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Tibial Plateau Leveling Osteotomy TPLO for cruciate ligament rupture.

Cranial or anterior cruciate ligament (CCL) rupture is the most common cause of hind limb lameness in dogs.

There are various surgical techniques available to replace the action of the cruciate ligaments. Traditionally these surgeries most often involved the placement of artificial ligaments along the outside of the knee joint. (DeAngelis 1970; Flo 1975). However, there are newer surgical techniques available including Tibial Plateau Leveling Osteotomy (TPLO) or Triple Tibial Osteotomy (TTO) that are especially beneficial for larger, more athletic dogs.  Most experienced orthopaedic surgeons and referral centres believe Tibial plateau levelling osteotomy TPLO or Triple Tibial Osteotomy (TTO) surgical methods have some significant advantages over the traditional extracapsular methods particularly in medium, large and giant breeds. These include less development of post operative arthritis (DJD), greater likelihood of return to normal athletic or working activity, better range of movement and more rapid recovery.

The function of the cruciate ligament is to prevent forward movement of the tibia and provide stability in the stifle (Knee joint). Instability can lead to further damage within the joint– in particular to the medial meniscus. Tibial plateau levelling osteotomy TPLO or Triple Tibial Osteotomy (TTO) surgery aim to level the tibial plateau to prevent the tibia (shin bone) moving forward when the dog is weight bearing so producing a stable action through the stifle (knee joint) in dogs which have a complete or partial cruciate ligament rupture.




















Tibial plateau levelling osteotomy TPLO procedures

As a result of research and work done by Barclay Slocum (Slocum B, Slocum TD 1993) we now know that in some dogs the slope of the tibial plateau is greater than desired causing excessive cranial thrust. This causes stress on the cruciate ligament which weakens the ligament over a period of time. Slocum designed a Tibial plateau levelling osteotomy TPLO surgical procedure to level the tibial plateau to 6 degrees. Many dogs have tibial slopes of 15 to 30 degrees and some have slopes of up to 45 degrees. Further work done in Europe by Dr. Slobodan Tepic of Zurich, Switzerland (Tepic & Montavon 2002, 2004) to improve the Tibial plateau levelling osteotomy TPLO technique has suggested that the tibial plateau also needs to be at 90 degrees to the patellar ligament, rather than long axis of the bone (in addition to having a slope of about 6 degrees).– Tibial Tuberosity Advancement -TTA method
Dr. Warwick Bruce, a specialist surgeon, Sydney, Australia has brought principles from both TPLO & TTA methods and designed the procedure called Triple Tibial Osteotomy (TTO) which may be more stable & produces less radical angular changes than the Tibial plateau levelling osteotomy TPLO. (Bruce et al, 2007).


Triple Tibial Osteotomy (TTO) procedure for TPLO

In the operation of triple tibial osteotomy (TTO) we perform a TPLO at an exact geometric point so that when the bone is rotated this simultaneously advances the tibial crest- similar to the  Tibial Tuberosity Advancement  TTA method. The site is packed with bone graft harvested from the closing wedge osteotomy and then a Tibial plateau levelling osteotomy TPLO plate and screws secure the tibia.

In all tibial plateau levelling osteotomy TPLO methods post operative rehabilitation is essential to assist in the building up of the musculature surrounding the stifle (knee) joint in order to speed the recovery process and return to activity.






























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Specialist Veterinary equipment


Stryker system 2000 autoclavable drills


Stryker system 2000 autoclavable ossicalating saw and reciprating saw to perform osteotomies


TPLO/ TTO plates VI & synthes locking plates  


3M mini driver system

   Tibial Plateau Leveling Osteotomy TPLO


� GVC


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Orthopaedic referrals Referral, Greenmount, Veterinary, vet, disc, disease, prolapse, Orthopaedic, orthopedic, specialist, clinic, fractures, joint, surgery, arthroscopy, endoscopy, spinal, northern, ireland, OCD, FCP, TPO, cruciate ligament, tplo, hip, dysplasia, dislocation, medial, patellar, luxation, broken, leg, wobbler, caudal cervical spondylopathy, lumbar, paralysis,ACL, anterior cruciate ligament rupture, dislocated, dislocation, plating, pinning, external fixator, triple pelvic osteotomy, portadown, co armagh northern ireland, www.vetortho.co.uk, www.vetclinic.co.uk Referral, Greenmount, Veterinary, vet, disc, disease, prolapse, Orthopaedic, orthopedic, specialist, clinic, fractures, joint, surgery, arthroscopy, endoscopy, spinal, northern, ireland, OCD, FCP, TPO, cruciate ligament, tplo, hip, dysplasia, dislocation, medial, patellar, luxation, broken, leg, wobbler, caudal cervical spondylopathy, lumbar, paralysis,ACL, anterior cruciate ligament rupture, dislocated, dislocation, plating, pinning, external fixator, triple pelvic osteotomy, portadown, co armagh northern ireland, www.vetortho.co.uk, www.vetclinic.co.uk Referral, Greenmount, Veterinary, vet, disc, disease, prolapse, Orthopaedic, orthopedic, specialist, clinic, fractures, joint, surgery, arthroscopy, endoscopy, spinal, northern, ireland, OCD, FCP, TPO, cruciate ligament, tplo, hip, dysplasia, dislocation, medial, patellar, luxation, broken, leg, wobbler, caudal cervical spondylopathy, lumbar, paralysis,ACL, anterior cruciate ligament rupture, dislocated, dislocation, plating, pinning, external fixator, triple pelvic osteotomy, portadown, co armagh northern ireland, www.vetortho.co.uk, www.vetclinic.co.uk Referral, Greenmount, Veterinary, vet, disc, disease, prolapse, Orthopaedic, orthopedic, specialist, clinic, fractures, joint, surgery, arthroscopy, endoscopy, spinal, northern, ireland, OCD, FCP, TPO, cruciate ligament, tplo, hip, dysplasia, dislocation, medial, patellar, luxation, broken, leg, wobbler, caudal cervical spondylopathy, lumbar, paralysis,ACL, anterior cruciate ligament rupture, dislocated, dislocation, plating, pinning, external fixator, triple pelvic osteotomy, portadown, co armagh northern ireland, www.vetortho.co.uk, www.vetclinic.co.uk Referral, Greenmount, Veterinary, vet, disc, disease, prolapse, Orthopaedic, orthopedic, specialist, clinic, fractures, joint, surgery, arthroscopy, endoscopy, spinal, northern, ireland, OCD, FCP, TPO, cruciate ligament, tplo, hip, dysplasia, dislocation, medial, patellar, luxation, broken, leg, wobbler, caudal cervical spondylopathy, lumbar, paralysis,ACL, anterior cruciate ligament rupture, dislocated, dislocation, plating, pinning, external fixator, triple pelvic osteotomy, portadown, co armagh northern ireland, www.vetortho.co.uk, www.vetclinic.co.uk

All cases are carefully assessed to determine the most suitable surgical method of repair for each case, and very exact x-ray views are necessary along with examination under sedation.

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