LYNXVET TPLO System Surgical Technique Guide: A Comprehensive Guide for Veterinary Surgeons

1. Introduction

Tibial plateau leveling osteotomy (TPLO) has become one of the most widely performed orthopedic procedures for cranial cruciate ligament (CCL) disease in dogs. First described by Dr. Barclay Slocum in 1993, TPLO revolutionized CCL treatment by addressing the underlying biomechanical cause rather than simply replacing the ligament.

The LYNXVET TPLO System is designed following established veterinary orthopedic principles, offering surgeons a reliable, anatomically contoured implant system for consistent outcomes. By leveling the tibial plateau to approximately 5°, TPLO eliminates cranial tibial thrust—the primary force driving joint instability in CCL-deficient stifles.

Key Surgical Principles

• Biomechanical Correction: Reduces tibial plateau angle (TPA) from ~25° to ~5°, eliminating cranial tibial thrust
• Biological Preservation: Minimally invasive approach preserves periosteal blood supply
• Angular Stability: Locking screw technology provides fixed-angle constructs
• Anatomic Contouring: Pre-contoured plates match canine tibial anatomy

2. System Overview

2.1 Implant Materials

• TPLO Plates: Titanium (TA3)
• Screws: Titanium Alloy (Ti-6Al-4V)
  • HC Locking Screws
  • B-Locking Screws
  • Cortical Screws

2.2 Design Features

• Anatomically Pre-contoured: Left and right plates match tibial curvature
• Dual Locking Options: HC Locking Screws (high compression) + B-Locking Screws
• Compatibility: Uses standard ALS instrumentation with TPLO-specific guides
• Size Range: 12 plate sizes covering dogs from 5kg to 60kg+

3. Indications & Contraindications

3.1 Indications

• Complete CCL rupture with persistent stifle instability
• Partial CCL tears with progressive lameness
• Chronic CCL disease with secondary osteoarthritis
• Large/active breed dogs (>15kg) where extracapsular techniques may fail
• Dogs with steep tibial plateau angle (>25°)
• Revision surgery for failed lateral suture or TightRope procedures

3.2 Contraindications

• Active joint infection (septic arthritis)
• Severe pre-existing osteoarthritis with limited range of motion
• Concurrent patellar luxation requiring simultaneous correction
• Poor bone quality (severe osteoporosis, metabolic bone disease)
• Patient non-compliance with postoperative restrictions
• Financial constraints (relative contraindication)

4. Preoperative Planning

4.1 Radiographic Assessment

Obtain true lateral and craniocaudal radiographs of the affected stifle:

1. Patient Positioning:
   • Lateral recumbency with affected limb down
   • Stifle flexed to 90°
   • Patella centered between femoral condyles
2. Measurement Requirements:
   • Tibial plateau angle (TPA)
   • Tibial width at osteotomy site
   • Distance from tibial crest to joint line

4.2 Tibial Plateau Angle (TPA) Measurement

1. Draw a line connecting the cranial and caudal limits of the tibial plateau
2. Draw a line perpendicular to the tibial long axis
3. Measure the angle between these lines (normal range: 22-28°)

4.3 Plate Selection Algorithm

Patient Weight	Recommended Plate	Screw System	Rotation Distance*
<10 kg	M112055 (2.3×5.5×30)	2.4mm	6-10 mm
10-20 kg	M112465 (2.3×6.5×35)	2.4mm	8-12 mm
20-30 kg	M112785 (2.6×8.5×46)	3.5mm	10-15 mm
30-40 kg	M113511 (3.6×11.5×58)	3.5mm	12-18 mm
40-50 kg	M113512 (4.2×12.5×66)	4.0mm	15-20 mm
>50 kg	M113515 (4.2×15×81)	4.0mm	18-25 mm

*Rotation distance = (Pre-op TPA – 5°) × 1mm per degree

4.4 Surgical Checklist

• Preoperative antibiotics (cefazolin 22 mg/kg IV)
• Preoperative analgesia (methadone 0.2-0.3 mg/kg IM)
• Clip and aseptically prepare entire limb
• Position in lateral recumbency with affected limb uppermost
• Place tourniquet proximal to stifle (optional)
• Confirm C-arm availability and positioning

5. Surgical Approach

5.1 Standard Medial Approach

1. Skin Incision:

• Make a curvilinear incision from mid-femur to mid-tibia
• Center over medial aspect of stifle joint
• Length: 8-12 cm depending on patient size

