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TPLO Surgery for Dogs: Success Rates and Alternative Options

Catherine Barnette, DVM

06/19/2024
TPLO Surgery in Dogs

Tibial plateau leveling osteotomy (TPLO) is frequently utilized to address cranial cruciate ligament (CCL) ruptures in dogs. Pet owners often seek information about the advantages of this surgery, the anticipated success rates, and the reasons for choosing this procedure over other available treatments.

Having a comprehensive understanding of CCL ruptures, the TPLO technique, and alternative surgical options can aid in these discussions with clients, ensuring that their pets receive the necessary care.

Causes and Risk Factors of Cranial Cruciate Ligament Rupture

The cranial cruciate ligament (CCL) plays a crucial role in stabilizing the stifle (knee) by preventing hyperextension, limiting internal rotation, and stopping the tibia from moving forward during weight-bearing activities.

CCL rupture is one of the most prevalent orthopedic issues in dogs. While some instances occur suddenly due to trauma, such as falls, car accidents, or other high-impact injuries, the majority result from the slow, progressive degeneration of the ligament. Often, a CCL injury starts as a partial tear and gradually advances to a complete tear.

CCL injuries are more common in older, large breed dogs. Additionally, spayed or neutered dogs are considered to have a higher risk of developing this condition. Factors like obesity, poor physical fitness, genetic predisposition, and certain body conformations also contribute to the likelihood of a CCL rupture.

Specific breeds that are more prone to CCL injuries include Rottweilers, Newfoundlands, Staffordshire Terriers, Mastiffs, Akitas, Saint Bernards, Labrador Retrievers, and Chesapeake Bay Retrievers.

TPLO for Managing CCL Rupture: Surgical Techniques

TPLO is a commonly performed surgical procedure for treating CCL rupture in dogs, especially large breeds. Some surgeons advocate for its use in all cases of CCL rupture, although evidence supporting its efficacy is primarily anecdotal and based on surgeon preference.

TPLO aims to address CCL rupture by modifying the biomechanics of the stifle joint. Normally, the dog’s tibial plateau slopes downward, causing instability when the CCL is ruptured and the femur slides down the tibia during weight-bearing. TPLO involves creating a flat or level tibial plateau to reduce this sliding motion.

During TPLO surgery, the patient is placed under anesthesia. The surgeon makes an incision craniomedial to the stifle and proximal tibia, exposes the joint, and evaluates the internal ligaments. Any damaged menisci or other joint injuries are addressed as needed.

A TPLO jig is then placed to stabilize the bone segments before osteotomy. Using a curved TPLO saw, the surgeon performs the osteotomy to detach the proximal tibia from the distal tibia. The proximal tibial bone segment is rotated to the correct position determined by preoperative radiographs. Once positioned correctly, it is secured with a TPLO plate.

Complications of TPLO Surgery: Infection and Other Issues

Complication rates following TPLO surgery range from 14% to 34%, with less than 10% of cases requiring a second surgery. The most frequent issues include infection (approximately 6% of cases) and implant loosening or failure.

Intraoperative risks include excessive bleeding from the popliteal vessels, while immediate post-operative complications may involve seroma or hematoma formation. Wound dehiscence, a risk in any surgical procedure, is also a concern.

Severe, albeit rare, complications encompass tibial crest fracture, fixation failure, and patellar desmitis, all of which can lead to sudden and severe lameness.

Indications for TPLO Surgery in Dogs

Most surgeons consider TPLO the optimal surgical option for young, active, large-breed dogs. For these patients, even slight functional improvements from TPLO over alternative surgeries can greatly enhance their overall quality of life and client satisfaction. TPLO is also associated with less arthritis progression compared to other surgical techniques.

Dogs with a steep tibial slope on radiographs (greater than 30 degrees) may particularly benefit from TPLO over alternative procedures. The abnormal forces on the stifle in these cases make alternative techniques less likely to succeed.

Conversely, small-breed dogs that are older and less active may not experience significant advantages from TPLO compared to alternative procedures.

Alternatives to TPLO Surgery: TTA and Other Techniques

Surgical alternatives for treating CCL rupture include tibial tuberosity advancement (TTA), extracapsular repair, and the Tightrope® method. The TTA technique aims to restore knee biomechanics, similar to TPLO, while the other two methods focus on replicating CCL function.

TTA
Tibial tuberosity advancement (TTA) involves advancing the tibial tuberosity to change the positioning of the patellar ligament. This procedure is suitable for large-breed dogs, similar to TPLO, and presents comparable advantages and disadvantages. The choice between TPLO and TTA is often based on the surgeon’s preference.

Extracapsular repair
Extracapsular repair, also known as lateral fabellar suture stabilization, aims to restore the function of the CCL using a heavy, monofilament nylon suture. This suture is placed outside the joint in a position similar to the original CCL alignment. It stabilizes the joint until enough scar tissue forms around the joint to provide additional stability.

Young and large-breed dogs often experience a higher complication rate with this procedure, but it is generally effective in cats and small-breed dogs. Advantages of this method include the absence of bone cuts required for surgery and the ability for many general practice veterinarians to perform it, which can result in lower costs for clients.

The Tightrope® method
The Tightrope® Method utilizes a suture placed outside the joint capsule, akin to extracapsular repair. However, a key distinction is the drilling of holes into the femur and tibia during the procedure. This enables the suture to be anchored into the bone, ensuring more precise placement.

Non-Surgical Options for CCL Rupture
Nonsurgical treatment of CCL rupture is seldom recommended, but options are available. Nonsurgical approaches are typically considered when patients have concurrent conditions that make surgery risky, or when pet owners cannot afford surgical treatment.

The main nonsurgical treatments for CCL rupture include restricting activity, promoting weight loss, and utilizing physical therapy. Non-steroidal anti-inflammatory drugs can help manage pain and inflammation, although lameness will persist as long as joint instability remains.

Custom knee braces may be suggested to aid in stifle stability and enhance patient comfort, but current studies do not show significant benefits from these braces.

Success Rates of TPLO Surgery for CCL Rupture

A study from 2013 compared clinical outcomes in patients undergoing surgical treatment for CCL rupture. It found that TPLO patients, on average, achieved a 93% restoration of limb function one year post-surgery. TPLO also resulted in a higher percentage of patients achieving a full return of limb function compared to those undergoing TTA.

Overall, TPLO is highly effective in treating CCL rupture in young, active, large-breed patients.

Sources and Further Reading on TPLO and CCL Rupture