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Tibial plateau leveling osteotomy (TPLO)

icanis

Introduction

  • The principle mechanical functions of the cranial cruciate ligemant (CrCL) include existing cranial tibial subluxation, internal tibial rotation and hyperextension of the stifle.
  • During weight bearing, contraction of the quadriceps muscle, contraction of the gastrocnemius muscles, and compression of the femoral condyles against the tibial plateau cause force vectors which result incranial tibial thrust; this cranially directed force is usually resisted by the CrCL.
  • In the presence of CrCL deficiency, the tibia subluxates cranially during weight-bearing. This instability causes pain and osteoarthritis, and predisposes to meniscal tears.
  • With TPLO, a cresenteric osteotomy is performed on the proximal tibia, and the tibial plateau is rotated , or "levelled" TPLO 01: measurement of tibial plateau angle (preoperative) - radiograph TPLO 09: postoperative - radiograph. This changes the mechanics of the stifle and obliterates or reduces cranial tibial thrust during weight bearing. Althoughpassiveinstability can be appreciated (by performing the cranial drawer manoevre), the joint isdynamicallystable during weight bearing.

Uses

Advantages

  • Unlike ligament replacement techniques such as intra- or extra-articular grafts which frequently fail, TPLO can permanently address cranial tibial thrust.
  • Dogs often recover rapidly following surgery; this is especially notable in large, active dogs, but is also seen in smaller dogs such as West Highland white terriers.
  • When performed early in the course of CrCL disease, TPLO can arrest ligament degeneration and prevent partial tears progressing to complete tears.
  • Concurrent correction of limb malalignment can be performed.
  • The procedure can be adapted to allow concurrent treatment of CrCL deficiency and patellar luxation Patella: medial luxation.

Disadvantages

  • Technically challenging; advanced surgical training is obligatory prior to attempting the procedure.
  • Requires more specialized equipment and is generally more expensive than ligament replacement techniques.
  • Although anecdotally favored by many surgeons, there is limited peer-reviewed data that supports a clear advantage of TPLO over ligament replacement techniques or alternative proximal tibial osteotomies such as tibial tuberosity osteotomies such as tibial tuberosity advancement (TTA Tibial tuberosity: advancement ) or cranial closing wedge ostectomy (CCWO).

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Excellent for return to good limb function.
  • Some long term osteoarthritis inevitable Arthritis: osteoarthritis and will require long term management (weight control, regular exercise, medications).
  • Approximately 60% risk of contralteral CrCL deficiency in future.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Conkling A L, Fagin B, Daye R M (2010) Comparison of tibial plateau angle changes after tibial plateau leveling osteotomy fixation with conventional or locking scew technology. Vet Surg 39 (4), 475-481 PubMed.
  • Fitzpatrick N, Solano M A (2010) Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 39 (4), 460-474 PubMed.
  • Hulse D, Beale B, Kerwin S (2010) Second look arthroscopic findings after tibial plateau leveling osteotomy. Vet Surg 39 (3), 350-354 PubMed.
  •  Kim S E, Pozzi A, Kowaleski M P et al (2008) Tibial osteotomies for cranial cruciate ligament insufficiency in dogs. Vet Surg 37 (2), 111-125 PubMed.
  • Pacchiana P D, Morris E, Gillings S L et al (2003) Surgical and postoperative complications associated with TPLO in dogs with cranial cruciate ligament rupture: 397 cases (1998 - 2001). JAVMA 222 (2), 184-193 PubMed.
  • Slocum B & Slocum T D (1993) Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 23 (4), 777-795 PubMed.
  • Slocum B, Devine T (1984) Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair. JAVMA 184 (5), 564-569 PubMed.

Other sources of information

  • Dejardin L (2003) TPLO. In:Textbook of Small Animal Surgery, 3rd edn. Ed D Slatter. W B Saunders, Philadelphia, p 2133.
  • Slocum B (1998) TPLO for CrCL rupture. In:Current techniques in Small Animal Surgery, 4th edn. Ed M J Bojrab. Lea & Febiger, Philadelphia, p 1209.

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