Age alone does not disqualify a dog from TPLO surgery.

The decision for an older or senior dog depends on overall health status, concurrent conditions, quality of life goals, and individual assessment -- not a chronological cutoff.

Many senior dogs benefit substantially from TPLO, while some older dogs are better managed conservatively. Understanding how to approach this decision is essential.

Quick answer: TPLO is viable for most older dogs with CCL rupture who are medically suitable for anesthesia. Published data estimates 85 to 90% of senior dogs regain near-normal or improved limb function. Age increases anesthetic risk and slows recovery -- manageable factors, not contraindications. Pre-surgical bloodwork and cardiac evaluation reduce risk.

Key takeaways

• Age alone is not a contraindication for TPLO: a comprehensive veterinary assessment is essential; the decision is based on health status, not chronological age
• 85 to 90% of senior dogs regain near-normal or improved limb function: comparable to the 90 to 95% general TPLO population; older dogs achieve similar success with appropriate post-operative care
• The primary risk factors for senior dogs are anesthetic risk and comorbidities: older dogs are more likely to have heart disease, kidney disease, or arthritis complicating anesthesia; pre-surgical screening manages these risks
• Recovery takes longer in older dogs: senior dogs need a longer recovery with extra monitoring and rehabilitation; timelines should be extended and expectations adjusted
• Conservative management is appropriate for some older dogs: very elderly dogs with limited activity needs, multiple health concerns, or advanced concurrent arthritis may benefit more from conservative management
• The quality of life cost of not operating is significant: untreated CCL rupture means chronic joint pain, progressive arthritis, and severe mobility impairment; TPLO offers a better quality of remaining life for many senior dogs

What changes with age in TPLO candidates

Anesthetic risk

General anesthesia in older dogs carries higher risk than in young adults. The primary reasons:

Cardiovascular function: cardiac output typically decreases with age. Dogs with occult cardiomyopathy, valve disease, or arrhythmias have reduced ability to compensate for the cardiovascular demands of general anesthesia. Pre-surgical cardiac evaluation (auscultation, chest radiographs, echocardiography if indicated) identifies and quantifies this risk.

Renal function: anesthesia and NSAIDs both affect renal perfusion. Dogs with reduced GFR are at risk for acute kidney injury. Pre-surgical blood chemistry (BUN, creatinine, SDMA) establishes baseline renal function and guides anesthetic protocol choices.

Hepatic function: the liver metabolizes most anesthetic agents. Hepatic insufficiency prolongs drug effect and increases toxicity risk. Pre-surgical liver enzyme panel and bile acids test if enzymes are elevated.

Thermoregulation: older dogs lose body heat more quickly during anesthesia. Active warming protocols (circulating warm water blankets, warm IV fluids, warm recovery environment) are particularly important.

Healing and regeneration

Bone healing takes longer in older dogs. The osteotomy that consolidates in 8 weeks in a 3-year-old Labrador may take 10 to 14 weeks in a 10-year-old dog.

Radiographic confirmation of healing before lifting restrictions is therefore even more critical in senior dogs.

Muscle rebuilding is also slower. Full muscle recovery may take 6 to 9 months rather than 4 to 6 months in older dogs.

Pre-existing arthritis

Most older dogs with CCL disease have concurrent arthritis in the affected stifle at the time of presentation.

This does not prevent TPLO from providing benefit, but it affects the baseline from which the dog recovers.

Upland Animal Hospital confirms: dogs with advanced degenerative joint disease may not be ideal candidates; existing joint damage could limit improvement in mobility.

The realistic expectation is not a return to young-dog mobility, but elimination of instability pain and slowing of further arthritis progression -- both of which meaningfully improve quality of life.

Pre-surgical assessment for older dogs

The pre-surgical workup for a senior dog should include:

Complete blood count: rule out anemia, infection, and thrombocytopenia.

Blood chemistry panel: kidney function (BUN, creatinine, SDMA), liver function (ALT, ALP, GGT), albumin, glucose.

Urinalysis: assess renal concentrating ability and rule out urinary tract infection (a source of bacteremia that can seed the implant).

Chest radiographs: assess cardiac silhouette and pulmonary fields for occult cardiac disease or pulmonary abnormalities.

Electrocardiography: if cardiac auscultation reveals arrhythmia or murmur.

Echocardiography: if the cardiac evaluation suggests significant structural disease; quantifies severity and guides anesthetic protocol.

Blood pressure: hypertension is common in older dogs and affects anesthetic management.

