Cruciate (knee) Disease
Fixed Price TPLO fee includes initial consultation and FREE 6-8 week follow-up re-assessment
Postoperative infection guarantee: We are running a trial on infection rates after TPLO surgery. If your dogs qualifies for the trial and you agree to it being enrolled then we will provide FREE treatment of any postoperative infection that might develop after TPLO surgery.
These fees assume a healthy pet with a routine cruciate ligament rupture; we reserve the right to charge additional fees if other health concerns warrant additional investigations/care. Brachycephalic breeds (such as Bulldogs and Pugs) will also incur additional fees due to the added complexity of their anaesthesia (click here for further information on brachycephalic anaesthesia).
There are two cruciate ligaments in the knee (or ‘stifle’ as we call it in dogs). Cruciate disease (affecting the cranial -or anterior- cruciate ligament) is one of the most common orthopaedic conditions seen in dogs. In people cruciate ligament (or ‘ACL’) ruptures are typically seen as acute sporting injuries, in footballers and skiers for example. In dogs it is a little different. In most dogs the condition is a more chronic degenerative condition. The ligament degenerates and gets weaker over time and at some point it will start to tear. The signs associated with the initial stages of the condition can be subtle and may be missed -signs such as stiffness on rising from rest and mild, occasional lameness. As the ligament continues to tear the signs may become more obvious but it is not uncommon for owners to first realise their dog has a problem when the already weakened ligament finally tears completely, often during relatively normal activity. At this stage the stifle will be unstable -the two bones of the stifle (the tibia and femur) will rock back and forth during walking. This instability will often lead to the menisci (cartilage ‘shock absorbers’ of the knee) being torn, which can cause significant lameness and discomfort unless treated appropriately.
The diagnosis is often made on palpation/manipulation of the stifle, although in some dogs this may require sedation. X-rays will show signs of osteoarthritis (OA or ‘arthritis’). Early cases may be less easy to diagnose, sometimes requiring exploratory surgery/arthroscopy to visually examine the cruciate ligament.
Some small dogs (less than 15kg) may do ok with a period of rest and antiinflammatories alone, although surgery is generally considered to offer a quicker and more reliable recovery. In some small dogs (especially terriers such as the West Highland White Terrier) the shape of their knee can mean that they are very unlikely to get better without surgery. Larger dogs are also unlikely to do well without surgery and so surgery is always advised.
Surgery involves examination of the menisci, so that any torn pieces can be removed, and stabilisation of the joint. Numerous stabilisation techniques have been described. A restraining suture can be placed around the outside of the joint to try to replicate the function of the torn ligament (known as extracapsular or lateral retinacular suture stabilisation) but these sutures frequently stretch or break, with recurrent instability. Tibial tuberosity advancement (TTA, also referred to as MMP) is another option although published studies and our experience suggest that this technique is not as robust or as effective as our prefered technique, TPLO.
At Anderson Moores we recommend Tibial Plateau Levelling Osteotomy (TPLO) for almost all dogs (and often cats too). TPLO changes the geometry of the tibia to counteract the forces that are responsible for the instability. TPLO provides a robust repair which is very reliable and results in a consistently early and good return to limb function. TPLO is however a very technical procedure and in the wrong hands complications can be serious. At Anderson Moores our specialist surgeons perform hundreds of these procedures every year and the risk of complications is very low. Published research studies from the University of Cornell confirm that TPLO returns dogs to better limb function than suture stabilisation in the short and medium term and in a 2016 study it is reported that TPLO is superior to TTA (Krotscheck et al Veterinary Surgery 2016: TPLO returned dogs to normal function by 6-12 months whereas TTA did not).
We have seen a number of catastrophic complications following the performance of some TTA/MMP -type surgeries by non-specialist veterinary surgeons and we would urge owners to be cautious in choosing their surgeon. Always ask your surgeon what level of orthopaedic expertise they have, what procedure they are going to perform, how many of these procedures they have performed and what complications they have encountered. And remember you can always ask your first opinion vet for a referral to a Specialist surgeon who performs hundreds of these surgeries every year safely and with great success rates.
‘Evidence most strongly supports the TPLO as a procedure that allows a dog with naturally occurring unilateral cruciate disease to return to normal clinical function.’ Bergh MS & others (2014) Systematic Review of Surgical Treatments for Cranial Cruciate Ligament Disease in Dogs. Journal of the American Animal Hospital Association 50:5
Extracapsular suture – Key Points:
- When performed by an experienced surgeon this can be a reliable technique for small/medium dogs, but there is a significant risk of suture stretching/failure which can result in recurrent instability
- Evidence shows that dogs do not return to as good limb function as with TPLO
TTA – Key Points:
- Traditional TTA, performed well by an experienced surgeron, will provide a satisfactory outcome in many dogs
- Published reports show that TTA does not result in as good an outcome as TPLO at 6-12 months after surgery
- TTA surgeries are not as robust as TPLO and there is a greater liklihood of complications, some of which can be very serious
- These are complex surgeries and in inexperienced hands complications can be very serious, especially with MMP-style TTA procedures (e.g. MMP, TTA Rapid, TTA 2)
TPLO – Key Points:
- Early return to limb use is expected (usually weight-bearing next day)
- Locking implant systems provide a very robust repair after surgery
- Greater cost than suture stabilisation due to the complexity of the surgery and implant costs
- TPLO provides a predictable and good outcome with a low complication rate. The published literature supports TPLO as providing better outcomes than other techniques.
- These are complex surgeries and in inexperienced hands complications can be serious (the complication rate at Anderson Moores is very low)
Further information on TPLO is available here: www.TPLOanswers.com
Why choose Anderson Moores?
- One of our surgeons will fully assess your pet to be sure surgery is the correct decision, and talk you through the procedure and the aftercare
- If a member of your family needed orthopaedic surgery they would be referred to a registrar or consultant surgeon. Our surgeons are the registrars and consultants of the veterinary world. Treating dogs for orthopaedic disorders is the only thing we do, every day, all year, and cruciate disease is the most common condition we see.
- We have invested a lot of time and money in state of the art surgical and anaesthetic facilities, which means reduced risk of complications for your pet.
- Pain management is a priority of ours, including epidural pain relief and/or local nerve blocks as standard for TPLO surgery. Fully qualified nurses and interns are on-site 24 hours/day to ensure your pet is comfortable through-out the night following surgery.
- Discharge with a physiotherapist (subject to availability)
The reason why we do this:
“Thank you for your skill, care and attention to Bryn. We are pleased to report that Bryn is exercising really well, no limping and extremely happy. We will always be grateful to you. Wendy & Bill R.”
“It’s just six months since Spingo’s TPLO so I thought I’d send you an update. Thanks to your skill’s he has made a perfect recovery with not a sign of any problems. I’m so pleased we where referred to you as you’ve made a total change to Spingo’s life, he’s happier in himself and running about great. At the end of the season he did half a day and we both enjoyed it, it’s good having him back working. A BIG THANKS! Kind Regards Maxwell”
Sample discharge instructions for TPLO or TTA surgery (pdf)
James’ overview of cruciate disease, published in ‘Dogs Monthly’ April 2012 (thanks to Dogs Monthly for allowing this to be posted here www.dogsmonthly.co.uk)