Rupture of the Cranial Cruciate Ligament (CCL) is one of the most common orthopedic injuries in dogs. This ligament is analogous to the ACL in people, and it can rupture as a result of a true traumatic injury, as in people. But, it more commonly occurs as a result of slow deterioration of the ligament as a dog ages. As the ligament wears, minor trauma can cause it to tear. It can also commonly (~50%) affect both knees in dogs due to the degenerative nature of the condition.
Tibial Plateau Leveling Osteotomy (TPLO) is a procedure that modifies the geometry of the knee joint in dogs to allow a return to function after a CCL rupture. This is accomplished by making a semi-circular cut to the top portion of the tibia (shin bone). This top portion of the bone is then rotated to decrease the tibial plateau angle. This decrease in angle decreases or eliminates the instability and pain associated with having a ruptured CCL. Once the cut and rotation are made, a specialized plate and screws are placed to allow healing of the bone, which can take up to 12 weeks. The majority of the time this plate will stay in place for the remainder of your pet’s life. There are rare occasions in which the plate needs to be removed (infection, cold sensitivity, etc.). Once the bone is healed, the plate is no longer needed and can be removed with no adverse effects.
Pain Management – Our pain management protocol with the TPLO procedure is very important to the success of the surgery and the comfort of your pet. We feel that preemptive analgesia is extremely important in controlling any pain associated with surgery.
We give pre-operative opioid pain medications, perform epidural blocks, provide intra-operative and postoperative continuous-rate-infusion (CRI) of pain medications and place a long-acting numbing medication around the entire surgical site. The combination of all of these things decreases the stress and pain associated with surgery. It also allows your dog to go home the same day as surgery where they are more comfortable, which allows for a less stressful recovery.
Results of TPLO Surgery – The success rate of TPLO surgery is extremely high, with the vast majority returning to normal or near-normal function. Obtaining the best function after TPLO is a combination of at-home care and professional rehabilitation. Some dogs take up to 6 months before reaching the level of function seen prior to the CCL rupture. Because of its high success rate, TPLO has become the treatment of choice for the majority of dogs, including large-breed/athletic dogs as well as small/medium breed dogs. With the TPLO, dogs use their leg sooner after surgery and recover faster compared to other procedures. This decreases muscle atrophy and speeds the healing of the bone. As with any procedure, there are risks associated with the TPLO. First, general anesthesia is required for this surgery. Your pet will be very carefully monitored by highly-trained and skilled veterinary technicians and supervised by multiple veterinarians in the hospital. Second, anytime an implant is placed into the body, infection is possible. We are very meticulous in surgical preparation to decrease the chance of any infection. Your pet will also be sent home with oral antibiotics. Lastly, if there is too much activity or your pet slips and falls, soft tissue injury, as well as screw/plate breakage, can occur. This is very rare but is possible.
After Surgery – At discharge, we will go over all of the post-operative instructions which will be typed out for you to take home. The most essential part of the healing process is restricted activity. Too much activity can lead to delayed healing, soft tissue injury, and implant breakage. All of these things can lead to a less than optimal outcome. You will also meet with our canine rehabilitation team to go over at-home care instructions as well as in-hospital rehabilitation recommendations. In-hospital rehab is essential to give the best chance of a full recovery. We are committed to helping you every step of the way and guiding you through the recovery process.