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What's Best for your Dog? TPLO Surgery Alternatives

by Dr. Pippa Elliott, MRCVS March 08, 2021 4 min read

Dog Recovering Post Surgery

Your dog has ruptured an anterior cruciate ligament (ACL) and the vet advises TPLO (Tibial Plateau Leveling Osteotomy) surgery. But this procedure involves cutting bone and you're worried. Is there something less invasive and is there a cruciate ligament dog alternative to surgery?

Is Surgery Essential?

Is there an alternative to TPLO surgery, which is to do nothing?

In truth, to do nothing is not recommended. However, there are a few rare exceptions, such as the dog with health problems that mean a long anaesthetic is a big risk. Also, small light dogs may get away with no surgery, but risks arthritis down the line.

What dog owners need to know is that left untreated, the lame dog will eventually improve. This happens because scar tissue forms inside the knee, which helps the dog use the leg to some extent. But this comes with several downsides.

  1. The knee is painful during the months it takes to heal
  2. The leg is never as good as before the cruciate rupture and the dog will still limp
  3. The knee will develop arthritis, which could be severe

The non-surgical alternatives to TPLO surgery include:

  • Rest: So the dog does not use the leg and cause further damage
  • Pain relief: Non-steroidal anti-inflammatories are often prescribed to reduce swelling and pain
  • Weight reduction: The dog now carries their weight on three legs, so for an overweight pet the extra demand on them, which risks injury to the 'good' legs.
  • Nutraceuticals: Glucosamine and chondroitin provide the damaged joints with the building blocks of repair
  • Physiotherapy: Rest causes muscle wastage, whilst physiotherapy helps to keep muscles strong and in good condition
  • Knee braces: The use of knee braces is controversial and the benefits not proven.

TPLO Surgery Alternatives

There might be specific aspects of TPLO surgery that worry you, and you might consider surgery if it avoids cutting bone.

Actually, TPLO surgery is a relatively new technique and there are other, older procedures which were used prior to TPLO being available..

Extracapsular Repair

This is the least invasive surgery because it doesn't enter the knee joint. This procedure involves the surgeon incising the skin on the outside of the knee. They place a 'figure-of-8' suture outside the joint, in such a way that it stabilizes the joint.

This is a temporary fix that stops the knee slipping long enough for scar tissue to form.

Benefits:

  • Relatively quick surgery and less time under anaesthetic
  • Works well for small, light dogs
  • Cost is $$$ rather than $$$$ for other procedures
  • Doesn't require referral to a specialist

Drawbacks:

  • Less effective for large dogs
  • Increased risk of arthritis compared to other surgical techniques

Tightrope ® Repair

This procedure falls in the middle, when it comes to invasive surgery. It is similar to the extracapsular repair because it involves placing a strong suture outside the knee joint to stabilise it. The difference is the surgeon drills a small hole through the crest of the shin bone, through which the suture is passed. This acts as a strong anchor, giving good stability

Benefits:

  • Similar to those of the extracapsular repair
  • May give a more secure anchor than the extracapsular technique

Drawbacks:

  • Less effective for large dogs
  • Increased risk of arthritis compared to other surgical techniques

Over-the-Top Technique (OTT)

This is an older procedure where the surgeon harvests a ligament graft from tissue of the thigh muscle, opens the knee joint, passes the graft through, and sutures it in its new position. The idea here is to replicate the path of the broken cruciate, and stabilize the knee that way.

Benefits

  • Can be done in first opinion practice
  • Works well for both small and large dogs
  • Good stabilization

Drawbacks

  • This is major surgery and is painful
  • A risk of haemorrhage during the surgery itself, due to a major artery that passes behind the knee
  • A risk of complications such as joint infection
  • A slow post-operative recovery

In truth, the OTT once was the main technique for repairing ruptured cruciates. But now it has fallen out of favour, because TPLO surgery gives better, more reliable results.

Tibial Tuberosity Advancement (TTA)

And last but not least, similar to TPLO surgery is TTA. This technique is used in large dogs, and does involve cutting bone in order to remodel the knee joint. In truth, the difference between choosing TTA or TPLO surgery is often due to preference of the individual surgeon, with the risks and benefits of both procedures being similar.

So for owners looking for TPLO surgery alternatives, then TTA probably isn't it.

Final Words

Long story short, TPLO surgery is a major procedure but it's popular for a reason. Once healed the dog has a strong leg and the risk of arthritis is reduced. Whilst there are dog ACL surgery alternatives, these also come with pros and cons. If in doubt, talk to your vet about any concerns as they may be able to either reassure you or suggest an alternative treatment.

Dr. Pippa Elliott, MRCVS
Dr. Pippa Elliott, MRCVS

Dr. Elliott graduated from the University of Glasgow, UK, with a Bachelor of Veterinary Medicine and Surgery. She has over three decades of experience working in companion animal practice and is the designated veterinarian for the Cats Protection rescue center, Harrow. In addition to hands-on work in the clinic, Dr. Elliott is an editor for small animal, veterinary textbooks from Improve International. She also writes a regular newsletter piece for the Webinar Vet and contributed to The Veterinary Times. Dr. Elliott is also qualified as an Official Veterinarian to oversee the export of animal products abroad.