Companion Animal Hospital confirms: older patients are more likely to have heart disease, kidney problems, or arthritis complicating anesthesia and recovery. Each patient is evaluated thoroughly to weigh complications against expected benefits.

When TPLO is appropriate for older dogs

TPLO is generally appropriate when:

• Pre-surgical assessment confirms the dog is medically suitable for general anesthesia
• The dog has a good quality of life before the CCL rupture
• The owner is committed to the post-operative care demands
• Life expectancy is at least 1 to 2 years (enough time to benefit from the recovery period)
• Pain from CCL instability is significantly reducing the dog's quality of life

SustainableVet.org confirms: 85 to 90% of senior dogs regain near-normal or improved limb function. Older dogs achieve similar success rates when conditions like arthritis are managed well.

When conservative management may be more appropriate

Conservative management (strict rest, NSAIDs, physical therapy, weight management) may be more appropriate when:

• The dog has severe concurrent cardiac, renal, or hepatic disease that significantly elevates anesthetic mortality risk
• Pre-existing arthritis is so advanced that functional improvement from TPLO is unlikely
• The dog has very limited mobility needs (sedentary older dog in minimal pain before the CCL event)
• Life expectancy is significantly limited by a concurrent condition

Chewy confirms: TPLO can be performed in dogs of any age, but your veterinarian will consider overall health in senior dogs.

Upland Animal Hospital confirms: very elderly dogs might benefit more from conservative management if they have limited activity needs and multiple health concerns.

Adjusting expectations and the recovery plan for older dogs

For older dogs undergoing TPLO:

• The restriction period is the same (8 to 12 weeks) but radiographic healing may take longer; follow-up imaging should be extended if healing is not confirmed at the standard 6 and 12 week timepoints
• Recovery plans should include additional physiotherapy support, hydrotherapy, and pain management beyond the standard protocol
• Concurrent arthritis management (joint supplements, periodic NSAIDs, hydrotherapy) continues long-term after recovery
• Body condition monitoring is critical -- older dogs are more likely to gain weight during restriction

SustainableVet.org confirms: senior dogs need a longer recovery with extra monitoring and rehabilitation. Physical therapy helps, but patience and adjusted expectations are essential.

For the surgery overview, see what is TPLO surgery in dogs?. For recovery, see post-surgery recovery after TPLO in dogs. For long-term outcomes, see long-term outcomes of TPLO surgery.

For anesthesia protocol, see TPLO anesthesia protocol in dogs.

Frequently asked questions

My dog is 11 years old with a torn CCL. Should I get TPLO?

Age 11 is not a contraindication. The decision depends on your dog's overall health. Schedule a thorough pre-surgical assessment including bloodwork, urinalysis, and chest radiographs.

If your dog is medically suitable for anesthesia and has a reasonable life expectancy, TPLO will likely provide a better quality of remaining life than conservative management of an unstable stifle.

Does TPLO take longer to heal in older dogs?

Yes. Bone healing in older dogs typically takes 2 to 4 weeks longer than in young adults.

Muscle recovery also takes longer -- expect 6 to 9 months rather than 4 to 6 months. Radiographic follow-up should reflect this extended timeline.

Is the anesthetic risk for TPLO too high in senior dogs?

This depends entirely on the individual dog's health status. Pre-surgical assessment quantifies anesthetic risk. Many senior dogs in good health tolerate TPLO anesthesia well.

Dogs with significant cardiac or renal disease have elevated risk that must be weighed against the benefit of surgical stabilization. There is no population-level answer -- only individual assessments.

Can conservative management work for an older dog with CCL rupture?

For some older dogs, yes.

For most medium and large dogs over 15 kg with complete CCL rupture, conservative management does not restore normal joint stability, and chronic pain with progressive OA is the expected outcome.

Whether conservative management is appropriate depends on the dog's baseline activity level, severity of rupture, concurrent health status, and owner goals.

What is the recovery quality like for older dogs after TPLO?

With appropriate rehabilitation and arthritis management, most older dogs achieve meaningful improvement in mobility and pain control after TPLO.

The realistic goal is not the function of a young adult dog but rather elimination of the pain of joint instability and a return to comfortable daily activity.

SustainableVet.org confirms: when combined with weight management and physical therapy, TPLO offers lasting relief, often keeping dogs active well into their senior years.

Resources

• SustainableVet. TPLO Surgery for Older Dogs. sustainablevet.org
• Companion Animal Hospital Maize. Senior Dogs and TPLO. maizevet.com
• Upland Animal Hospital. What Is TPLO Surgery in Dogs? uplandanimalhospital.com
• ACVS. Cranial Cruciate Ligament Disease. acvs.org

Post-surgical swelling after TPLO is normal, expected, and self-limiting when managed correctly. Most incision-area swelling peaks within the first 2 to 5 days and resolves by 2 weeks.