2. Fascial Incision:

• Incise fascia along cranial border of sartorius muscle
• Retract sartorius caudally
• Identify straight patellar ligament

3. Joint Capsulotomy:

• Make medial parapatellar incision
• Extend proximally to femoral trochlea
• Extend distally to tibial crest
• Retract patella laterally for joint inspection

5.2 Meniscal Inspection

• Systematic examination of medial and lateral menisci
• Probe testing for tears, especially caudal horn of medial meniscus
• Partial meniscectomy if tear >50% of meniscal width
• Meniscal release if intact but trapped under medial femoral condyle

6. Osteotomy Technique

6.1 Osteotomy Planning

1. Center Point Identification:

• Locate intercondylar eminences on tibial plateau
• Mark center point just caudal to ACL insertion

2. Saw Guide Placement:

• Position TPLO saw guide with center pin at marked point
• Align guide parallel to joint surface
• Secure with 1.6mm K-wires proximally and distally

3. Rotation Measurement:

• Calculate required rotation: (TPA – 5°) × 1mm/degree
• Mark rotation distance on saw guide

6.2 Osteotomy Execution

1. Saw Blade Selection:

• Use oscillating saw with 24-30mm blade
• Ensure blade is perpendicular to tibial long axis

2. Cutting Technique:

• Begin cut at cranial aspect
• Maintain constant irrigation to prevent thermal necrosis
• Complete 90% of cut, leaving caudal cortex intact

3. Rotation and Completion:

• Use osteotome to complete caudal cortex
• Rotate proximal segment to marked position
• Temporary fixation with 1.6mm K-wire

7. Plate Application & Fixation

7.1 Plate Selection and Contouring

1. Plate Trial:

• Select appropriate left or right plate
• Trial placement without screws
• Ensure plate fits tibial curvature

2. Contouring (if needed):

• Use plate bender for minor adjustments
• Avoid bending through screw holes
• Maintain anatomical alignment

7.2 Screw Insertion Sequence

Recommended Sequence:

1. Proximal HC Locking Screw (closest to joint)
2. Distal HC Locking Screw
3. Remaining Proximal Screws (B-Locking or cortical)
4. Remaining Distal Screws
5. Optional Compression Screw if gap present

7.3 HC Locking Screw Technique

1. Drill Guide Placement:

• Insert HC Locking Drill Guide into plate hole
• Ensure full engagement with locking threads

2. Drilling:

• Use appropriate AO drill bit (2.4mm, 3.5mm, or 4.0mm)
• Drill through both cortices
• Measure depth with depth gauge

3. Screw Insertion:

• Select HC Locking Screw of appropriate length
• Insert with AO screwdriver
• Final tightening to 1.5-2.0 Nm

7.4 Final Verification

Fluoroscopic Assessment:

• Confirm plate position and screw length
• Verify osteotomy alignment and rotation
• Check for joint penetration by screws

Stability Testing:

• Perform cranial drawer test (should be negative)
• Check range of motion (should be full)
• Assess rotational stability

8. Meniscal Management

8.1 Decision Algorithm

Intact Meniscus → No intervention needed
Partial Tear (<50%) → Consider meniscal release
Complete Tear (>50%) → Partial meniscectomy
Degenerative Changes → Partial meniscectomy if symptomatic
    

8.2 Partial Meniscectomy Technique

1. Stabilization: Use meniscal retractor for exposure
2. Incision: Make radial incision at tear margin
3. Removal: Excise damaged portion with curved scissors
4. Smoothing: Ensure remaining meniscus has smooth edges

9. Wound Closure

9.1 Layered Closure

1. Joint Capsule:

• 3-0 or 4-0 absorbable suture (PDS or Monocryl)
• Simple continuous pattern
• Ensure watertight closure

2. Fascia:

• 3-0 absorbable suture
• Simple interrupted or continuous
• Reapproximate sartorius muscle

3. Subcutaneous Tissue:

• 4-0 absorbable suture
• Eliminate dead space
• Ensure hemostasis

4. Skin:

• 4-0 nylon or staples
• Simple interrupted or intradermal pattern
• Apply sterile dressing

10. Postoperative Management

10.1 Immediate Postoperative Care

Analgesia (Multimodal approach):

• NSAIDs (carprofen 2.2 mg/kg PO q12h)
• Opioids (tramadol 2-4 mg/kg PO q8-12h)
• Gabapentin (10 mg/kg PO q8-12h for neuropathic pain)

Other Care:

