Literature and Studies

Below are scientific articles reviewing the TPLO procedure.

Articles reviewing TPLO outcomes

Systematic Review of Surgical Treatments for Cranial Cruciate Ligament Disease in Dogs

  • The strength of the evaluated evidence most strongly supports the ability of the TPLO in the ability to return dogs to normal function
  • Provides strong support that functional recovery in the intermediate postoperative time period was superior following TPLO compared with lateral extracapsular suture.

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Long-Term Functional Outcome of Tibial Plateau Leveling Osteotomy Versus Extracapsular Repair in a Heterogeneous Population of Dogs

  • Dogs achieved normal limb loading faster after TPLO than extracapsular suture repair
  • TPLO resulted in operated limb function that was indistinguishable from the control population by 1 year postoperatively.

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Long-Term Functional Outcome of Tibial Tuberosity Advancement vs. Tibial Plateau Leveling Osteotomy and Extracapsular Repair in a Heterogeneous Population of Dogs.

  • At the walk, tibial tuberosity advancement (TTA) achieves normal function by 12 months; however, at the trot, TTA is indistinguishable from extracapsular repair
  • TPLO resulted in operated limb function that was similar to the control population by 6-12 months postoperatively at the walk and the trot.

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Comparison of the lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease

  • Dogs in both groups improved after surgery
  • Kinematic and owner satisfaction results indicated dogs that underwent TPLO had better outcomes than those that underwent lateral fabellar suture (LFS)
  • Owner satisfaction was 93% for patients undergoing TPLO and 75% for patients with LFS

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Lameness and osteoarthritis development following Tibial Plateau Leveling Osteotomy (TPLO) and potential prognostic predictors. A long-term retrospective study.

  • Good to excellent results were obtained in 90.4% of patients up to 6.8 years after TPLO surgery
  • In the long term, there was a moderate but significant progression of OA following TPLO
  • Patients with totally ruptured CCL were significantly more likely to have a meniscal injury than dogs with partially ruptured CCL
  • Dogs with partial meniscectomy had a significantly higher rate of “excellent” long-term clinical results and less frequently showed the progression of OA compared to those having the meniscus released or left untouched.
  • The overall complication rate was 22.2%, with the type of complication having no influence on the long-term clinical outcome.

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Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle.

  • Owner-perceived outcome was superior for eTPA group dogs when TPLO resulted in TPA<or=14 degrees compared with those with postoperative TPA>14 degrees.
  • Postoperative complications were more common in dogs with eTPA than in dogs without eTPA; however, no difference in owner-perceived outcome was identified.
  • Postoperative TPA<or=14 degrees and the addition of ancillary implants are recommended when using TPLO to treat dogs with eTPA.

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Early kinematic outcome after treatment of cranial cruciate ligament rupture by tibial plateau leveling osteotomy in the dog.

  • Pelvic limb stance duration significantly increased during the 12 week study period, recovering to near-normal values.
  • The range of pelvic limb paw velocity also significantly increased but did not reach normal values by 12 weeks postoperatively.

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Second look arthroscopic findings after tibial plateau leveling osteotomy.

  • Stifles with an early partial tear had normal to near normal appearance of intraarticular structures
  • Most dogs with a complete or incompetent partial CCL tear had grades 3 or 4 articular cartilage abrasion of the medial or lateral femoral condyle
  • Early diagnosis of a CCL injury and treatment by TPLO may be protective against further CCL disruption lending stability to the joint and decreasing the incidence of meniscal injury and articular cartilage damage.

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Comparison of tibial plateau angle changes after tibial plateau leveling osteotomy fixation with conventional or locking screw technology.

  • Stifles in the locking screw group had significantly less change in postoperative tibial plateau slope than stifles in the conventional screw group
  • Locking screw fixation had significantly higher grades of osteotomy healing

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Short-term and long-term outcomes for overweight dogs with cranial cruciate ligament rupture treated surgically or non-surgically

  • Dogs were randomly assigned to nonsurgical (physical therapy, weight loss, and NSAID administration) or surgical (TPLO) treatment groups; dogs in both groups received the same nonsurgical treatments.
  • Owner questionnaire responses indicated dogs in both groups improved during the study, but dogs in the surgical treatment group had greater improvement.
  • Body fat percentages for dogs in both treatment groups significantly decreased during the study
  • Surgical treatment group dogs had significantly higher peak vertical force for affected limbs versus nonsurgical treatment group dogs at the 24- and 52-week evaluation times.
  • Surgical treatment group dogs had a higher probability of a successful outcome versus nonsurgical treatment group dogs

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Partial Cranial Cruciate Ligament Tears Treated with Stem Cell and Platelet-Rich Plasma Combination Therapy in 36 Dogs: A Retrospective Study.

This study evaluated outcomes in 36 dogs with a partial cranial cruciate ligament (CCL) tears (<50% torn) treated with autologous bone marrow aspirate concentrate (BMAC) or adipose-derived progenitor cells (ADPC) with platelet-rich plasma (PRP) combination.

  • Stifle arthroscopy results performed at 90 days posttreatment were available in only 13 of the 36 dogs.
  • In nine dogs, a fully intact CCL with marked neovascularization and a normal fiber pattern was found with all previous regions of disruption healed.
  • One dog revealed significant improvement and received an additional injection.
  • The remaining three dogs had a >50% CCL tear, and a TPLO was performed.
  • Four additional dogs were known to have had a TPLO performed elsewhere.
  • The authors concluded the use of BMAC-PRP and ADPC-PRP shows promise for the treatment of early partial CCL tears in dogs. Further studies are needed and should be randomized, blinded, and controlled.

