TPLO Surgery - Tibial Plateau Leveling Osteotomy
What is TPLO?
When it comes to choosing the right knee injury or knee ligament tear surgery for dogs, many pet owners often times get confused. Within the veterinary profession even to date, there is still constant debate which surgical procedure is the best overall. One veterinary surgeon may say one thing and another a completely different opinion. Currently, one of the most common surgery performed for canine ACL (CCL) injury dog is the TPLO or Tibial Plateau Leveling Osteotomy.
Developed by Dr. Barclay Slocum, TPLO early in its day was a radical procedure for addressing canine ACL injuries. Now in existence for over 20 years, the surgery has proven itself, time and time again, to be an extremely effective long term solution for addressing cruciate ligament injury in dogs.
The philosophy behind the TPLO surgery is to completely change the dynamics of the dog's knee so that the torn ligament becomes irrelevant to the stability of the knee itself.
Let's quickly review the basics. When your dog stands, if you look from the side, you can see that your dogs knee is bent, at a slight degree of flexion. Because of this bending, the ACL in dogs is always load- bearing, meaning it always has tension on it. This constant tension on the dogs ACL, therefore it makes this ligament the most susceptible to injury.
When a dog tears its ACL, every time the dogs goes to stand or put weight on the leg, the femur slides/rubs on the back of the tibia. This rubbing causes pain and inflammation, which is very uncomfortable. This is why most dogs with a torn ACL will not even put any weight on the leg, or if they do, they will just toe touch the leg to the ground.
The true beauty of the surgery is that it completely alters the dynamics of the knee. Once the bone is cut and rotated the tibial plateau, where the femur and the tibia communicate, no longer can slide backwards. The knee is immediately stabilized. By doing so, this eliminates the need for the ACL ligament entirely and returns stability to the joint immediately. Once the knee is stabilized, the dogs will begin to use the limb again. As a result of the surgery correcting this issue immediately, this is the reason why dogs that undergo the procedure begin to use their leg so quickly after treatment.
What is the cost of the surgery?
Like everything in the world, the cost of TPLO surgery varies depending on region and who is performing the surgery. On average, the cost of the procedure ranges from $2500-$4500.
Depending on the veterinary surgeon and hospital, this cost can include pre-surgery bloodwork, anesthesia, the cost of surgery itself, all post-surgery medications, and in some cases the post-surgical physical therapy as well.
As you already know, there are several options for surgical repair of ACL tears in dogs. Some of the more traditional dog ACL surgery cost run between $1200 to $2500 per surgery.
At the end of the day you need to take all of this factors into account when deciding which is the best option for both you and your dog.
It is always important to remember that there are other alternatives to TPLO. Though this is a great surgery to fix ACL tear in dogs, often times there are several factors when deciding which is the right surgery for our dog. Such as:
- Age of our dog
- Financial Considerations
- Degree of joint disease. I.e. Arthritis
- Physical location to a surgeon skilled at TPLO surgery
Three of the most common alternatives to ACL surgery are:
- Traditional Extracapsular Lateral Suture Technique
- Tightrope Technique
- Tibial Tuberocity Advancement (TTA Surgery)
No matter which surgery you choose, the post-surgery physical therapy care is critical to success.
Comparison with other Surgeries
Many people whose dogs have suffered an ACL tear often times get confused which surgery is going to be the best for their dog. Simply put there is no one "best way". All of the surgeries have their own individual pros and cons. In addition, there are so many variables to consider when choosing the "best" surgery option for your dog. Listed below are a few to consider.
- Dogs size
- Dogs weight
- Dogs age
- Disposition i.e. Whether your dog is calm or a very active dog
- Degree of existing joint disease
- Financial considerations
- Post-surgery physical therapy
As stated previously the TPLO surgery, no doubt is a great option for your dog, but also understanding the other surgery options never hurt anyone. Your veterinary surgeon, whom you know, like and trust, will recommend the surgery that is best for your dog.
TPLO vs TTA
Perceived by pet owners as two of the more invasive surgical options, both TPLO and TTA are very effective procedures that achieve similar results. Both of these surgeries involve bone cutting and repositioning in order to correct the instability in the dogs knee. Lets take a closer look at both surgeries.
Remember first that the main problem when a dog tears its ACL ligament is that when the dog goes to put their weight on the leg, the femur slides off the back side of the tibia, an area called the tibial plateau slope. The main philosophy behind the TPLO is to change the angle of this tibial plateau slope. By rotating the top part of the tibia, the once problematic tibial slope is now rotated so that it is flat; therefore the sliding action can no longer occur when the dog bears weight.
On the other hand the TTA, tibial tuberocity advancement, provides a solution with a totally different philosophy. The theory behind this surgery is to prevent the femur from ever sliding backwards off of the tibial plateau slope, utilizing the existing and very strong patellar ligament. Let me explain in more detail.
Dogs just like people have a patella, we commonly refer to as our kneecap. This small bone glides up and down within two groves on the top of the femur. In reality the main purpose of the patella is to serve simply as a stabilizer for the tendons of your quadriceps muscle on the top of your thigh. This huge muscle group crosses the knee joint and attaches to the front of the tibia on what is referred to as the tibial tuberocity, which is a "fin-like" boney projection on the front of the tibia. In the TTA surgery this tibial tuberocity is cut and rotated or advanced forward. By advancing this patellar tendon forward the force keeps the femur from ever sliding backwards off of the tibial plateau.
Here are two images to better show the structural dynamics of the two surgeries:
Again it is important to discuss with your veterinarian which surgery option is best for your dog. Also it is very important to make sure that your veterinary surgeon has extensive experience and training in either both or one of these surgery options. Not just any veterinarian can perform either of these procedures. In order to truly master these surgical techniques, extensive training is required.
Finding TPLO Surgeons
When it comes to finding the best and right veterinary surgeon for your dog, it always is a good idea to do a little investigative research. The American College of Veterinary Surgeons (acvs.org) provides a national directory of all the board certified surgeons searchable by geographic region.
Make sure that you are 100% comfortable with the surgeon, the hospital and support staff when making the finally decision for surgery.
Now that you know more about the surgery, the next step is to prepare for recovery or rehabilitation. Proper recovery and rehabilitation is the key to restoring your dog's mobility and quality of life.