Tibial Plateau Leveling Osteotomy (TPLO) Surgery for Dogs: Cost, Recovery & Success

Causes of Cranial Cruciate Ligament (CCL) Injuries in Dogs

CCL injuries in dogs can result from both trauma and degeneration, with many cases involving a combination of both factors. Dogs are particularly prone to CCL tears, often due to underlying ligament degeneration that makes them more susceptible to injury.

Traumatic CCL Injuries

• Most commonly occur when a dog suddenly rotates the stifle joint while it is flexed at

  20 to 50 degrees.

• Can also result from hyperextension of the knee due to forceful impact.

Degenerative CCL Injuries

• More common in large-breed dogs as they age.

• Can result from conformational abnormalities, such as straight rear limbs, which place extra stress on the knee.

• Immune-mediated joint diseases can weaken the ligament over time.

• Increased Tibial Plateau Angle (TPA) may contribute to excessive strain on the ligament, leading to gradual failure.

Risk Factors for CCL Injuries in Dogs and Cats

• Obesity: Overweight dogs and cats have a significantly higher risk of CCL rupture. Even minor incidents, like stumbling, can cause injury.

• Luxating Patella: Dogs with a luxating patella (kneecap dislocation) are more likely to develop a CCL tear, particularly in small and toy breeds.

• Bilateral Ruptures: Dogs that rupture one CCL have a 40-50% chance of injuring the other within two years.

• Breed Predisposition: Some breeds, including Newfoundland's, Rottweilers, and Labrador Retrievers, are more prone to early-onset bilateral CCL injuries (often between 1 to 2 years of age).

Diagnosis of Cranial Cruciate Ligament (CCL) Injuries in Dogs

Accurate diagnosis of CCL injuries is essential for determining the best course of treatment. Dogs of any age or breed can be affected, though young, active, large-breed dogs are the most commonly diagnosed. CCL injuries are rare in cats.

Clinical Presentation of CCL Injuries

CCL injuries can present in three forms:

• Acute Injury – Sudden onset of non-weight-bearing or partial-weight-bearing lameness.

• Chronic Injury – Prolonged weight-bearing lameness, often worsening over time.

• Partial Tears – Mild, intermittent lameness that worsens with activity and improves with rest, making early diagnosis challenging.

Some dogs may also experience bilateral (both knees) CCL ruptures, especially in chronic cases.

Differential Diagnosis of CCL Injuries in Dogs

Several orthopedic conditions can mimic the clinical signs of a cranial cruciate ligament (CCL) injury, making differential diagnosis essential for proper treatment. Common conditions that should be ruled out include:

• Mild joint sprains or muscle strains

• Patellar luxation (dislocation of the kneecap)

• Caudal cruciate ligament injury (less common than CCL tears)

• Primary meniscal injury (without ligament damage)

• Long digital extensor tendon avulsion

• Primary or secondary arthritis

• Immune-mediated arthritis

Partial Rupture of the Cranial Cruciate Ligament

A significant number of stifle lameness cases are caused by partial CCL ruptures, which can be more difficult to diagnose than complete tears. Labrador Retrievers and Rottweilers are particularly prone to partial CCL tears at a young age (6-24 months), often affecting both knees and mimicking hip dysplasia. However, CCL issues typically cause more severe lameness than hip dysplasia and should be treated first.

Clinical Signs of a Partial CCL Tear

• Similar to complete ruptures but less severe.

• Lameness worsens with activity but improves with rest.

• Secondary arthritis develops more slowly compared to full ligament ruptures.

• Effusion (joint swelling) may be present, indicated by the fat pad sign on X-rays.

Understanding CCL Structure and Injury Patterns

The cranial cruciate ligament (CCL) consists of two key bands:

• Craniomedial Band (CrMB) – Taut in both flexion and extension.

• Caudolateral Band (CdLB) – Taut only in extension.

How the Type of Injury Affects Diagnosis

• Hyperextension injuries often damage the CdLB, leaving the CrMB intact, resulting in no detectable drawer motion.

  • Drawer motion in flexion (CdLB is relaxed).

  • No drawer motion in extension (CdLB remains taut).

• Twisting or rotational injuries typically affect the CrMB, leading to pain during full extension of a stable but swollen stifle is highly suggestive of a partial CCL tear.

