There are still very few clinical studies on the Tibial Plateau Leveling Osteotomy (TPLO) procedure. The following recommendations are based upon the experience of Drs. Huss and Benson. Dr. Huss started
performing the TPLO procedure in 1997, and currently has performed thousands of TPLO surgeries.
The TPLO instrumentation and implants have expanded to 4 different size
bi-radial saw blades (14, 18, 24 & 30 mm radius) and 4 different size plates (2.0, 2.7 3.5 mm & 3.5 mm broad). This
range of sizes permits a surgeon the ability to perform the TPLO procedure on animals ranging in size from approximately 10
pounds to over 250 pounds. The smallest size TPLO plate (2.0 mm) is equivalent in size to human finger plates.
The tiny plates are even more technically demanding to implant than the already demanding standard (3.5 mm) TPLO.
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| TPLO repair at Vetcision |
What procedure should be performed to repair a
ruptured cranial cruciate ligament?
This
question has been the hot topic of the last several ACVS Symposium meetings. Each year more and more basic science research
has validated Dr. Slocum's recommendations and research on the TPLO. There is no longer a question as to whether the
procedure works. The big questions now are 1.) Is the the TPLO better than other techniques and 2.)
Which patients benefit from the TPLO procedure.
Having performed some of the largest numbers of
TPLO procedures, we feel qualified to make the following recommendations based upon our experience.
- It takes 50-75 TPLO procedures to become proficient with this complex surgery.
- We do not recommend bilateral TPLO repairs at the same surgery.
- TPLO repairs can be performed on any age animal, however, care must be taken
in imature animals with open tibial physis.
- The TPLO can be used succesfully as a revision surgery in patients that
have done poorly with other cruciate repair techniques.
- The TPLO can consistently get athletic dogs back to performance level.
- The TPLO can be performed on cats and dogs from ~10-15 pounds to over 250
pounds. The size of the bone related to implant size is the determining factor. TPLOs on small animals should
only be performed by surgeons very experienced with the procedure.
Recommendations based upon patient size
10-35 pound patients
- Patients < 20 pounds may not need surgery if they show significant signs
of improvement within 2 weeks of injury and do not have signs of meniscal injury. Treatment should entail strict cage
rest for a month with NSAIDS. If they are not significantly improved within 2-3 weeks, consider surgery.
- Patients in this weight range will likely do well with any surgical procedure.
We perform the TPLO procedure or lateral fabellar suture stabilization. The only subset of patients we have noted, are
dogs with extremely steep tibial slopes (30+ degree). These dogs have not done well with lateral fabellar sutures.
When revised with TPLO surgery, they have done excellent.
Patients 35-60 pounds
- We offer both TPLO and lateral fabellar suture repair for the dogs
in this weight group.
- If the dog is a performance/working dog, or the owner wants to maximize the
potential for a good functional outcome, we recommend the TPLO.
Patients 60-250+ pounds
- We strongly recommend TPLO repair for the dogs in this weight group. If
for no other reason, studies have demonstrated that dogs with TPLO surgery will start weight bearing on the surgery leg
sooner than with any other repair technique.
- We recommend the TPLO repair exclusively for Rottweilers. The curvature
in this breed's hindlimbs has resulted in an increased incidents of problems with other cruciate repair techniques.
- The giant size dogs have resulted in concern for implant size. Some
surgeons are double plating the 200+ lbs. size dogs. We have not, but we are looking forward to a new larger size plate.
We have had giant breed dogs bend the plate when they have not been properly confined.
The preceding statements are based upon our years
of experience with thousands of TPLO procedures. From our first TPLO (a Bull Mastiff who went on to a CDX obediance
title) our goal was to duplicate Dr. Slocum's technique as precisely as possible. Our hope was to achieve the same success
he had reported. We have been able to do that. Over the years, we have made very slight modifications to the technique
based upon problems or issues we had found with the way our patients had responded.
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| Postop radiograph of a 3.5 mm broad TPLO plate repair |
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| Cruciate Repair Recommendations Postcard |
