Tibial Plateau Leveling Osteotomy: My Two Cents on TPLO Repair

The tibial plateau leveling osteotomy (TPLO) surgery is considered the mainstay treatment for cruciate ligament tears in dogs.

The purpose of the surgery is to stabilize the knee joint by altering the joint anatomy, namely the tibial plateau angle. Is TPLO a good option for your dog?

Tibial Plateau Leveling Osteotomy: My Two Cents on TPLO Repair

Introduction

It’s been over ten years when I first heart the term. When my Rottweiler, Jasmine, received the diagnosis of a partial cruciate ligament tear, the veterinarian gave us one option—TPLO. I had no idea what any of that meant.

When I returned home, I turned to research to figure out what I just heard at the vet office. After learning what a CCL injury is, I realized we had to do something to address the problem. But after looking up what TPLO is, I didn’t like it at all. Now, years later, I still don’t like it.

Further information on CCL injuries: Talk To Me About Dog ACL/CCL Injuries

What to know about TPLO

The rationale behind TPLO is that leveling the tibial plateau provides stabilization to a stifle with a damaged CCL.

If you take a look at the bones of the canine knee joint, you can see the point—considering the stresses it has to withstand, the dog knee looks like a flimsy joint, doesn’t it? It looks like those two tiny ligaments are all that is holding it together. While that is not so, once the CCL is lost, the joint does become lax with the thigh bone (femur) sliding forward where it should not.

Such instability causes pain and leads to arthritis.

Side view of canine knee joint

The TPLO aims to give the femur a more level platform to sit on, prevent it from excessive movement. That is achieved by cutting and repositioning the top portion of the shinbone (tibia) to create a more level surface to prevent forward sliding.

Once I saw how it is done, that’s where they lost me. I’m supposed to do this to my dog?

Tibial Plateau Leveling Osteotomy: My Two Cents on TPLO Repair
Tibial Plateau Levelling Osteotomy. Image Riverbend Veterinary

What I hated about the procedure

There is no doubt the TPLO is an invasive procedure, and I haven’t shown any photos of what the leg looks like after the surgery. It involves cutting and repositioning of a bone and inserting hardware to hold it all together.

When I look at the schematic, I can’t believe that this could ever work. Is the resulting spike going to break off or poke at tissues? Is the hardware going to split the bone? Can this stay in place and heal?

Further, because this surgery requires a circular cut in the bone, it generates a lot of heat which can burn the bone surface which delays healing.

Argument for selecting TPLO

In spite of all that, TPLO has a good track record.

  • bones heal amazingly well
  • it has a good record of stability post-surgery
  • it has a good record of return to normal function post-rehabilitation

The repair is strong enough that a dog can function even when they need surgery on both stifles—bilateral surgery.

One of the main advantages of TPLO is that it is a procedure that most veterinary surgeons are most familiar with. Practice makes perfect; a track record and comfort level the surgeon has with a procedure does make a difference. You don’t want the surgeon to practice a new—however fantastic—surgery on your dog. At least I wouldn’t.

Recovery expectations

Many dogs start using the injured leg within a day post surgery, especially with adequate pain management. Within two weeks, your dog will bear some or full weight on the leg and by ten weeks most dogs don’t have a visible limp.

Pain management during and after stifle surgery is critical.

Tammy Hunter, DVM

After a six month rehabilitation period, most dogs return to normal function and physical activity.

To facilitate successful recovery, it is essential to obtain a detailed post-op rehabilitation plan from your surgeon and follow it.

Further information :Example post-op recovery plan

Don’t forget that no surgery can have good results without physical therapy.

Further information: Canine Post-op Recovery: Don’t Forget the Physical Therapy

TPLO complications

Any major intervention in the body brings the potential of complications. It is true for any surgery.

Even though anesthesia protocols are increasingly safe, it is essential to be aware that a degree of risk is always there.

Immediate complications with TPLO surgery include:

  • swelling, bruising, and seromas at the incision
  • poor incision healing
  • infections
  • slow healing where the bone was cut
  • meniscal tears
  • implant failure
  • tibial fracture
  • fibular fracture

Long term complication which can happen at any point after surgery involves infections at the implant site. If that happens, the hardware has to be removed.

Further information: Complications of Tibial Plateau Leveling Osteotomy in Dogs

Why consider TPLO?

