Managing bilateral cruciate disease with staged TPLO surgeries

Overview

Betsy was referred to East Kent Veterinary Referrals for investigation and management of left hindlimb lameness caused by cranial cruciate ligament disease. Following successful left TPLO surgery and recovery, she later developed instability in the contralateral stifle and subsequently underwent a staged right TPLO.

This case highlights the management of progressive bilateral cruciate disease, the importance of careful orthopaedic assessment and surgical planning, and the value of close communication and structured post-operative support throughout recovery.

Initial presentation

Betsy initially presented with an intermittent left hindlimb lameness. Although there had been some improvement with rest and anti-inflammatory medication, she remained uncomfortable and continued to struggle after activity.

Orthopaedic examination identified left stifle effusion, mild quadriceps muscle loss, and instability consistent with cranial cruciate ligament disease. Sedated radiographs were performed to support diagnosis and surgical planning.

For owners, the cranial cruciate ligament is an important stabilising structure within the knee joint. When the ligament becomes damaged or ruptures, the joint becomes unstable and painful. Dogs commonly present with limping, stiffness after rest, difficulty exercising, or reluctance to jump and climb stairs. The symptoms can be acute or chronic in duration.

Radiographs and orthopaedic assessment supported a diagnosis of left cranial cruciate ligament failure, and following discussion of treatment options with Betsy’s owners, TPLO surgery was recommended.

Left TPLO surgery

Betsy underwent left tibial plateau levelling osteotomy (TPLO) under general anaesthesia.

TPLO is a commonly performed orthopaedic procedure designed to stabilise the knee by altering joint mechanics, rather than replacing the damaged ligament itself. The aim is to improve comfort, restore limb function, and reduce progression of osteoarthritis.

Surgery proceeded routinely, with intra-operative confirmation of complete cranial cruciate ligament failure and no evidence of meniscal injury. Post-operative radiographs confirmed good implant placement and correction of the tibial plateau angle.

Betsy recovered smoothly from anaesthesia and was discharged with multimodal pain relief, anti-inflammatory medication, strict exercise restriction, and a structured follow-up plan.

Recovery and post-operative support

Betsy’s recovery included regular nurse-led wound checks, controlled lead exercise, home monitoring, and ongoing reassessment with Andy.

Her early recovery progressed well. She remained bright, comfortable, and consistently weight-bearing on the operated limb, with healing progressing appropriately.

As many terrier owners will appreciate, one of the biggest challenges during recovery was keeping Betsy calm enough during the strict rest period. Clear guidance and regular support helped her owners navigate wound care, medication administration, exercise restriction, and the gradual return to activity.

Development of bilateral disease

As is often seen in dogs with cruciate disease, Betsy later developed instability within the opposite stifle during recovery from her first procedure.

She presented with acute right hindlimb lameness, and orthopaedic examination identified instability consistent with right cranial cruciate ligament failure. Repeat imaging was performed to assess both stifles and support ongoing surgical planning.

Importantly, radiographs of the left stifle confirmed that the initial TPLO healing was progressing well, with stable implants and excellent bone healing. Assessment of the right stifle confirmed cruciate instability without evidence of additional major pathology.
Given Betsy’s good recovery from the first surgery and the progression of disease within the opposite limb, staged right TPLO surgery was recommended.

This is an important discussion point in cruciate disease management. Many dogs affected in one stifle will subsequently develop disease in the contralateral limb, either due to underlying conformational and degenerative factors or altered weight-bearing over time. Early communication around this possibility can help owners prepare for recovery expectations, rehabilitation, and longer-term planning.

Right TPLO surgery

Betsy subsequently underwent right TPLO surgery under general anaesthesia.

Intra-operative findings confirmed cranial cruciate ligament failure, again without evidence of meniscal injury. Surgery and anaesthetic recovery were uneventful, and post-operative radiographs confirmed implant positioning and stabilisation.

Following discharge, Betsy continued a structured recovery programme including pain management, strict exercise restriction, wound monitoring, and planned reassessment with repeat post-operative imaging.

Discussion

Betsy’s case demonstrates several important aspects of managing cruciate disease within our local referral practice.

Clinically, it highlights the value of detailed orthopaedic examination, appropriate imaging, and thoughtful staged surgical decision-making when managing bilateral disease. Careful reassessment before the second procedure helped ensure the initial TPLO was healing appropriately before proceeding with surgery on the opposite limb.

From an owner-support perspective, the case also illustrates the importance of communication and continuity throughout treatment. Bilateral cruciate disease can feel overwhelming for owners, particularly when a second limb becomes affected during recovery from the first surgery. Regular updates, structured rechecks, accessible advice, and consistent post-operative support all play an important role in helping owners feel confident throughout the process.

Outcome

Betsy recovered well following both procedures and remained a bright and engaging patient throughout her treatment.

Her case demonstrates how advanced orthopaedic surgery can be delivered locally, with continuity from initial assessment and imaging through to surgical management, rehabilitation, and follow-up care.

At East Kent Veterinary Referrals, our orthopaedic service works closely with referring veterinary surgeons to support the investigation and management of conditions including cranial cruciate ligament disease, patellar luxation, fracture repair, and complex orthopaedic lameness cases.

Need support with a cruciate case?

We are always happy to discuss orthopaedic cases with referring veterinary surgeons, including imaging interpretation, treatment options, TPLO suitability, staged surgical planning, and ongoing case management.

To discuss a case or arrange referral, please contact East Kent Veterinary Referrals.