Tibial Plateau Leveling Osteotomy 223function at 8 weeks, as compared to standard
home-exercise-restricted dogs (Monket al. 2006;
Romano & Cook 2015). This highlights the
importance of postoperative physiotherapy, as
alossof≥ 10 ◦ROM has been associated with
significantly higher subjective clinical lameness
scores than dogs with< 10 ◦ROM loss. Loss of
extension is also correlated with osteoarthritis
(OA) in the cranial femorotibial joint (Jandi &
Shulman 2007). Although progression of OA
occurs after TPLO (Boydet al. 2007; Hurleyet al.
2007), in general the presence of stifle OA corre-
lates poorly with clinical function (Gordonet al.
2003).
Outcome after TPLO
Despite these potential complications, outcome
after TPLO has been reported as favorable
in subjective and objective studies in both
large- and small-breed dogs. Subjective stud-
ies employed clinical assessments such as lame-
ness scoring, radiographic osteophyte scoring,
and client questionnaires (Kergosienet al. 2004;
Staufferet al. 2006; Thiemannet al. 2006; Boyd
et al. 2007; Christopheret al. 2013). The objec-
tive evaluation of limb use after TPLO via
force plate and kinematic analysis has corrobo-
rated the observation that recovery after TPLO
is rapid in the early stages, particularly when
compared to lateral fabello-tibial suture sta-
bilization (de Medeiroset al. 2011; Boddeker ̈
et al. 2012). Very good long-term outcome is
seen in large breeds after TPLO, with improve-
ment of ground reaction forces comparable to
(Conzemiuset al. 2005; Milliset al. 2008) or
greater than lateral fabello-tibial suture stabi-
lization (Gordon-Evanset al. 2013; Nelsonet al.
2013). Improvement in ground reaction forces
greater than lateral fabello-tibial suture stabi-
lization is also seen in small-breed dogs with
TPLO (Bergeret al. 2015). A meta-analysis of
the literature on surgical treatments for CR by
Berghet al. (2014) concluded that the evidence
evaluated strongly supports TPLO in its ability
to return dogs to normal function.
While ex vivostudies (Warzeeet al. 2001)
have demonstrated that a postoperative TPA
of 6.5±0.9◦neutralizes cranial tibial thrust,
a study of 32 client-owned Labrador Retriev-
ers with naturally occurring CR undergoing
TPLO evaluated via force platform gait analysis
preoperatively and≥4 months postoperatively,
found no relationship between postoperative
TPA (range 0–14◦) and postoperative ground
reaction forces (Robinsonet al. 2006). Client sat-
isfaction with postoperative outcomes of TPLO
in both large- and small-breed dogs has been
reported as very good in multiple studies, even
though such subjective assessments often do
not correlate with the incidence of postopera-
tive complications or objective measures of limb
function (Priddyet al. 2003; Talaatet al. 2006;
Thiemanet al. 2006; Boydet al. 2007; Waxman
etal. 2008; Christopheretal. 2013; Gordon-Evans
et al. 2013; Bergeret al. 2015).Conclusions
TPLO is an important surgical stabilization
technique with documented short- and long-
term favorable outcomes in both large- and
small-breed dogs.References
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