There are many options for the treatment of a torn CCL in dogs. Doing nothing, however, is not one of them. Without treatment, the knee will remain unstable, painful, and increasingly arthritic. Over time, the problem will escalate to loss of quality of life and significant loss of function. Further, compensatory injuries follow.

Which option is best for your dog depends on a number of factors, such as:

  • level of the ligament damage (partial or full)
  • size and weight of your dog
  • age and activity level of your dog
  • your dog’s tibial plateau angle
  • availability of alternative options
  • other considerations

Would I select TPLO for my dog?

I might, depending on circumstances.

For a partial tear in otherwise fit dog, I give first consideration to regenerative therapy. I keep updated on surgical options for dog knee injuries. If my dog had a full ligament rupture and surgery was the best way to go, I’d give higher consideration to some of the alternate options depending on their availability.

For example, I consider Cora-based Leveling Osteotomy (CBLO) a superior update to the TPLO. Instinctively, I am a fan of the Triple Tibial Osteotomy (TTO), but availability in my country is poor. I am intrigued by the Simitri Stable in Stride stabilization.

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

In closing

When it comes to cranial cruciate ligament tears, doing something is better than doing nothing. TPLO is a vialable option with good tract record.

I recommend you research all options and then make a decision. Your surgeon can assist you with the selection process or you might need to surgeon-shop.

I put a lot of thought to such decisions, weighing pros and cons of each approach.

Related articles:
Dog CCL Injury Grading: Cruciate Tears “All or None, or Partial?”
Cora-based Leveling Osteotomy: My Two Cents on (CBLO) Repair
Triple Tibial Osteotomy: My Two Cents on TTO Cruciate Repair
Simitri Stable in Stride Stabilization

Further reading:
Cranial Cruciate Ligament Repair: Tibial Plateau Leveling Osteotomy (TPLO)

Categories: CCL injuriesCruciate ligament injuriesDog health advocacyJoint issuesKnee issuesKnee issuesTibial plateau leveling osteotomy (TPLO)Treatments

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Jana Rade

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.

13 Comments
  1. Thank you for including the diagrams. My brain likes to check out on medical stuff and that made it very helpful to follow along. All the hardware would be very daunting for me! But I’ve seen some customers in my store with dogs that come back like nothing has happened after rehab.

    • Yes, most dogs do well with it. Looks awful, though, even from strictly mechanical perspective. And I do think that the CBLO is an upgrade, though.

  2. Wow! I’ve seen some of the procedures done on some of the vet shows on Animal Planet. I don’t know what I would do if I had a dog that had this problem,. but thank you for the information and diagrams.

    • If you had a dog who had this problem, you’d have to do something. TPLO is not the best option, in my opinion, but a solid one most surgeons had enough practice doing.

  3. It sounds like this operation is something that dog owners should very cautiously consider (when their dog is in need of it). Six months is a long time for a dog to be in rehab, but it is better than a lifetime of pain and misery. This is a great guide for anyone who wants a little more information on TPLO.

    • The length of rehab is about the same for any of the surgical options and for conservative management too. Surgical repair has generally better chance of working; I know several people who tried conservative management but ended up having to do the surgery at the end.

      Not fixing the problem means a miserable and painful dog for life.

  4. Marjorie Dawson

    This made my hair curl. While the surgery sounds as though it has a lot of success, I share your disquiet about the downsides.

    Your post is a tremendous summary for any stressed parent who does not even know where to start after such a serious diagnosis. There are good sides, there are bad sides and every pet parentd needs to do some reading..

  5. This is really informative. I think that it’s incredibly important to take your time and do your research on the pros/cons or benefits/potential complications any time you’re considering a medical decision – whether it’s for yourself or for your pup. After all, they count on us to make the right choices for their well-being. I can definitely see why some people would opt for the TPLO and, depending on the circumstances, I would definitely consider it. However, as you shared, it shouldn’t be entered into lightly. Thank you for taking the time to put all this together in such an easy to follow format!

  6. This is a great write up on a serious issue. Canine health in general can be hard to understand when you are not in the veterinary field and there are so few resources that us non-vets can relate to.

    I found your diagrams to be particularly helpful in understanding what is done with a TPLO.

    I also appreciate the fact they you gave possilbe alternative treatments. Of course I would talk about all the options to my vet before deciding what to do. It is still good to have a place where I can research this condition on my own.

    Thank you,

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