Patellar tendonitis more precisely called patellar desmopathy or patellar ligament desmitis in veterinary literature is a recognized complication of TPLO surgery. It is also one of the most under-discussed.

Research published in PMC shows radiographic evidence of patellar ligament thickening in 93% of dogs at 4 weeks after TPLO, though most cases are asymptomatic.

Understanding what this condition is, when it becomes a clinical problem, and how it is treated helps owners navigate one of the more commonly missed post-TPLO findings.

Quick answer: Patellar desmitis after TPLO is inflammation and thickening of the patellar ligament. Radiographic thickening occurs in 93% of TPLO dogs at 4 weeks but is usually asymptomatic. Clinically significant cases cause pain and increased lameness. Most are self-limiting; shock wave therapy accelerates resolution.

Key takeaways

• Radiographic patellar ligament thickening occurs in 93% of TPLO dogs at 4 weeks: most are asymptomatic and self-limiting
• Clinically significant patellar desmitis causes pain, swelling, and increased lameness beyond expected post-op discomfort
• TPLO changes stifle biomechanics and increases patellar tendon load: this explains why desmitis occurs more after TPLO
• Shock wave therapy (SWT) significantly reduced patellar ligament thickness at weeks 6 and 8 in a 2012 clinical trial
• Most cases are self-limiting: rest and NSAIDs resolve the majority of clinically significant cases within weeks to months
• Excessive post-operative activity is a modifiable risk factor: strict restriction in the first 8 weeks reduces desmitis risk

What is patellar desmitis after TPLO?

The patellar ligament runs from the kneecap (patella) to the tibial tuberosity — the bony bump just below the knee on the front of the tibia.

It is a critical structure for leg extension and stifle stability.

After TPLO surgery, the biomechanics of the stifle change fundamentally. The tibial plateau is rotated and held at a new angle.

This changes how forces are distributed around the knee, including the forces that pass through the patellar ligament.

The patellar ligament experiences altered tension and loading patterns after TPLO that it did not experience before surgery.

PMC research (2025 retrospective study) confirms desmopathy typically develops within 2.5 months after surgery, affecting the distal portion, and that TPLO causes more ligament thickening than other CCL repair methods.

A separate PMC study using elastosonography confirmed that patellar tendon tendinopathy can be easily detected clinically but that the exact damage evaluation is challenging without ultrasound or advanced imaging.

Why does TPLO cause patellar tendonitis?

Several mechanisms contribute:

Altered stifle biomechanics: TPLO changes the angle of the tibial plateau and the position of the tibial tuberosity relative to the femur. This alters patellar tendon geometry and tension during weight-bearing.

Surgical trauma: retraction and manipulation of soft tissues around the tibial tuberosity during the procedure causes local inflammatory changes that can involve the patellar tendon.

Intraoperative tension increase: rotating the proximal tibial segment may change the tension in the patellar tendon directly, especially during the initial healing phase.

Excessive postoperative exercise: Clinicians Brief's treatment review notes that excessive postoperative exercise is a commonly proposed contributing factor. Dogs allowed too much activity too early are more likely to develop clinically significant desmitis.

How common is patellar desmitis after TPLO?

Radiographic evidence of patellar ligament thickening at 4 weeks post-TPLO is reported in 93% of dogs in clinical studies.

The vast majority of these dogs have no clinical signs the radiographic finding does not translate into a symptomatic problem for most patients.

Clinically significant desmitis where the dog shows pain and lameness attributable to the patellar ligament specifically is less common but well-recognized by veterinary orthopedic surgeons.

Laguna Hills Animal Hospital notes that patellar tendinosis is relatively benign in most cases and improves with rest and medication.

Signs of clinically significant patellar desmitis

Unlike the asymptomatic radiographic finding, clinical patellar desmitis produces:

• Pain on direct palpation of the patellar ligament (between the kneecap and tibial tuberosity)
• Swelling or thickening directly over the ligament
• Lameness that is worse than expected for the dog's recovery stage
• Reluctance to fully extend the stifle during walking or exercise
• Stiffness after rest that improves briefly with movement

These signs typically appear in the first 6 to 10 weeks after TPLO.

Diagnosis

A veterinarian diagnoses patellar desmitis through:

Physical examination: palpation of the patellar ligament for thickening, pain response, and heat. A dog with significant desmitis will react to direct pressure on the ligament.

Radiographs: thickening of the soft tissue shadow over the patellar ligament on a lateral stifle projection. This is often identified at the routine 4 to 6 week post-TPLO radiographic recheck.

Ultrasound: provides direct visualization of the ligament, showing thickening, fiber disruption, and periligamentous edema. Ultrasound is more sensitive than radiographs and is the preferred modality for detailed assessment.

Treatment

Rest and activity restriction

The foundation of treatment for most cases. Reducing the mechanical load on the patellar ligament allows the inflammatory process to resolve.

Strict activity restriction should already be in place for post-TPLO recovery patellar desmitis is a reason to enforce it rigorously.

NSAIDs

Anti-inflammatory medication reduces pain and local inflammation. Meloxicam or carprofen at appropriate veterinary doses is the standard pharmaceutical approach for most dogs with symptomatic desmitis.

Shock wave therapy (SWT)

Clinicians Brief reviewed a trial of 30 large-breed TPLO dogs: SWT at weeks 4 and 6 significantly reduced patellar ligament thickness on radiographs at weeks 6 and 8 vs. controls.

SWT should be considered for dogs with clinically significant patellar desmitis.

Laser therapy

Low-level laser therapy (photobiomodulation) may reduce local inflammation and support tissue healing, though evidence specific to patellar desmitis after TPLO is limited compared to the SWT evidence base.

For the complete TPLO complications reference, see 15 common complications after TPLO surgery in dogs. For the incision infection guide, see TPLO incision infection symptoms and prevention.

For the general lameness guide that helps distinguish desmitis from other causes of post-TPLO lameness, see lameness after TPLO surgery in dogs.

For the TPLO failure rate context, see TPLO failure rate in dogs explained.

Frequently asked questions

Is patellar tendonitis after TPLO serious?

In most dogs, no. The radiographic finding is near-universal but typically asymptomatic and self-limiting.

Clinically significant desmitis causes pain and increased lameness but usually resolves with rest, NSAIDs, and sometimes shock wave therapy. It rarely causes permanent dysfunction.

How do I know if my dog has patellar tendonitis vs. normal post-TPLO soreness?

