Help! My vet told me my dog needs a TPLO! What is that, exactly?
Cranial cruciate ligament (CCL) injury is one of the most common reasons for dogs to have a hind leg limp. The CCL is one of the major ligaments in a dog’s knee, it is the same as the ACL in humans. Its main job is to keep the shin bone (tibia) from sliding forward in relation to the thigh bone (femur). Partial or full tearing of the CCL results in an unstable and painful knee which causes a limp.
Some dogs tear their CCL completely and may suddenly stop putting weight on their injured leg. But the most common story I hear from clients is that the limping comes and goes. Their dog might have been limping off and on for weeks to months (or sometimes years). At the beginning, the limping would get better with rest and pain medications, but the latest episode of limping is worse than before, or didn’t get any better with rest. Worsening of limping often happens when a long-standing partial CCL tear becomes a full CCL tear. Or when dogs with a CCL tear also tear their medial meniscus. The medial meniscus is one of the shock absorbers in the knee. About 50-60% of dogs with full CCL tears and 5-7% of dogs with partial CCL tears will also injure their meniscus.
Diagnosis of a CCL tear is based on finding cranial drawer (instability between the shin bone and the thigh bone) during an orthopedic exam. While most dogs are able to be examined awake, some dogs may be too painful, tense, or anxious to allow a complete exam without sedation.
There are many procedures available to treat CCL tears in dogs. One of the most common CCL surgeries is the TPLO (Tibial Plateau Leveling Osteotomy). The purpose of a TPLO is to change the forces going through the knee so that a dog WITHOUT a CCL can have a stable joint to walk and run on. This is done by making a curved cut in the shin bone (tibial osteotomy). Taking the cut piece of bone, rolling it down the curve that was made, and stabilizing it in the new position with a bone plate and screws. By flattening the top of the shin bone, the thigh bone has a more stable platform to rest on, and other muscles and ligaments are recruited to help keep the knee stable.
Having performed and assisted in over 500 TPLOs, I consider the TPLO to be a very good and very reliable surgery. In the hands of an experienced surgeon, most dogs that have a TPLO have a good to excellent chance for a full recovery with a low likelihood of complications. But, as with most things in life, the TPLO is not perfect and certain individual factors may influence the success of the surgery.
To accurately plan for a TPLO surgery, specifically positioned and calibrated x-rays of the knee and shin bone are taken. Precise measurements of the shin bone are made and our bone cut is planned before surgery. That way I know what size saw blade I will use, where on the shin bone to make my cut, and how far I should rotate the joint surface to achieve a TPLO. Depending on the shape of your dog’s shin bone, whether or not they have torn their meniscus, or if they have other problems in addition to their torn CCL (i.e. a dislocating kneecap), changes may need to be made to the surgery. In some cases, a different procedure may be recommended.
Cost for TPLO surgery can differ (usually based on cost of living where you live, anesthesia protocol used, and whether or not your pet stays overnight after surgery). At Sunstone Veterinary Specialists, a TPLO for one knee will typically cost $3000 plus the cost of the surgical implants (plates and screws). Implant costs will range between $350-500 depending on the size of the dog.* The initial exam and consultation with Dr. Su and any additional diagnostics (such as bloodwork) are not included.
*Extra-large or giant breed dogs (>120lbs) would have extra fees to cover the additional medications, disposables, and resources required. This estimated cost includes the surgical visit (which includes a night in hospital) and routine follow-up (2 and 8-week post-op rechecks).
Lillian Su, DVM, MVSc, CCRP, Diplomate ACVS-SA
Board Certified Small Animal Surgeon