TPLO – Cruciate Ligament Surgery

TPLO – Cruciate Ligament Surgery2021-03-16T23:21:33+00:00

Clinical signs of CrCL tear in dogs range from intermittent limping to acute complete non-weight bearing lameness in the hind limb. CrCL tears can be partial, complete, or complete with a damaged meniscus. A dog with a partial CrCL tear may be intermittently lame, and might be hesitant to flex the knee. They may sit with their leg out to the side. A dog with a complete CrCL tear is often 3-legged lame for a few days with some improvement as the inflammation resolves. The last phase of a tearing CrCL involves damaging the meniscus, which will cause the dog to bear very little weight on the leg. Most partial CrCL tears will progress to complete rupture. Bilateral CrCL tears are common due to underlying etiology. Because dogs have more cranial tibial thrust than humans, they usually do not heal with rest. They may function well enough to get along with conservative treatment, but they will continue to be lame without knee surgery.

TPLO SURGERY

TPLO Surgery

Just like in Football players and Athletes, cranial cruciate injuries are common occurrences in dogs as well. Anterior cruciate ligament (ACL) aka Cranial Cruciate ligament (CCL) is a band of tissue in the knee joint, responsible for stabilizing the joint during movements. Trauma (sudden jerk, jumping from the bed, running and making sudden turn etc) can lead to cruciate ligament tears in dogs, however due to sloping of the tibial plateau the ligament undergoes wear and tear through normal walking and running activities as well. It is very important that anterior cruciate ligament injuries are treated surgically in dogs. Tibial Plateau Leveling Osteotomy, or TPLO surgery is the most common surgical procedure to improve the joint’s long-term stability. Compared to other ligament repair procedures, TPLO surgery usually provide more rapid recovery, a better range of motion, less arthritic development and more athletic performance ability.

WHO SHOULD GET TPLO:

We strongly recommend TPLO surgery for any dog over 10-20 pounds with torn ACL. In our experience TPLO surgery has better outcome in dogs over 20 pounds as compared to traditional Extra Capsular Imbrication procedure. The results of TPLO have been far superior to those of other surgeries and is considered “The gold standard” to treat ACL tears. Additional follow up needs to be performed; however, in our practice >95% of dogs return to full function. Additionally, dogs are often able to return to athletic exercises such as hunting or field training.

What is the success rate of TPLO?

The success rate of TPLO surgery is extremely high, with as many as 90-95% of dogs returning to near-normal function. Most dogs achieve about 95% of their normal limb function and return to their prior level of activity approximately 10-12 weeks post-TPLO surgery. We have a 95% success rate due to years of experience with the TPLO procedure, high quality instrumentation, and locking plates. Complications are rare but can include infection at the surgical site, patellar luxation, and implant failure.

Preparing your home:

Prior to your pet’s surgery, you should speak with your veterinarian about how to best confine your dog during their recovery. Making your dog as comfortable as possible is just as important as a good rehabilitation plan.

Since your dog’s mobility will be restricted, we recommend taking the following steps:

  • If your dog is crate trained, find a crate that’s large enough for him/her to stand up in & turn around.
  • Create a gated off area in your home, such as the kitchen or living room to restrict them to certain areas.
  • Rooms with hardwood floors, tile, or linoleum can be particularly difficult for dogs to walk on, especially after surgery. If the room you’ve chosen has slippery surfaces like these, be sure to place some throw rugs with rubber backing on the floor to help your dog walk around more easily.

Preparing your pet: 

We recommend that you provide your dog an early meal the night before the surgery day and do not allow any food in the morning. Your dog can have water 1 hour before dropping off. Your pet should not be given any medication before dropping off unless instructed to do so by the surgeon.

We strongly recommend giving a full bath or at the minimum wash the rear part including both rear legs 1 day prior to surgery with an antibacterial dog shampoo. This will help reduce bacterial population in our surgical field during surgery.

If your pet has occasional or chronic skin allergies and is currently experiencing a flare up, the skin issue needs to be treated first and the surgery should be rescheduled to reduce chances of post surgical infections.

TPLO PROCEDURE:

Before surgery, an x-ray of the stifle is taken to measure the angle at the top of the shin bone, called the tibial plateau angle. The goal of the surgery is to reduce this angle so that dynamic joint instability (cranial tibial thrust) is eliminated. This is usually accomplished by creating a post-surgical angle of between 3 and 6 degrees ideally, an angle not much different than is found in the human knee. In all cases the surgical procedure starts with a minimal invasive exploration stifle joint via mini arthrotomy.  The goal is to assess the meniscal cartilages for any possible damage and removal of torn remnants of the ACL. Damaged cartilage must be removed if the dog is to regain normal pain-free function. These steps help in minimising and delaying onset of  arthritis in the joint due to ACL tear. The TPLO procedure itself involves the use of a saw blade to make a curved (radial) cut on the medial surface of the tibia. The cut top portion is then rotated to create the desired tibial plateau angle. A stainless steel bone plate and locking bone screws then placed on the bone to hold the two pieces in their new alignment. We use Biomedtrix and VOI locking plate systems.

