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Tibial Plateau Leveling Osteotomy (TPLO)
Cranial Cruciate Ligament Rupture is an injury that happens to dogs and requires surgical repair. It can happen to any dog, but if your dog is overweight, it may predispose them to this injury. Dogs can also have congenital disease in their joints that will make them more likely to tear a ligament. Very active dogs, dogs that play frisbee or make sudden turns can also injur their cruciate ligament.
A ligament consists of tough, fibrous tissue connecting two bones. The cruciate ligaments of the knee are cross-shaped ligaments that connect the femur to the tibia. Rupture of the cranial cruciate ligament allows the femur to slide back and forth over the tibia resulting in pain.
There are many causes of cruciate ligament rupture. Trauma, such as being hit by a car, or falling hard on the back leg, can tear cruciate ligaments. Many cases, however, occur in dogs whose ligaments have deteriorated with age. The ligament can rupture with minor trauma such as running or jumping. Obesity puts an additional stress on the ligament and may be a contributing factor.
The Rupture first causes pain and leads to rapid onset of rear leg lameness. Then, the joing instability and abnormal wear and tear lead to arthritis. The onset of arthritis has been reported to occur as soon as ten days following cranial cruciate rupture.
Cranial Cruciate rupture is diagnosed by palpating the knee joint for instability. Occasionally, we may suspect the presence of a partial tear. Although strict rest may be discussed as an option, many of these patients eventually rupture their ligament and surgery is recommended at that point.
Surgery is always recommended for total cranial cruciate ruptures. Whitefish Animal Hospital performs two surgeries to repair a ruptured cranial cruciate ligament. The first type is performed by removing remaining damaged ligament and stabilizing the knee with an artificial ligament made of suture material. The second type is called the Tibial Plateau Leveling Osteotomy or TPLO. In the TPLO procedure, a curved cut is made in top of the tibia and the bone segment is rotated in order to level the slope of the tibial joint surface, creating joint stability. A stainless steel plate and screws are used to hold the bone in place. Surgery also allows the inside of the knee to be examined for tears in the cartilage which often occur with cranial cruciate rupture. This cartilage, called the meniscus, is removed if damaged.
Post-operatively, most patients will go home the day after surgery and return for weekly rechecks the first month. During this time, it is imperative the animal stay quiet and activity restricted. The veterinarian will go over more detailed instructions and rehabilitation at the time of discharge from the hospital. Click here for a detailed rehab protocol.
For all dogs that are diagnosed with a cranial cruciate rupture, we recommend joint supplements such as Cosequin and Adequan. These are natural dietary supplements that improve the health of joints. Often times dogs are started on these supplements at the time of diagnosis and continued for life. We have seen remarkable improvements in terms of healing time post surgery, minimizing arthritic changes, and better alleviation of pain, leading to a better quality of life. We will also prescribe a non-steroidal anti-inflammatory for short term usage before and after surgery.
Lastly if your pet is overwight, we strongly urge weight loss. This can be done with prescription dog food recommended by your veterinarian and an appropriate exercise routine. Please ask for details.