our hospital. Dr. Koehler graduated from University of California, Davis School of Veterinary Medicine in 1998. Completed rotating internship in 1999 at the California Animal Hospital in West Los Angeles. Completed a surgical internship in 2001 from Gulf Coast Veterinary Specialists in Houston, Texas. Completed a small animal surgical residency.
Several clinical pictures are seen with ruptured cruciate ligaments. One is a young athletic dog playing roughly who takes a bad step and injures the knee. This is usually a sudden lameness in a young large-breed dog.
A recent study identified the following breeds as being particularly at risk for this phenomenon: Neapolitan mastiff, Newfoundland, Akita, St. Bernard, Rottweiler, Chesapeake Bay retriever, and American Staffordshire terrier.
On the other hand, an older large dog, especially if overweight, can have weakened ligaments and slowly stretch or partially tear them. The partial rupture may be detected or the problem may not become apparent until the ligament breaks completely. In this type of patient, stepping down off the bed or a small jump can be all it takes to break the ligament. The lameness may be acute but have features of more chronic joint disease or the lameness may simply be a more gradual/chronic problem.
Larger overweight dogs that rupture one cruciate ligament frequently rupture the other one within a year's time. An owner should be prepared for another surgery in this time frame.
Surgical Repair for Cruciate Tear
Today, the Tibial Plateau Leveling Osteotomy is the used to overcome the effects of cranial tibial thrust. Thus, the need for the anterior cruciate ligament is eliminated as a restraint to the cranial tibial thrust. The medial meniscus is also removed if the cruciate ligament tear is complete. If there is a partial rupture of the cranial cruciate ligament the medial meniscus is left intact.
Healing takes approximately two months for the bone to heal, and slightly longer for the soft tissues to return to normal. The tibial compression test will be slightly positive initially and usually absent by three months post-operatively.
Because the tibial plateau leveling permits the joint pain to subside, the major problem in this surgery has been related to excessive patient activity before the bone has completely healed. Owners are advised that absolute restriction of activity is mandatory during the healing process. Most patients return to very light activity at two to three months, and full training at five to six months. Complete return of thigh diameter, complete flexion of the stifle, and good athletic performance usually results from this surgery. This is success as far as the working dog is concerned.
The surgery results over the past ten years have been excellent. Even patients that had ruptured ligaments for up to five years have made marked improvement. Many of these cases have a longer period of regaining flexibility in the stifle. However, dogs with poor conformation may not respond well to this surgery and a consultation with the surgeon prior to surgery will be necessary.
This surgery is not size dependent. The TPLO can be performed on all sizes of breeds. Because being overweight can be a factor in tearing an anterior cruciate ligament, it is recommended to keep your pet at a healthy weight both before and after surgery.
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