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Developed by Barclay Slocum in Eugene, Oregon, tibial plateau leveling osteotomy (TPLO) is a unique approach for managing cranial cruciate ligament (CCL) disease in canines.

Labeled as a geometry altering procedure, TPLO’s method for correction of CCL rupture is to alter the conformation of the knee by stabilizing shear forces across the joint, removing the need for a CCL at all. Compared with other surgical techniques for CCL repair, TPLO offers less osteoarthritic progression over time, quicker return to full function, and overall better range of motion.

The TPLO procedure is accomplished through the use of an oscillating biradial bone saw to allow rotation of the tibial plateau, and assorted orthopedic hardware, including a unique bone plate (TPLO) and cortical bone screws. At Oakland Animal Hospital, we use a locking TPLO plate manufactured by Synthes.

This procedure requires a thorough understanding of stifle biomechanics. Without that understanding, there is a much higher probability of complications (see below). In addition, the learning curve is very steep and unforgiving. Make sure your surgeon has been trained appropriately in the technique, and has enough experience in performing TPLO to give your pet the best outcome possible, minimizing potential complications.

Potential complications of TPLO include patellar ligament thickening, tibial crest fracture, and implant failure. ALL of these complications occur secondary to excessive activity too early after the procedure. You, as the client, need to understand this prior to putting your pet through TPLO. Using the bone saw, the TPLO procedure creates a fracture, and then repairs it using a bone plate. This fracture needs to heal prior to return to full, unrestricted activity, otherwise these, or potentially other more serious complications may occur.

Other potential complications include meniscal tear, infection, and osteoarthritis progression. Meniscal tear is treated with a second operation to remove the torn portion of the structure. Infection is minimized through the usage of antibiotics during and after the procedure. In certain situations, a tibial pateau blow out fracture has been reported post-operatively, secondary to the pet falling on the operated leg after surgery. This requires additional surgical correction to ensure a good outcome.

TPLO is quickly becoming the standard of care for treatment of cranial cruciate ligament disease in canines. With proper technique and appropriate aftercare, your pet should have greater than 95% return to full function, allowing return to activities such as hunting, Frisbee, flyball, working, or just the occasional chase after the tennis ball. If you have any additional questions regarding this procedure, feel free to contact Dr. Duncan directly.