TPLO Surgery for Dogs
Tibial Plateau Leveling Osteotomy — Complete Guide to Cranial Cruciate Ligament (CCL) Repair
Antietam Valley Animal Hospital | Berks County, PA | Reading, PA
Understanding the Cranial Cruciate Ligament (CCL) Injury
The cranial cruciate ligament (CCL) is one of several ligaments that stabilize your dog's stifle, or knee. It is the primary structure preventing the femur from sliding excessively forward and backward over the tibia — a motion called “cranial drawer.” When the CCL partially tears or fully ruptures, the joint becomes unstable. That instability causes inflammation, pain, and the limping or leg-favoring that most owners notice first.
Left unaddressed, an unstable knee accelerates osteoarthritis (OA) — the progressive breakdown and loss of cartilage within the joint. Because CCL injuries don't heal on their own the way a sprain might, surgical stabilization is the standard of care for most active dogs, particularly those over roughly 20–25 lbs.
Signs Your Dog May Have a CCL/ACL Injury
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Sudden or gradual hind limb lameness, often worse after rest or exercise
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Difficulty rising, jumping into the car, or climbing stairs
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Sitting with the affected leg held out to the side
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Audible clicking when walking (can indicate a concurrent meniscus tear)
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Thigh muscle loss on the affected leg
What Is a TPLO?
TPLO (Tibial Plateau Leveling Osteotomy) is a surgical technique that changes the biomechanics of the knee rather than replacing the torn ligament. Instead of reconstructing the CCL, the surgeon makes a controlled, circular cut across the top of the tibia (the tibial plateau) and rotates that segment to reduce its natural slope. A surgical-grade stainless steel bone plate and screws hold the two bone segments in their new position while they heal.
By leveling the tibial plateau, the TPLO eliminates the forward-sliding force the CCL used to resist — so the knee becomes stable even without an intact ligament. Over the following weeks, the bone segments fuse together (much like healing a fracture), and the plate provides lifelong structural support.
TPLO is widely regarded among veterinary surgeons as one of the most reliable techniques for restoring normal function, particularly in medium, large, and giant breed dogs, and in highly active dogs of any size.
Preparing for Surgery
Required Pre-Operative Workup
Before scheduling your dog's TPLO, we complete a thorough evaluation to confirm the diagnosis, rule out complicating factors, and ensure your dog is a safe anesthetic candidate. This typically includes:
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Orthopedic exam — palpation for cranial drawer motion and tibial thrust, gait assessment, and evaluation of the opposite knee (since it's at elevated risk)
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Radiographs (X-rays) of the affected knee — used to confirm the diagnosis, rule out bone tumors or other pathology, and precisely measure the tibial plateau angle (TPA), which determines how much correction is needed during surgery
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Pre-anesthetic bloodwork — a complete blood count (CBC) and chemistry panel to screen organ function and overall health prior to anesthesia; senior or higher-risk dogs may also need a coagulation panel, urinalysis, or chest films
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Sedated orthopedic measurements — in many cases the surgeon takes precise measurement radiographs under light sedation to plan the exact rotation needed
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Physical exam and weight check the morning of surgery to finalize anesthetic dosing
Preparing Your Home Before Surgery Day
Getting your home ready before your dog comes home makes the first two weeks dramatically easier. We recommend setting this up before surgery, not after:
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A confinement space: a crate large enough to stand and turn around in, a gated-off room, or a small area on the main floor with minimal stairs
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Rubber-backed rugs or yoga mats over hardwood, tile, or laminate floors to prevent slipping
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A sling or towel for supporting the hind end on walks and stairs (we can recommend or provide one)
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A properly fitted e-collar (cone) or recovery suit on hand
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Elevated food and water bowls if your dog will be resting on the floor for extended periods
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A plan for bathroom breaks — someone available for short, controlled leash walks every few hours the first day or two, with sling support.
The Day Before Surgery
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No food after 8pm the night before; water is generally fine until the morning
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Bathe your dog if needed — the incision can't get wet for at least 10–14 days
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Confirm your confinement area and rugs are set up and ready
Surgery Day
Your dog is admitted in the morning for a pre-anesthetic exam, then placed under general anesthesia with continuous monitoring throughout the procedure. The surgeon places the stabilizing suture through small anchor points in the bone on either side of the joint and tightens it to the correct tension. The incision is closed in layers. Because no bone is cut, anesthesia and surgery time are typically shorter than with a TPLO.