The key distinguishing feature is pain specifically on palpation of the patellar ligament the structure running from the kneecap to the bump just below the knee.

Normal post-TPLO soreness is diffuse and improves steadily. Patellar desmitis produces focal pain at this location, often with visible swelling over the ligament.

Can patellar desmitis be prevented?

Strict activity restriction in the first 8 weeks post-TPLO is the most effective preventive measure, since excessive early activity is a recognized contributing factor.

It cannot always be prevented altered biomechanics from the surgery itself play a role regardless of activity level but minimizing mechanical load during the healing phase reduces severity.

Does patellar tendonitis require a second surgery?

Almost never. The vast majority of cases resolve with conservative management. Shock wave therapy is effective in cases that need more active treatment.

Surgical intervention for patellar desmitis after TPLO is extremely rare.

Will this affect my dog's long-term outcome after TPLO?

For most dogs, no. Clinically significant patellar desmitis is typically a temporary complication that resolves during the recovery period.

Long-term stifle function in dogs that develop and recover from patellar desmitis is generally comparable to dogs that do not develop the condition.

Resources

• PMC. Retrospective Study on Patellar Desmopathy Following Surgical Resolution of CCL Rupture in 28 Dogs. ncbi.nlm.nih.gov
• PMC. Radiographic, Ultrasonographic and Shear Elastosonographic Changes in Patellar Ligament in Dogs Undergoing TPLO. ncbi.nlm.nih.gov
• Clinicians Brief. Treating Patellar Ligament Desmitis. cliniciansbrief.com
• Laguna Hills Animal Hospital. TPLO Surgery Complications. lhah.com
• ACVS. Cranial Cruciate Ligament Disease. acvs.org

TPLO surgery is not a cure for arthritis it is a mechanical correction that stabilizes the stifle and slows the rate at which arthritis progresses.

Understanding what happens to the joint long-term is one of the most important conversations an owner can have with their veterinarian.

Quick answer: All dogs develop some OA after CCL rupture, and it continues after TPLO. Research shows OA progresses more slowly after TPLO than after TTA or non-surgical management. Long-term management includes weight control, joint supplements, NSAIDs, and controlled exercise.

Key takeaways

• OA develops in all dogs with CCL rupture: TPLO stops instability that accelerates OA but does not eliminate existing arthritis
• TPLO slows OA progression: a PubMed study found OA progressed significantly more after TTA than TPLO (p=0.003)
• Radiographic OA scores increase significantly at 24 months post-TPLO in dogs with complete CCL rupture
• MedVet confirms: all dogs develop arthritis within weeks of ligament tearing, but knee stabilization slows the progression
• Weight management is the most impactful owner intervention: excess weight increases stifle load and accelerates cartilage wear
• Long-term NSAID use requires veterinary guidance: kidney and liver monitoring is required for dogs on chronic NSAID therapy

Why arthritis develops after TPLO

CCL rupture damages the joint before surgery even begins. The instability the tibia sliding forward under the femur with each step causes:

• Cartilage microtrauma from abnormal loading
• Synovial membrane inflammation, releasing enzymes that break down cartilage
• Medial meniscus injury (30 to 40% of CCL dogs have concurrent meniscal damage)
• Subchondral bone remodeling in response to abnormal forces

TPLO corrects the mechanical instability, but the cartilage damage already present does not reverse.

The joint has a permanently altered surface that is more susceptible to progressive OA than an intact, never-injured stifle.

Surgical trauma from the TPLO procedure itself also contributes.

The operation creates local inflammation that can accelerate cartilage breakdown in the first months, even as it creates the long-term stability that slows OA over years.

What research shows about OA progression after TPLO

Rate of progression

A prospective radiographic study (Rayward et al., 40 dogs, JSAP) found a significant increase in mean osteophyte score between the preoperative assessment and 6-month post-surgical examination.

However, in the majority of dogs in this study, there was no further radiographic progression of osteophytosis during the study period.

A larger long-term study (94 TPLO dogs, 133 stifles, followed to 3+ years) found OA progressed more after TTA (p=0.003) and in dogs with bilateral stifle surgery (p=0.022).

Dogs treated with TPLO had less pain and fewer mobility issues than TTA dogs at long-term follow-up, including better scores for stiffness, limping, jumping, climbing, and quality of life.

Functional outcomes vs. radiographic findings

Radiographic OA does not always correlate directly with clinical signs. Many dogs have significant osteophyte formation on radiographs but remain comfortable and functional with appropriate management.

Conversely, some dogs with relatively mild radiographic changes show significant clinical signs.

Early signs of arthritis after TPLO

Signs typically appear gradually rather than acutely. Watch for:

Morning stiffness: reluctance to get up or moving stiffly for the first few minutes after resting, improving with gentle activity.

Reduced activity: decreased willingness to run, jump, climb stairs, or sustain exercise at previous levels.

Lameness after exercise: the dog is comfortable on a short leash walk but noticeably lame after a longer walk or play session.

Behavioral changes: irritability, reluctance to be touched on the operated limb, reduced interaction with family members.

Muscle loss: loss of thigh muscle mass on the operated limb as the dog offloads it.

Joint swelling: persistent low-grade swelling around the stifle due to chronic synovial inflammation.

Long-term management of post-TPLO arthritis

Weight management

The most impactful single intervention. Every pound of excess body weight multiplies the compressive force on the stifle joint with each step.

Dogs at ideal body condition score 4 to 5 out of 9 consistently have better long-term joint outcomes than overweight dogs.

Controlled, low-impact exercise

Regular, low-impact exercise maintains muscle mass, supports joint fluid circulation, and prevents joint stiffness. Leash walks on flat terrain, swimming, and underwater treadmill work are ideal.

High-impact activities ball chasing, jumping, sustained running accelerate cartilage wear.

Joint supplements

Glucosamine and chondroitin sulfate support cartilage health and reduce inflammation. Omega-3 fatty acids (EPA and DHA) have anti-inflammatory properties with evidence for benefit in canine OA.

These are maintenance-level interventions appropriate for all post-TPLO dogs as lifelong support.

NSAIDs

Non-steroidal anti-inflammatory drugs (meloxicam, carprofen, grapiprant) are the most effective pharmaceutical interventions for OA pain.

They are used on a needs basis for dogs with intermittent discomfort, or continuously for dogs with chronic significant OA pain.

Kidney and liver function monitoring is required for dogs on long-term NSAID therapy.

