Was your dog running happily through the yard one minute, then limping and unable to put weight on one of its rear legs the next? Or, have you watched your older dog become less active due to a gradual deterioration in one of its knees, a problem that you know is affecting your dog’s quality of life?
A torn cranial cruciate ligament (called CCL in pets and ACL in humans) may be to blame. This is a common problem in dogs and, in many cases, requires surgery to correct and to prevent further damage to the knee joint as time goes on.
Tibial Plateau Leveling Osteotomy (TPLO) surgery is one of the most widely used procedures for repairing a torn CCL in dogs (and sometimes cats). At Lone Tree Veterinary Medical Center, we are fortunate to have a skilled and certified TPLO surgeon on our medical team who has helped hundreds of dogs return to an active life through TPLO surgery. Since we have seen so many successful results with this procedure, we thought it important to explain what TPLO surgery is, why it’s so effective, and offer tips for supporting your dog’s orthopedic health after TPLO surgery.
How CCL Ruptures Happen
In dogs, the knee joint functions like a hinge supported by 4 ligaments: The medial and lateral collateral ligaments, and the cranial and caudal cruciate ligaments. Together, they have three important functions: They connect the upper leg bone (femur) and the lower leg bone (tibia) to form the knee joint, they prevent the joint from hyperextending while walking or running, and they keep the leg bones from rotating internally. In other words, they not only connect the leg bones, they prevent cranial and caudal instability of the knee so it can function as it is meant to.
When the CCL is injured or ruptured, the joint can no longer function normally and the result is usually severe pain and immobility of the leg. A dog with a CCL rupture will be limping and have partial to no weight bearing capability on that leg. The following factors can lead to or cause CCL ruptures:
Poor Conformation — In most dogs, CCL tears are the result of poor conformation of the knee joint, due to genetics, which places abnormal stress on the supporting ligaments. Over time, the ligaments can wear down and weaken, predisposing the ligaments to tears.
Wear and Tear Over time — The CCL ligaments can also break down, weaken and rupture due to overuse from excessive physical activity, being overweight, or as a part of the aging process.
Acute Injury — The CCL can be injured suddenly from an acute trauma such as a fall, jumping on or off of something, or during a physical activity.
Regardless of the cause, CCL tears or ruptures are quite painful and will result in immobility of the dog’s leg. An orthopedic examination and X-rays are used to determine whether or not a CCL is torn and to what extent. Once the diagnosis is established, the determination will be made regarding whether the TPLO procedure will provide the best surgical solution.
Benefits of the TPLO
The TPLO procedure was developed almost 30 years ago with the original goal of helping field trial dogs, police dogs and other athletic dogs regain active lives after a CCL injury. It is unique in that it was based on the idea that most CCL tears are due to poor conformation of the knee. Instead of just repairing a CCL tear and leaving it at that, the TPLO corrects the underlying conformation problem of the knee by permanently removing the stress on the supporting ligaments, which greatly reduces the chance for ligament damage in the future. It also allows the pet to resume a normally active life. Over the years, our TPLO surgeon has helped hundreds of dogs regain active lives with this procedure and it is our gold standard method for correcting CCL problems.
The TPLO surgery is carefully planned ahead of time. This includes detailed analysis of the knee X-rays, determining the exact degree of tibial plateau leveling needed – based on the existing slope of the tibial plateau – and the size of surgical plate needed to secure the tibial plateau with the tibia once it has been realigned. Further analysis of the ligament damage and other structures of the knee will be done once the incision is made and a visual inspection of the joint is possible.
The TPLO surgery is performed by cutting the tibial plateau (the proximal end of the tibia) to reposition the angle at which it articulates with the femur. A plate is then applied to hold the plateau in its re-aligned (rotated) position. The surgeon will also use this time to repair any damage to the meniscus and surrounding knee anatomy, as needed.
Once it is determined that the joint is functioning properly, our surgeon will begin the process of closing up the surgical site. When completed, new x-rays will be taken to verify the position of the hardware (plate and screws) and the angle of the tibial plateau. Our surgeon will then bandage the leg to provide support and protection during the healing process. He will sometimes devise a supportive bandage for the non-surgery leg as well, if he thinks it is needed. Bandages will remain on for the first 2 weeks after surgery to allow early use of the surgery leg and to minimize stress on the other leg.
The Road to Recovery
The recovery period after TPLO surgery is about 8-12 weeks. During this time, the dog will need plenty of quiet time and limited activity to ensure that the knee heals properly. Other important things to remember include the following:
- To monitor healing, TPLO patients are checked weekly for the first two weeks following the procedure and every other week for the next 3 months.
- At home, providing a comfortable, indoor resting place for the dog is key, and outside potty breaks must be done on a leash until our veterinarian has cleared the dog to resume normal activities. This includes no off-leash outdoor activity, no rough-housing or going up and down stairs.
- It is important to follow our veterinarian’s instructions for the administration of pain and any other medications.
- Physical therapy instructions will be given to the owner so therapy exercises can be provided by the owner at home on a daily basis.
- If needed, we can provide additional healing support, such as laser therapy, after the bandage is removed.
- Most dogs will be cleared to resume normal off-leash activities after 3 months.
Long Term Goals
Supporting your dog’s ongoing orthopedic health may require some simple lifestyle changes. These include:
- Following our veterinarian’s instructions for postoperative care and keeping up with follow-up appointments and annual exams.
- Keeping your dog at a healthy weight.
- Making sure your dog gets age-appropriate exercise everyday – walking and swimming are excellent forms of low impact exercise.
- Ask your veterinarian about laser therapy and other pain relief modalities that can help reduce inflammation and support your dog’s continued mobility.
- Keep in mind that 50% of dogs with a CCL tear in one knee will likely experience one in the other knee due to similar knee conformation. Monitoring your dog’s mobility is key in catching and treating problems early on.