Cranial cruciate ligament repair (CCL) and TPLO surgery in dogs

When a dog injures their knee, it’s often a tear of the cranial cruciate ligament (CCL). Alongside the caudal cruciate ligament, the CCL’s cross over one another inside the center of a dog’s knee. When a CCL tear occurs, it causes the shin bone to slide forward leading to a movement called a positive drawer sign. This injury causes pain and misaligned walking, which can lead to further bone and cartilage injuries.

TPLO surgery for CCL

TPLO stands for tibial plateau leveling osteotomy, which is, in short, a surgery to repair a torn CCL. The procedure was created by the late Dr. Barclay Slocum, (Trusted Source) a well-known pioneer in domestic pet surgeries. TPLO surgery is an effective treatment because it completely changes the way a dog’s knee works, providing incredible long-term results.  The surgery reduces tibial shifts during strides,  realigns the surfaces within the knee to provide stability, and reduces risks of further injury.

During TPLO surgery, the surgeon will remove the torn ends of the CCL and address the damaged areas of the meniscus cartilage before deciding whether they, too, require removal. The knee is reconfigured and a titanium plate is used to hold the new configuration in place, eliminating the need for an artificial ligament to stabilize the joint.

After the operation, your veterinarian will send you home with post-operative care instructions. You may notice some lameness or balance issues, and joint and muscle pain in your pup. You should  limit your dog’s activity for around six to eight weeks following the surgery to ensure normal function returns to the joint.

Complications to watch for in TPLO surgery

Like any surgery, there is always the risk of potential complications, though the rate of complications for TPLO surgery is minimal. These are the most common risks:

• Infection. The most common complication of TPLO surgery is infection, but it occurs in less than 10% of all patients. It’s typically caused by dogs licking their incisions. To prevent infection, ensure your dog’s e-collar is on at all times, and consult your veterinarian to make sure the site is healing well.
• Patellar luxation. A luxating patella is an out-of-place kneecap (or patella) and is a potential complication of TPLO surgery in larger breeds. (Trusted Source) This complication can be corrected (Trusted Source) surgically or non-surgically, depending on the degree of injury.
• Implant failure. Implant failure or rejection is a potential complication in any surgery where foreign hardware is added to the body. This isn’t very common with this surgery but improper placement of the hardware, infection, or abnormality in the bone where the hardware is placed can cause it.
• Fracture of the bone. Your pet may suffer a tibial fracture following TPLO surgery. In most cases, the fracture of the bone will occur at the time of the surgery when the plate is being placed. If a fracture is discovered later, the plate may need to be surgically removed.

TPLO surgery costs

As with many surgeries, the cost can vary depending on where you receive care and where you live. The price of this surgery can also vary depending on what is included in the cost. For example, some clinics may include blood work, medication, surgery, post-operative medications, and physical therapy in their cost, while others charge per service. Overall, you’ll want to ask your pet’s provider some of the following questions to ensure you fully understand.

• Is pre-surgery blood work included? Blood work is necessary to determine if your dog qualifies for TPLO surgery. This testing can also tell them if your dog has any concerns like hypoglycemia that could interfere with surgery as well as their organ function, which is important in determining how they’ll handle anasethisa.. Routine blood work can cost anywhere from $100-$300.
• Are x-rays and other diagnostics/imaging included? While X-rays can’t determine whether a ligament has been torn, it can show if your dog’s CCL injury has affected any surrounding bones or if any other orthopedic issues are present. Other imaging can include an ultrasound or MRI to physically look at the injury prior to surgery. These images can run from $150-$2,500.
• Are medications (pre-and post-operative) included? As this is an invasive procedure, your dog will require pain medication to soothe the inflammation and swelling. Your pet will likely be given some of these medications at the clinic, but you may also be prescribed at-home medication. Prescription medication can range from $30-$100.
• Is the cost of anesthesia and anesthesia monitoring included? This surgery does require your dog to be put under general anesthesia and monitoring to ensure their safety. The cost varies depending on your dog’s size as well as how long it takes. Anesthesia can range from $200-$1,200+.
• Is post-surgery physical therapy included? As with humans and ACL’s, your dog’s CCL surgery isn’t the last step in recovery. It will take physical therapy to help them regain strength and control. Initial examinations can run up to $170 with follow-up appointments being anywhere from $70-$120+. Underwater treadmill therapy can cost upwards of $80 per session.

