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TPLO, CBLO, and TTA: A Guide to Cruciate Surgery Options

TPLO, CBLO, and TTA: A Guide to Cruciate Surgery Options

Best Practices

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Compare TPLO, TTA, and CBLO surgeries for dog cruciate ligament injuries. Learn differences, costs, recovery, and best option for your dog

By 

Sustainable Vet Group

Updated on

April 21, 2025

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Understanding Cruciate Ligament Injuries in Dogs

The cranial cruciate ligament (CCL) is a strong band in your dog's knee (stifle) that helps keep the joint stable. When this ligament tears, either partially or fully, your dog may limp, feel pain, or avoid putting weight on the leg. This injury is similar to an ACL tear in humans.

CCL tears don't heal well on their own because of the constant motion in the joint. That's why surgery is often recommended. It helps restore stability, reduce pain, and prevent long-term joint damage like arthritis.

Signs that your dog may need CCL surgery include limping on one back leg, stiffness after rest, swelling in the knee, or difficulty standing up. If these symptoms appear, your vet may suggest imaging and a physical exam to confirm the diagnosis and discuss the best surgical option.

Overview of Surgical Options: TPLO, TTA, and CBLO

There are several surgical options for treating a torn cranial cruciate ligament in dogs. Each method has a different approach to stabilizing the knee joint.

The choice depends on your dog’s size, activity level, and the severity of the tear. Your vet will choose the technique that offers the best long-term results for your dog’s specific needs.

What is TPLO Surgery?

Tibial Plateau Leveling Osteotomy (TPLO) is a surgery that changes the angle of the shin bone (tibia) to stabilize the knee without needing the torn ligament. The surgeon cuts and rotates the top of the tibia, then secures it with a metal plate. TPLO is often recommended for large or active dogs with full CCL tears. It allows them to return to high activity levels and reduces the risk of arthritis over time.

What is TTA Surgery?

Tibial Tuberosity Advancement (TTA) surgery moves a part of the shin bone forward to change how the knee handles weight. This shifts the force in the joint and helps it stay stable even without a healthy CCL. A spacer and metal implants are used to hold the new position.

TTA is often chosen for small to medium-sized dogs or dogs with partial tears. Recovery is usually smooth, and dogs can regain good mobility if the joint shows no signs of other damage.

What is CBLO Surgery?

CORA-Based Leveling Osteotomy (CBLO) is a newer surgery that combines ideas from TPLO and TTA. It changes the angle of the tibia but follows the dog’s natural bone shape more closely. This helps protect the cartilage and makes healing smoother.

CBLO uses a curved cut and a special plate for support. It is becoming popular because it works well for dogs of all sizes and activity levels, especially younger dogs or those with early signs of joint damage. It offers strong stability and good long-term joint protection.

Choosing the Right Procedure for Your Dog

When selecting the right CCL surgery for your dog, several factors come into play. These include your dog’s size, age, activity level, the severity of the ligament tear, and any other joint problems.

Some dogs may do better with one surgery than another based on how their bones are shaped and how active they are. Your veterinarian will assess these factors to recommend the safest and most effective option for your dog’s long-term health.

When is TPLO the Best Option?

TPLO is often the best choice for large, athletic, or working dogs that put a lot of pressure on their knee joints. It is also recommended when there’s a complete CCL tear or when the joint is already unstable. TPLO changes the way the knee moves by leveling the slope of the shin bone, which removes the need for the torn ligament.

Dogs who undergo TPLO usually return to a high level of activity within a few months. It is a strong, proven option that works well for dogs over 50 pounds or those with strong muscle build. This surgery also helps slow down arthritis in the long term, making it ideal for younger, high-energy dogs that need lasting joint support.

When is TTA the Right Choice?

TTA is a good choice for medium or small dogs that are not extremely active or do not have full CCL tears. It works by moving a part of the tibia forward, changing how the joint handles stress and making it stable even without the ligament. This method is best when the dog’s tibial slope is suitable for this type of surgery, and there’s minimal existing damage to the joint.

Dogs that benefit most from TTA usually have partial tears, good muscle control, and no signs of meniscal damage. TTA can also be less invasive than TPLO, with a slightly faster recovery for some dogs. It’s especially helpful for pets that need a strong repair but are not running or jumping constantly. When chosen correctly, TTA can provide solid long-term results with less stress on the joint.

When to Consider CBLO Surgery

CBLO is a flexible option that is becoming more common for dogs of all sizes, especially those with a steep tibial slope or a more natural bone curve. It works by making a curved cut in the bone to adjust the joint angle, similar to TPLO, but in a way that better protects the cartilage.

