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Tibial Plateau Leveling Osteotomy

Has your pet been diagnosed with a ruptured cranial cruciate ligament (CCL)? Your veterinarian may have told you that a TPLO is the only solution to this problem. TPLO is a surgical procedure that alters the way the knee functions by changing the angle between the quadriceps muscle and the top of the tibia so that it pulls backwards on the bone the way the broken ligament used to function.

If you have a big dog, TPLO (or TTA) are usually better options, resulting in better clinical outcomes and return to function of the limb when compared with the lateral suture techniques many veterinarians perform.  We also offer TPLO down to a weight of about 20 pounds.  

 
How is the TPLO performed? This is an animated video, turn on your speakers and click here<<TPLO VIDEO>>.
 
If you are looking for video on how to measure the tibial plateau angle, turn on your sound and click here <<MEASURE TPA>>.
 
Looking for rehabilitation methods for postoperative TPLO care?  www.tploguide.com
 
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In-Hospital Training Opportunities

 

Tibial Plateau Leveling Osteotomy

 

Goal: To acquaint the participant with the biomechanics of the canine stifle and how tibial plateau leveling alters those biomechanics to produce a stable knee when the cranial cruciate ligament has torn.

 

Method: On-site training in your hospital using cadavers, real patients, or models, to instruct you hands-on in the proper technique of tibial tuberosity advancement for the treatment of cranial cruciate ligament disease in the dog. We send notes and a video (pending) prior to showing up in your hospital, and bring our own equipment to show you what you need to perform the procedure properly. We will even help you acquire the equipment if needed. We are available after the training by telephone or email to assess your technique radiographically, and help you develop postoperative rehabilitation programs.

 

Instructional Itinerary Includes:

  • Diagnostic methods for detecting cranial cruciate ligament disease, and rule outs for other causes of hindlimb lameness.
  • Radiographic analysis of the hindlimb
  • Radiographic analysis of tibial plateau angle, and proper preoperative choice of TPLO implants
  • Pain control
  • Sterile methods of surgical preparation
  • Choosing the right patient for TPLO
  • The TPLO surgical procedure, including potential mishaps surgical and postoperative
  • Postoperative radiographic analysis
  • Model building for client "show and tell"
  • Equipment acquisition

 

Participants are free to schedule 2 surgeries in a one-day period. If you wish to do more than 2 surgeries in a day, please let me know as there are additional fees. You may also bring in one other veterinarian if you wish, and videotape the procedure. Group teaching rates are also available, as well as state convention presentations.

 

Costs vary depending on location, number of procedures performed, and number of days at your location. For an estimate, please call 425-967-7999, or send an email to info@jeffmayodvm.com. 


 
Tibial Plateau Leveling Osteotomy

"TPLO" was first invented and described by Dr. Barclay Slocum in 1993. At the time, the procedure was patented, as was the equipment, and there was a long waiting list of people wanting to take the course. TPLO is one of the best and most proven methods of repairing a torn cranial cruciate ligament in the knee of a dog, particularly large and active breed dogs. The procedure has also been performed successfully on smaller dogs, as well as cats. A lot of research has been completed on the procedure to either prove or disprove the theory that it works. Nonetheless, it remains the current "gold standard" for repair of the cranial cruciate ligament in dogs, and is the technique of choice for many surgeons, as well as the one to which others are compared.
 
The objective of traditional surgeries, based on the passive model, is the elimination of cranial drawer. This procedure, commonly called the "modified-retinacular imbrication" technique, simply involves placing a large gauge nylon suture from the lateral fabella of the knee into the tibial tuberosity. Although this procedure commonly works, most dogs have some degree of arthritis a few years later, and this procedure can fail. If one simply considers the biomechanics of the stifle joint, with the high tendency of the tibia to rotate inwards during flexion of the knee, it seems obvious that the amount of stress placed on the suture should force it to break eventually, resulting in failure.
 
Cranial tibial thrust is a force created in the knee of the dog when the dog bears weight on the leg. If one thinks of the knee joint as being a hill, the top of the tibia is the hill, and the end of the femur is a car. When the parking break is damaged (the cranial cruciate ligament), the car rolls down the hill. Clinically, we see this when the tibial moves forward relative to the femur when a force is applied to the foot of the dog much in the way the dog bears weight on the leg. This cranial tibial thrust creates pain, damages the meniscus, and leads to the development of muscle atrophy and arthritis in the leg. Further, this pain causes the dog to shift the weight to the good leg, in a sense doubling the weight load on that limb, resulting in potential damage to the good leg if the injured one is not repaired soon.