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Vet Rec. 2018 Apr 21;182(16):461. doi: 10.1136/vr.104491. Epub 2018 Jan 26.
Long-term complications following tibial plateau levelling osteotomy in small dogs with tibial plateau angles > 30°.
Knight R1,2Danielski A1.

  • Minor complications were reported in 22.7% of cases
  • Smaller post-op tibial plateau angle was the only variable significantly associated with an increased complication rate
  • There were no major complications identified

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Tierarztl Prax Ausg K Kleintiere Heimtiere. 2017 Aug 10;45(4):226-233. doi: 10.15654/TPK-170049. Epub 2017 Jul 26.
Comparison of two cold compression therapy protocols after tibial plateau leveling osteotomy in dogs.
von Freeden N1Duerr FFehr MDiekmann CMandel CHarms O.

  • In one group CCT was applied immediately prior and immediately following surgery for 20 minutes.  In a second group CCT was performed 4 times after surgery at 6 hour intervals.  A control group was not iced.
  • Both CCT groups had greater range of motion and lower pain scores 24 hours after surgery compared to the control group
  • Both CCT groups had less severe lameness at 10 days after surgery and better range of motion at 6 weeks following surgery than the control group
  • There were no significant differences between the CCT groups at any time points

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J Am Vet Med Assoc. 2018 Mar 15;252(6):686-700. doi: 10.2460/javma.252.6.686.
Evaluation of the clinical effects of diet and physical rehabilitation in dogs following tibial plateau leveling osteotomy.
Baltzer WISmith-Ostrin SWarnock JJRuaux CG.

  • Dogs were assigned to one of four groups: 1) received a dry omega-3 fatty acid and protein enriched dog food (Purina JM Joint Mobility Diet formulated to support joint health); 2) received a control maintenance diet (Pedigree Adult Complete Nutrition); 3) received the Purina JM plus 6 months of rehabilitation; or 4) Pedigree with rehabilitation.
  • Peak vertical force and vertical impulse were greater after surgery for dogs in the joint diet groups than in the maintenance diet groups
  • Peak vertical force was greater after surgery in dogs that underwent rehabilitation than in those that did not

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Vet Surg. 2018 May;47(4):507-515. doi: 10.1111/vsu.12794. Epub 2018 Apr 26.
Influence of class IV laser therapy on the outcomes of tibial plateau leveling osteotomy in dogs.
Renwick SM1Renwick AI1Brodbelt DC2Ferguson J1Abreu H1.

  • Three treatments (laser or placebo) were administered within a 4 day peri-operative period
  • Outcomes were measured by difference  in the Liverpool Osteoarthritis in Dogs (LOAD) and adjusted Canine Orthopedic Index (aCOI), radiographic osteotomy healing, time to cessation of anti-inflammatory administration, and wound healing by owner questionnaire
  • The only detected difference was a greater improvement in the gait section of the aCOI in the laser group

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Vet Surg. 2018 May;47(4):481-489. doi: 10.1111/vsu.12796.
Protocol changes to reduce implant-associated infection rate after tibial plateau leveling osteotomy: 703 dogs, 811 TPLO (2006-2014).
Stine SL1Odum SM2Mertens WD1.

  • An established TPLO protocol was altered to include an iodophore-impregnated adhesive drape, cefazolin every 90 minutes intraoperatively and then every 4 hours until hospital discharge, orthopedic surgery gloves, triclosan-coated intradermal sutures (instead of staples), soft-padded bandage with mupirocin ointment, use of single-use gloves while handling treated dogs, and placement of an Elizbethan collar.
  • TPLO plates were removed from 8.5% of dogs prior to the protocol changes and from 1.3% of patients following protocol changes.
  • Bacterial culture results from an explanted screw were positive in 7.4%of dogs prior to changes and in 0.94% of dogs following the protocol change.
  • Staphylococcus spp. were isolated from all implants removed from dogs post-change, 4/5 were methicillin resistant.  No methicillin-resistant isolates were grown from the prechange cohort implants.

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PLoS One. 2018 Jun 19;13(6):e0197204. doi: 10.1371/journal.pone.0197204. eCollection 2018.
Use of a platelet-rich plasma-collagen scaffold as a bioenhanced repair treatment for management of partial cruciate ligament rupture in dogs.
Sample SJ1Racette MA1Hans EC1Volstad NJ1Schaefer SL1Bleedorn JA1Little JP1Waller KR 3rd1Hao Z1Block WF2Muir P2.

  • 29 dogs with an unstable stifle due to a complete cruciate rupture with a stable contralateral stifle with a partial cruciate rupture were included
  • TPLO was performed on the unstable stifles, while a single intra-articular application of PRP-collagen was placed in the stable partial cruciate rupture stifle.
  • The placement of the collagen sponge with PRP was not an effective disease-modifying therapy for the prevention of progression to complete cruciate rupture.  29.6% of dogs progressed to a complete tear of the cruciate within the 12-month study duration.  This is within the previously reported range of 22-54% of dogs that develop a complete cruciate rupture on the contralateral limb within one year of diagnosis.