Diagnosing Partial CCL Tears

Partial tears are often overlooked due to minimal drawer motion. However, they should always be considered in medium to large-breed dogs experiencing stifle pain.

• Radiographs (X-rays) – The fat pad sign and presence of osteophytes (bone spurs) indicate possible CCL damage.

• MRI, Arthroscopy, or Ultrasound – Advanced imaging can confirm partial tears before surgery.

• Surgical Exploration – If physical findings are inconclusive, exploratory surgery may be necessary to assess the ligament.

Surgical Approach for Partial CCL Tears

Surgeons should treat partial ligament tears the same way as complete ruptures, as the ligament loses its functionality once damaged. If osteoarthritis is present without an obvious cause (e.g., patellar luxation, meniscal damage, or joint disease), a CCL tear should be suspected.

By using advanced imaging techniques and careful ligament evaluation, early intervention can prevent long-term joint damage and improve treatment outcomes for affected dogs. Learn more about partial CCL tear.

Tibial Osteotomy Techniques for torn CCL in Dogs

Tibial osteotomy procedures, such as Tibial Plateau Leveling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA), offer an innovative approach to treating cranial cruciate ligament (CCL) ruptures in dogs. Instead of reconstructing the damaged ligament, these surgical techniques alter the geometry of the stifle joint, effectively eliminating cranial tibial thrust—a key factor in joint instability during movement.

How Tibial Osteotomy Works

• Unlike traditional ligament repair methods, TPLO and TTA work by reshaping the tibia, reducing the shear forces between the femur and tibia. Learn more about TTA.

• These procedures don't eliminate cranial drawer movement, which is the forward motion of the tibia relative to the femur, detected during orthopedic examinations.

• Immediately after surgery, cranial drawer movement may still be present, but cranial tibial thrust should be eliminated both at rest and during movement.

• Over time, capsular fibrosis (the natural thickening of joint tissue) helps reduce static cranial drawer motion, further stabilizing the joint.

Tibial Plateau Leveling Osteotomy (TPLO) Surgery in Dogs

Tibial Plateau Leveling Osteotomy (TPLO) is a highly effective surgical procedure developed by Dr. Barclay Slocum to treat cranial cruciate ligament (CCL) injuries in dogs. Dr. Slocum identified the concept of anterior tibial thrust, where the tibia naturally moves forward during weight-bearing. Normally, the CCL stabilizes the knee, much like a rope holding a wagon on a hill. However, when the ligament is torn, this instability causes lameness, pain, and osteoarthritis.

Instead of attempting to reconstruct the CCL, which has shown limited long-term success, TPLO surgery modifies the tibial plateau angle to eliminate instability and restore proper biomechanics to the stifle joint.

How TPLO Surgery Works

• The proximal tibia (top of the shinbone) is carefully cut and rotated to change the slope of the tibial plateau.

• A specialized bone plate is used to stabilize the osteotomy, ensuring proper healing.

• By reducing the tibial plateau angle, the cranial tibial thrust is neutralized, allowing the dog to bear weight without abnormal joint movement.

• TPLO is a technically advanced procedure with a steep learning curve.

• Complications can be severe if the procedure is not performed correctly.

• Experienced orthopedic surgeons are recommended for optimal outcomes.

Meniscal Injuries and TPLO Surgery

Inside the knee joint are menisci, specialized cartilage structures that act as shock absorbers between the femur and tibia. When the CCL ruptures, the medial meniscus is frequently damaged:

• Acute Meniscal Tears – Occur at the time of injury.

• Chronic Meniscal Damage – Due to prolonged joint instability, leading to crushing and shredding of the caudal horn of the medial meniscus.

Because of the high risk of meniscal damage, TPLO surgery often includes meniscal repair or removal to prevent further joint deterioration.

TPLO Implants and Fixation

Different types of bone plates and screws are used to stabilize the tibia post-surgery. At our hospital, we use the TPLO Locking System (Plate and Screws) from DePuy Synthes Vet, which ensures maximum strength and stability during healing.

TPLO vs. Other ACL Surgery Options

• Best Functional Outcomes – TPLO is widely regarded as the gold standard for CCL repair, allowing even working and performance dogs to return to high activity levels.

• Slower Progression of Arthritis – Studies suggest that arthritis progression is slower in dogs that undergo TPLO compared to MRIT (Modified Retinacular Imbrication Technique). However, some degree of arthritis will develop over time regardless of surgical method.