Swelling that does not follow this trajectory -- that is not declining, or that appears new after initial improvement -- is the key indicator that requires veterinary attention.

Quick answer: Normal TPLO swelling peaks at days 2 to 5 and resolves within 1 to 2 weeks with cold therapy and rest. Ankle swelling from gravity-dependent fluid migration appears at days 3 to 5. Swelling increasing after day 5, or with warmth, redness, or discharge, warrants veterinary evaluation.

Key takeaways

• Normal TPLO swelling peaks at days 2 to 5: SustainableVet.org confirms mild incision swelling usually goes away within two weeks
• Ankle swelling is a normal gravity-dependent phenomenon: TPLO Info confirms ankle swelling typically appears at days 3 to 5; it is fluid migrating downward from the surgical site
• Cold therapy in the first 48 to 72 hours is the primary management tool: 10 to 15 minutes, 3 to 4 times daily, reduces swelling and pain
• Swelling worsening after day 5 or accompanied by warmth, redness, or discharge indicates infection, seroma, or hematoma; contact your vet within 24 hours
• Mild swelling can persist for weeks at a low level in larger dogs and those with poor activity restriction compliance; trajectory matters more than absolute level
• Nighttime swelling is common and normal: dogs move less at rest, allowing fluid to settle; this should improve by morning or after repositioning

Normal swelling: timeline and characteristics

Days 1 to 3: acute post-surgical swelling

Swelling begins within hours of surgery and results from:

• Surgical tissue trauma (incision through skin, subcutaneous tissue, and fascia)
• Bone cutting at the osteotomy site
• Inflammatory response to the metal plate and screws
• Fluid accumulating in the disrupted tissue spaces

This early swelling is diffuse, soft, and warm to the touch. It is the expected cellular response to surgery.

Days 2 to 5: peak swelling

Swelling typically peaks between days 2 and 5. The dog's leg may look noticeably larger at this stage, and some extension of swelling down the lower leg toward the ankle is normal.

Vetplayas confirms: swelling typically peaks within the first few days after surgery but should gradually subside over time.

Days 3 to 5: ankle swelling appears

A distinct swelling often appears at the ankle (tarsus) between days 3 and 5, sometimes alarming owners who notice it away from the surgical site. This is entirely normal.

TPLO Info confirms: it is completely normal for swelling to develop around the ankle approximately 3 to 5 days following surgery on the TPLO leg.

This swelling can be massaged and iced if it occurs and will resolve over a few days.

TPLO Austin confirms this finding identically. The mechanism is gravity-dependent migration of tissue fluid from the surgical site through the fascial planes of the lower leg.

Days 5 to 14: progressive resolution

From day 5 onward, swelling should consistently decrease with each daily inspection. Cold therapy, rest, and anti-inflammatory medication all contribute to this resolution.

SustainableVet.org confirms: mild swelling around the incision site usually goes away within two weeks. The trajectory must be consistently improving.

Beyond 2 weeks: residual low-level swelling

Some dogs retain mild soft swelling around the lower leg beyond 2 weeks, particularly larger dogs with greater tissue volume and dogs who have been less compliant with activity restriction.

This is usually minor and does not indicate a problem if:

• The swelling is soft and not warm
• There is no discharge or redness
• The dog is bearing weight and improving in lameness

Cold therapy: the primary management tool

Cold therapy is the evidence-based first-line intervention for post-surgical swelling.

Protocol:

• Wrap an ice pack or bag of frozen peas in a thin cloth or towel
• Apply to the incision and plate site for 10 to 15 minutes
• Repeat 3 to 4 times daily
• Begin on day 1 post-surgery
• Continue for the first 48 to 72 hours (the acute inflammatory phase)

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.

After the initial period, warm compresses can be used to promote circulation.

Never apply ice directly to the skin or incision -- frostbite and wound damage can result. Remove the pack immediately if the skin appears pale or very cold.

For the ankle specifically, TPLO Info confirms: ankle swelling can be massaged and iced. Gentle proximal-to-distal massage (toward the toes) applied after icing helps lymphatic drainage.

Concerning swelling: signs requiring veterinary contact

Swelling that is not declining after day 5

Normal swelling is consistently declining from day 5 onward. Swelling that is the same or larger than on day 3, measured at day 7, is not normal.