We use a layered ("multimodal") anesthesia and pain-control protocol for every orthopedic surgery, designed to keep your dog calm and comfortable at every stage and to stay ahead of pain rather than catching up to it. Before surgery, your dog receives a combination of a calming sedative and pain-relieving medications (dexmedetomidine, midazolam, and methadone) to ease anxiety and provide the first layer of pain relief before anesthesia even begins. Anesthesia is then induced gently with propofol and maintained during surgery with isoflurane gas -- a well-established, closely monitored combination used in veterinary and human hospitals alike. Throughout the procedure, a dedicated team member continuously monitors your dog's heart rate, blood pressure, oxygen levels, and body temperature. At the surgical site, we use Nocita, a long-acting local anesthetic that numbs the area for up to 72 hours after surgery -- similar to a nerve block a person might receive after their own orthopedic surgery -- which meaningfully reduces how much pain your dog feels as they wake up and in the days that follow. We also give an anti-inflammatory pain medication (carprofen) during surgery to start reducing pain and swelling right away, and send you home with carprofen, gabapentin (a nerve pain medication), and an antibiotic to keep your dog comfortable and support healing over the following days and weeks.
Anesthesia and Pain Management
The First 12 Hours: Going Home (Outpatient Recovery)
As a general practice, we don't have overnight staffing on-site, so all of our surgical patients — including amputations — go home with their owners the same day, once they're comfortable, stable, and recovered enough from anesthesia to travel. In our experience, most pets do just as well, and often better, resting overnight in the comfort of home with their own family rather than in a hospital kennel, as long as you follow the aftercare instructions below closely. In the rare case that a pet needs a higher level of overnight monitoring than we can provide, we'll coordinate a direct transfer to a 24-hour emergency/specialty hospital such as BluePearl Pet Hospital in Wyomissing or Metropolitan Veterinary Associates, and stay in close contact with both their team and you throughout.
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Grogginess from anesthesia and pain medication for several hours — keep confined and supervised
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First walk: short, leash-controlled bathroom breaks only, with sling support if needed
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Icing: towel-wrapped ice pack to the knee for 10–15 minutes, 2–3 times the first evening
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Pain medication given exactly as prescribed, on schedule
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A reduced appetite the first evening is common; a dog not eating or drinking at all by the next morning should be reported to us
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Mild swelling, bruising, and a small amount of clear or blood-tinged discharge from the incision is normal for the first few days
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Overnight confinement so your dog can't jump, slip, or attempt stairs unsupervised
Recheck Appointments & Healing Timeline
1. 14 days post-op: Suture/staple removal and incision check.
2. 6 weeks post-op: Recheck radiographs to confirm the bone segments are healing (fusing) properly. This determines whether activity can begin to progress.
3. 10 weeks post-op: If x-rays show good bone healing, restrictions begin to loosen — supervised off-leash activity in a secure area, longer walks, and water-based exercise may be approved.
4. 6 months post-op: Full activity clearance for most dogs, assuming consistent, confident use of the leg. Full muscle symmetry between the hind legs can take up to 6 months to return even in straightforward recoveries.
Home Rehabilitation Program
Structured rehab is not optional extra credit — it's a core part of how well your dog recovers. The goals are to control pain, rebuild the muscle lost around the joint, restore full range of motion, and protect the opposite leg from compensatory injury. We send every TPLO family home with a detailed week-by-week schedule; the overview below shows how the program progresses.
Weeks 0–2: Foundation Phase
Focus: pain control, gentle motion, and protecting the repair while the incision heals.