CBLO may be ideal for younger dogs with developing bones, dogs with early signs of arthritis, or dogs where TPLO or TTA are not a perfect match. It’s also a good option when bone structure or joint wear makes other techniques harder to perform.

CBLO offers strong stability, low risk of complications, and a smooth healing path. Vets may suggest CBLO when they want to protect joint health for the long term while still allowing the dog to return to normal activity. It’s a versatile and modern approach for many cases.

Recovery Time and Long-Term Healing

After CCL surgery, most dogs need several weeks to months to fully recover, no matter which method is used. During the first two weeks, rest is critical. Activity must be restricted, and your dog may need a cone, pain medication, and short leash walks. Physical therapy often starts around week 3 or 4.

Long-term healing depends on the surgical technique, your dog’s size and age, and how well you follow the post-op plan. All three surgeries—TPLO, TTA, and CBLO—aim to reduce pain, restore function, and prevent arthritis over time.

TPLO Recovery Timeline

TPLO recovery is usually 12 to 16 weeks. In the first 2 weeks, your dog should rest with very limited movement. By week 4, short leash walks begin. Around 6 to 8 weeks, most dogs can start light physical therapy and build strength. Full bone healing is expected at 12 weeks.

After that, your vet may allow more active play or even off-leash walks. Most dogs return to their normal activity levels within 4 months, including running and jumping. TPLO offers one of the best long-term outcomes for large and active dogs, with strong joint stability and a lower risk of arthritis progression over time.

TTA Recovery Timeline

TTA recovery often feels quicker in the first month, but full healing still takes about 10 to 14 weeks. After surgery, your dog needs rest for 2 weeks with limited movement. By week 3 or 4, leash walks and light rehab can begin.

Some dogs seem more comfortable early because TTA can cause less bone disruption. However, long-term care is still important. Full bone healing should be confirmed by X-rays before any intense activity resumes.

Dogs usually return to full function by 3 months. While recovery may feel smoother at the start, joint stability can be slightly lower than TPLO in very active dogs, so TTA is best for pets with moderate exercise needs and no advanced arthritis.

CBLO Recovery Timeline

CBLO recovery is typically about 8 to 12 weeks. The curved bone cut allows for faster bone healing and strong joint support. In the first 2 weeks, your dog needs crate rest and close monitoring.

Around week 3 or 4, guided leash walks and rehab exercises begin. Many dogs show improved comfort earlier compared to other surgeries. CBLO provides excellent joint stability and protects the cartilage well, which helps reduce long-term arthritis risks.

By 8 to 10 weeks, most dogs have solid bone healing, and activity can increase under vet guidance. CBLO is often chosen for dogs needing a smoother, more natural healing path, especially those with steep tibial slopes or younger, growing joints.

Comparing Cost of Each Surgery

The cost of cruciate ligament surgery can vary widely based on the type of procedure, your location, the clinic’s equipment, and your dog’s size.

  • On average, TPLO surgery is the most expensive, usually ranging from $3,000 to $5,000. This is because it requires specialized tools, implants, and advanced surgical skill.
  • TTA surgery tends to cost slightly less, typically between $2,500 and $4,500, depending on the region and the dog’s condition.
  • CBLO, being a newer and specialized technique, also falls within the $3,000 to $5,000 range.

Several factors can influence the final price. Larger dogs may need stronger implants, longer anesthesia, and extended monitoring, which can raise the cost. Clinics with advanced imaging or rehab facilities may charge more, but they also offer better outcomes. Costs are generally higher in urban areas due to clinic overhead and demand.

Pre-surgical tests, post-op pain meds, physical therapy, and follow-up X-rays are often billed separately, so it’s important to ask for a full breakdown. While surgery can seem costly, it’s a long-term investment in your dog’s health, helping prevent chronic pain, arthritis, and future mobility issues that could lead to more expenses over time.

Potential Risks and Complications

Like all orthopedic surgeries, cruciate ligament repair comes with some risks. These include infection, swelling, bleeding, or delayed bone healing. Anesthesia always carries a small risk, especially in older or sick dogs.

Even with the best care, some dogs may not respond as expected or may develop arthritis later. Following all post-op instructions is key to reducing complications.

TPLO Risks to Be Aware Of

TPLO is highly effective, but it involves cutting and rotating the top of the tibia, which carries some risk. One concern is infection at the surgical site, especially if your dog licks the wound or the incision is not kept clean.

Implant failure can happen if the screws or plates loosen or break, usually due to early overuse. Dogs that return to running or jumping too soon may strain the healing bone. Swelling, bruising, or pain may also last longer than expected if activity is not controlled.