New swelling after apparent resolution

If swelling had reduced and then reappears -- particularly at the plate site rather than the incision -- this suggests a developing seroma, hematoma, or early infection.

SustainableVet.org confirms: you should be concerned if swelling increases after the first week or is accompanied by heat, redness, oozing, or a bad odor.

Warmth, firmness, redness, or discharge alongside swelling

These features distinguish infection from normal surgical edema. Normal edema is diffuse, soft, not dramatically warm, and has no discharge. Infection produces focal warmth, firmness, redness spreading beyond the incision, and discharge.

Swelling at the plate site (not the incision) weeks after surgery

This can indicate an implant-associated infection with seroma or early osteomyelitis. Requires radiographic assessment and deep sampling.

Seroma: a specific type of post-surgical swelling

A seroma is a localized collection of clear serous fluid under the skin, forming when tissue spaces fill with tissue fluid that has not been reabsorbed.

Seromas after TPLO are common and are distinct from infection.

Signs of seroma:

• A soft, fluctuant (fluid-filled) swelling at or near the incision
• Typically appears 1 to 3 weeks post-surgery
• Fluid is clear or pale yellow when aspirated
• No warmth, redness, or discharge from the incision itself

Most seromas resolve without treatment. Your vet will assess whether aspiration or monitoring is appropriate.

For the fluid buildup guide, see fluid buildup after TPLO surgery in dogs. For the ankle swelling guide, see ankle swelling after TPLO surgery in dogs.

For the infection signs guide, see TPLO plate infection signs and treatment. For the bruising guide, see bruising after TPLO surgery in dogs.

Frequently asked questions

Is it normal for the whole leg to swell after TPLO?

Yes, in the early days. Diffuse swelling of the lower leg, extending from the surgical site toward the ankle, is normal in the first 1 to 2 weeks.

Gravity and the inflammatory response both contribute. This resolves as the inflammatory process settles and the dog begins controlled weight bearing.

My dog's leg looks huge at day 3. Is that too much?

Day 3 is within the normal peak swelling period.

Unless the swelling is dramatically asymmetric compared to the other leg, is very hot, or is producing discharge, observe and continue cold therapy as directed.

If you are concerned, contact your vet to describe the swelling -- they can advise whether in-person assessment is needed.

Should I massage the swollen leg?

Gentle lymphatic massage (soft strokes toward the body, from the ankle upward) after icing can help reduce distal swelling.

Do not massage directly over the incision or plate site, and do not massage aggressively. Ask your vet or rehabilitation therapist to demonstrate the correct technique.

My dog's swelling is going up and down -- bigger in the evening, smaller in the morning. Is that normal?

Yes. SustainableVet.org confirms that mild nighttime swelling occurs because dogs move less while resting, allowing fluid to settle. Morning improvement after repositioning and movement is normal.

The concern is when the morning maximum is larger than the previous day's morning maximum -- a consistently worsening trend.

When does warm therapy replace cold therapy?

Cold therapy is most beneficial in the first 48 to 72 hours (the acute inflammatory phase). After 72 hours, warm compresses promote circulation and may help reabsorb residual fluid.

The transition is typically around days 3 to 5. Never apply warmth to an incision that looks infected or discharging -- this can worsen infection.

Resources

• TPLO Info. TPLO Recovery FAQ. tploinfo.com
• SustainableVet. Post-Surgery Recovery After TPLO in Dogs. sustainablevet.org
• TPLO Austin. TPLO Incision Care After Surgery. tploaustin.com
• VCA Animal Hospitals. Tibial Plateau Leveling Osteotomy (TPLO) in Dogs. vcahospitals.com

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

Range of motion (ROM) exercises are one of the earliest and most consistently prescribed rehabilitation interventions after TPLO surgery.

They prevent joint stiffness, reduce scar tissue adhesion, and maintain the joint mobility that ultimately determines how well the dog walks and bears weight long-term.

A key research finding from a study of 412 TPLO patients: loss of stifle extension greater than 10 degrees was associated with significantly greater long-term lameness.

Quick answer: TPLO ROM exercises involve gently flexing and extending the stifle for 10 repetitions, 2 to 3 times daily, beginning 2 to 5 days post-surgery. Extension is critical: loss of more than 10 degrees is strongly linked to long-term lameness.

