TPLO: Tibial Plateau Leveling Osteotomy

Peter Pelissier
Peter Pelissier, Veterinarian

“Cheech” waiting for his surgery.

This is “Cheech”, a 3 year old neutered Rottweiler that presented to MVVH 9/2015 with a right hind lameness. After a physical exam, sedation and radiographs, it was determined that “Cheech” was in need of a surgical procedure referred to as a TPLO.

To begin, understanding the anatomy is important. A TPLO surgical procedure helps stabilize the “knee” (or stifle) of the dog. In most cases trauma has occurred to the cranial cruciate ligament (CCL), which is the ligament that prevents the femur, or thigh bone, from moving backwards and forwards along the top of the tibia. In other words, it is a very important piece to a normal, pain free function of the knee.

To officially diagnosis the issue, radiographs are taken under sedation to ensure motionless views with correct angles of the knee. A normal range of the knee is compared to the angle at the time of the radiograph to determine what size of implant is needed to reconstruct the angle of the knee to a more ideal and/or correct angle to ensure the future comfort of the pet.

Prior to any orthopedic surgical procedure, blood is collected and ran to confirm the safety of anesthesia with the pet. An intravenous catheter is placed to guarantee security of fluid and drug administration. Once the patient is intubated and the leg is clipped, the patient receives an epidural to deliver pain relief in the hind quarters of the pet.

Dr. Pelissier administrating the epidural prior to taking “Cheech” into the surgery suite.
Dr. Newton making the initial incision. The surgical field is very well draped for sterile protection. Even the portions of the patient are wrapped in sterile material to ensure complete protection.

Once the patient is aligned correctly on the surgical table, draped and all instruments are unwrapped and placed in desired locations, the surgical incision is made along the midline of the knee.

Following the initial incision, the first step is the arthrotomy where the inside of the stifle joint is visually inspected to find and remove traumatized ligament. Additionally, the meniscus will be inspected and if damage is present those pieces will be also removed.

The second step to the surgery is the osteotomy of the tibia, which where the tibia is actually cut with a concentric saw. This enables the rotation of the tibia into a more normal, ideal angle of the knee. The osteotomy is stabilized with a designated plate that has anywhere from six to eight screws to secure the plate in place.

Dr. Newton and Dr. Pelissier working hand in hand stabilizing the knee for the plate to be placed.
Placement of the plate.

Once the plate is placed and the surgeons feel they have successfully completed the surgical procedure, the patient is taken to radiology while still under anesthesia where a radiograph is taken to verify the placement of the plate and screws to ensure completion.

Aftercare of the surgical procedure can be time consuming with limited walks, mild physical therapy, laser treatment and post surgical radiographs to guarantee continued placement of the plate and screws. The pet should be back to full function of that limb within 10-12 weeks of the surgery.

Dr. Pelissier studying the placement of the plate and pins.

Why a TPLO? A TPLO is highly regarded as the gold standard of surgical treatment for a torn cruciate ligament. There are other procedures available, but the statistics in the end still favor a TPLO for the best return to normal function for medium and large breed dogs.