• Strict confinement between exercise sessions — crate, small gated room, or leash-controlled only
• Passive range of motion (PROM) and massage, 2–3 times daily once cleared by the surgical team
• Short, slow, leash-controlled walks for bathroom purposes only, several times a day rather than one long walk
• Ice therapy after each exercise session; gentle heat to the muscles above the knee can begin around day 4
• E-collar or recovery suit worn at all times to prevent licking — this is the single most common cause of post-operative infection, and it's entirely preventable
• No jumping, no off-leash activity, no unsupervised stairs, no play with other dogs
Weeks 3–12: Strength & Balance Phase
Once the incision has healed and the surgical team has cleared the next phase, exercises progress to rebuilding strength, balance, and proprioception (body awareness):
• Longer, varied controlled leash walks — figure-8 patterns, gentle inclines, stepping over low obstacles
• Weight-shifting and three-legged standing exercises to rebuild core and hind-end strength
• Sit-to-stand “doggy squats” and cookie stretches for spinal mobility and quadriceps strength
• Controlled wading in water (after sutures are out) and, after the 8-week x-rays are cleared, swimming
• Gradual reintroduction of uneven terrain — grass, gentle trails — always on leash and under control
Months 3–6: Return to Normal Activity
With a good 8-week x-ray result and consistent, confident use of the leg, most dogs progress toward off-leash activity, play with other dogs, and normal exercise by around 6 months. Muscle mass typically continues to build during this period — it takes roughly 2–4 times as long to rebuild muscle as it does to lose it, so patience during the slow phases pays off.
Incision Care: What's Normal vs. What Needs a Call
Normal
• Mild swelling and bruising for the first week
• A small amount of clear or blood-tinged discharge for the first few days only
• Mild discomfort and warmth around the leg
Contact Us Right Away If You Notice
• Swelling that lasts longer than a week, or new swelling appearing later
• Large amounts of discharge or active bleeding
• Discharge that is white, green, or thick/sticky
• Pain that doesn't improve with medication and icing, or sudden new lameness after initial improvement
Frequently Asked Questions
How much does TPLO surgery cost?
$3800 ($4200 for dogs over 80lbs) – includes pre-operative examination, anesthesia, implant and instruments, surgery, local anesthesia and intra-operative pain management, recovery and nursing care.
Rechecks are included, however, follow-up radiographs/sedation are at an additional cost.
Why choose TPLO over a less invasive procedure like a lateral suture or extracapsular repair?
For dogs over roughly 20–25 lbs, and for very active or working dogs of any size, TPLO generally provides more predictable long-term stability and a faster return to full function because it changes the underlying biomechanics of the joint rather than relying on a suture that can stretch or fail over time. We're happy to discuss which technique best fits your dog's size, activity level, and anatomy at a consultation.
Is TPLO painful for my dog?
Like any orthopedic surgery, there is post-operative discomfort, which we manage proactively with a multimodal pain protocol —injectable pain medication, local anesthesia during surgery, take-home oral pain medication, and cold therapy at home. Most dogs are placing some weight on the leg within the first few days.
How long until my dog walks normally again?
Most dogs are touching the toe down or partially weight-bearing within the first week and walking with a noticeable limp improvement by 4–6 weeks. Full, confident use of the leg with return to normal activity is generally expected by 4–6 months, with complete muscle symmetry sometimes taking up to 6 months.
Will my dog need surgery on the other leg too?
Not necessarily, but the risk is real: dogs who tear one CCL have a meaningfully higher chance of tearing the other. Maintaining a healthy body weight and staying consistent with rehab and conditioning are the best ways to reduce (though not eliminate) that risk.
Will my dog need to stay overnight after surgery?
No — as a general practice, we don't have overnight staffing on-site, so all of our surgical patients go home with their owners the same day. In our experience, most dogs recover just as well, and often more comfortably, resting at home with their family than they would in a hospital kennel overnight. On the rare occasion a pet needs a higher level of overnight monitoring, we'll arrange a direct transfer to a 24-hour facility such as BluePearl Pet Hospital in Wyomissing or Metropolitan Veterinary Associates.
Can I do this surgery at your general practice instead of a referral hospital?
Yes — our surgical team performs TPLO in-house with the same implants and surgical technique used at specialty referral hospitals. Because we're a general practice rather than a large corporate referral center, we're able to offer this level of orthopedic care with less overhead, which often makes it more accessible for families — without cutting corners on anesthesia monitoring, implants, or aftercare.
What if my dog doesn't seem to be improving?
Contact us any time during the recovery process. Recovery isn't perfectly linear, but if your dog plateaus, regresses, or you're simply unsure whether something is normal, we would rather hear from you early.