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J Am Vet Med Assoc. 2018 Aug 1;253(3):315-321. doi: 10.2460/javma.253.3.315.
Retrospective study of factors associated with surgical site infection in dogs following tibial plateau leveling osteotomy.
Lopez DJVanDeventer GMKrotscheck UAryazand YMcConkey MJHayashi KTodhunter RJHayes GM.

  • 320 dogs underwent unilateral or bilateral TPLO and were examined at least once more than 8 weeks after the procedure
  • Surgical site infection (SSI) resulted in 8.4% of cases
  • Though the incidence of SSI was higher in patients with dermatitis at the surgical site (16.7%) than in those without (10.2%), the difference was not significant
  • An increased risk of SSI was associated with German Shepherd breed, meniscectomy (vs no meniscectomy), and attending surgeons performing fewer than 20 procedures over the 8 year time frame in which the study was conducted

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Am J Vet Res. 2018 Aug;79(8):893-904. doi: 10.2460/ajvr.79.8.893.
Effects of low-level laser therapy on bone healing and signs of pain in dogs following tibial plateau leveling osteotomy.
Kennedy KCMartinez SAMartinez SETucker RLDavies NM.

  • 12 dogs that underwent unilateral TPLO were fitted with an accelerometer for 2 weeks prior to surgery and for another 8 weeks following surgery
  • Dogs were randomly assigned to received low-level laser therapy (LLLT) or a placebo treatment immediately before and at predetermined times for 8 weeks after TPLO.
  • Patients in the control group had greater ground reaction forces at 2 and 4 weeks post-TPLO and owner-assigned pain scores were lower during weeks 1-5 after TPLO, compared with the LLLT group
  • The LLLT protocol had no beneficial effects on signs of pain or pelvic limb function following TPLO

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J Am Vet Med Assoc. 2018 Sep 1;253(5):586-597. doi: 10.2460/javma.253.5.586.
Results of a survey of Veterinary Orthopedic Society members on the preferred method for treating cranial cruciate ligament rupture in dogs weighing more than 15 kilograms (33 pounds).
von Pfeil DJFKowaleski MPGlassman MDejardin LM.

  • Members of the Veterinary Orthopedic Society responded to an online survey to determine which method of treatment was preferred for cranial cruciate ligament rupture
  • TPLO was the most commonly preferred method (78.6% or respondents), followed by TTA (13.9%), the lateral fabellar suture (5.9%), and the tightrope procedure (1.6%).
  • The preference for the TPLO was independent of board certification or college of training

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Vet Surg. 2018 Jul;47(5):634-639. doi: 10.1111/vsu.12915.
Factors associated with early tibial tuberosity fracture after tibial plateau leveling osteotomy.
Mehrkens LR1Hudson CC2Cole GL2.

  • Radiographs of 3000 stifles from dogs that underwent TPLO were reviewed for evidence of tibial tuberosity fracture (TTF)
  • Fractures were identified in 0.77% of cases
  • Risk factors were placement of anti-rotational pins distal to the insertion of the patellar ligament, tuberosities with the narrowest point below the insertion of the patellar ligament, placement of multiple pins distal to the patellar ligament, and bilateral simultaneous TPLO
  • Tuberosities that fractured were significantly taller and narrower than those that did not fracture
  • Rotation past the “safe point” (a level even with the insertion of the patellar ligament) and presence of a gap at the osteotomy were not correlated with fracture

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Tierarztl Prax Ausg K Kleintiere Heimtiere. 2018 Aug;46(4):223-235. doi: 10.15654/TPK-170486. Epub 2018 Aug 27.
Tibial plateau leveling osteotomy and tibial tuberosity advancement – a systematic review.
Beer PBockstahler BSchnabl-Feichter E.

  • A comparison of subjective gait analyses could not detect differences in the decrease of lameness between TPLO and TTA
  • Objective gait analysis supports the superiority of TPLO
  • Fewer patients treated with TPLO were diagnosed with postoperative joint instability
  • TPLO had a lower percent increase of osteoarthritis after surgery
  • Owner satisfaction was high for both techniques
  • The assessed literature supports that TPLO is associated with lower complication rates, an improved clinical-functional outcome, and less increase of osteoarthritis compared to TTA
  • Results are indicative of a long-term restoration of normal limb function after TPLO
  • The strength of available evidence and the comparability of each study’s results were poor and more comparative studies are needed to draw strong conclusions

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Am J Vet Res. 2018 Sep;79(9):970-979. doi: 10.2460/ajvr.79.9.970.
Retrospective analysis of corrosion and ion release from retrieved cast stainless steel tibia plateau leveling osteotomy plates in dogs with and without peri-implant osteosarcoma.
Sprecher CMMilz SSuter TKeating JHMcCarthy RJGueorguiev BBoudrieau RJ.

  • Cast and forged stainless steel TPLO plates were retrieved from dogs with and without osteosarcoma (OSA)
  • All cast plates demonstrated high spatial variability of their electrochemical surface properties and inhomogenous superficial and cross-sectional composition, compared with forged plates
  • Greater metal ion release was observed in cast plates than in forged plates and in cast plates from dogs with OSA than in cast or forged plates from dogs without OSA
  • Accumulation of metal ions from implants could be a trigger for neoplastic transformation in neighboring cells
  • Implants that do not comply with recommended standards of the American Society for Testing and Materials International or the International Organization for Standardization could potentially place patients at increased risk of tumor development.