Key takeaways

• ROM exercises begin at 2 to 5 days post-TPLO: early initiation prevents scar tissue formation that progressively limits joint mobility
• Extension is more critical than flexion: loss of more than 10 degrees is strongly associated with increased long-term lameness
• Normal stifle ROM: extension 158 to 162 degrees, flexion 41 to 45 degrees; loss of more than 10 degrees warrants intervention
• Hydrotherapy significantly improves stifle ROM: 122 vs 105 degrees at week 12 in a randomized controlled trial
• Goniometry is the clinical tool: a goniometer measures joint angles and tracks ROM improvement at each rehabilitation assessment
• 10 repetitions, 2 to 3 times daily is the standard passive ROM protocol; stop if the dog vocalizes or tenses

What range of motion means after TPLO

Range of motion is the arc through which a joint can move from maximum flexion (the most bent position) to maximum extension (the most straight position).

In the stifle (knee), this is measured in degrees using a goniometer, a protractor-like device placed over the joint.

After TPLO surgery, the stifle is swollen, painful, and surrounded by muscles that have contracted to protect the injury.

Without regular movement, periarticular muscles tighten and scar tissue forms between tissue planes.

Clinical research confirms: dogs with normal stifle extension have greater weight-bearing on the operated limb at trot than those with restricted extension. ROM restoration is directly linked to functional outcome.

Normal stifle ROM values in dogs

Understanding what "normal" looks like helps set realistic goals for rehabilitation:

Extension: approximately 158 to 162 degrees (near full straightening of the joint)Flexion: approximately 41 to 45 degrees (the most bent position)

Loss of extension or flexion greater than 10 degrees from these reference values is clinically significant and associated with increased lameness (Veterian Key, 412-dog TPLO study).

Extension loss is worse than flexion loss: it is less tolerable, less amenable to rehabilitation, and more strongly correlated with osteoarthritis.

TPLO ROM exercise technique

Passive ROM (PROM) weeks 1 to 6

Passive ROM means you move the joint; the dog's muscles are relaxed.

Setup: dog lying on their side, operated leg facing up. Support the leg above and below the stifle with both hands.

Movement: gently flex the stifle (bring the lower leg toward the body), then extend it back toward neutral. Slow, smooth, continuous bicycle motion. Stay within the comfortable range do not push past resistance.

Repetitions: 10 per session, 2 to 3 sessions daily.

After: apply a cold pack for 5 to 10 minutes to reduce post-exercise inflammation.

This is identical to the PROM technique described in PROM exercises for dogs after TPLO surgery.

Active-assisted ROM weeks 4 to 8

As the dog begins bearing weight, active-assisted ROM incorporates the dog's own muscle activation:

Sit-to-stand: the dog moves from sit to stand repeatedly. Each sit flexes the stifle; each rise extends it. Begin with 5 to 10 repetitions, 2 to 3 times daily. This is one of the most effective active ROM exercises because the dog controls the movement within their own comfortable range.

Slow leash walks: controlled leash walking through a full gait cycle moves the stifle through its functional ROM repeatedly. Walking pace and surface affect how much ROM is required slow walks on level ground are most appropriate in early recovery.

Warm pack before exercise: from day 5 onward, apply a warm pack for 5 minutes before ROM sessions to relax the periarticular muscles and improve the range achieved.

Facilitated ROM weeks 6 to 12

As strength and confidence improve, exercises that challenge and expand ROM are introduced:

Cavaletti poles: stepping over poles at shoulder height (approximately 10 to 15 cm) requires active stifle flexion beyond normal walking ROM. Begin with 2 to 4 passes over 4 to 5 poles, increasing as strength improves.

Incline walking: walking up a gentle slope increases hindlimb extension demand; walking down increases flexion demand. Progress from 1 to 3 minutes per session at weeks 6 to 8 onward.

Passive stretching: gentle end-range holding of flexion and extension, 10 to 30 seconds per position, introduced at weeks 6 to 8 to address persistent stiffness. Do not force the joint; hold at comfortable resistance only.

The role of hydrotherapy in ROM recovery

A randomized controlled trial comparing hydrotherapy vs. land-based physiotherapy in post-TPLO dogs found that by week 12, hydrotherapy dogs achieved stifle ROM of 122 degrees compared to 105 degrees in land-only controls.

This is a clinically and statistically significant difference.

The underwater treadmill protocol involved twice-weekly sessions from week 3 onward, water at the level of the greater trochanter, 15 to 30 minute sessions.

Water buoyancy reduces joint load while the resistance and natural gait pattern in water challenge ROM more effectively than many land exercises at the same stage.

PMC (UWTM pilot study, 50 dogs): after 10 sessions, significant ROM improvement occurred in all joints including the stifle.