Rarely, dogs may react to the metal implant or need a second surgery if healing is delayed. Regular follow-ups and X-rays help your vet monitor recovery and spot any issues early, giving your dog the best chance at a smooth and full recovery.

Risks Specific to TTA

TTA involves shifting part of the tibia forward and securing it with a cage, spacer, and screws. While it can offer quicker comfort early on, there are some risks to watch for. One issue is joint instability if the bone does not heal properly or if the implant shifts. This can lead to limping or uneven weight-bearing later on.

Implant-related problems, like broken screws or the cage moving, may require follow-up surgery. Since TTA does not fully change the joint angle like TPLO or CBLO, there’s a chance that dogs with steep tibial slopes may still have some sliding motion in the joint. This is why TTA is not ideal for very active dogs or those with full ligament tears.

Post-op care must include crate rest, limited walks, and no off-leash activity until healing is confirmed by X-ray. If the rehab is done correctly, TTA can still provide excellent function and comfort.

How CBLO Reduces Some Common Complications

CBLO is designed to be gentler on the joint while still offering strong stability. Unlike TPLO, it uses a curved bone cut that better matches the natural shape of the tibia. This often means less disruption to the joint surface and better protection for the cartilage.

One of CBLO’s strengths is its flexible cut location, which allows the surgeon to adjust based on the dog’s bone shape and age. This reduces the risk of misalignment or stress on healing tissues.

CBLO also lowers the chance of developing meniscus injuries, which can happen in unstable knees. While the risk of infection, swelling, or implant issues still exists, it may be slightly lower compared to other methods. Some dogs experience quicker weight-bearing and less pain early in recovery. However, strict rest and rehab are still needed to avoid setbacks.

Overall, CBLO offers a modern approach that addresses many of the limitations found in older techniques, making it a strong choice for long-term joint protection.

Other Treatment Options

When surgery isn’t possible—due to cost, age, or health concerns—some dogs may be treated with alternatives like knee braces or extracapsular repair.

  • Braces aim to support the joint from the outside, but they don’t stop the joint from sliding and often don’t work well in large or active dogs.
  • Extracapsular repair uses a strong suture placed outside the joint to hold the knee stable. It’s mostly used in small dogs under 25 pounds and in cases of partial tears.

However, TPLO, TTA, and CBLO are considered more reliable for long-term recovery. They change how the knee handles weight, offering better stability during movement.

These techniques also lower the risk of arthritis and long-term lameness. While non-surgical methods may provide short-term relief, they often fail to restore full function, especially in bigger or more active dogs.

Final Thoughts: Which Cruciate Surgery Should You Choose?

Choosing the right cruciate surgery depends on many factors, including your dog’s size, age, activity level, bone structure, and the severity of the ligament tear. TPLO is often best for large, active dogs with full tears. TTA works well for smaller or medium dogs with partial tears and less joint stress. CBLO is a newer, flexible option that fits many situations, especially for dogs with steep tibial slopes or early arthritis.

While each surgery has its pros and cons, all aim to restore movement, reduce pain, and prevent long-term damage. The best choice is the one that matches your dog’s specific needs. Always talk to your veterinarian or a board-certified surgeon. They can evaluate your dog’s condition through imaging, joint exams, and overall health to recommend the safest and most effective treatment for a strong recovery.

FAQs About TPLO, CBLO, and TTA

Which cruciate surgery has the best long-term results?

TPLO is often considered the gold standard for long-term results, especially in large or active dogs. It provides strong joint stability and reduces the risk of arthritis. However, CBLO is gaining popularity for its joint-friendly approach. The best option depends on your dog’s size, age, and activity level.

Is one surgery less painful than the others?

All three surgeries involve some pain, but proper medication and care help manage it well. TTA and CBLO may offer quicker comfort in the early days due to their surgical approach. However, long-term pain relief and joint function depend more on healing, rehab, and your dog’s activity during recovery.

Can small dogs have TPLO or CBLO?

Yes, small dogs can have TPLO or CBLO if the joint shape and tear severity make it the better choice. While extracapsular repair is often used for small dogs, many still benefit from TPLO or CBLO if they are active or have full CCL tears. Your vet will assess this during evaluation.

How do I know if my dog needs surgery right away?

If your dog is limping, avoiding weight on one leg, or shows pain when moving, they may need surgery soon. A full tear often requires prompt treatment to prevent more joint damage. A vet can confirm the tear with an exam and imaging and help you decide on timing.

Are there financing options for cruciate surgery?

Yes, many veterinary clinics offer payment plans or work with third-party financing services like CareCredit. Pet insurance may also cover part of the cost if the plan was active before the injury. Always ask your clinic about available options to make the treatment more affordable.

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