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J Am Vet Med Assoc. 2018 Sep 15;253(6):752-756. doi: 10.2460/javma.253.6.752.
Association of tibial plateau leveling osteotomy with proximal tibial osteosarcoma in dogs.
Selmic LERyan SDRuple APass WEWithrow SJ.

  • Patients diagnosed with proximal tibial osteosarcoma between 2005 and 2012 and had a previous TPLO were evaluated, along with patients without osteosarcoma.
  • Dogs with a history of TPLO were 40 times as likely to develop proximal tibial osteosarcoma as were dogs with no history of TPLO
  • Each 1kg (2.2lb) increase in body weight was associated with an 11% increase in the odds of proximal tibial osteosarcoma

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Vet Surg. 2018 Oct;47(7):916-922. doi: 10.1111/vsu.12942. Epub 2018 Sep 4.
Influence of methods of joint inspection during tibial plateau leveling osteotomy on the radiographic appearance of the patellar tendon.
Owen DJ1Manley R2Casale SA1.

  • Patellar tendon thickness was greater 8-12 weeks after TPLO when stifles were inspected arthroscopically rather than via arthrotomy

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Vet Surg. 2018 Nov;47(8):E79-E87. doi: 10.1111/vsu.12958. Epub 2018 Sep 28.
A prospective, randomized, double-blinded, placebo-controlled clinical study on postoperative antibiotherapy in 150 arthroscopy-assisted tibial plateau leveling osteotomies in dogs.
Spencer DD1Daye RM1.

  • A prospective, randomized, double-blinded, placebo-controlled study in which dogs underwent arthroscopy and TPLO and either received or did not receive a week of antibiotics post-operatively (cefpodoxime)
  • Surgical site infection (SSI) rates did not differ between the placebo group (17%) and the treatment group (11%).
  • The only association between the factors tested in this study and SSI involved body weight, with each kilogram increase increasing the odds of developing an SSI by 4.7%

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Vet Comp Orthop Traumatol. 2018 Nov;31(6):396-404. doi: 10.1055/s-0038-1667139. Epub 2018 Oct 22.
Comparison of the Effect of Dog, Surgeon and Surgical Procedure Variables on Improvement in Eight-Week Static Weight-Bearing following Tibial Plateau Levelling Osteotomy.
Wilson ML1Roush JK1Renberg WC1.

  • Patients with a lower tibial plateau angle (TPA) at the 6-12 week recheck had greater improvement than those patients with a higher recheck TPA, though an ideal TPA was not determined.
  • Surgeon, surgical experience, arthrotomy, meniscal damage, meniscal intervention, complications, postoperative TPA, and preoperative TPA had no significant effect on weight bearing at recheck.
  • Following TPLO, patients showed a 4.58% improvement in body weight loading on the affected limb at 6-12 week recheck

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Vet Surg. 2019 Jan;48(1):35-41. doi: 10.1111/vsu.13114. Epub 2018 Oct 30.
The use of absorbable staples for skin closure after tibial plateau leveling osteotomy.
Watson FC1McMullan W1Jordan CJ1Egan P1Tuan J1Solano MA1Fizpatrick N1.

  • Dogs undergoing TPLO were randomly assigned to have the incision closed with a stainless steel or an absorbable staple
  • 18.8% of incisions were diagnosed with inflammation or infection
  • There was no difference between inflammation-infection scores, incision length, number of staples used, or general anesthetic time between the 2 staple groups
  • Wound closure was faster with stainless steel staples by approximately 30 seconds

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J Am Vet Med Assoc. 2018 Dec 1;253(11):1439-1444. doi: 10.2460/javma.253.11.1439.
Rate of return to agility competition for dogs with cranial cruciate ligament tears treated with tibial plateau leveling osteotomy.
Heidorn SNCanapp SO JrZink CMLeasure CSCarr BJ.

  • Records were reviewed for 31 dogs involved in agility competition that were diagnosed with cranial cruciate ligament tears treated by TPLO
  • 20 dogs (65%) returned to agility competition after TPLO, and 80% of those returned within 9 months of surgery.  Six (30%) of the dogs in the group that returned to agility had bilateral TPLO’s.
  • 11 dogs did not return to agility – 55% of those dogs were not returned to agility for factors unrelated to CrCL tears or TPLO, while the other 45% (5 dogs) were not performing at their preinjury level so their owners decided not to return them to agility competition.
  • No dog that returned to competition sustained an injury to the affected limb during the follow up period (mean follow-up period was 4.6 years)
  • No significant difference was found between dogs that returned or did not return to agility regarding severity of arthritis or proportions with meniscal injury or partial versus complete cruciate tears.

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Vet Surg. 2019 May;48(4):505-512. doi: 10.1111/vsu.13151. Epub 2019 Jan 6.
Influence of fixation systems on complications after tibial plateau leveling osteotomy in dogs greater than 45.4 kilograms (100 lb).

  • Fixation of a TPLO with the 3.5mm broad TPLO plate with an additional String of Pearls (SOP) plate, increased the risk of complications compared to fixation with the 3.5mm broad TPLO plate alone.

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Vet Comp Orthop Traumatol. 2019 Jan;32(1):18-25. doi: 10.1055/s-0038-1676352. Epub 2019 Jan 15.
Prospective Evaluation of Surgical Wound Dressings and the Incidence of Surgical Site Infections in Dogs Undergoing a Tibial Plateau Levelling Osteotomy.
Giannetto JJ1Aktay SA1.