INCISION CARE (First 2 weeks) :

Use of an Elizabethan collar (Cone) is mandatory during the first two weeks until the staples are removed. Monitor the incision daily for signs of progressive redness, swelling, discharge, or excessive licking. Mild redness and swelling are part of the healing process and should be expected for the first few days after surgery. For orthopedic surgeries the swelling can also travel down the leg and gather around the hock and paw. This condition is temporary and should self resolve. After the first 3 to 5 days, the swelling and redness should subside and the incision should look better each day. Please call us for advice if you notice excessive swelling, redness, heat, or discharge that is cloudy (pus).

For the first 5 days after surgery you may ice the incision. To do this use a bag of frozen peas or an ice pack and wrap it in a clean wash towel. The pack may then be applied directly over the incision for 10 to 15 minutes two times daily . Only do this if it is well tolerated by your pet.

POST OPERATIVE INSTRUCTIONS:

ACTIVITY RESTRICTION:

  • WEEK 1 and 2: When you are not at home or your pet is not directly supervised, please keep your pet in a crate, pen, or small room. When you are at home, it is preferable to keep your pet confined. It is absolutely essential to keep her on a LEASH and a belly sling when going to the bathroom outside. The belly sling will help reduce the stress on the normal leg and prevent damage to its ACL during recovery. At the end of the two weeks your pet should have its incision checked by us or your family veterinarian. ( It is not necessary to have this recheck with the surgeon unless there is a concern)
  • WEEK 3: The same as weeks 1-2 except, you can allow 5 minute leash walks 2 to 3 times a day. Walk them outside very slowly which will allow them to start to toe touching or to begin to use the leg. This is the period when Physical therapy is started, especially Massaging of muscles and passive range of motion exercises.
  • WEEK 4: The same as weeks 1-3 except you can increase the leash walks to 10 minutes 2 to 3 times a day. You can also start swimming for 10-15 minutes once or twice daily. A pool will work best rather than a lake or beach. Do not allow your pet to jump in the water- assist him or her in or out.
  • WEEKS 5: The same as weeks 1-4 except you can increase the leash walks to 15 minutes 2 to 3 times a day.
  • WEEK 6: The same as weeks 1-5 except you can increase the leash walks to 20 minutes 2 to 3 times a day.
  • WEEK 7: The same as week 1-6, except you can increase the leash walks to 25 minutes 2 to 3 times a day.
  • WEEK 8-12: Most pets can handle longer leashed walks during this period. Your pet may go for an hour long walk or 1 mile – 2 mile walk to allow the muscles to regain their lost strength. We recommend a recheck at our clinic at this time. Pending the recheck you may start off leash activity after this next visit.Remember during these 8 weeks there should be no running, jumping, playing, or using stairs off a leash. Proper confinement is critical in the healing of your pet and over activity can result in implant failure or delayed healing that often requires a second surgery.
  • WEEK 10-12: We recommend X Rays to be done with us or your local veterinarian and reviewed by the surgeon personally or via email. We assess these x rays for osteotomy site healing. If adequate healing is noted, all confinement, crate and exercise restrictions will be lifted at this time.

REHABILITATION:

  • Passive Range of Motion: Your pet may benefit from Passive Range of Motion therapy. To do this place your pet with the unoperated side down and flex and extend all the joints in the operated limb as far as what is comfortable. Do not do this if your pet seems too anxious or uncomfortable and tries to “fight” the exercises. You can do this 3 to 4 times a day for 10 to 15 minutes.
  • Other rehab exercises may be recommended as healing progresses. Your pet may also benefit from a formal rehabilitation session. There are many centers available and please let us know if you would like a local referral.

MEDICATIONS:

Please give all medications as prescribed by your family veterinarian. Examples of common post operative medications are included below:

  • NSAID: This is a non-steroidal anti-inflammatory medication. It is meant to help with pain and inflammation during the healing process. Side effects include gastrointestinal upset and very rarely liver or kidney problems. Please stop the medication and notify us if you see any vomiting or diarrhea.
  • ANTIBIOTIC: This medication is an antibiotic and can cause gastrointestinal upset in some patients. Please call u for advice if you see any vomiting or diarrhea.
  • GABAPENTIN : This medication is a morphine like medication used for pain. The major side effect seen is sedation.
  • SEDATIVES : Acepromazine or Trazodone:- These medications are strongly recommended for all pets in post surgery period. They will help reduce anxiety of been crate rested initially and allow proper rest when pets become anxious to play and run outside a few weeks after the surgery.

