TIBIAL PLATEAU LEVELING OSTEOTOMY

Dr. Barclay Slocum developed this sophisticated surgery for the treatment of a tear or rupture of the cranial cruciate ligament (CCL) in dogs. Veterinariy surgeons around the world have been specially trained and certified to perform this procedure. Because this surgery is so successful, it is our belief it may replace all other surgeries performed for this condition.

Dogs normally have a downward slope on the top part of their shin bone (tibia) from front to rear. The degree of this slope varies from dog to dog. It has been found that the steeper (greater) the slope, the higher the incidence of cranial cruciate ligament tear. The normal function of the cruciate ligament is to keep the thigh bone (femur) sitting directly on top of the shin bone. When the cranial cruciate ligament tears, the thigh bone slides off the top of the slope of the shin bone towards the back (downhill) side of the slope. Every time the dog puts weight on the leg, the thigh bone partially “dislocates” as it slides down the slope. This causes pain, instability, and eventually irreversible arthritis.

The TPLO surgery levels the tibial slope so when the dog puts weight on the knee, the thigh bone remains centered on the top of the shin bone. Technically speaking, an x-ray of the shin bone is taken and the angle of the slope is measured. An incision is made in the skin along the inside of the knee and the top of the shin bone. Another small incision is made farther down the shin bone. A small “key hole” incision is made into the joint, then the meniscus is inspected for tears. If found, these tears are removed – similar to a person having the torn cartilage in their knee removed. Next , a jig is placed and, using a specifically designed nitrogen- driven bone saw, a “C” shaped cut is made in the top part of the shin bone. A calculation using the preoperative degree of slope is then made and the top (cut) part of the shin bone is rotated so that the slope in the bone becomes level. A metal plate and six screws are inserted to hold the bone in place. The entire leg is then bandaged to keep postoperative swelling to a minimum. This bandage is removed prior to discharge from the hospital. A nurse will meet with you at the time of discharge to review all home care instructions and also to instruct you in a very simple physical therapy program designed to enhance return of function.

The bone heals in approximately eight weeks and during this postoperative period, exercise must be limited. Patients are not permitted to climb stairs, jump on furniture, play with other pets, run around the house, or be off-leash outside. Skin sutures are removed two weeks after surgery and at that same time, a nurse will evaluate the healing progress. Eight weeks postoperatively, we take an x-ray to confirm that bone healing has occurred. The rehabilitation process begins at eight weeks if the osteotomy is completely healed. Slow short leash walks are preferred for four weeks followed by an additional four weeks of controlled activity on a long leash. Full activity is usually possible after the eight weeks of rest and eight weeks of rehabilitation. We are very impressed how well TPLO works for large, heavy and performance/athlete patients.

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