  • 437 dogs undergoing TPLO were randomly selected to have their incision covered with no dressing, with skin glue, or with an adhesive wound dressing
  • The overall rate of surgical site infection (SSI) was 2.3% and methicillin-resistant Staphylococcus pseudintermedius was the most common bacteria isolated (90%)
  • There was no association between type of dressing and SSI
  • Increasing body weight was the only significant risk factor that increased the risk of overall infection

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Vet Comp Orthop Traumatol. 2019 Jan;32(1):26-32. doi: 10.1055/s-0038-1676296. Epub 2019 Jan 15.
Technique and Outcome of a Modified Tibial Plateau Levelling Osteotomy for Treatment of Concurrent Medial Patellar Luxation and Cranial Cruciate Ligament Rupture in 76 Stifles.
Flesher K1Beale BS2Hudson CC2.

  • Dogs with concurrent CrCL and medial patellar luxation (MPL) injuries weighing less than 15kg were treated via a modified-TPLO with or without adjunctive treatment methods while other dogs were treated with a standard TPLO with adjunctive treatment methods.
  • The complication rate was 18.4% for dogs undergoing the modified-TPLO and 28.9% in the standard TPLO group.  This difference was not significant.
  • Reluxation of the patella occurred in 6.6% of cases in the modified group and 8.8% in the standard group.  This was not statistically significant.
  • There was no difference in healing time between groups.

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Vet Surg. 2019 Apr;48(3):401-407. doi: 10.1111/vsu.13177. Epub 2019 Feb 17.
Influence of tibial plateau leveling osteotomy and tibial tuberosity advancement on passive laxity of the cranial cruciate deficient stifle in dogs.
Ober CA1Factor G2Meiner Y2Segev G2Shipov A2Milgram J2.

  • This study used cadaver limbs and a TPLO or TTA was performed.  Stifle stability was then determined.
  • TPLO and TTA caused a decrease in cranial tibial translation (tibial thrust), especially at greater angles of flexion.
  • TPLO caused a greater decrease in cranial tibial translation
  • Only TPLO was associated with a degree of translation that did not differ from joints with an intact CrCL, regardless of the degree of stifle flexion it was tested at.

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Vet Comp Orthop Traumatol. 2019 Jul;32(4):314-323. doi: 10.1055/s-0039-1684050. Epub 2019 Apr 3.
Comparison of Outcomes Associated with Tibial Plateau Levelling Osteotomy and a Modified Technique for Tibial Tuberosity Advancement for the Treatment of Cranial Cruciate Ligament Disease in Dogs: A Randomized Clinical Study.
Livet V1,2Baldinger A1,2Viguier É1,2Taroni M1,2Harel M3Carozzo C1,2Cachon T1,2.

  • Duration of surgery was significantly shorter for the TTA Rapid procedure
  • There was no significant difference in the occurrence of complications rates between TTA Rapid and TPLO
  • Lameness scores were significantly higher during the first 3 days after TPLO
  • One month after surgery, the symmetry index between healthy and affected limbs for the relative stance time during the gait cycle was significantly higher for the TTA Rapid group
  • No gait parameters were significantly different between groups at the 6 month recheck.
  • All of the owners of dogs in the TPLO group were completely satisfied at the 6 month recheck, vs 84.6% in the TTA Rapid group were completely satisfied.

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Am J Vet Res. 2019 May;80(5):461-468. doi: 10.2460/ajvr.80.5.461.
Evaluation of recovery of limb function by use of force plate gait analysis after tibial plateau leveling osteotomy for management of dogs with unilateral cranial cruciate ligament rupture.
Amimoto HKoreeda TWada N.

  • Force plate gait analysis was performed before and 1, 2, 4, and 7 months after TPLO.  Ground reaction forces (GRFs) measured included peak vertical force, vertical impulse, peak braking force, braking impulse, peak propulsion force, and propulsion impulse, time to switching from braking to propulsion, and vector magnitude at peak vertical force.
  • Ground reaction forces (GRF) were significantly lower in the affected limb than the non-affected limb prior to TPLO.
  • All GRFs, except for peak propulsion force, were not significantly different 7 months after TPLO

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Am J Vet Res. 2019 Jun;80(6):607-612. doi: 10.2460/ajvr.80.6.607.
Radiographic evaluation of patellar ligament length after tibial plateau leveling osteotomy in dogs.
Jay MRMattoon JSGilbert PJTanaka TTBeaty BL.

  • Dogs undergoing TPLO had a shorter patellar ligament length (PLL) at the postoperative and follow-up evaluations, compared to the preoperative evaluation
  • The PLL did not differ significantly between the postoperative and follow-up evaluation
  • The clinical relevance of a shorter PLL is unknown

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Vet Surg. 2019 Jul;48(5):700-706. doi: 10.1111/vsu.13249. Epub 2019 Jun 5.
Use of an amikacin-infused collagen sponge concurrent with implant removal for treatment of tibial plateau leveling osteotomy surgical site infection in 31 cases.
Lee SJ1Frederick SW2Cross AR2.