Disease-modifying osteoarthritis agents

Librela (bedinvetmab), an anti-nerve growth factor monoclonal antibody approved for canine OA pain, is a newer option for dogs that do not respond adequately to NSAIDs or cannot tolerate them.

Discuss with your veterinarian if your dog's arthritis is not well-controlled with standard approaches.

Physical rehabilitation

Certified canine rehabilitation practitioners can provide individualized programs combining therapeutic exercises, hydrotherapy, laser therapy, and acupuncture to maintain muscle mass, joint mobility, and overall comfort.

For the full recovery guide that sets the foundation for arthritis prevention, see 10 essential TPLO recovery tips for pet owners. For the long-term outcomes data, see long-term outcomes of TPLO surgery.

For the complications overview including OA, see 15 long-term effects of TPLO surgery on dogs. For the lameness guide covering OA-related limping, see lameness after TPLO surgery in dogs.

Frequently asked questions

Does every dog get arthritis after TPLO?

Yes. All dogs that rupture a CCL develop some degree of OA in that stifle the process begins at the time of ligament injury and is not fully stopped by surgery.

TPLO significantly slows the rate of progression compared to no treatment or less effective surgeries, but it does not prevent OA entirely.

How quickly does arthritis progress after TPLO?

Research shows a significant increase in radiographic OA scores at 6 months post-TPLO, then a more gradual increase over the following 24 to 36 months.

In many dogs, radiographic progression stabilizes after 2 to 3 years. Clinical signs depend on individual pain tolerance and concurrent management.

Can I see signs of arthritis before X-rays show it?

Yes. Dogs show clinical signs (stiffness, reduced activity, gait changes) often before radiographic changes are apparent.

This is why monitoring behavior and function not just waiting for X-ray evidence is important for timely intervention.

Is arthritis the same as TPLO failure?

No. Arthritis progression is expected and does not constitute surgical failure. TPLO failure refers to mechanical problems implant complications, non-union, persistent instability.

OA progression is a separate, expected degenerative process that is managed over the dog's lifetime.

What is the single best thing I can do to slow arthritis after TPLO?

Maintain your dog at an ideal lean body weight.

This single factor has the greatest impact on the rate of cartilage wear, joint inflammation, and long-term comfort of any intervention within owner control.

Resources

• PubMed. Extended Long-Term Radiographic and Functional Comparison of TPLO vs TTA. pubmed.ncbi.nlm.nih.gov
• PubMed. Progression of Osteoarthritis Following TPLO Surgery: A Prospective Radiographic Study of 40 Dogs. pubmed.ncbi.nlm.nih.gov
• MedVet. Dogs and Knee Surgery: Understanding TPLO Surgery. medvet.com
• ACVS. Cranial Cruciate Ligament Disease. acvs.org
• VCA Animal Hospitals. Tibial Plateau Leveling Osteotomy (TPLO) in Dogs. vcahospitals.com

The TPLO plate is designed to stay in permanently. TPLO Info confirms that implants are designed to stay in for life they only need to be removed if a problem develops.

When plate removal is necessary, it is generally a less complex procedure than the original TPLO, and most dogs recover well.

Understanding when removal is needed, what recovery involves, and what to watch for helps owners navigate this phase confidently.

Quick answer: TPLO plate removal is performed when the plate causes infection, chronic pain, or implant failure. Recovery takes 6 to 12 weeks: 2 weeks for wound healing, 6 to 8 weeks for bone remodeling at the screw holes. Activity restriction for at least 6 weeks is required.

Key takeaways

• The TPLO plate does not routinely need to be removed: designed for permanent placement; removal is only indicated when it causes a problem
• The three main reasons for plate removal are: infection, chronic implant-associated pain causing ongoing lameness, and implant failure requiring revision
• Removal is only safe after the osteotomy has healed: typically 6 to 12 months post-TPLO once radiographs confirm bone union
• Recovery after plate removal takes 6 to 12 weeks: 2 weeks for wound healing; 6 to 8 weeks for bone remodeling
• Screw holes take 6 to 8 weeks to remodel: cortical defects temporarily weaken the bone; activity restriction prevents fracture
• Most dogs improve significantly after plate removal: implant irritation-related lameness typically resolves within weeks of removal

When is TPLO plate removal necessary?

Infection involving the implant (most common indication)

Bacterial biofilm colonizing the implant surface is the most common reason for plate removal.

Implant-associated infections often fail to resolve with antibiotics alone because bacteria form protective biofilms on the metal surface that antibiotics cannot penetrate adequately.

Once the osteotomy has healed typically at 6 to 12 months post-TPLO the plate can be safely removed, the bone is debrided, and the infection treated without the implant present.

Veterinary Orthopaedic and Mobility Center (VOMC) confirms that infection is the most common reason for implant removal.

For the full infection guide, see TPLO plate infection signs and treatment and when does a TPLO implant need to be removed due to infection.

Implant-associated pain without infection

Some dogs develop chronic lameness caused by the plate irritating surrounding soft tissues rather than infection.

The plate may irritate the periosteum, cause a local inflammatory reaction to the metal, or become symptomatic once the dog returns to activity.

TPLO Austin confirms: in rare instances, patients may simply be uncomfortable with the presence of the plate. In these cases, removal of the plate after bone healing will typically resolve the lameness.

Implant failure

If the plate bends, breaks, or screws loosen or fail, structural revision may be required.

Depending on the degree of bone healing at the time of failure, revision may involve plate removal and replacement, or removal alone once healing is sufficient.

TPLO Austin notes this is a very rare complication (under 1%) when activity restriction protocols are followed.

When is plate removal safe?

Plate removal requires confirmed radiographic bone healing the osteotomy must be fully bridged before the plate is removed.

The plate is the only structure holding the osteotomy in place; removing it before healing is complete risks the bone segments displacing.

Sustainablevet.org confirms: the plate can be removed once the bone is fully healed, typically 6 to 12 months after the operation.

SustainableVet's clinical guide for post-removal recovery confirms: removing hardware too early or in cases with incomplete healing increases the risk of delayed union or fracture. Careful radiographic assessment before surgery is essential.

The plate removal procedure

Plate removal is performed under general anesthesia. The original incision is reopened, the plate and screws are removed, and the wound is closed.

The procedure is significantly shorter and simpler than the original TPLO there is no bone cutting or rotation involved.

Vetplayas explains that the procedure involves removing the metal plate and screws from the tibia, with the wound closed in layers after removal.

