Cora-based Leveling Osteotomy: My Two Cents on CBLO Repair

If your dog injures their cruciate ligament, you have some serious homework to do. There are many treatment options out there, and the number continues to grow. You can explore everything from conservative management, holistic therapies, regenerative therapies, to surgical repairs.

Cora-based Leveling Osteotomy: My Two Cents on (CBLO) Repair

Surgical solutions themselves include eight different techniques I know of at the time I’m writing this. That tells you something–there is no one perfect solution out there. Think about it.

Another thing to keep in mind. During a consultation, you are quite likely to be offered one or two.

Tibial Plateau Leveling Osteotomy (TPLO). is likely going to be on of them. It is the most broadly recommended surgery. While it is not the latest one, it’s the one most popular with many veterinary surgeons.

The latest, and possibly greatest, is Cora-based Leveling Osteotomy (CBLO).

Logic would dictate that the best way to repair the knee ligament damage should be by actually repairing or replacing the ligament. That, however, is much easier said than done. There have been substantial difficulties with making this repair strong enough to hold up. Although, my veterinary friend in Australia says one of these techniques is still used there with comparable success. Australians seem to be freer thinkers when it comes to veterinary medicine.

Why is TPLO the number one recommendation and is it that great?

The funny thing is that the answer to this question is not really. At least, there is no conclusive evidence that it is reliably better than other interventions. Yet, it is undoubtedly the most popular. Why? Familiarity, perhaps. Don’t get me wrong; familiarity does have its importance; you don’t want a surgeon experimenting on your dog with a surgery they are not used to doing. However …

The TPLO was originally developed in the early 1990s. Many surgeons think that it is the best thing since sliced bread. Meanwhile, others had been trying to come up with different or improved solutions.

I confess that I never liked this technique much at al. That is the reason why I keep up with what new surgeries are out there.

Dog knee injuries: TPLO
Tibial Plateau Leveling Osteotomy (TPLO). Image Elizabeth Street Pet Hospital

Is Cora-based Leveling Osteotomy (CBLO) an improvement?

CBLO was developed to refine the TPLO procedure and address some of the issues that can cause complications with TPLO.

The idea behind all of the cruciate injury treatment options is to restore the stability of the injured joint.

With TPLO, this is achieved by altering the orientation of bones within the joint–changing the slope of the joint surface. Which works, after a fashion. It has been found, however, that the dramatic change in the joint anatomy results in abnormal mechanics and often damage to the cartilage.

One of the issues with TPLO is that in a lot of dogs the end result is that the load bearing axis of the tibia is moved further away from the anatomical axis of the tibia. CBLO addresses this by inverting the rotation which results in the weight bearing axis being brought into alignment with the anatomical axis.

Eurocast Veterinary Centre

Natural anatomy matters. I’ve been trying to come up with a good metaphor, but the best I can think of is walking on very high heels. You can do it, but you are going to pay for it.

Cora-based Leveling Osteotomy: My Two Cents on (CBLO) Repair
Cora-based Leveling Osteotomy (CBLO). Photo United Veterinary Clinic

The CBLO aims to address this problem.

CBLO too cuts the top part of the shin bone. But it is done in a different location and alters the rotation to better align the weight-bearing and anatomical axis. If you compare the CBLO and TPLO illustrations, which one of them looks more natural to you? I like this approach much better.

An additional advantage is that CBLO combines the benefit of TPLO and Tibial Tuberosity Advancement (TTA). TTA is a technique that stabilizes the joint by modifying the angle between the shinbone and the patellar tendon.

Tibial Tuberosity Advancement (TTA
Tibial Tuberosity Advancement (TTA). Image DePuy Synthes

To me, the CBLO looks much more sensible, elegant and sturdy as well as it seems much more logical. It is quite new, though, so finding a surgeon well-versed in doing it might be a challenge. It is also likely too early to have enough data to tell how much better it is or isn’t.

Instinctively, though, I’d be much more likely to choose CBLO over TPLO any day. I don’t like that it is just as invasive and I don’t think it’s the last we will see of new procedures. But if the choice was between the two, I think the CBLO could be superior. That doesn’t mean something better won’t come along tomorrow.

Do your research.

The main purpose of this article is to introduce what is new in dog cruciate injuries repair. You should know there is more than the one or two options you might feel stuck with. Personally, regenerative medicine is the top of my list of considerations. Whether or not that might work depends on a bunch of factors. Platelet-rich plasma therapy, though, did work for Cookie’s partial tear(s).

For fully torn ligament, surgery is likely the best option for most dogs. But there is still the pressure of the choice of a specific procedure.

I recommend you do your homework. Only then you can make an educated decision about what treatment you believe is going to be best for your dog. Talk to a lot of different surgeons. Remember that none of them are likely having tried all of the options to offer full insight. They are likely to recommend what they are most familiar with and what they’ve seen work. That doesn’t mean that something else wouldn’t work better.

The best strategy is prevention.

The best-case scenario, of course, is your dog never rupturing their cruciate ligament in the first place. There are a few risk factors which you can try and avoid, such as acute injury, spaying and neutering too early, obesity, unaddressed thyroid dysfunction, insufficient or high-impact exercise, and others, but unfortunately, some dogs are simply genetically predisposed to cruciate ligament disease.

Categories: CCL injuriesCora-based leveling osteotomy (CBLO)Joint issuesKnee issues

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Jana Rade edited by Dr. Joanna Paul BSc BVSc

I am a graphic designer, dog health advocate, writer, and author. Jasmine, the Rottweiler of my life, was the largest female from her litter. We thought we were getting a healthy dog. Getting a puppy from a backyard breeder was our first mistake. Countless veterinary visits without a diagnosis or useful treatment later, I realized that I had to take Jasmine's health care in my own hands. I learned the hard way that merely seeing a vet is not always enough. There is more to finding a good vet than finding the closest clinic down the street. And, sadly, there is more to advocating for your dog's health than visiting a veterinarian. It should be enough, but it often is not. With Jasmine, it took five years to get a diagnosis. Unfortunately, other problems had snowballed for that in the meantime. Jasmine's health challenges became a crash course in understanding dog health issues and how to go about getting a proper diagnosis and treatment. I had to learn, and I had to learn fast. Helping others through my challenges and experience has become my mission and Jasmine's legacy. I now try to help people how to recognize and understand signs of illness in their dogs, how to work with their veterinarian, and when to seek a second opinion. My goal is to save others the steep curve of having to learn things the hard way as I did. That is the mission behind my blog and behind my writing. That is why I wrote Symptoms to Watch for in Your Dog, which has turned out being an award-winning guide to dog owners. What I'm trying to share encompasses 20 years of experience. Dr. Joanna Paul BSc BVSc is our wonderful sponsor and has been kind to edit and fact-check my important articles.

  1. “It is also likely too early to have enough data to tell how much better it is or isn’t.” Indeed. Still today (more than a decade after CBLO was first introduced into patients), it has no prospective controlled clinical trials to substantiate its use. Instead, the implant manufacturer focused its resources on seeding the procedure by sponsoring courses (ie, put profits before patients).

    My dog had a CBLO in 2013 and did not fare well. The complications about which I’ve been ringing the alarm for years are finally beginning to be confirmed and published in journals and book chapters.

    As Jana suggested, do your research, ask lots of questions, and proceed with caution.

    • Jodi, I’m sorry to hear about your dog’s complications; there is always the possibility that things won’t go right for various reasons. Can I ask what the complications were?

      I don’t believe your dog could have had CBLO in 2013; this repair is quite new–are you sure it wasn’t TPLO?

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