TPLO Surgery: Start to Finsh at PAH

What is a Cruciate Ligament Tear?

The cranial cruciate ligament (CCL) helps stabilize your dog’s knee. When it tears or ruptures, the knee becomes unstable, painful, and prone to arthritis if left untreated.

In humans, ACL tears are usually acute, traumatic injuries, whereas dogs rarely tear this ligament from a single injury. In most cases, it’s a progressive condition caused by wear, genetics, and body mechanics.

 Signs pet owners may notice:

• Limping or sudden lameness, ranging from a slight limp to not bearing weight at all

• Difficulty standing up or sitting down, hesitation with stairs or jumping

• “Toe-Touching” 

• Stiffness, especially after rest

• A "popping" or "clicking" sound from the knee

• Muscle atrophy (wasting) in the affected limb due to lack of use

• Decreased activity or playfulness

"Some dogs show subtle signs at first, which can make early diagnosis tricky. If any of these signs sound familiar, you’re not alone, and you don’t have to guess."

How we evaluate a suspected CCL injury

Because the signs of a cranial cruciate ligament (CCL) injury can be subtle and sometimes mimic other orthopedic issues, diagnosis is more than just watching how a dog walks.

Here’s what a veterinary evaluation typically includes:

Physical examination

Your pet will be placed on his/her side, and the veterinarian will feel the knee for a “cranial drawer motion”. Which will assess your dog’s knee stability, muscle tone, and range of motion. Cranial drawer motion refers to an abnormal forward sliding of the tibia (shin bone) relative to the femur (thigh bone) in a dog's knee, resembling a drawer opening. Any instability or excessive movement signifies a positive test, pointing to ligament damage. 

“Diagnosis isn’t based on just one test. We look at the whole picture: the exam, imaging, and how the dog is using the leg before making recommendations.” — Dr. Johnson

X-rays

While X-rays don’t show the ligament itself, they are an important tool. They help rule out other causes of lameness, assess joint changes, and look for signs of arthritis or inflammation associated with CCL disease.

The full picture

Diagnosis isn’t based on just one finding. Age, breed, activity level, body condition, and how long symptoms have been present all factor into determining the best next steps.

Because CCL injuries are often progressive, early and accurate diagnosis is key to protecting the joint and preventing further damage. Once a CCL injury is confirmed, treatment options are discussed based on your dog’s size, lifestyle, and long-term joint health.

“From the first exam to imaging, we are focused on your pet’s comfort and safety before, during, and after surgery.” — Amber, Surgery Nurse

What are my treatment options?

TPLO (Tibial Plateau Leveling Osteotomy):  A surgical procedure that stabilizes the leg joint by changing the biodynamics of the knee with a plate and screws. This is the best recommended treatment for larger, active dogs.

Lateral suture (Extracapsular stabilizing suture):  A surgical procedure where a strong, non-biodegradable suture is placed outside the joint capsule to stabilize the knee. This procedure is best for dogs under 30 lbs that have a more inactive lifestyle.

Medical management: No surgical procedure. 4-6 months of activity restriction, where the knee builds up scar tissue to help stabilize the knee. Not the optimal treatment.

“Once a CCL injury is confirmed, our job is to help families understand all their options, what each one involves, what recovery looks like, and how it may affect their dog long-term. There’s no one-size-fits-all answer, and that conversation matters.”— PAH Surgery Team

What is a TPLO surgery, and when might we recommend it

Once a cranial cruciate ligament (CCL) injury is confirmed, the next question is often: “What happens next?”

In many medium to large dogs, surgery is recommended because the knee remains unstable without the ligament, even with rest or medication. Over time, that instability can lead to chronic pain and progressive arthritis.

One of the most commonly recommended procedures is TPLO (Tibial Plateau Leveling Osteotomy). Rather than replacing the ligament, TPLO changes the mechanics of the knee so it no longer relies on the torn ligament for stability.

Why does that matter?