When to be concerned about ROM

Contact your veterinarian or rehabilitation therapist if:

• The dog resists or vocalizes during ROM exercises that were previously comfortable
• You notice a hard end-point to ROM (hard stop rather than soft resistance) suggesting joint capsule contracture
• ROM appears to be decreasing rather than improving at the 4- or 8-week recheck
• The dog is significantly lame and the stifle will not flex or extend near normal range

For the full PROM technique guide, see PROM exercises for dogs after TPLO surgery. For the complete rehab program that ROM fits into, see TPLO rehab exercises for dogs.

For the physical therapy guide, see when to start physical therapy after TPLO surgery. For the recovery exercises guide, see TPLO recovery exercises for dogs.

Frequently asked questions

How do I know if I'm achieving enough range of motion during home exercises?

Normal stifle flexion is approximately 41 to 45 degrees; normal extension is approximately 158 to 162 degrees.

If you are performing PROM correctly, you should feel gentle resistance at the end of each range not a hard stop, not complete looseness.

A rehabilitation practitioner can demonstrate the correct technique and measure your dog's current ROM with a goniometer at their first session.

My dog gets stiff after rest. Is this related to ROM?

Yes. Post-rest stiffness is one of the earliest signs of reduced ROM following TPLO. The joint has developed some adhesion and scar tissue that resolves partially with movement.

This is a signal to increase the frequency of ROM sessions and to ensure warm-up before walks.

If stiffness does not improve with ROM exercises over 1 to 2 weeks, contact your vet.

How long should ROM exercises continue after TPLO?

Passive ROM (PROM) is typically discontinued around weeks 6 to 8 when the dog achieves near-normal active ROM.

Active ROM exercises sit-to-stand, leash walks, cavaletti continue through weeks 8 to 16 and beyond until full function is restored. Ongoing ROM maintenance through normal activity continues for the dog's lifetime.

Can I use a goniometer at home to track progress?

Yes, but training is needed to use it accurately. Goniometers are inexpensive and available from physiotherapy suppliers. Your rehabilitation therapist can demonstrate the correct placement for the stifle joint.

Accurate home tracking provides useful objective data for your veterinarian alongside clinical assessments.

Does every TPLO dog need formal ROM therapy?

Home-based PROM performed 2 to 3 times daily produces good results for most dogs when performed correctly. Formal rehabilitation sessions add goniometric tracking, professional technique guidance, and modalities like hydrotherapy and laser.

Dogs that enter surgery with significant pre-surgical muscle atrophy or stiffness, or those not progressing at expected milestones, particularly benefit from formal rehabilitation.

Resources

• Veterian Key. Range-of-Motion and Stretching Exercises. veteriankey.com
• ScienceDirect. How Does CCL Rupture Treatment Affect Range of Motion in Dogs? sciencedirect.com
• PMC. Pilot Study on the Effects of UWTM on Canine Joint Range of Motion. ncbi.nlm.nih.gov
• TPLO Info. Rehab for Dogs After TPLO Surgery. tploinfo.com
• WM Referrals. Post-Operative Rehabilitation After TPLO. wm-referrals.com

TPLO recovery is a structured 8 to 12 week process. The surgery takes 1.5 to 2 hours; the recovery takes months.

Understanding what is normal at each stage allows owners to support recovery confidently, recognize complications early, and avoid mistakes that extend recovery or cause setbacks.

Quick answer: After TPLO surgery, expect 8 to 12 weeks of graduated activity restriction. Weeks 1 to 2: crate rest, short walks, e-collar on. Weeks 3 to 8: progressive walks and range-of-motion exercises. Weeks 8 to 12: confirm bone healing and resume normal activity. Full muscle recovery takes 6 months.

Key takeaways

• The 8 to 12 week bone healing period is non-negotiable: the plate holds the osteotomy until new bone consolidates; premature high-impact activity before radiographic healing can cause plate failure
• Weeks 1 and 2 are highest-risk for infection and wound complications: the incision is healing; activity and wound management must be strictly controlled
• Most dogs begin partial weight bearing within the first few days: early weight bearing maintains muscle mass and supports bone healing per TPLO Info
• The 2-week recheck, 6-week radiograph, and 12-week radiograph are essential milestones: each has a specific purpose; missing them risks missing early complications
• Full muscle recovery takes up to 6 months after bone healing is confirmed; bone union and functional recovery are not the same endpoint
• The e-collar must stay on for 10 to 14 days without exception: licking is the leading owner-controlled cause of TPLO surgical site infection

Immediately after surgery: days 1 to 3

Coming home

Dogs are typically discharged 24 to 48 hours after TPLO surgery, or sometimes the same day at facilities with same-day discharge protocols.

