Tibial Plateau Leveling Osteotomy (TPLO)
Cranial cruciate ligament (CrCL) insufficiency is considered the most common orthopedic problem in dogs. A considerable number of techniques to stabilize the CrCL insufficient stifle have been described,all of which have produced variable and inconsistent results. All have beenassociated with advanced degenerative joint disease long-term.These intra and extra-capsularsurgical techniques are based on the traditional or passive model of stifle stability relying on stabilizing the stifle against drawer movement. This model incompletely explains ligament damage in the absence of trauma, the actual mechanisms of ligament and meniscal damage, or inconsistent surgical outcomes.
The more plausible, active model expands upon the passive model taking into consideration the biomechanics of the stifle which involves the forces created by muscles and weightbearing. Forces created by muscles and weightbearing in relation to the conformation of the joint requires the recruitment of passive components (cruciate ligaments, joint capsule, caudal horn of the medial meniscus) to stabilize the motion of cranial thrust of the tibia. The magnitude of this thrust is subsequent to compression between the femur and tibia, and is proportional to the slope of the tibial plateau. When this forward thrust of the proximal tibia exceeds the integrity of the CrCL, tearing of this ligament as well a tearing and stress of the meniscus occurs. Recent scientific studies have shown that excessive tibial slope predisposes dogs to cranial cruciate ligament injury, and that decreasing the slope reduces the cranial tibial thrust. The objective of the Tibial Plateau Leveling Osteotomy (TPLO) is to redesign the stifle so the cranial cruciate is unnecessary for joint stability. Cranial thrust is thus neutralized during functional loading of the joint after the TPLO procedure.
Total rehabilitation time is normally 16 weeks of which physical therapy plays an instrumental role in the postoperative care and success in these patients. The TPLO is an extremely technique sensitive procedure requiring formal surgical training and exceptional orthopedic expertise, obligatory training and a substantial orthopedic caseload for proficiency. We at VSS are proud to be the premier facility in the Southeast offering TPLO surgery and the only facility in the region providing physical therapy as an integral part of this treatment of choice for cruciate ligament insufficiency. To learn more about the TPLO procedure click here