When it comes to canine injury, orthopedic injuries are among the most common and debilitating. Many of these injuries can undoubtedly be painful and require medical attention. One of the most common orthopedic injuries is the rupture of the cranial cruciate ligament (CCL), which can cause instability of the knee joint and pain in the affected limb. Fortunately, there are surgical options available to treat this injury, including tibial plateau leveling osteotomy (TPLO). However, it is important to understand that a dog can still injure its TPLO, which is why it is essential for pet owners to know how to protect their dog from further injury. In this blog post, we will discuss the potential causes of a TPLO injury in dogs and how pet owners can take measures to protect their pet.
What is the ACL or CCL? (Cranial Cruciate Ligament)
The dog knee (stifle) and human knee are similar in many ways. The cranial cruciate, caudal cruciate, medial collateral, and lateral collateral are the four ligaments that hold the stifle together. The top of a dog tibia has a greater slope (tibial plateau slope/angle) than that of a human knee, which distinguishes the dog stifle from the human knee. The cranial cruciate ligament (CrCL/CCL, equivalent to the anterior cruciate ligament or ACL in people) is in charge of preventing forward sliding/drawer motion of the tibia in relation to the femur and limiting internal rotation of the tibia (shin bone) in relation to the femur.
What are the risks of surgery?
There are always possible complications when performing surgery, just like with any procedure. Prior to performing surgery, it’s crucial to take the patient’s overall health into account because anesthetic complications are possible. Prior to surgery, blood work is advised to check kidney and liver function and to help screen for other diseases processes. Small postoperative complications like swelling, bruising, or seroma formation are possible but usually self-limiting and go away within a few days.
The most disastrous potential complication is implant failure, which is incredibly uncommon. Plates and screws used with the TPLO are very strong. However, it is possible for the plate to bend or for the screws to break or bend in rare instances when pets are allowed to engage in excessive activity very early in the healing process.
About 5% of lateral sutures and 7% of TPLOs become infected. Some of these infections are skin-specific, in which case a brief course of antibiotics can effectively treat the condition. In other situations, the implant may become contaminated with bacteria, necessitating the continued administration of antibiotics to the patient until the bone has fully recovered (12–16 weeks after surgery), at which point the plate may need to be removed. Infections related to implants (plates) can develop weeks, months, or even years after surgery. Three to five percent of patients who have surgery eventually need to have the implant removed.
Meniscal injuries are possible with CrCLR. Patients with a meniscal tear may experience more pain and limping than those without one because the meniscus contains nerve fibers. As was already mentioned, 40% of CrCLR patients will have a meniscal tear at the time of surgery. A patient is more likely to sustain a meniscal injury the longer the cruciate injury has been present and the more unstable the joint is. When performing surgery, the torn portion of the meniscus is removed. Since the meniscus plays crucial roles in maintaining joint health, it will typically be left alone if it is intact. There is proof that dogs with meniscal damage and those whose meniscus must be partially removed develop osteoarthritis more quickly. Fortunately, dogs rarely experience severe pain or lameness from arthritis alone as long as the underlying disease process (cranial cruciate ligament injury) is treated. A meniscal tear will eventually occur in 10% of dogs who have surgery to repair a cruciate injury. However, a surgically stabilized joint has a much lower risk of developing a meniscal tear than one that is persistently unstable.
What is recovery like for my dog?
A bone cut (osteotomy) is made during the TPLO procedure, and the stabilizing bone plate and screws are then inserted. To put it simply, we fracture the bone and stabilize it in a new position. At this point, the implants are our only source of support for stabilizing the surgical site. Despite the invasiveness of this procedure, dogs usually recover from it quickly (24–48 hours) and can start bearing weight on the amputated limb within days. Even though too much activity can be harmful during the healing process, regular, controlled weight bearing is essential for quick bone healing.
