222 Surgical Treatment
Figure 27.4 Lateral view radiograph of a dog 8 weeks
after tibial plateau leveling osteotomy, demonstrating
marked thickening of the patellar tendon (white arrows).
(A) (B)Figure 27.5 Cranial-caudal (A)
and lateral (B) radiographic
views of a dog 10 weeks after
tibial plateau leveling osteotomy,
showing a short oblique proximal
fibular fracture (white arrows).complication is unclear and is more commonly
identified in heavily muscled dogs with genu
varum conformation. Most cases improve with
aggressive physical therapy. However, a lateral
fabellar imbrication suture or a femoral correc-
tive osteotomy may be required in severe cases.
Fractures of the fibula or tibia are poten-
tially more serious complications that may be
encountered during or after the TPLO proce-
dure (Figure 27.5). Fibular fractures occurred in
5.4% of cases in a series of 168 TPLO procedures,
with identified risk factors including increased
body weight, greater preoperative TPA, greater
change in TPA, and TPLO performed without
the use of a jig (Tuttle & Manley 2009). A subse-
quent study by Tayloret al. (2011) of 355 TPLO
cases reported a 15% fibula fracture rate, with
increased body weight and an unfilled fibular
drill hole identified as risk factors. Risk factors
for tibial tuberosity fracture after TPLO include
simultaneous bilateral TPLO, a thinner postop-
erative mean thickness of the tibial tuberosity,
and an increase in TPA during convalescence
(Kergosienet al. 2004; Berghet al. 2008).
The use of a structured postoperative phys-
iotherapy program has been shown to result
in a greater stifle range of motion (ROM)
for dogs undergoing TPLO at 3 and 6 weeks
postoperatively, and greater likelihood of full