  • Dogs that developed surgical site infection (SSI) after TPLO were treated with an amikacin-infused collagen sponge and removal of the TPLO plate and screws.
  • 77.4% of dogs had uneventful incision healing, 19.4% of dogs exhibited incisional inflammation a median of 4 days postoperatively that resolved without treatment, and one dog (3.2%) required antibiotic treatment 7 days postoperatively
  • In all cases where long-term follow-up was available, there was no evidence of SSI recurrence and no lameness noted

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Vet Comp Orthop Traumatol. 2019 Jun 21. doi: 10.1055/s-0039-1692189. [Epub ahead of print]
A Retrospective Study Using the String of Pearls Tibial Plateau Levelling Osteotomy Locking Plate for the Treatment of Cranial Cruciate Ligament Disease.
McGregor RE1Buffa EA1Tan CJ2Schembri MA3Badcock CA4Lai A5.

  • A radiographic osteotomy union score at 6-8 weeks follow-up was a median grade 2 (26-50% healed).  This is less than previous TPLO locking plate studies
  • Improved healing occurred when the anti-rotational pin was left in place and when there is a lower change in tibial plateau angle
  • Major and minor complication rates were greater than those in other locking plate studies; fibular fracture (8.8%) was a common complication

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Vet Surg. 2019 Jul 9. doi: 10.1111/vsu.13277. [Epub ahead of print]
Extended long-term radiographic and functional comparison of tibial plateau leveling osteotomy vs tibial tuberosity advancement for cranial cruciate ligament rupture in the dog.
Moore EV1Weeren R1Paek M2.

  • Osteoarthritis progressed more after TTA and in dogs with bilateral stifle surgery
  • Dogs treated with TPLO subjectively seemed to have less pain and fewer mobility issues (average pain in last 7 days, interference with walking, morning stiffness, jumping and climbing, limping during mild activities, and overall quality of life) when scored with the Canine Brief Pain Inventory and the Canine Orthopedic Index
  • Concluded that TPLO provides a better long-term radiographic and functional outcome than TTA

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Vet Comp Orthop Traumatol. 2019 Jul 30. doi: 10.1055/s-0039-1693153. [Epub ahead of print]
Short-Term Complications following Single-Session versus Staged Bilateral Tibial Plateau Levelling Osteotomies Stabilized with Locking Plates for Treatment of Bilateral Cranial Cruciate Ligament Disease: A Retrospective Study.
Cappelle KK1Barnhart MD1.

  • There was no significant difference in incidence of major or minor complication rates between the two groups
  • Increasing age was the only significant risk factor for major complications in either group

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Vet Surg. 2019 Aug 2. doi: 10.1111/vsu.13300. [Epub ahead of print]
The effect of tibial plateau leveling osteotomy on patellofemoral kinematics in dogs: An in vivo study.
Zann GJ1Kim SE1Tinga S1Pozzi A1Banks SA2.

  • There was an approximately 1mm increase in cranial displacement of the patella following TPLO compared with the normal stifle at equivalent femorotibial flexion angles between 120-140 degrees and predominantly during the stance phase
  • The patellofemoral kinematics in TPLO-treated stifles were subtly different from normal.  The clinical significance of this is unknown.

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Vet Surg. 2019 Aug 13. doi: 10.1111/vsu.13308. [Epub ahead of print]
Risk of infection after double locking plate and screw fixation of tibial plateau leveling osteotomies in dogs weighing greater than 50 kilograms.
Tuan J1Solano MA1Danielski A2.

  • Records of dogs weighing greater than 50kg that underwent TPLO with double locking plate and screw fixation, standard locking plate and screw fixation, and nonlocking plate and screw fixation, were reviewed.
  • The overall rate of surgical site infection was 17.5%.
  • There was no significant difference in infection rates detected between the three groups.

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Risk Factors For ACL Tear

Tibial plateau angle in four common canine breeds with cranial cruciate ligament rupture, and its relationship to meniscal tears.

  • Labrador Retrievers, Rottweilers, Boxers, and German Shepherd Dogs had mean tibial plateau slopes of 25.9 degrees, 26.2 degrees, 25.9 degrees, and 28.2 degrees, respectively.
  • The tibial plateau slope of German Shepherd Dogs was significantly higher than that of the other breeds of dogs examined
  • TPA higher than the mean for dogs in this study did not significantly increase the risk for concurrent meniscal injury

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Age, tibial plateau angle, sex, and weight as risk factors for contralateral rupture of the cranial cruciate ligament in Labradors.

  • Subsequent CCLR occurred in 48% of dogs at a median time of 5.5 months
  • Bilateral CCLR on admission was identified in 10.6% of patients
  • There were no significant differences between dogs with or without a contralateral rupture in regards to age or weight at initial rupture, sex or tibial plateau slope
  • There were associations toward longer time to contralateral rupture for dogs older than the median age and female dogs (intact and spayed)
  • There were no significant differences in age, sex, weight, or tibial plateau slope of dogs with bilateral CCL ruptures compared with initial unilateral ruptures
  • There was a trend toward dogs presenting at an older age and with lower tibial plateau slopes in the bilateral rupture group.

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TPLO In Small Dogs

Long-term outcome after surgical treatment of cranial cruciate ligament rupture in small breed dogs. Comparison of tibial plateau leveling osteotomy and extra-articular stifle stabilization.

  • Twenty-one of 23 operated limbs (91.3%) treated with TPLO and five of 17 (29.4%) treated with the capsular fascial imbrication (CFI) showed absolute values comparable to healthy dogs when evaluated by peak vertical force, vertical impulse and its symmetry index during objective gait analysis
  • Both groups showed mild, but the continuous progression of osteoarthritis
  • TPLO led to a significantly faster recovery and a higher degree of owner satisfaction

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Short-term outcome and complications of TPLO using anatomically contoured locking compression plates in small/medium-breed dogs with “excessive” tibial plateau angle.