DIET:

  • Your pet may continue on its normal diet at home but make a 10-20 percent reduction in quantity to discourage weight gain during the recovery period of reduced activity. Some pets do not want to eat well for a couple days after anesthesia and surgery but please call us for advice if your pet has not eaten at all in 2 to 3 days.
  • Because of the medications and hospitalization dogs can often become constipated after anesthesia or surgery. It is not abnormal for your dog to go 3 to 5 days without a bowel movement. If you notice straining to defecate or your pet has not had a bowel movement in 5 days please call us for advice.

RECHECKS:

Please make an appointment for the rechecks before you leave today to ensure availability.

  • Please bring your pet back for a recheck in 14 days to check the incision  and staple removal by a technician.
  • Please bring your pet back in 12 weeks for recheck radiographs to assess the healing of your pet. Please fast your pet the morning before this visit in case sedation is needed. (Note:- there will a charge for these x rays and are not pre -paid with the initial surgery)

MONITORING:

Please monitor your pet at home for any vomiting, diarrhea, extreme lethargy, or increased respiratory effort. If any of these are seen please call us for advice or bring your pet in for a recheck exam.

Physical Therapy:

Activities to Build Strength and Body Awareness The following exercises will be incorporated into the next 12 weeks of recovery. The intent of this program is to gradually increase strength, balance, and body awareness so that your pet can return to normal activity. These two pages provide detailed descriptions of the exercises. Please follow the schedule indicated on the table on the following page.

  1. Controlled Leash Walks: Walks should be on a 6’ lead with the dog by your side. Up until this point, you have been walking up to 5 minutes per walk 3 – 4 times per day. From this point on, you can add 3 – 5 minutes per walk per week. This activity should only be increased if your pet is consistently using his/her leg at a walk. You can incorporate activities such as: Figure 8 patterns, walking up and down curbs in a S-pattern, gentle inclines (hills), stepping over obstacles/through long grass or snow, and short trotting intervals (10 steps) into these walks to make them more challenging and to increase muscle mass and strength.
  2. Weight Shifting Exercise: Have your pet stand squarely on a non-slip surface and gently nudge the hind end from side to side for 10 repetitions. This will help with balance and core strength and will lay the groundwork for further core conditioning. For a further challenge, have your pet stand with the front legs elevated (first on a stable surface like some stairs, and then on an unstable one like a cushion, air mattress, or FitPAWS equipment). This will force more weight onto the hind end.
  3. Exercises to increase body awareness: These exercises have you walking your dog on a leash in a “figure 8” pattern and/or through a series of obstacles in a “weave” pattern. This exercise helps to encourage the use of the leg and increases proprioception (Proprioception is the knowledge of where all one’s body parts are in space). Another great exercise to help with proprioception is walking slowing through the rungs of a ladder laid on the ground. As your pet walks slowly through this obstacle, they must carefully think about where they are putting their feet. Drop treats in between the rungs to make this an extra fun game.
  4. Cookie Stretches: Have your pet stand squarely on a non-slip surface and guide his nose to each hip, up, and then down for one repetition. Do this 5 times working up to 10 repetitions. Once he is comfortable with this exercise, you can place him on an unstable surface such as a couch cushion (on the floor), air mattress, or FitPAWS giant disc/balance pad/peanut ) to further challenge him. This exercise will help with spinal mobility and core strengthening.
  5. Sit-to-Stand: This exercise is a “Doggy Squat”. Have your pet sit squarely and then stand for 5-10 repetitions. They have a tendency to cheat and use their nonsurgical leg to push up so it is often helpful to have their surgical leg against a wall as you perform this exercise. This can also be incorporated into daily walks or, at feeding time, you can use part of his kibble to entice him to do this exercise.
  6. Three Legged Standing: Have your pet stand squarely on a non-slip surface and then gently lift one leg off of the ground and hold for 5 – 10 seconds. Alternate with all but the surgical limb. Once your pet becomes good at this exercise, you can try two legged standing by lifting diagonal legs (left front and right hind) and vice versa.
  7. Wading in water: Once your pet has their sutures removed, they are able to walk in water that is up to hip height. The buoyancy of the water will displace some of your pet’s weight and take some pressure off of the joints. There is also resistance in the water so they are also working on strength and flexibility. IMPORTANT: If you pet will not walk in a controlled manner and likes to leap in water then this is not a good activity until after the 12 week x-ray is assessed by your Veterinarian.
  8. Walking in deep snow or in long grass: Walking in deep snow and in longer grass will make your pet pick their legs up higher which will build strength. This should only be done if you have your dog on a short leash and have control of them.