By eliminating cranial tibial thrust, TPLO surgery restores stability, reduces pain, and significantly improves long-term mobility in dogs suffering from CCL injuries.

TPLO Surgery for Small Dogs

TPLO surgery is highly effective for small and toy breeds, especially those with steep tibial slopes that increase ACL injury risk

Post-Operative Care and Potential Complications After TPLO Surgery

While Tibial Plateau Leveling Osteotomy (TPLO) is a highly effective treatment for cranial cruciate ligament (CCL) injuries, proper post-operative care is crucial for a successful recovery.

Potential Post-Surgical Complications

Although complications are rare, some potential risks include:

• Delayed or abnormal bone healing

• Loosening or breaking of the TPLO plate and screws

• Post-surgical infections

How to Minimize Complications During Recovery

To ensure proper healing, we recommend:

• Strict crate rest – TPLO patients should be confined to a crate or small space to prevent excessive movement.

• Regular X-rays (radiographs) – Follow-up X-rays at 4- and 8-weeks help assess healing progress.

• Gradual rehabilitation exercises – Supervised home exercises aid in recovery, with options for continued care at an Animal Rehabilitation Center.

• Full healing may take up to 16 weeks in some dogs, requiring patience and careful monitoring.

TPLO Surgery Recovery & Aftercare

• Most dogs recover in 8 to 12 weeks with proper post-op care.

• Expected Recovery Timeline After TPLO Surgery

  • 3 to 7 Days Post-Surgery – Most dogs will begin partially bearing weight on the operated leg.

  • 3 to 4 Weeks Post-Surgery – Dogs typically walk comfortably with only a slight limp.

  • 8 to 16 Weeks Post-Surgery – The bone heals completely, and most dogs regain near-normal function with proper post-op care.

• Activity must be restricted during this period to avoid complications.

• We provide detailed post-operative care & rehabilitation plans to ensure a smooth recovery.

TPLO Surgery Success Rate & Long-Term Prognosis

How Successful Is TPLO Surgery?

• TPLO has a 90-95% success rate, restoring full mobility in most dogs.

• It eliminates cranial tibial thrust, preventing arthritis.

• Most dogs return to their pre-injury activity levels within a few months.

Will My Dog Be Pain-Free After TPLO?

• Yes! TPLO significantly reduces pain & inflammation over time.

• Dogs regain full weight-bearing on the leg within weeks after surgery.

How Much Does TPLO Surgery Cost?

The cost of TPLO surgery depends on factors like your dog's size, and anesthesia time. On average, TPLO surgery costs between $3,500 and $4,500.

At Canton Animal Hospital, we offer:

• Transparent pricing with no hidden fees

• Flexible payment plans & financing options

Contact us for a Free Consultation & detailed TPLO surgery estimate!

Choosing a Skilled Veterinary Surgeon for TPLO Surgery

TPLO is a technically advanced procedure with a steep learning curve. It is best performed by an experienced orthopedic surgeon with specialized TPLO certification.

Why Choose Dr. Ajaib Dhaliwal for TPLO Surgery?

• Dr. Dhaliwal is Slocum TPLO Certified, ensuring advanced training and expertise.

• He has extensive experience in orthopedic procedures, trained under:

  Dr. Terri Zachos (Former Assistant Professor at MSU) Dr. Claude Gendreau (Board-Certified Orthopedic Surgeon, Veterinary Orthopedics Center)

• Free TPLO Consultation – Dr. Dhaliwal offers second opinions and referral consultations

  for TPLO surgery.

If your pet is experiencing CCL injury symptoms, schedule a free TPLO consultation with Dr. Dhaliwal today!

At Canton Animal Hospital, we perform a variety of orthopedic surgeries to help pets recover from joint injuries and improve mobility. Each procedure is carefully selected based on the individual needs of the patient to ensure the best possible outcome.

• Extracapsular Lateral Suture (MRIT) – Best for small to medium-sized dogs.

• Tibial Plateau Leveling Osteotomy (TPLO) – The gold standard for large, active dogs.

• Tibial Tuberosity Advancement (TTA) – A less invasive alternative to TPLO.

• General Orthopedic Procedures – We offer surgical solutions to support joint and ligament health.