Frequently Asked Questions
Below is an overview of questions we frequently hear. If you have other questions that are not listed, be sure to reach out to your local TPLO Info surgeon.
Is ACL or CCL surgery a time-sensitive procedure? What happens if I wait?
Yes and no. An ACL injury does not merit an emergency surgical procedure. As a general rule, most surgeons feel if we can address the injury sooner we have a better chance of slowing the progression of arthritis. In addition, the longer a pet goes with an unstable knee the risk of a meniscal injury (if not already present at the time of diagnosis) likely increases. Finally, the sooner surgery is performed, the faster your pet can become comfortable and return to normal activity. If you are on the fence about deciding between medical or surgical management, there is typically minimal change in long-term outcome by waiting a few weeks until you and your family can decide what is the best course of action.
My dog has ruptured both ACL’s – can we do surgery on both legs at once?
This is typically surgeon dependent and can often be a very difficult decision for both a pet owner and the veterinary surgeon. What may be good for one family, may not be best for the next. So let’s look at the pros and cons.
We know that approximately half of all patients who tear one ACL will go on to tear the other, and it is not uncommon to examine patients that have ruptured both ligaments at the time of diagnosis. Performing surgery on both knees at once means your pet goes through one anesthetic episode, one surgery, one period of hospitalization, and one rehabilitation period. It is also more economical to perform surgery on both knees at once. However, it is known that increased duration of anesthesia time and surgical time can increase the risk of surgical site infection. In addition, if surgery is performed on both limbs at once, then your pet literally doesn’t have a good leg to stand on in the immediate post-operative recovery, making the first few days of the recovery difficult for getting your pet outside to go to the restroom. However, if surgery is performed on only one knee, and the other is also affected by a cruciate tear, then once the surgical limb is feeling better than the injured limb (which may be only days following surgery), then more weight is born by the surgical limb, and thus there is more stress on that implant. With surgery done on both limbs at once, stress on the implants may be minimized assuming weight bearing is symmetrical.
Though older literature advised steering clear of performing bilateral TPLO’s, with recent advances in implant technology the most recent peer-reviewed literature on the subject has shown no difference in the complication rate when performing single-session bilateral TPLO’s over staged TPLO’s.
Does my dog need x-rays before surgery?
Yes. Radiographs (x-rays) of the knee are required prior to surgery so that the tibial plateau angle can be measured. This is required to determine how much the small top segment of the tibia must be rotated. This x-ray is typically best performed on a sedated patient so precise patient positioning can be obtained.
Does my dog need blood work prior to surgery?
In most cases, yes. The majority of patients with ACL tears are happy, healthy, middle-aged dogs. However, a patient’s overall health is important to know prior to anesthesia. Blood work allows your veterinarian to evaluate certain vital organ functions prior to administering medications that alter the body’s physiology.
What happens if there are complications after surgery?
Approximately 10% of patients that undergo a TPLO surgery have complications of one sort or another. Most often these complications are minor (swelling, bruising, inflammation). If complications occur post-operatively, we work directly with you and your veterinarian to make sure your pet returns to peak potential as soon as possible. Sometimes, this may simply involve emailing photographs of an incision, while other times it may require a full evaluation at your veterinarian’s office. It is important to remember that even if your pet endures a complication, a good to excellent outcome can still be obtained.
What are the potential complications of surgery?
Potential complications of the TPLO procedure may include, but are not limited to, implant failure, infection, meniscal injury, bruising, and swelling.
Implant failure includes bending, breaking, or backing out of the screws or the TPLO plate. This is thankfully a very rare complication, occurring in less than 2% of cases. Complete failure of the fixation is even rarer. It is important to understand that with the TPLO surgery, a surgical fracture is created and the bone is then stabilized in a new position. The plate and screws are responsible for holding the bone together until it heals in this new position. Therefore, too much activity too soon can put the implants at risk for failure. To limit the risk of this complication, please strictly adhere to your veterinarian’s discharge instructions regarding activity level following surgery. Signs of implant failure may range from non-existent (single screw breaking) to an acute onset of pain and lameness in the operated limb.
Infection may occur in approximately 5% of patients following a TPLO procedure. In some cases, the infection can be treated with a short course of antibiotics, while other cases may require a longer course of antibiotics followed by implant removal. Normally the bone plate and screws are left in place for the duration of your pet’s life. However, if the implant becomes infected and there is persistent lameness, swelling, or draining from an incision site, your veterinary surgeon may recommend removal of the plate. Thankfully, the plate will only be removed once the bone has healed in its new position. This means that even though the implants are removed, the benefit from the surgery is maintained.
Meniscal injury is frequently seen in conjunction with ACL injuries. In some cases, this injury is noted at the time of the TPLO procedure. In most cases, if a meniscal tear is noted intra-operatively, the torn portion of the meniscus will be removed. If the meniscus is intact, it will generally be left in the joint. Even with a stabilization procedure such as the TPLO, it is still possible for the meniscus to tear in the future. According to the veterinary literature, the incidence of this occurring ranges from approximately 3%-12%. If the meniscus tears following TPLO, your veterinary surgeon may recommend an additional surgery to remove the torn portion of the meniscus.
Bruising and swelling are common complications following surgery and the TPLO is no exception. Please follow your veterinarian’s instructions for managing these complications. It is common to see swelling around the ankle following the TPLO procedure. This typically occurs 3-5 days following surgery and may be present for about a week. This is self-limiting and should improve on its own.
Will performing a TPLO procedure negatively affect the opposite leg?
The short answer is no, it will not. ACL injuries in dogs are commonly degenerative in nature with a largely genetic underlying component. As a result, it is common for pets to tear both ACL’s. One study found 60% of dogs tore the ACL on their “good leg” within two years of diagnosis of the first ACL tear, while another study found up to 15% of pets had bilateral injuries at the time of diagnosis. If your pet is lame on one leg, they often compensate by bearing more weight on the “good leg”. This shifting of weight may be difficult to perceive. The TPLO procedure will, in most cases, relatively quickly allow the pet to begin using the “bad leg” and help with weight distribution. If the ACL tears on the “good leg” during the surgical recovery period, it’s highly likely it was already in the process of tearing, to begin with.
Can the TPLO also be performed in small dogs?
Yes, it can. Many surgeons are now performing TPLO’s on small dogs as they feel these pets, similar to large dogs, have a quicker and more full return to function than with other procedures.
Will my dog be in pain during the post-operative recovery period?
The TPLO is an invasive surgery. Thankfully, the appropriate use of opioids such as morphine, in combination with other medications, can be very successful in preventing and treating post-operative pain. In addition, most surgeons use epidurals and local anesthetics to keep pets comfortable.
Have questions about TPLO that was not answered above?
Send us a message and we would happy to talk with you.