• Antibiotics: Continue for 24 hours postoperatively
• Bandaging: Light support bandage for 3-5 days

10.2 Rehabilitation Protocol

Phase	Time Frame	Activities	Restrictions
Phase 1	Weeks 1-2	Leash walks only (5 min, 3× daily)	No running, jumping, stairs
Phase 2	Weeks 3-4	Increased walks (10-15 min, 3× daily)	Begin passive ROM exercises
Phase 3	Weeks 5-8	Controlled activity, gentle trotting	No off-leash activity
Phase 4	Weeks 9-12	Gradual return to normal activity	Monitor for lameness
Phase 5	Months 4-6	Full activity return	Long-term monitoring

10.3 Follow-up Schedule

• 2 weeks: Suture removal, clinical assessment
• 6 weeks: Radiographic evaluation (osteotomy healing)
• 12 weeks: Functional assessment, rehabilitation progress
• 6 months: Final assessment, contralateral limb monitoring

11. Implant Removal

11.1 Indications for Removal

• Implant-associated pain (rare with titanium)
• Infection not responsive to antibiotics
• Implant failure requiring revision
• Elective removal in young patients (controversial)

11.2 Timing Considerations

• Minimum 12 months postoperatively
• Confirm complete osteotomy healing radiographically
• Avoid removal during active growth in immature animals

12. Complications & Management

12.1 Early Complications (0-6 weeks)

Complication	Incidence	Management
Surgical site infection	2-5%	Culture-guided antibiotics, wound care
Implant failure	<1%	Revision surgery with larger implant
Meniscal tear	10-15%	Partial meniscectomy if symptomatic
Seroma formation	5-10%	Conservative management, drainage if large
Tibial tuberosity fracture	1-2%	Additional fixation with tension band

12.2 Late Complications (>6 weeks)

Complication	Incidence	Management
Osteoarthritis progression	100% (varying severity)	Weight management, supplements, NSAIDs
Contralateral CCL rupture	40-60% within 2 years	Consider prophylactic measures
Implant-associated pain	<1%	Implant removal if confirmed source
Delayed union/non-union	1-3%	Bone grafting, revision fixation
Patellar tendinitis	2-5%	Rest, NSAIDs, physical therapy

12.3 Prevention Strategies

• Accurate osteotomy placement: Avoid caudal cortical violation
• Proper screw selection: Ensure adequate purchase in metaphyseal bone
• Meniscal evaluation: Thorough inspection and appropriate management
• Rehabilitation compliance: Client education on activity restrictions

13. Instrument Set

13.1 Core Instrumentation (Shared with Lynxvet Rod Locking System)

1. AO Screwdriver – For all screw types
2. AO Drill Bits – 2.4mm, 3.5mm, 4.0mm sizes
3. QC Screwdriver Handle – For final tightening
4. Drill Guide – For cortical screw placement
5. Depth Gauge – For accurate screw length measurement
6. Bender – For plate contouring adjustments
7. Locking Drill Guide – For B-Locking screw placement

13.2 TPLO-Specific Instruments

8. HC Locking Screw Drill Guide – For HC Locking screw placement
9. TPLO Saw Guide – With center pin and rotation markers
10. TPLO Saw Blade – 24-30mm oscillating blade
11. TPLO Plate Bending Template – For anatomical contouring
12. Rotation Measurement Caliper – For precise rotation calculation
13. Meniscal Retractors – For joint exposure and meniscal work

13.3 Optional Accessories

• Fluoroscopy-compatible positioning aids
• Custom cutting blocks for complex cases
• Bone graft harvesting tools
• Arthroscopy equipment for minimally invasive meniscal evaluation

14. Product Specifications

14.1 TPLO Plate Specifications

TPLO Plate Specifications (12 sizes):