If the indication was infection, the bone surface around the screw holes is debrided and the area flushed thoroughly. Bacterial culture is obtained to guide antibiotic selection.

Recovery timeline after TPLO plate removal

Weeks 1 to 2: wound healing

The incision heals similarly to the original TPLO incision. Pain management with NSAIDs and, in many cases, gabapentin is prescribed. The dog is confined and leash-walked only. Cold packing reduces post-surgical swelling.

SustainableVet's recovery guide confirms: the first 2 weeks focus on wound healing and pain management after surgery.

Weeks 2 to 8: bone remodeling

The primary recovery challenge after plate removal is the screw holes left in the tibia. These cortical defects temporarily reduce bone strength at those sites.

The bone requires 6 to 8 weeks to remodel and fill in these defects before normal activity loads can be tolerated.

SustainableVet's clinical guide confirms: bone typically requires 6 to 8 weeks post-plate removal to regain sufficient strength; high-impact activities must be limited during this critical period to prevent fracture.

Activity restrictions during recovery

• Leash walks only for the first 6 weeks minimum
• No running, jumping, stairs, or off-leash activity
• Rehabilitation exercises (PROM, sit-to-stand, controlled leash walks) as prescribed
• 8-week radiographs typically required to confirm screw hole remodeling before return to normal activity

Weeks 8 to 12: return to activity

If radiographs at week 8 confirm adequate bone remodeling, the surgeon approves progressive return to normal activity. Most dogs return to full activity by 10 to 12 weeks post-removal.

Complications of plate removal

Infection: the surgical site can develop a new infection during the removal procedure. Strict aseptic technique and sometimes antibiotic prophylaxis reduce this risk.

Fracture through screw holes: the cortical defects from screw removal temporarily weaken the bone. Activity restriction during the remodeling phase is essential to prevent fracture through these sites.

Delayed union: rare, but can occur if the bone at the surgical site is already compromised by chronic infection.

Incomplete resolution: if implant irritation was the indication and lameness persists after removal, additional investigation (nerve involvement, joint pathology) is warranted.

For related guides, see TPLO plate rejection symptoms in dogs, can a dog heal normally after TPLO plate removal, and TPLO implant loosening causes and treatment.

For the cost of plate removal, see TPLO plate removal cost.

Frequently asked questions

Does every TPLO dog eventually need the plate removed?

No. Most dogs retain the plate for life without problems. TPLO Info confirms that implants are designed to stay in place permanently.

Plate removal is only performed when there is a clinical indication: infection, persistent lameness from implant irritation, or implant failure.

How long does it take to recover from plate removal?

Generally 6 to 12 weeks, depending on the indication and the individual dog. Infection cases may take longer because bone debridement and antibiotic treatment add complexity.

Straightforward irritation-related removals with no infection typically have the shorter end of this timeline.

Is plate removal surgery serious?

It is a general anesthetic procedure and carries the standard risks of any surgical intervention, but it is significantly simpler than the original TPLO.

The main specific risk is fracture through the screw holes if activity restriction is not followed. Most dogs do well with appropriate post-operative care.

Can the plate be removed too early?

Yes, and this is dangerous. Removing the plate before the osteotomy has fully healed causes the bone segments to lose their only structural support, potentially leading to displacement or fracture.

Radiographic confirmation of bone healing is mandatory before plate removal is scheduled.

Will my dog need another round of rehabilitation after plate removal?

Typically a milder version, yes controlled leash walks, PROM if stiffness is present, and gradual return to activity over 6 to 12 weeks.

Dogs that had ongoing lameness from implant irritation often improve quickly once the plate is removed, but the bone still requires the restricted activity period regardless of how well the dog feels.

Resources

• TPLO Info. Step 6: TPLO Surgery Recovery Process. tploinfo.com
• TPLO Austin. Step 6: TPLO Surgery Recovery. tploaustin.com
• Vetplayas. Ensuring a Successful TPLO Plate Removal Recovery. vetplayas.com
• VOMC. TPLO Veterinary Orthopaedic and Mobility Center. vomcvet.com
• VCA Animal Hospitals. Tibial Plateau Leveling Osteotomy (TPLO) in Dogs. vcahospitals.com

Bilateral CCL (cranial cruciate ligament) disease -- affecting both stifle joints -- is common in dogs.

Midvalley Animal Clinic confirms 30 to 40% of dogs with unilateral CCL rupture will eventually develop rupture of the contralateral CCL.

When both stifles are significantly affected, the decision between simultaneous bilateral TPLO and staged TPLO is one of the most important surgical planning discussions an owner will have.

Quick answer: Simultaneous bilateral TPLO operates on both stifles in one anesthetic event, offering a single recovery period and lower total cost. Staged TPLO operates on one leg at a time, reducing anesthetic risk. Simultaneous is preferred for healthy, large dogs with both stifles unstable. Staged is preferred for older, smaller, or compromised dogs.

Key takeaways

• 30 to 40% of dogs with unilateral CCL disease develop contralateral CCL rupture: bilateral TPLO may be planned proactively at presentation or urgently when the second CCL ruptures during recovery
• Simultaneous bilateral TPLO offers a single anesthetic event and shorter overall recovery: both knees heal together; total cost is lower than two staged surgeries
• Staged bilateral TPLO reduces surgical risk: each surgery is shorter; the dog has one functional leg during recovery; preferred for older or medically compromised dogs
• The critical challenge of simultaneous bilateral TPLO is recovery: with both rear legs restricted, owners must provide intensive physical support (slings) for the first 2 to 3 weeks
• PubMed research (176 bilateral TPLO cases) found no significant difference in overall complication rates between simultaneous and staged approaches in appropriately selected patients
• Large dogs with strong front limbs handle simultaneous TPLO better: smaller or weaker dogs benefit from the staged approach due to greater difficulty bearing weight on two compromised rear legs

Why bilateral CCL disease is common

CCL disease in dogs is degenerative, not purely traumatic.

The same factors that caused one CCL to rupture -- degenerative fiber changes, abnormal tibial plateau angle, breed predisposition, obesity, and mechanical overload -- are typically present in both stifles.

When a dog ruptures one CCL, it often shifts weight onto the contralateral leg, increasing the load on the already-compromised contralateral CCL. This accelerates degeneration and the timeline to rupture.

The clinical implication: even when only one stifle is symptomatic at presentation, the surgeon will typically assess both stifles.

