Tibial Plateau Leveling Osteotomy TPLO for cruciate ligament rupture.
Cranial or anterior cruciate ligament (CCL) rupture is the most common cause of hind
limb lameness in dogs.
There are various surgical techniques available to replace the action of the cruciate
ligaments. Traditionally these surgeries most often involved the placement of artificial
ligaments along the outside of the knee joint. (DeAngelis 1970; Flo 1975). However,
there are newer surgical techniques available including Tibial Plateau Leveling Osteotomy
(TPLO) or Triple Tibial Osteotomy (TTO) that are especially beneficial for larger,
more athletic dogs. Most experienced orthopaedic surgeons and referral centres believe
Tibial plateau levelling osteotomy TPLO or Triple Tibial Osteotomy (TTO) surgical
methods have some significant advantages over the traditional extracapsular methods
particularly in medium, large and giant breeds. These include less development of
post operative arthritis (DJD), greater likelihood of return to normal athletic or
working activity, better range of movement and more rapid recovery.
The function of the cruciate ligament is to prevent forward movement of the tibia
and provide stability in the stifle (Knee joint). Instability can lead to further
damage within the joint– in particular to the medial meniscus. Tibial plateau levelling
osteotomy TPLO or Triple Tibial Osteotomy (TTO) surgery aim to level the tibial plateau
to prevent the tibia (shin bone) moving forward when the dog is weight bearing so
producing a stable action through the stifle (knee joint) in dogs which have a complete
or partial cruciate ligament rupture.
As a result of research and work done by Barclay Slocum (Slocum B, Slocum TD 1993)
we now know that in some dogs the slope of the tibial plateau is greater than desired
causing excessive cranial thrust. This causes stress on the cruciate ligament which
weakens the ligament over a period of time. Slocum designed a Tibial plateau levelling
osteotomy TPLO surgical procedure to level the tibial plateau to 6 degrees. Many
dogs have tibial slopes of 15 to 30 degrees and some have slopes of up to 45 degrees.
Further work done in Europe by Dr. Slobodan Tepic of Zurich, Switzerland (Tepic &
Montavon 2002, 2004) to improve the Tibial plateau levelling osteotomy TPLO technique
has suggested that the tibial plateau also needs to be at 90 degrees to the patellar
ligament, rather than long axis of the bone (in addition to having a slope of about
6 degrees).– Tibial Tuberosity Advancement -TTA method Dr. Warwick Bruce, a specialist
surgeon, Sydney, Australia has brought principles from both TPLO & TTA methods and
designed the procedure called Triple Tibial Osteotomy (TTO) which may be more stable
& produces less radical angular changes than the Tibial plateau levelling osteotomy
TPLO. (Bruce et al, 2007).
Triple Tibial Osteotomy (TTO) procedure for TPLO
In the operation of triple tibial osteotomy (TTO) we perform a TPLO at an exact geometric
point so that when the bone is rotated this simultaneously advances the tibial crest-
similar to the Tibial Tuberosity Advancement TTA method. The site is packed with
bone graft harvested from the closing wedge osteotomy and then a Tibial plateau levelling
osteotomy TPLO plate and screws secure the tibia.
In all tibial plateau levelling osteotomy TPLO methods post operative rehabilitation
is essential to assist in the building up of the musculature surrounding the stifle
(knee) joint in order to speed the recovery process and return to activity.
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