The dog will be sedated, disoriented from anesthesia, and may have bandaging on the surgical leg.

Expect:

• Groggy, disoriented behavior for 12 to 24 hours from anesthesia
• Some whining or restlessness (normal -- from anesthesia, not necessarily pain)
• Refusal to bear weight on the operated leg
• Mild to moderate swelling around the incision, peaking at days 2 to 3

Pain management

Give prescribed medications on the exact schedule provided. Typical medications include NSAIDs (meloxicam, carprofen, or similar) and gabapentin. Give NSAIDs with food to reduce gastric irritation.

TPLO Info confirms: dogs may experience slight discomfort from surgical inflammation in the days following surgery; this should be managed with appropriate pain medications given on schedule.

Confinement

Strict crate rest or confinement in a small, non-slippery room. No stairs, no jumping, no access to furniture. Leash walks outdoors for bathroom purposes only, 3 to 5 minutes, multiple times daily.

Weeks 1 to 2: incision healing phase

This is the highest-risk period for wound complications and infection.

Incision care:

• E-collar must be on at all times except supervised eating and drinking
• Keep the incision dry -- no baths, no wet grass walks
• Inspect the incision daily for spreading redness, cloudy or malodorous discharge, or wound dehiscence
• Normal: a small amount of clear serum discharge in the first 2 to 3 days; mild redness at the incision line fading from day 5 onward
• Abnormal: spreading redness, cloudy discharge, increasing warmth, or wound edges separating -- contact your vet immediately

Activity:

• Leash walks only, 5 minutes maximum, multiple times daily
• No running, jumping, stairs, or playing with other pets
• No unsupervised time without the e-collar

Weight bearing:

• Many dogs begin toe-touching within the first few days
• Some dogs refuse weight bearing for the full two weeks -- this is also normal
• Encouraging gentle, slow walking on a leash helps maintain muscle mass

2-week recheck:SustainableVet.org confirms: the 2-week visit confirms incision healing, removes sutures or staples if healing is complete, and reviews pain management and early mobility status.

Weeks 3 to 6: progressive walking phase

The incision is closed; the focus shifts to controlled progressive activity increase and gentle range of motion.

Activity:

• Increase leash walk duration gradually -- TPLO Info recommends increasing by up to 5 minutes per week from the week 2 baseline
• No off-leash activity, no running, no jumping, no stairs without a ramp
• No playing with other pets

Range-of-motion exercises:

• Passive range-of-motion (PROM) exercises can begin in most dogs at weeks 2 to 4 if the vet approves
• Gentle flexion and extension of the stifle for 5 to 10 repetitions, 2 to 3 times daily
• Supports joint flexibility and prevents stiffness during the bone healing period

Weight bearing:

• By weeks 3 to 4, most dogs are consistently bearing weight on the operated leg
• Occasional toe-touching or three-legged walking during activity is still normal

What to watch for:

• Lameness that worsens after a period of improvement (trajectory reversal)
• New swelling at the plate site, separate from the healed incision
• Any discharge from the healed wound area

Weeks 6 to 8: early consolidation phase

6-week radiograph (critical milestone):SustainableVet.org confirms: the 6-week visit includes follow-up radiographs to evaluate bone alignment and early plate stability; if healing looks good, limited physical therapy or short walks may begin.

If the radiograph shows good progression of bone healing, activity is increased. If healing is delayed, restrictions continue with a re-radiograph at 8 weeks.

Activity (if healing is confirmed):

• Leash walks increasing to 15 to 20 minutes twice daily
• Rehabilitation exercises as directed
• Hydrotherapy (if available) is an excellent low-impact option for muscle building

Weeks 8 to 12: bone consolidation and return to activity

Follow-up radiograph at 8 to 10 weeks:Medcovet confirms: a follow-up radiograph is commonly performed at weeks 8 to 10 to assess bone healing; if healing is good, the vet may approve a gradual increase in activity.

12-week visit (major milestone):SustainableVet.org confirms: the 12-week visit includes final radiographs to confirm bone fusion and plate integrity; the vet may lift most activity restrictions at this stage.

Activity (if healing confirmed at 12 weeks):

• Progressive return to normal activity
• Running, jumping, and play can gradually resume over weeks 12 to 16
• Supervised play and controlled activity continue until full muscle recovery

Animal Outpatient Surgery confirms: full muscle recovery takes up to 6 months to restore full strength and coordination in the operated leg.