Pre-operative radiographs of both stifles help determine whether the contralateral joint shows early instability, effusion, or an elevated TPA that warrants planning for bilateral surgery.

Simultaneous bilateral TPLO

Overview

Both stifles are operated on during a single general anesthetic event. The dog is positioned, the first TPLO is performed, the dog is repositioned, and the second TPLO is performed.

Total surgical time is approximately 3 to 4 hours.

Advantages

Single anesthetic event: the dog is exposed to general anesthesia once rather than twice. Each anesthetic event carries inherent risk; eliminating one event reduces cumulative anesthetic risk.

Faster total recovery: both legs heal simultaneously. Rather than 8 to 12 weeks of restriction for the first leg, then a second 8 to 12 week restriction for the second leg, the dog completes one restriction period covering both.

SustainableVet.org confirms: when both knees are corrected in a single surgery, the dog undergoes just one healing phase rather than two separate ones, returning to normal activity sooner.

Lower total cost: while the simultaneous surgery costs more than a single TPLO, it is less than two completely separate procedures with individual hospitalization, anesthesia fees, and post-operative care expenses.

SustainableVet.org confirms: simultaneous TPLO often reduces overall costs by avoiding duplicate anesthesia, hospitalization, and post-operative care fees.

Risks and challenges

Both rear legs are compromised simultaneously: the dog cannot transfer weight to a strong rear leg during the recovery period. All rear-limb support requires either front-limb loading (difficult for large breeds) or active owner assistance via sling.

Increased owner demand: SustainableVet.org confirms post-surgical care is more challenging because the dog cannot rely on a strong leg for support, requiring owners to provide intensive assistance.

Longer anesthetic duration: total surgical time of 3 to 4 hours for bilateral vs. 1.5 to 2 hours for unilateral increases the physiological burden of anesthesia and surgery.

Potentially higher complication rate in some populations: the PubMed 176-case study compared simultaneous and staged TPLO complications and found no significant overall difference, but the study population was highly selected.

Staged bilateral TPLO

Overview

The more significantly affected stifle is operated on first. After a full recovery (typically 8 to 12 weeks until bone healing is confirmed), the second stifle is operated on.

Advantages

Reduced surgical risk per event: each procedure is a standard unilateral TPLO, carrying the same risk profile as any single TPLO.

One functional rear leg during recovery: the dog can weight-bear on the unoperated leg immediately after the first surgery. This simplifies nursing care significantly and allows most dogs to stand and toilet independently.

Better option for older or compromised dogs: SustainableVet.org confirms older dogs or those with other health issues benefit from a staged approach to reduce surgical risk. Dogs with cardiac, renal, hepatic, or respiratory disease may not tolerate a 3 to 4 hour bilateral procedure safely.

Disadvantages

Two separate anesthetic events: two exposures to general anesthesia over a 3 to 6 month period.

Longer total recovery timeline: the dog may not reach full bilateral function for 6 to 9 months or longer from the date of the first surgery.

Higher total cost: two separate surgeries, two hospitalizations, two sets of post-operative medications and supplies.

Risk of contralateral rupture during the first recovery: the contralateral leg bears additional load during the first recovery period, accelerating degeneration. In some dogs, the second CCL ruptures acutely during the first recovery -- this forces an emergency decision about timing of the second surgery.

Which approach is right for a given dog?

Generally prefer simultaneous bilateral TPLO when:

• Both stifles are confirmed significantly unstable at presentation
• The dog is young, healthy, and large with strong front limb musculature
• The owner is able to provide intensive physical support during the bilateral recovery period
• The surgeon is experienced with bilateral TPLO technique
• Financial considerations favor the single-event approach

Generally prefer staged bilateral TPLO when:

• Only one stifle is currently significantly symptomatic (the second may be monitored and staged only if it progresses)
• The dog is older, small, or has significant concurrent health conditions
• The owner's ability to provide intensive bilateral recovery support is limited
• The anesthetic risk for a prolonged bilateral procedure is elevated

SustainableVet.org confirms: large dogs with strong front limbs may handle simultaneous TPLO better, while smaller or weaker dogs may benefit from a staged approach.

Bilateral TPLO recovery: what to expect

Simultaneous recovery

Weeks 1 to 2: the most demanding period. Both rear legs are compromised. The dog requires a sling for all mobility. Bathroom trips require active owner support.

Crate rest at all other times.

Weeks 2 to 6: gradual improvement. Both legs begin partial weight bearing. Sling use may reduce but is still needed for most dogs on stairs or uneven surfaces.

Weeks 6 to 12: radiographic assessment of both osteotomies. Activity increases based on healing of both legs.

Key equipment for bilateral TPLO recovery

• Lifting harness or rear-end sling (essential, not optional)
• Non-slip mats throughout the house
• Ramps for car access (no jumping in or out)
• Low dog beds at floor level

For the standard TPLO recovery timeline, see what to expect after TPLO surgery in dogs. For confinement advice, see how to confine your dog after TPLO surgery.

For post-op tips, see 10 essential TPLO recovery tips for pet owners. For the cost guide, see TPLO surgery cost in dogs.

Frequently asked questions

How will I know if my dog needs bilateral TPLO?

Your vet will assess both stifles during the physical examination.

Signs that the contralateral stifle is also affected include drawer sign or tibial thrust on the second side, joint effusion on radiographs, or intermittent lameness on both rear legs.

Both stifles are typically radiographed at the pre-operative planning visit.

Can the second CCL rupture while my dog is recovering from the first TPLO?

Yes. This is one of the main risks of staged TPLO. The unoperated leg bears more weight during recovery, accelerating degeneration.

If the second CCL ruptures acutely, the dog becomes bilateral suddenly and the timing of the second surgery must be reassessed with your vet.

Is bilateral TPLO safe for large breeds?

Yes, when appropriately selected. Large dogs with good front limb strength typically handle the bilateral recovery better than small dogs.

The challenge is the nursing care requirement, which is significant regardless of size. Ensure you have the physical ability to support a large dog in a sling before committing to simultaneous surgery.

My dog needs bilateral TPLO but I can only afford one surgery now. What should I do?

This is a common situation. Staged TPLO is appropriate and legitimate. Operate on the more severely affected stifle first and monitor the second closely.

Discuss weight management and controlled activity to reduce load on the second stifle during the first recovery. Plan financially for the second surgery.

Do both TPLO plates stay in permanently?

Yes, unless a complication (infection, implant failure) necessitates removal.

