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Tibial Plateau Leveling Osteotomy

TPLO Preoperative Planning + Postoperative

The Tibial Plateau Leveling Osteotomy (TPLO) procedure is one of the most commonly used methods of cranial cruciate ligament (CrCL) repair in dogs.

by Rick Wong, DVM,
and Michael Huber, DVM, MS,
Diplomate American College of Veterinary Surgeons


Background and Principle

The tibial plateau leveling osteotomy (TPLO) is a surgical procedure originally developed by Dr. Barclay Slocum in 1993. This procedure is performed to stabilize the canine stifle when there is a tear or rupture of the cranial cruciate ligament (CrCL) which is the same as the anterior cruciate ligament (ACL) in humans. CrCL injury is the most commonly recognized orthopedic injury in dogs. Today, the TPLO procedure is one of the most commonly used methods of CrCL repair.

In a CrCL deficient stifle, the tibia (shin bone) is allowed to slide forward in relation to the femur. The reason for this motion is due to several biomechanical properties of the canine stifle joint. The proximal (top) aspect of the tibia is flat but has varying degrees of slope (normal is 30 degrees). The distal (bottom) aspect of the femur is rounded. A round object placed on a slope will tend to roll downhill, which is the same physical properties that allows the abnormal motion to occur. There are other active stabilizers of the canine stifle to help prevent this abnormal motion from occurring but the CrCL is the main stabilizer. The TPLO procedure makes the hill (tibial slope) almost level (~6 degrees) which eliminates the abnormal motion (sliding).

Pre-Operative Planning

Radiographs (x-rays) of the stifle joint are required for preoperative planning. These radiographs are used to make measurements of the joint angles in order to know how much rotation is necessary in surgery to eliminate the slope and correct for other abnormal angles. Additionally, they are used to properly size the implants and saw blade.

TPLO Procedure

The procedure begins with exploration of the stifle joint which is accomplished either through an arthrotomy (incision into the joint) or arthroscopy (exploration with a camera). The joint is inspected to confirm that a tear is present, assess the degree of degenerative joint disease (arthritis), and assess for other concurrent injuries (meniscus tears). The CrCL is then debrided to help remove a source of inflammation within the joint.

If meniscal injury is present then it can be treated with a partial or total menisectomy (removal of the meniscus). A special jig is placed on the tibia to hold it stable during the rest of the procedure. An osteotomy (cutting of the bone) is then performed on the proximal part of the tibia after planning with a bi-radial saw. After the osteotomy is performed the top portion of the tibia is rotated and held in place with a small pin. Any angular or rotation corrections are then performed and the tibia is tested for subluxation. The proximal bone fragment is then fixed in place using a stainless steel locking plate and screws. Closure is performed and post-operative radiographs are taken to ensure the implants are in good positioning in relation to the joint and osteotomy line.

TPLO Recovery

Most patients will have the ability to walk with minimal weight bearing on the limb when leaving the hospital but will improve over the next couple of weeks.
For the first 2 weeks after surgery the incision will need to be evaluated daily for increased swelling or redness, bleeding or discharge, or missing sutures. Any mild bruising or swelling can be treated with a warm compress applied to the incision for 10-15 minutes 2-3 times daily.

Activity restriction is the MOST IMPORTANT aspect of postoperative care. The pet should be STRICTLY CONFINED for the 2 months after surgery. When not under your direct supervision, your pet should be confined in an airline kennel, crate, small room with non-slip floors or equivalent. No running, jumping or playing is allowed. Short (10 minute) leash walks to urinate and defecate are allowed. Additionally, we send home a sling, which should be used under the belly to help support the back legs (keep them from slipping or trying to run).

Most owners find it difficult to hold their pets back by the first month after the surgery is performed.

Recheck examinations are performed at 2, 4 and 8 weeks after surgery. At these rechecks the knee is examined for stability and radiographs (x-rays) are taken to assess healing.

Once radiographs confirm bone healing, a rehabilitation program is started consisting of a slow return to normal function over the following 4-6 weeks.

Complications

As with any surgery or anesthesia there are potential complications. Preoperative blood tests are performed to eliminate any metabolic conditions that may complicate anesthesia. Mild incisional infections and seroma (fluid pocket under the skin) formation occur infrequently. Occasionally, an infection may require plate removal once healing is complete. If the postoperative instructions are followed, complications are not common.

It should be noted that approximately 30-50% of pets will rupture the opposite leg cruciate ligament within 2 years.


 

Animal Specialty Group

DVM, MS, Diplomate American College of Veterinary Surgeons

After Dr. Michael Huber received his Doctor of Veterinary Medicine degree in 1993 from Purdue University, he completed an internship at the University of Minnesota (in small animal medicine, surgery, and emergency medicine), followed by a three-year residency at Auburn University.


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