A TPLO recovery period lasts about 8 weeks because it takes that long for the bones to heal and for healthy scar tissue to form. The most crucial two weeks for your pet’s recovery are the first two. It is extremely important that you restrict activity. There shouldn’t be any running, jumping, or engaging in dog or toy play. Your pet may go outside for 3-5 minutes at a time, on a leash, only to relieve themselves. If your pet is doing well after two weeks, you can gradually start extending the length of walks by three to five minutes per walk per week; for example, in week three, your pet might take a leashed walk for about ten minutes, in week four, for thirteen to fifteen minutes, etc. By eight weeks, your pet can go on two daily walks lasting 20 to 30 minutes, ALWAYS ON LEASH, with a few shorter leash walks for bowel movements.
Your pet must not be allowed to lick or chew on the incision site. Licking or chewing the incision may result in the sutures being removed too soon and/or an infection at the incisional site, both of which may need to be repaired with a different procedure. When you are not immediately monitoring your pet, an E-collar needs to be on at all times.
Exercises that maintain joint range of motion through passive range of motion may be beneficial for your pet. The surgical limb should be moved through its full range of motion three to four times a day, ensuring that all joints can bend and extend. Although we don’t want to injure your pet, range of motion should ideally get better every day during this exercise. We advise first flexing the limb until your pet just starts to show discomfort, and then similarly extending the limb. This can be done for 15-20 repetitions each time.
After surgery, icing the limb for the first three to four days can reduce pain and swelling. Kindly place a bag of frozen peas or ice directly over the incision. Ice for 15 minutes per session. It is not advised to place a towel between the ice and the incision because doing so prevents the tissues from actually reaching a lower temperature, which reduces the effectiveness of icing.
You can start heat packing the incision site after 3–4 days. You can either fill a tube sock with rice and microwave it for this purpose, or you can use a heat pack that you can buy from a pharmacy. Always keep in mind that if it’s too hot for your skin, it’s also too hot for your pet. Heating can be done three to four times per day for 15 minutes at a time. In addition to reducing swelling, this can be done before passive range-of-motion therapy.
Please contact MVS or your veterinarian if your pet stops using the operated leg at any point during the healing process or does not start using the leg within two weeks.
Please follow your veterinarian’s instructions for administration of medications.
To help with swelling and pain relief and to keep the incision covered, a bandage was put on. For the purpose of avoiding complications related to bandages, this bandage must be removed within 24 hours. Prior to discharge, your veterinarian can remove this bandage, or you can do it yourself at home by carefully peeling off each layer. When removing the bandage at home, avoid using scissors to avoid accidentally cutting the skin.
The healing of the incision on your pet should be assessed in 10 to 14 days; sutures were inserted and will need to be removed at this time. Please schedule this appointment with your veterinarian. It might be necessary to take X-rays to confirm the proper implant position and signs of healing if your pet develops lameness or doesn’t get better. Before returning to normal activity at 8 weeks following surgery, X-rays will need to be taken to confirm complete bone healing. The implants are designed to stay in for life. However, we can quickly remove these implants if discomfort, infection, or irritation develops.
FAQ
Can a dog re injure after TPLO surgery?
Can my dog re-tear the cruciate ligament after surgery? No. It cannot be torn because we are not replacing the CCL. Likewise, after full healing is achieved (in about 6 months), there is little risk of the implants breaking or moving.
Can a dog injure their leg after TPLO surgery?
What to Do if Your Dog Jumped After TPLO Surgery. Following the post-operative recommendations provided by your veterinarian will help your dog prevent reinjuring the leg while it is still healing. After TPLO surgery, your dog shouldn’t be allowed to run or jump until the knee has healed. However, incidents might still occur.
What happens if my dog jumped after TPLO surgery?
Your dog should be fine after one instance of exerting the knee too early because recovery from TPLO surgery usually involves no complications, but it’s best to avoid jumping or running as much as you can.
How do you know if a TPLO has failed?
The absence of any symptoms (a single screw breaking) to a sudden onset of pain and limb lameness in the operated limb are all possible indications of implant failure. Following a TPLO procedure, about 5% of patients may develop an infection.