If both plates require removal, it can be done as a single procedure or staged, depending on the reason for removal and the healing status of each osteotomy.

Resources

• SustainableVet. Bilateral TPLO Surgery. sustainablevet.org
• PubMed. Comparison of Intra- and Postoperative Complications Between Bilateral Simultaneous and Staged TPLO. pubmed.ncbi.nlm.nih.gov
• Midvalley Animal Clinic. Pre-Op Instructions for TPLO. midvalleyanimalclinic.com
• ACVS. Cranial Cruciate Ligament Disease. acvs.org

Physical therapy after TPLO begins on day one -- not after the bone heals. The question is not whether to start, but which type is appropriate at each stage.

Early rehabilitation is about pain management and encouraging weight bearing. Later rehabilitation is about restoring muscle mass, range of motion, and functional strength.

The timing for each phase is defined by healing biology, not by how the dog appears to feel.

Quick answer: Physical therapy begins on day 1 with leash walks and cold therapy. Passive range-of-motion exercises start at days 3 to 5. Hydrotherapy begins at weeks 2 to 3. Strengthening increases from weeks 4 to 8. Plans complete by weeks 8 to 12; full recovery takes 4 to 6 months after TPLO surgery.

Key takeaways

• Leash walking begins within 24 hours of surgery: TPLO Info confirms short 5-minute walks multiple times daily from day 1; early weight bearing maintains muscle mass and bone healing
• Passive range-of-motion exercises start at days 3 to 5: gentle manual flexion and extension of the stifle maintains joint mobility during restricted activity
• Hydrotherapy can begin around weeks 2 to 3 after incision healing is confirmed; underwater treadmill provides resistance and buoyancy simultaneously
• Professional rehabilitation offers advantages over at-home protocols: certified therapists provide therapeutic laser, TENS, underwater treadmill, and individualized monitoring
• Strengthening exercises begin around weeks 3 to 4 when the dog consistently bears weight; cavaletti poles, weight-shifting, and balance work rebuild lost muscle
• Free running and high-impact activities resume only after radiographic bone healing confirmation at weeks 8 to 12; earlier return risks osteotomy failure

Phase 1: immediate post-surgical period (days 1 to 14)

What begins immediately

Leash walking: begins within 24 hours of surgery. TPLO Info confirms short 5-minute leash walks multiple times daily from day one. These walks are bathroom trips only in the first week -- not exercise walks. The goal is to maintain the neural stimulus for weight bearing and to prevent the complete disuse that leads to rapid muscle atrophy.

Veterinary Partner VIN confirms: Phase 1 begins immediately after surgery; slow, controlled leash walks 3 to 4 times daily for 5 to 10 minutes are the primary activity.

Cold therapy (icing): ice applied to the incision site for 10 to 15 minutes after each walk during the first 3 to 5 days. TPLO Info recommends icing the incision directly for the first 3 to 5 days post-surgery. Cold therapy reduces local inflammation and pain, making the dog more comfortable and more likely to bear weight.

Edmonton Veterinary TPLO protocol confirms: time physical therapy exercises approximately 30 minutes after pain medications are given so the dog is most comfortable during exercise.

Passive range-of-motion exercises (days 3 to 5)

PROM exercises are gentle manual flexion and extension of the stifle joint. SustainableVet.org confirms: gentle passive exercises usually start within 3 to 5 days post-surgery.

How to perform PROM:

• Hold the thigh and lower leg, not the joint itself
• Slowly flex the stifle toward the chest (as far as comfortable without resistance)
• Slowly extend the stifle toward straight
• 5 to 10 repetitions, 2 to 3 times daily
• Never force the range -- stop at the point of resistance or discomfort

PROM maintains joint cartilage health, prevents fibrous tissue formation in the joint, and maintains range of motion during the period when the dog is resting.

Phase 2: early rehabilitation (weeks 2 to 4)

What begins at the 2-week recheck

The 2-week recheck confirms incision healing and reviews early recovery. If healing is proceeding normally, Phase 2 activities begin.

Increased leash walk duration: TPLO Info recommends increasing walk duration by up to 5 minutes per week from the 2-week baseline. Vetplayas confirms: by week 2, controlled leash walks should be extended to promote muscle strength and flexibility.

Hydrotherapy: SustainableVet.org and the Vetplayas recovery guide both confirm hydrotherapy can begin around week 2 to 3, once the incision is healed. Underwater treadmill therapy provides three simultaneous benefits:

• Buoyancy reduces joint loading while still requiring weight bearing
• Water resistance builds muscle without impact
• Warmth promotes circulation and reduces stiffness

Professional hydrotherapy (certified facility with underwater treadmill) is preferable to open-water swimming in the early phase -- controlled depth and therapist supervision improve safety.

Balance training (from week 3 to 4): TPLO Info confirms that once the dog is consistently bearing weight on the operated leg (typically around weeks 3 to 4), weight-shifting exercises can begin. Stand the dog on a non-slip surface and gently push the hindquarters from side to side -- the dog responds by shifting weight to maintain balance, which activates the hip stabilizers.

Phase 3: progressive strengthening (weeks 4 to 8)

Core strengthening and higher-level exercises

Veterinary Partner VIN confirms: Phase 2 (which overlaps with what most owners call weeks 3 to 8) involves core strengthening once sufficient basic strength is achieved.

Activities that begin in weeks 4 to 8 (vet-directed):

• Cavaletti poles: slow stepping over low poles placed on the ground; encourages deliberate limb placement and hip flexion
• Hill walking: gentle inclines on a leash (begin by week 6 in most protocols)
• Sit-to-stand exercises: transitions from sitting to standing strengthen hip extensors
• Balance board or wobble board exercises: builds proprioception and stabilizer strength

WM-Referrals TPLO physiotherapy protocol confirms: start hydrotherapy, cavaletti poles, and balance board work at week 6; progress to 30 to 40 minute walks by this phase.

6-week radiograph checkpoint: activity level in Phase 3 is calibrated against radiographic findings at the 6-week visit. If bone healing is progressing well, activities increase as above. If healing is delayed, Phase 3 activities are deferred.

Phase 4: return to function (weeks 8 to 12 and beyond)

Radiographic confirmation at 8 to 12 weeks

SustainableVet.org confirms: most structured plans complete within 8 to 12 weeks. By 4 to 6 months, most dogs regain full mobility including running and playing.