  • Short-term radiographic and clinical outcome of TPLO stabilized with anatomically contoured locking compression plates for the treatment of small dogs with large tibial plateau angle suggests a very low risk of complications
  • Rotation beyond the “safe point” is necessary to perform a full rotation in some cases, but does not appear to incur an increased risk of tibial tuberosity fracture.

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Short-term complications associated with TPLO in dogs using 2.0 and 2.7 mm plates.

  • The purpose of this study was to evaluate short-term complications associated with TPLO in small and medium size dogs
  • Radiographic evidence of delayed healing of the TPLO osteotomy site was the most common complication in the dogs (9%), none of which had clinical signs attributed to delayed healing
  • Other common complications included patellar tendon thickening (8%) and tibial tuberosity fracture (6%)
  • Seven percent of the complications were considered major (requiring additional surgical intervention)
  • Fifty-two percent of complications did not require treatment

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Potential Complications

Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs.

  • The overall complication rate was 14.8%, of which 6.6% were major complications.
  • The incidence of primary meniscal injury (PMI) was 33.2%, and subsequent meniscal injury (SMI) 2.8%.
  • Postoperative infection occurred in 6.6% dogs.
  • Bilateral CCL rupture was diagnosed in 14.6% dogs
  • No statistically significant complication incidence difference was recorded for simultaneous or staged bilateral surgical procedures.
  • Administration of postoperative antibacterial therapy and being a Labrador reduced infection incidence
  • Increased body-weight and being an intact male increased infection risk.
  • Increased body-weight and complete (versus partial) CCL rupture were significant predictors of overall complications.

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Radiographic outcome and complications of tibial plateau leveling osteotomy stabilized with an anatomically contoured locking bone plate.

  • Use of an anatomically contoured, locking TPLO plate was associated with accurate tibial plateau leveling, reliably excellent bone union at follow-up exam, minimal change in the tibial plateau slope (minimal loss of rotation), and a lower complication rate than previously reported.

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Risk factors for surgical site infection-inflammation in dogs undergoing surgery for rupture of the cranial cruciate ligament: 902 cases (2005-2006).

  • Infection-inflammation developed in 6.1% of surgeries within 6 months after surgery
  • There was a significant difference in infection-inflammation rate after the extracapsular suture (ECLS) surgeries (4.2%), compared with rate after the TPLO surgeries (8.4%).
  • Factors associated with a significantly lower rate of infection-inflammation included the use of suture material other than stainless-steel staples for skin closure and postoperative oral administration of antimicrobials.

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Complications associated with tibial plateau leveling osteotomy: a retrospective of 1519 procedures.
This retrospective study identified complications associated with tibial plateau leveling osteotomy (TPLO) and predisposing factors for these complications in a large population of dogs

  • Total complication rate (major or minor) was 11.4%
  • The major complication rate was 3.1%
  • The minor complication rate was 8.3%
  • Factors associated with the development of complications included being a German shepherd dog tibial plateau slope > 30°, and heavier weights
  • Tibial plateau leveling osteotomy is a common treatment for dogs with cruciate ligament deficiency and has a low complication rate.

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Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997-2001)

  • Complications were identified in 20% of the TPLO’s
  • 93% of owners were satisfied with the outcome of surgery
  • Assessments of outcome were not significantly different between owners of dogs that had complications and owners of dogs that did not

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A client-assessed long-term outcome in dogs with surgical site infection following tibial plateau leveling osteotomy

  • Surgical site infection (SSI) occurred in 4.7percent of procedures
  • Of the dogs with SSI, 37.5 percent required implant retrieval
  • Later onset SSI was associated with the increased requirement for retrieval
  • Crossbreed dogs had a lower risk of developing SSI
  • There was no association between SSI and long-term functional outcome in dogs following TPLO
  • Later onset of SSI is more likely to require implant retrieval to resolve

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Comparison of complications following tibial tuberosity advancement and tibial plateau leveling osteotomy in very large and giant dogs 50 kg or more in body weight

  • Surgical site infection (SSI) was the single most common major complication following both TTA (15.4%) and TPLO (25.9%) surgery.
  • There were no significant differences between TTA and TPLO treatment regarding the rate of SSI, surgical revision, or overall occurrence of major complications.
  • Postoperative antibiotic therapy significantly reduced the risk of a major complication in all dogs ≥50 kg

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A retrospective study of 476 tibial plateau leveling osteotomy procedures. The rate of subsequent ‘pivot shift’, meniscal tear and other complications.

  • Postoperative complications were reported in 9.7% of patients; 4.2% were classified as major complications requiring an additional surgical intervention, and 5.5% as minor complications.
  • No risk factors associated with postoperative complications were identified.
  • Subsequent meniscal injuries occurred in 2.1% of stifles with normal unaltered menisci at time of TPLO with a median postoperative time of 9.5 months.
  • Signs of postoperative ‘pivot shift’ were reported in 3.1% of stifles, and all stifles with a ‘pivot shift’ had a complete CCL rupture or a debrided partial CCL rupture
  • Medial meniscectomy was identified as a risk factor for a ‘pivot shift’
  • Dogs with intact medial meniscus had a significantly higher activity level and a shorter time to peak function than dogs that underwent meniscectomy according to an owner questionnaire.

