What Is TPLO?
Tibial Plateau Levelling Osteotomy — commonly known as TPLO — is a surgical procedure performed to treat rupture of the cranial cruciate ligament (CCL) in dogs. The CCL is the equivalent of the human anterior cruciate ligament (ACL) and is the most commonly injured ligament in dogs, affecting millions of animals each year. TPLO is now considered the gold standard surgical treatment for this injury in medium to large dogs.
Why Does the Cruciate Ligament Rupture?
Unlike in humans, where cruciate ligament tears are typically caused by a single acute traumatic event, canine CCL rupture is most often the result of progressive degeneration of the ligament over time. Genetic predisposition, obesity, breed conformation (particularly steep tibial plateau angles), and repetitive stress all contribute. Because the ligament weakens gradually, many dogs experience partial tears before complete rupture occurs.
Breeds with higher incidence include Labrador Retrievers, Rottweilers, Newfoundlands, Staffordshire Bull Terriers, and West Highland White Terriers.
How Does TPLO Work?
TPLO does not attempt to replace or repair the torn ligament. Instead, it changes the geometry of the knee joint so the ligament is no longer needed to provide stability during weight-bearing.
The procedure involves:
- Making a curved bone cut (osteotomy) through the tibial plateau — the top surface of the shin bone.
- Rotating the tibial plateau to reduce its angle (typically to approximately 5°).
- Securing the rotated bone segment with a bone plate and screws while it heals.
By levelling the tibial plateau, the shearing forces that were previously destabilising the joint are eliminated, allowing the dog to bear weight comfortably without a functional cruciate ligament.
TPLO vs. Other Surgical Options
| Procedure | How It Works | Best For |
|---|---|---|
| TPLO | Alters tibial plateau angle to eliminate instability | Medium–large dogs; best long-term outcomes |
| TTA (Tibial Tuberosity Advancement) | Advances the tibial tuberosity to neutralise forces | Alternative in some cases |
| Lateral Suture / Extracapsular Repair | Synthetic ligament placed outside the joint | Small dogs and cats; lower cost option |
What Happens on the Day of Surgery?
TPLO is performed under general anaesthesia by a veterinary surgeon, ideally a board-certified orthopaedic specialist. The procedure typically takes 1–2 hours. Most dogs are hospitalised for 1–2 nights post-operatively for pain management and monitoring before going home.
Recovery: What to Expect
Recovery from TPLO is a structured process that typically spans 10–16 weeks. Key milestones include:
- Weeks 1–2: Strict rest, wound care, and pain management. Toe-touching weight-bearing is expected.
- Weeks 3–6: Gradual introduction of short leash walks (5–10 minutes, 3–4 times daily). Hydrotherapy may begin.
- Weeks 6–8: Follow-up X-rays to assess bone healing. Walk duration increases.
- Weeks 8–12: Continued increase in controlled exercise. Off-lead activity remains restricted.
- Week 12–16: Progressive return to normal activity pending veterinary clearance and confirmed radiographic healing.
Complications and Risks
TPLO is a generally safe procedure with high success rates, but as with any surgery, complications can occur. These may include:
- Infection at the surgical site
- Implant-related issues (loosening or fracture, though uncommon)
- Meniscal injury — either present at the time of surgery or developing afterwards ("late meniscal tear")
- Patellar tendon thickening
Most dogs (reported consistently across veterinary literature as the vast majority of surgical cases) return to excellent function following TPLO when recovery protocols are followed carefully.
When Is Surgery Recommended?
Surgery is generally recommended for any dog with a confirmed cruciate ligament rupture, particularly those over 15–20 kg. Without surgical treatment, most larger dogs will not regain full function, and progressive osteoarthritis will develop regardless. The sooner surgery is performed, the better the chances of minimising joint damage.