Tearing or rupturing of the anterior cruciate ligament, often referred to as the ACL, can lead to serious problems, especially in large, active dogs. Tibial plateau leveling osteotomy (TPLO) is different from other, more traditional procedures used in the treatment of cruciate ligaments because it doesn̵7;t attempt to replicate the dog̵7;s anatomical structure by replacing the damaged ligament. Intracapsular stabilization or extracapsular stabilization are two of the traditional types of surgical treatment for ruptured cruciate ligaments in dogs. In these procedures, the torn or ruptured tendon is replaced by wire or other materials. Often the traditional procedures are classified as passive techniques, and the newer TPLO procedure is classified as an active technique.
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Reason to Operate
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Two ligaments cross the joint of a dog̵7;s knee. These are the cruciate ligaments, which function like a hinge and prevent the ends of a dog's femur and tibia from moving across each other and damaging the joint and surrounding tissue. If left untreated, sections of the knee̵7;s cartilage can become torn or crushed, leading to severe lameness and pain as the bones move around and damage the cartilage. Professor John Innes, a Royal College of Veterinary Surgeons specialist in small animal surgery (orthopedics), states that larger dogs with persistent or recurring problems have better recovery rates after surgical procedures. Non-surgical treatments have been found to be equally effective in dogs weighing fewer than 15 lb. and in house cats.
Wire Repair
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Among the many types of passive procedures, some replace the damaged or torn tendons with either transplanted tissue or synthetic materials to rebuild the damaged ligament. Extracapsular stabilization is commonly performed. In this procedure, the wire is fixed outside of the joint capsule, holding the joint together in the same way the ligaments would, and the ruptured ligament is removed.
TPLO Repair
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In a TPLO operation, the tibia, which is the lower bone in the joint, is cut and rotated to change the angle of the upper surface of the bone. The two pieces of the tibia are then pinned back together. The nature of the procedure means that it is not suitable for dogs weighing less than 40 pounds. The change of the angle at the tibia̵7;s top (the tibial plateau) prevents the femur from sliding across the tibia, and so it prevents the damage associated with untreated torn cruciate ligaments.
Pros and Cons of Passive Procedures
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Traditional procedures using wires to replace ligaments are less invasive and less drastic than TPLO, and they have been used successfully for more than 50 years. A danger, however, is that the material used to replace the tendon can break or stretch, which causes more damage and can cause complications for the dog̵7;s recovery. The knee becomes stabilized by scar tissue, which hinders the dog̵7;s range of motion. Too much exercise, or exercise that is too vigorous, soon after the operation enhances the risk of stretching or breaking, as does the dog's size and weight. Most veterinary surgeons can perform these operations; so specialists don̵7;t need to be consulted, reducing time, travel and consultancy costs. Because they are less complex than TPLO, the types of operations using wires to replace ligaments are normally less expensive than TPLO procedures.
Pros and Cons of TPLO Surgery
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TPLO is a quite drastic operation; the bone is cut and pinned back together in a different shape. It doesn't result in a risk of stretching or breaking of materials, however, unlike cruciate replacement, making TPLO a popular choice for large and giant breed dogs and for very lively, athletic dogs. While it is an invasive procedure and lacks long-term studies, many experts state the recovery time for TPLO patients is shorter than that of other, less invasive operations, making it a common choice for lively dogs. Veterinarians need to be specially trained and licensed in this technique. So it is likely that a general vet would have to refer a dog to a specialist for assessment and treatment. Because it is a much more complex procedure, it costs more, keeps a dog in surgery longer and is a less suitable choice for a dog with other medical problems.
Considerations
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One of the few comparative studies that has been published in the "Journal of the American Veterinary Medical Association" suggests ̶0;the incidence of major complications was similar,̶1; and rates of gradually increasing arthritis seems to be similar in dogs who had either type of surgery. So no definitive better choice exists between the two kinds of ACL repair. The most suitable form of treatment depends on a specific dog̵7;s bone structure, the extent of damage to the ligament and joint, and the dog's size, athleticism and health. Large, highly active dogs seem to benefit more from TPLO . Smaller dogs can be less suited to TPLO due to the size of their bones. Qualified veterinarians are able to discuss and assess individual cases with the owners of dogs suffering from cruciate problems.
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