After the 12-week radiograph confirms bone healing:

• Progressive jogging on leash
• Longer off-leash exploration in controlled environments
• Return to normal activity for most dogs
• Athletes and working dogs continue structured rehab for 4 to 6 months

Professional rehabilitation vs. at-home protocols

When professional rehab is recommended

TPLO Info confirms: ideally every dog would follow up with a rehabilitation therapist so a doctor can develop an individualized protocol. Professional rehabilitation is particularly beneficial when:

• The dog is slow to bear weight
• Significant muscle atrophy is present at the 6-week recheck
• The dog is a working dog, sports dog, or agility competitor
• Progress has stalled at any phase of recovery

What professionals offer

Certified canine rehabilitation therapists (CCRPs) provide:

• Therapeutic laser (reduces inflammation, promotes tissue healing)
• Transcutaneous electrical nerve stimulation (TENS) for pain management
• Controlled underwater treadmill protocols
• Individualized exercise prescription based on daily assessment
• Early detection of complications (inappropriate gait patterns, asymmetric muscle development)

At-home protocols

At-home rehabilitation following the vet's guidelines is appropriate for most dogs.

The core elements -- short leash walks, PROM exercises, cold therapy, gradual activity increase, and balance work -- are all achievable at home with proper instruction.

For the recovery timeline overview, see what to expect after TPLO surgery in dogs. For PROM exercises specifically, see PROM exercises for dogs after TPLO surgery.

For range-of-motion exercises, see TPLO range-of-motion exercises for dogs. For rehab exercise detail, see TPLO rehab exercises for dogs.

Frequently asked questions

Can physical therapy start before the incision heals?

Yes -- the early elements (leash walking, cold therapy, and PROM exercises) begin before the incision is fully healed, typically from day 1 to 5 onward.

Hydrotherapy and balance work require incision healing confirmation, typically at the 2-week recheck.

Is professional physical therapy necessary for TPLO recovery?

Not strictly necessary for all dogs, but beneficial for those recovering slowly, those with significant muscle atrophy, and working or sport dogs. At-home protocols following vet instructions are appropriate for most dogs.

Professional rehab adds precision and advanced modalities.

How often should my dog have hydrotherapy sessions?

Typically 1 to 3 times per week during the active rehabilitation phase (weeks 2 to 8). Frequency depends on the dog's response, transportation constraints, and cost.

Each session's therapeutic benefit persists for several days, so daily hydrotherapy is not required.

What if my dog refuses to use the leg despite physical therapy?

Persistent non-weight-bearing beyond 3 to 4 weeks warrants veterinary investigation. Possible causes include inadequate pain control, implant complication, late meniscal tear, or infection.

Physical therapy cannot proceed normally until the underlying cause of non-weight-bearing is addressed.

Can I use a swimming pool at home for hydrotherapy?

Only with vet guidance and with the dog supervised at all times. Open water swimming is less controlled than an underwater treadmill.

Risks include the dog launching themselves off the pool edge (impact on landing), inability to control depth, and water contamination of the incision if not fully healed.

Resources

• TPLO Info. Rehabilitation After TPLO Surgery. tploinfo.com
• Veterinary Partner VIN. Physical Rehabilitation of Dogs Following TPLO. veterinarypartner.vin.com
• SustainableVet. TPLO Rehab Exercises for Dogs. sustainablevet.org
• WM Referrals. Post-operative Rehabilitation After TPLO. wm-referrals.com

TPLO recovery takes 8 to 12 weeks of structured care. Most owners know the broad requirements -- rest, medications, vet visits -- but the specific actions that protect recovery are less obvious.

These 10 tips translate the key principles of TPLO recovery into concrete, actionable guidance.

Quick answer: The 10 most essential TPLO recovery tips: keep the e-collar on; give medications on schedule; confine in weeks 1 to 2; inspect the incision daily; apply cold therapy for 3 to 5 days; use a leash indoors; provide mental stimulation; clean bedding weekly; attend check-ups; call the vet early if something looks wrong.

Key takeaways

• E-collar compliance is the highest-priority single action: VetSurgInfo confirms most TPLO incision infections are caused by licking; the e-collar must stay on at all times for 10 to 14 days
• Medication timing matters as much as compliance: giving NSAIDs and gabapentin at the exact scheduled intervals maintains therapeutic blood levels; gaps allow pain to break through
• Strict confinement in weeks 1 to 2 prevents plate failure: jumping, slipping, or running applies forces to the plate that risk displacement before the osteotomy heals
• Daily incision inspection detects infection before it becomes deep: the window between superficial and deep infection is days; daily inspection closes that window
• Cold therapy in the first 72 hours is the most underused home tool: 10 to 15 minutes, 3 to 4 times daily, reduces swelling and pain in the acute phase
• Mental stimulation replaces physical activity: a bored dog becomes restless and moves; food puzzles, lick mats, and scent games provide neural reward without mechanical risk

Tip 1: Keep the e-collar on without exception

The e-collar is not a suggestion.

A single licking episode can inoculate the incision with S. pseudintermedius from the dog's oral cavity, introducing infection that may require antibiotics or, in the worst case, plate removal.

VetSurgInfo confirms: most incision infections are due to licking; the cone is the mainstay for avoiding incision infections.

The best test: place peanut butter on the dog's leg before surgery and check whether they can reach it with the collar on. If they can, the collar is not effective.

The e-collar must stay on during sleep, during unsupervised periods, and any time the dog is not under direct visual supervision. Remove only for supervised eating and drinking, then immediately replace it.

Tip 2: Give all medications on schedule

Pain medications work through consistent blood levels. An NSAID given 2 hours late allows a pain gap that makes the dog uncomfortable.

Discomfort leads to restlessness, inability to settle, and -- critically -- attempts to move around or adjust position that stress the plate.

Medcovet confirms: a strong TPLO surgery recovery plan includes pain management with prescribed pain medication to ensure comfort during the initial recovery phase.

Practical guidance:

• Set phone alarms for each medication
• Give NSAIDs with food to reduce gastric irritation
• Never double dose if a dose is missed -- contact your vet for guidance
• Time gabapentin/trazodone about 30 minutes before anticipated stressful periods (vet visits, times when other family members arrive home)

Tip 3: Confine strictly in weeks 1 to 2

The first 14 days are the highest-risk period for plate displacement.

The osteotomy site has the least mechanical strength at this stage and cannot tolerate the forces generated by running, jumping, or sudden twisting.