Alternatives to TPLO surgery

There are a few treatment options for a ruptured CCL, including tuberosity advancement (TTA (Trusted Source) ), capsular suture stabilization, and others. Here’s why TPLO is often recommended over other procedures:

• Faster recovery. TPLO surgery (Trusted Source) has a faster recovery time than other procedures and is best for avoiding reliance on long-term pain medications.
• Arthritis prevention. TPLO may help prevent the progression of arthritis better than other procedures. It allows very active dogs, such as ones that do competitive or performance athletics, to resume normal exercise.
• High success rate. Success rates for this surgery are very high (90%-95%), and the rate of complications is minimal.

Here we explore the other options:

CCL surgeries, compared

Post-op care following TPLO surgery

Patience and preparation will help you and your pup sail through the six to eight weeks of recovery time following TPLO surgery. Here are a few steps you could follow.

Make a few changes around the house

Because your dog’s mobility will be restricted, we recommend the following supplies to ensure a smooth recovery:

• A properly-sized crate. If your dog is crate trained, find a crate that’s large enough for them to stand up in and turn around.
• Gates. Create a gated-off area in your home, such as the kitchen or living room, to restrict them to certain areas.
• Throw rugs. Rooms with hardwood floors, tile, or linoleum can be particularly difficult for dogs to walk on, especially after surgery. If the room you’ve chosen has slippery surfaces like these, be sure to place some throw rugs with rubber backing on the floor to help your dog walk around more easily.

Continue consulting your vet

Routine rechecks following TPLO are scheduled at two weeks postoperatively, with recheck radiographs (X-rays) obtained at the eight-week point. Additional rechecks may be scheduled as needed per your vet’s recommendation. While your dog may seem fine, it’s still vital to keep these appointments.

Follow up appointments are important to make sure healing is appropriate, and that there are no signs of infection.

Dr. Dwight Alleyne

Confine and limit exercise

You should limit exercise and confine your dog to controlled leash walks for six to eight weeks postoperatively while the bone heals. They are allowed to walk on the affected leg, but no jumping, furniture climbing, or running. They should be confined to a crate or very small room while healing.

Keep that e-collar on

Don’t take your pup’s e-collar off until the incision has fully healed. Licking the wound could potentially lead to infection or opening stitches.

Work on rehabilitation

Rehabilitation is often recommended to rebuild muscle strength, improve mobility, and decrease swelling. You can opt for professional post-operative rehabilitation, which covers a range of services, including stretching, nutrition management, cryotherapy, and aquatic therapy, among others. Many pet parents also request at-home rehabilitation guidance from their veterinarians.

Work in supplements and weight management

Adding a joint supplement to your dog’s diet can help with arthritis post-surgery. It’s also useful to keep an eye on weight gain as excess weight can not only lengthen recovery, it can also predispose your dog to a future CCL rupture or tear.

👉 Many surgeries plus post-care rehabilitation are covered by pet insurance. Find the best plan for you with our pet insurance review.

If your dog is showing signs of pain, like limping or favoring one side when walking, consult with your vet to determine what may be the cause. Should it be a CCL tear, know that surgical options may be the best way forward to ensure your dog’s health.

Frequently asked questions

How successful is TPLO surgery in dogs?

Success rates for this surgery are very high — around 90%-95% — and the rate of complications is minimal. The success largely depends on the surgeon’s skills, the severity of the injury, and whether your pup has any other underlying conditions.

How much does TPLO surgery cost for dogs?

TPLO surgery costs average between $1,200 to $5,000. Some pet insurance companies may cover the surgery.

How long are dogs in pain after TPLO surgery?

Your dog may experience some pain and swelling at the knee 2-7 days after the surgery, though you should not expect much pain.

Is TPLO surgery major?

TPLO surgery is a major but common procedure.

What kind of medication should my dog be on after TPLO surgery?

Anti-inflammatory medications may be prescribed by your vet to reduce swelling, pain, and inflammation.

What do I do if I think my dog is having a complication from TPLO surgery?

If you suspect an infection or other complication related to the procedure, consult your vet immediately.