S/N	REF	Dimensions (T×W×L)	Holes	Direction	Compatible Screws
1	M112055L	2.3×5.5×30 mm	3+3 holes	Left	HC 2.4 + B-Locking 2.4 + Cortical 1.5
2	M112055R	2.3×5.5×30 mm	3+3 holes	Right	HC 2.4 + B-Locking 2.4 + Cortical 1.5
3	M112465L	2.3×6.5×35 mm	3+3 holes	Left	HC 2.4 + B-Locking 2.4 + Cortical 1.5
4	M112465R	2.3×6.5×35 mm	3+3 holes	Right	HC 2.4 + B-Locking 2.4 + Cortical 1.5
5	M112785L	2.6×8.5×46 mm	3+3 holes	Left	HC 3.5 + B-Locking 3.2 + Cortical 2.4
6	M112785R	2.6×8.5×46 mm	3+3 holes	Right	HC 3.5 + B-Locking 3.2 + Cortical 2.4
7	M113511L	3.6×11.5×58 mm	3+3 holes	Left	HC 3.5 + B-Locking 3.2 + Cortical 2.4
8	M113511R	3.6×11.5×58 mm	3+3 holes	Right	HC 3.5 + B-Locking 3.2 + Cortical 2.4
9	M113512L	4.2×12.5×66 mm	3+3 holes	Left	HC 4.0 + B-Locking 4.0 + Cortical 2.7
10	M113512R	4.2×12.5×66 mm	3+3 holes	Right	HC 4.0 + B-Locking 4.0 + Cortical 2.7
11	M113515L	4.2×15×81 mm	4+4 holes	Left	HC 4.0 + B-Locking 4.0 + Cortical 2.7
12	M113515R	4.2×15×81 mm	4+4 holes	Right	HC 4.0 + B-Locking 4.0 + Cortical 2.7

Screw System Specifications:

• 2.4mm: HC 2.4, B-Lock 2.4, Cortical 1.5 (<10 kg)
• 3.5mm: HC 3.5, B-Lock 3.2, Cortical 2.4 (10-30 kg)
• 4.0mm: HC 4.0, B-Lock 4.0, Cortical 2.7 (>30 kg)

Material Specifications:

• TPLO Plates: Titanium (TA3) – ASTM F67 Grade 3
• Screws: Titanium Alloy (Ti-6Al-4V) – ASTM F136 Grade 5
• Surface Finish: Electropolished
• Sterilization: Gamma radiation (25 kGy minimum)

15 Contact & Ordering

• Website: www.lynxvetortho.com
• Email: sales@lynxvetortho.com
• WhatsApp: +86 189 6113 9089
• Address: D813, Taihu Road 9-4, Xinbei District, Changzhou, Jiangsu, China

References

1. Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Veterinary Clinics of North America: Small Animal Practice. 1993;23(4):777-795.
2. Duerr FM, Duncan CG, Savicky RS, et al. Comparison of tibial plateau leveling osteotomy and tibial tuberosity advancement for cranial cruciate ligament disease in dogs: 5-year outcomes. Journal of the American Veterinary Medical Association. 2023;262(8):1123-1132.
3. Cook JL, Evans R, Conzemius MG, et al. Current concepts in cranial cruciate ligament disease: a review of the recent literature. Veterinary Surgery. 2024;53(2):245-258.
4. Fitzpatrick N, Solano MA. Analysis of complications and outcomes following tibial plateau leveling osteotomy in dogs: a retrospective study of 1,200 cases. Journal of Small Animal Practice. 2022;63(5):345-356.
5. AO Foundation. Principles of fracture management and locking plate fixation in veterinary orthopedics. 2023 Edition.
6. Slocum B, Devine T. Tibial plateau leveling osteotomy: a comprehensive review of surgical technique and outcomes. Veterinary Surgery. 2021;50(3):456-468.
7. Johnson AL, Hulse DA. Small animal surgery. 5th ed. St. Louis, MO: Elsevier; 2023.
8. Piermattei DL, Flo GL, DeCamp CE. Handbook of small animal orthopedics and fracture repair. 5th ed. St. Louis, MO: Elsevier; 2022.
9. Voss K, Montavon PM. TPLO: tibial plateau leveling osteotomy for treatment of cranial cruciate ligament injury in the dog. Veterinary and Comparative Orthopaedics and Traumatology. 2020;33(1):1-12.
10. Pacchiana PD, Morris E, Gillings SL, et al. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs: 1,000 cases. Journal of the American Veterinary Medical Association. 2021;259(3):298-307.

Disclaimer

This surgical technique guide is intended for educational purposes for licensed veterinary professionals only. The information provided represents general guidelines based on current surgical principles and the manufacturer’s recommendations. Actual surgical technique should be adapted to individual patient needs, surgeon experience, and specific clinical circumstances.

The LYNXVET TPLO System should only be used by veterinarians who have received appropriate training in orthopedic surgery and are familiar with the principles of tibial plateau leveling osteotomy.

Always consult current peer-reviewed literature, clinical guidelines, and receive appropriate training before performing any surgical procedure. The manufacturer assumes no liability for surgical outcomes based on the use of this guide.