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Surgery Library


TPLO for Treatment of the Cranial Cruciate Deficient Stifle

Matt G. Oakes, DVM, ACVS
Kimberly R. Cox, DVM, ACVS
Cranial cruciate ligament (CCL) rupture occurs commonly in the dog and results in instability and secondary degenerative joint disease. Partial or complete CCL rupture usually occurs secondary to trauma, but progressive degeneration of the CCL may be a factor in some cases. Numerous surgical techniques have been described for the treatment of CCL rupture in dogs and people. Similar results have been reported for both intracapsular (i.e. fascial grafts, patellar tendon grafts) as well as extracapsular (i.e. extracapsular suture imbrication, fibular head transposition) techniques. Most dogs (80-90%) regain acceptable leg usage after surgery despite the fact that the great majority of dogs develop substantial degenerative joint disease. It has been stated that surgical treatment of CCL rupture is better than conservative treatment, but it is inconsistent and does not provide for normal joint function post-surgically. Tibial plateau leveling osteotomy (TPLO) is a surgical technique originally developed for the treatment of the CCL deficient stifle in performance dogs. An understanding of the concept of "cranial tibial thrust" is helpful in understanding the theory behind the TPLO procedure. Cranial tibial thrust is created by compression between the femur and tibia. The forces of weightbearing as well as contraction of the extensor muscles of the stifle and hock create the compression. This compression results in cranial tibial thrust because of the caudal slope of the tibial plateau. The forces that oppose the cranial tibial thrust to prevent cranial translation of the tibia include active components (hamstring muscles, pes anserinus), and passive components (cranial cruciate ligament, caudal horn of the medial meniscus). In the CCL deficient stifle, cranial tibial thrust results in cranial translation of the tibia (anterior drawer) with weightbearing. The cranial tibial thrust can be controlled by changing the slope of the tibial plateau.

The TPLO procedure is performed through a medial approach to the stifle. The stifle is explored to confirm the preoperative diagnosis and to inspect the menisci for damage. After debridement of torn CCL fibers and any damaged meniscal cartilage, the TPLO is performed. The proximal tibia is exposed and the TPLO jig is applied to the medial side of the tibia to guide the osteotomy. An oscillating saw is used to create a cylindrical cut in the proximal tibia. The proximal tibia is rotated until the tibial plateau is level. The two segments are stabilized with a TPLO plate. Post-operative care includes leash restriction until bony union (approximately 8 weeks), followed by a 6-8 week rehabilitation period of gradually increasing activities.

The TPLO procedure has been performed by the surgical service at Tampa Bay Veterinary Specialists, Inc., since 1997 and we have been very pleased with the results. Treated dogs appear to have superior early function and range of motion compared with other repair techniques, as well as minimal progression of degenerative joint disease. The technique is currently applicable to dogs weighing at least 10 pounds, those with acute or chronic injuries, and those with failed previous stabilization.