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Risk factors associated with fibular fracture after tibial plateau leveling osteotomy.

  • Fibular fractures occurred in 5.4% of TPLOs.
  • Body weight, change in tibial plateau slope, and preoperative tibial plateau slope were significantly higher in dogs with a fibular fracture.
  • TPLO without the use of a jig was significantly associated with fibular fracture.
  • Age, postoperative TPA, and plate type were not significantly associated with fibular fracture.

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Radiographic evaluation and comparison of the patellar ligament following tibial plateau leveling osteotomy and tibial tuberosity advancement in dogs: 106 cases (2009-2012).

  • Patellar ligament thickening occurred following TPLO and TTA in dogs. The clinical relevance of this thickening remains unknown.

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Radiographic and ultrasonographic evaluation of the patellar ligament following tibial plateau leveling osteotomy.

  • Significant thickening of the distal patellar ligament was noted postoperatively as evidenced by thickness and area measurements and a decreased radiographic ratio
  • Body weight (kg) and postoperative TPLO angle had a significant influence on 1-month postoperative distal patellar ligament area
  • Clinical significance (i.e., correlation with a residual lameness) was not evaluated in this study

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Meniscal Injuries

Incidence and type of meniscal injury and associated long-term clinical outcomes in dogs treated surgically for cranial cruciate ligament disease.

  • Meniscal tears were diagnosed in 83% of stifles assessed by arthroscopy and 44% of stifles assessed by arthrotomy
  • Subsequent meniscal tears were diagnosed in 6.7% of patients with median time to diagnosis of 5.8 months.
  • Cases treated with meniscal release did not have subsequent meniscal tears, whereas dogs not treated with meniscal release had a subsequent meniscal tear rate of 11%
  • Cases diagnosed and treated for concurrent meniscal tears were 1.3 times more likely to have a successful long-term outcome

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The incidence of medial meniscal tears after arthroscopic assisted tibial plateau leveling osteotomy.

  • Concurrent meniscal tears were found in 32.2% of patients
  • Late-onset meniscal tears occurred in 5.6% of patients
  • There was a significantly lower prevalence of concurrent meniscal tears and incidence of late-onset meniscal tears in dogs that had a partial CCL tear compared with those that had a complete CCL tear.
  • All dogs with late-onset meniscal tears treated by partial meniscectomy (PMM) returned to peak postoperative limb function

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Effect of meniscal release on the ate of subsequent meniscal tears and owner-assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy.

  • Subsequent meniscal tears were diagnosed in 6.3% of patients
  • The subsequent meniscal tear was 3.8 times more likely to occur in patients with an open arthrotomy without meniscal release than for those with an open arthrotomy with meniscal release or arthroscopy without meniscal release.
  • No significant differences among groups were noted for measures of outcome.
  • Authors suggest that a meniscal release is performed when complete and thorough exploration of the joint and meniscus cannot be, or are not, performed.

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PT and the recovery

Effect of bandaging on post-operative swelling after tibial plateau leveling osteotomy.

  • The use of a modified Robert-Jones bandage after TPLO did not prevent statistically significant postoperative swelling, and thus may not be indicated for this purpose

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Safety and functional outcomes associated with short-term rehabilitation therapy in the post-operative management of tibial plateau leveling osteotomy.

  • This retrospective study compared the perioperative complication rates of TPLO surgery and the 8-week, 6-month, and 1-year functional outcomes, between rehabilitation and traditional post-operative management 
  • “Traditional” management involved restriction to cage rest and leash walking; “rehabilitation” was performed by a certified practitioner
  • There was no statistically significant difference in complication rates in the perioperative period between the 2 treatment groups
  • The rehabilitation group was 1.9 times more likely to reach full function at 8 week
  • The traditional group was 2.9 times more likely be categorized as having an acceptable function at 8 weeks after surgery
  • This study suggests that rehabilitation performed by a certified practitioner is safe and may improve short-term outcomes when used in the initial postoperative management for dogs treated with TPLO

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Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament.

  • Before surgery, CCL-deficient limbs had significantly reduced thigh circumference (TC) and reduced flexion and extension range of motions (ROMs), compared with values for the contralateral control limb
  • Six weeks after TPLO, the physiotherapy group had significantly larger TC than the home-exercise group, with the difference no longer evident between the affected and non-affected limbs
  • Extension and flexion ROMs were significantly greater in the physiotherapy group, compared with values for the home-exercise group, 3 and 6 weeks after surgery
  • Six weeks after surgery, the difference in flexion and extension ROMs was no longer evident between the affected and non-affected limbs in the physiotherapy group
  • Both groups had improvements in lameness and weight-bearing scores over time, but no difference was found between the 2 groups.

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Preoperative low-level laser therapy in dogs undergoing tibial plateau leveling osteotomy: A blinded prospective, randomized clinical trial.

  • Dogs undergoing TPLO were randomly assigned to receive either a single preoperative low-level laser therapy (LLLT treatment, 800-900 nm dual wavelength, 6 W, 3.5 J/cm2, 100 cm2area) or a sham treatment
  • No major complications occurred.
  • At eight weeks postoperatively, a significant difference in peak vertical force analysis was noted between the LLLT and sham groups
  • Although not significant, a greater proportion of LLLT dogs (5/8) had healed at the eight-week time point than in the sham group (3/12)

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