SustainableVet.org confirms: dogs typically need 6 to 8 weeks of restricted activity; strict confinement ensures the bone plate stabilizes and heals properly.

Confinement means:

• Crate or exercise pen at all times when not supervised
• Bathroom leash walks of 5 minutes maximum, 3 to 5 times daily
• No stairs, no furniture access, no running
• All other pets separated from the recovering dog

Tip 4: Inspect the incision daily

A 30-second daily inspection at the same time each day catches early infection before it progresses. Normal healing shows consistently fading redness, no discharge, and a healing incision line.

Early infection shows spreading redness, cloudy or malodorous discharge, or increasing warmth.

Medcovet confirms: a strong recovery plan includes wound care and close monitoring of the surgical site.

What to look for:

• Redness: fading daily from day 5 onward is normal; spreading is not
• Discharge: clear serum only in the first 2 to 3 days is normal; anything cloudy or malodorous at any stage is not
• Warmth: mild for the first week; increasing after day 5 is a warning sign

Tip 5: Do cold therapy in the first 3 to 5 days

Cold therapy reduces swelling, pain, and inflammation during the acute post-surgical phase. It is the most effective home intervention for managing early post-TPLO swelling and the least frequently done consistently.

SustainableVet.org confirms: cold therapy, like applying an ice pack wrapped in a towel for 10 to 15 minutes several times a day during the first 72 hours, helps reduce inflammation.

Wrap an ice pack in a thin cloth. Apply to the incision for 10 to 15 minutes, 3 to 4 times daily. Begin day 1 and continue through day 5.

Never place ice directly on skin.

Tip 6: Leash the dog indoors

A house leash held by the owner prevents sudden movements that cause plate failure: slipping, running to the door, or startling at a noise.

Every uncontrolled moment indoors is a risk. The house leash gives the owner instant control.

Tip 7: Provide mental stimulation instead of physical exercise

A dog with no cognitive engagement will self-stimulate physically. Mental stimulation provides the same dopamine reward as physical activity without mechanical impact on the healing plate.

SustainableVet.org confirms: redirect energy through mental stimulation like puzzle feeders or scent games; a mentally stimulated dog is less likely to feel the physical restrictions.

Effective options:

• Frozen Kong: stuffed with wet food or peanut butter (xylitol-free) and frozen
• Lick mat: spread wet food or peanut butter on a textured mat
• Scatter feeding: spread kibble across a towel or crate mat
• Sniff games: hide treats in a muffin tin covered with tennis balls

Tip 8: Keep bedding clean weekly

Dirty bedding accumulates S. pseudintermedius and other bacteria from the dog's skin. The healing incision is in close proximity to bedding throughout recovery.

Contaminated bedding is a low-grade but continuous source of bacteria that can reach the incision.

TPLO Info confirms: dogs do not like dirty bedding; wash crate items at least once a week to keep them clean and free of dog fur.

Wash bedding in hot water with laundry detergent. Air dry or use a hot dryer cycle. Replace immediately with clean bedding.

Tip 9: Attend all scheduled vet appointments

The 2-week, 6-week, and 12-week checkpoints each have a specific clinical purpose. Missing them means missing the opportunity to catch complications before they become serious.

Texas A&M VetMed confirms: complications are easier to manage when caught early; minor issues may be resolved with oral medications and rest, but evaluation and X-rays may still be needed.

What happens at each visit:

• 2-week: incision assessment, suture removal, pain management review
• 6-week: radiograph of osteotomy, activity level adjustment based on healing
• 12-week: final radiograph, clearance for return to full activity

Tip 10: Call the vet early, not late

The most common mistake owners make is waiting to see if something resolves on its own.

A sign that is concerning today and is still concerning tomorrow warrants a call -- not continued observation.

Texas A&M VetMed confirms: if anything seems off during recovery, it is always best to contact the surgical team immediately rather than waiting.

Call same day or immediately if:

• Any cloudy, yellow, green, or malodorous wound discharge
• Redness spreading beyond the incision line
• Fever, lethargy, or loss of appetite
• Lameness worsening after prior improvement
• Wound edges separating

For the full recovery timeline, see what to expect after TPLO surgery in dogs. For confinement setup, see how to confine your dog after TPLO surgery.

For keeping the dog calm, see how to keep a dog calm after TPLO surgery. For the infection prevention guide, see post-operative care mistakes that increase TPLO infection risk.

Frequently asked questions

How strict does the activity restriction need to be?

Very strict in weeks 1 to 2. The dog cannot run, jump, use stairs, or play with other pets. Leash walks of 5 minutes for bathroom purposes only.

This is not an exaggeration -- a single running episode in the first 2 weeks can displace the plate and require revision surgery.

My dog seems completely fine by week 2. Can I relax the restrictions?

No. Clinical improvement (the dog appears comfortable and energetic) does not mean the osteotomy is healed.

The plate holds the rotated tibial plateau in position while new bone grows across the cut -- a process that takes 8 to 12 weeks regardless of how well the dog appears.

Radiographic confirmation of healing is required before any restriction is relaxed.

Which medication side effects should I watch for?

NSAIDs: vomiting, diarrhea, reduced appetite, dark stools (suggests GI bleeding). Gabapentin: sedation (which is expected), unsteadiness (monitor and report if severe). Trazodone: sedation (expected), vomiting in some dogs.

Contact your vet if any medication appears to be causing significant side effects -- alternatives are usually available.

Can I give my dog human supplements like fish oil or turmeric during recovery?

Fish oil (omega-3 fatty acids) is generally considered safe and potentially beneficial for joint health.

However, do not add any supplement without discussing with your vet first -- some supplements interact with NSAIDs or affect bleeding. Turmeric in high doses has similar concerns. When in doubt, ask.

My dog is crying or whining a lot. Should I give extra pain medication?

No -- never give extra medication beyond what is prescribed without vet guidance. Contact your vet and describe the pain signs.

They may adjust the dosing schedule, add a medication, or ask you to bring the dog in.

Whining can also reflect anesthesia effects, anxiety, or opioid dysphoria rather than uncontrolled pain -- your vet can help distinguish these.

Resources

• VetSurgInfo. TPLO Recovery Tips. vetsurginfo.com
• Medcovet. Essential Guide to Dog Recovery TPLO Surgery. medcovet.com
• Texas A&M VetMed. TPLO Recovery: Setting Pets Up for Success. vetmed.tamu.edu
• SustainableVet. 10 Essential TPLO Recovery Tips for Pet Owners. sustainablevet.org