• Improved stability

• Better long-term comfort

• Reduced progression of arthritis

• Faster return to normal activity (when paired with proper recovery)

For many medium-to-large dogs, TPLO offers the best long-term outcome. It is always our goal to help you make informed decisions. Not rushed ones.

What TPLO Recovery Really Looks Like: A Week-by-Week Guide for Pet Parents

Hearing that your dog needs a TPLO surgery can feel overwhelming and for many pet parents, one of the biggest questions we get is: what recovery will look like afterward.

At PAH, we believe in setting clear, honest expectations so you can feel confident every step of the way. TPLO recovery is a commitment, but with structure, patience, and support, most dogs return to an active, happy life. Below is a realistic look at what TPLO recovery typically involves.

The First 24–72 Hours: Rest, Pain Control & Support

Immediately after surgery, your dog’s main job is rest.

What’s normal:

• Grogginess from anesthesia

• Mild swelling around the incision

• Limited appetite the first day

• Needing help standing or walking

• Overnight stay with our team for close monitoring, pain control, incision care, and overall comfort

Your role:

• Strict crate or confined rest

• Short, leash-only potty breaks

• Administer all prescribed pain medications exactly as directed

• Keep the incision clean, dry, and protected (cone or body suite stays on!)

  
  

PAH surgery team tip: Pain control is a big priority during this phase and most dogs are surprisingly comfortable when medications are given consistently

The First 1–2 Weeks: Rest, Protection & Pain Control

This phase is all about healing and restriction.

What to expect:

• Strict activity restriction (short, leashed potty breaks only)

• Medications for pain and inflammation

• Typically, most dogs are touching their toes to the ground within 10 days post-surgery

• The skin staples will need to be removed 10-14 days after surgery. This is performed at a recheck appointment at PAH

• Laser therapy is included for all orthopedic surgeries and is conducted in the 2 weeks after surgery

What pet parents should focus on:

• Keeping the incision clean and dry

• Preventing licking (cone or recovery suit)

• Crate rest or confinement to a small area

• Sticking closely to medication instructions

  
  

PAH surgery team tip: This is often the hardest phase emotionally, both for pets and their people, but it is also the most important

Weeks 3–4: Controlled Movement Begins

By this stage, many dogs start feeling much better. 

What to expect:

• Gradual improvement in comfort and mobility

• Leash walks only (no free roam of the back yard)

Important reminders:

• Feeling better does not mean healed

• No running, jumping, stairs, or rough play

• Mental enrichment becomes essential (food puzzles, training games)

  
  

PAH surgery team tip: Overdoing it during this phase is the most common setback we see

Weeks 5–8: Building Strength Safely

Bone healing is progressing, and muscle strength is slowly returning.

What this phase may include:

• Gradual increases in walk duration

• Physical therapy or at-home rehab exercises (if recommended)

• Improved weight-bearing on the surgical leg

Still restricted:

• Off-leash activity

• Fetch, dog parks, and sudden movements

  
  

PAH surgery team tip: Each dog progresses differently, so follow-up exams are key during this stage

Weeks 9–12: Returning to Normal Activity

Around this time, many dogs are cleared for increased freedom.

What to expect:

• X-rays are  taken to confirm bone healing

• Gradual return to normal daily activity

• Continued strengthening and conditioning

  
  

PAH surgery team tip: Even after clearance, we recommend easing back into activity rather than returning to full intensity all at once

How We Support You at Papillion Animal Hospital

We know TPLO recovery is a team effort. That’s why we provide:

• Clear recovery instructions

• Ongoing check-ins and rechecks

• Guidance for activity progression

• Support when recovery feels overw

• helming

• Follow these 10 tips on "things to do after a TPLO surgery"

  
  

10 Things to Do After a TPLO.pdf

Download PDF • 2.75MB

If you have questions, concerns, or just need reassurance,  we’re here.

PAH surgery team tip: Your dog’s comfort, mobility, and long-term quality of life matter to us.

If your dog has been diagnosed with a cruciate ligament injury or you’re considering TPLO surgery, please contact our team to learn more or schedule a consultation.