Medications and supplements

NSAIDs: given for 2 to 4 weeks post-surgery or as directed. Never exceed the prescribed dose; never use human NSAIDs (ibuprofen, aspirin) -- they are toxic to dogs.

Gabapentin: helps with pain and anxiety in the early recovery period; typically tapered off after 2 to 4 weeks.

Joint supplements: glucosamine and omega-3 fatty acids are commonly recommended for long-term joint health. Starting them at surgery is reasonable; discuss with your vet.

Signs requiring immediate veterinary contact

At any stage of recovery, contact your vet immediately if you see:

• Spreading redness or warmth at the incision or plate site
• Cloudy, yellow, green, or malodorous discharge from the wound
• Wound edges separating
• Severe worsening of lameness
• Fever, lethargy, or loss of appetite beyond the first 2 to 3 days
• Any draining tract opening near the surgical site

For the week-by-week rehabilitation exercises guide, see TPLO recovery exercises for dogs. For the infection prevention guide, see how can TPLO infections be prevented post-operatively?.

For the PROM exercises guide, see PROM exercises for dogs after TPLO surgery. For the earliest infection signs, see earliest signs of TPLO infection.

Frequently asked questions

When will my dog be back to normal after TPLO?

Bone healing is typically confirmed by radiograph at 8 to 12 weeks. Most activity restrictions are lifted at the 12-week mark.

Full muscle recovery and functional normalization takes up to 6 months from surgery.

TPLO has a high success rate (more than 90%) and most dogs return to their pre-injury activity level after full recovery.

My dog is not using the leg at all after surgery. Is that normal?

Some dogs refuse to bear weight for the full first 2 weeks. This is within normal range.

If the dog was bearing some weight and has now stopped completely after day 5, contact your vet to rule out a complication.

PROM exercises and gentle encouraged walking help prompt early weight bearing.

Can my dog go up stairs during recovery?

Not during weeks 1 to 6. Stairs generate impact and torsion on the healing osteotomy. Carry small dogs over stairs or use a ramp.

Larger dogs may need a sling or harness to assist navigating a small number of essential steps.

When can my dog swim or do hydrotherapy?

Hydrotherapy (underwater treadmill or controlled pool swimming) typically begins after incision healing is confirmed at 2 weeks. Check with your vet.

Swimming in open water (lakes, rivers) is not appropriate until the vet explicitly clears the dog, typically after the 12-week radiograph.

When should I be concerned about my dog's pain during recovery?

Increasing pain after initial improvement -- the dog more lame or more distressed today than yesterday -- is the key warning sign. Normal recovery pain decreases progressively.

Worsening pain warrants veterinary assessment to rule out infection, implant complication, or late meniscal injury.

Resources

• TPLO Info. What to Expect After Your Dog's TPLO Surgery. tploinfo.com
• Animal Outpatient Surgery. What to Expect After Your Dog's TPLO Surgery. animaloutpatientsurgery.com
• Medcovet. Essential Guide to Dog Recovery TPLO Surgery. medcovet.com
• VCA Animal Hospitals. Tibial Plateau Leveling Osteotomy (TPLO) in Dogs. vcahospitals.com

TPLO is the most commonly recommended surgical procedure for CCL rupture in medium and large breed dogs, but it is not the only option and it is not always the right option.

Some dogs are better served by a different surgical technique; others by non-surgical management. Understanding the full menu of alternatives helps owners have more informed conversations with their veterinarians.

Quick answer: Surgical alternatives to TPLO include TTA, extracapsular repair, Tightrope, MMP, and CBLO — most achieving 90 to 93% good function in the right patient. Non-surgical options produce variable outcomes and are not recommended for complete CCL rupture in large dogs.

Key takeaways

• Surgical alternatives achieve comparable outcomes in the right patient: TTA and Tightrope show 90 to 93% good function at one year
• Extracapsular repair is appropriate for dogs under 15 to 35 lbs: above 90% success in small dogs; significantly worse in larger breeds
• Conservative management is not recommended for large dogs with complete CCL rupture: outcomes are worse; appropriate only for comorbidities or small partial tears
• Knee braces do not have strong evidence of restoring joint stability; current studies show no significant benefit per Vetamac
• MMP and CBLO are newer alternatives with growing evidence: MMP uses a titanium wedge; CBLO uses a different osteotomy geometry
• The best alternative to TPLO is determined by dog size, activity level, surgeon training, and individual clinical factors not by owner preference alone

Surgical alternatives

TTA (Tibial Tuberosity Advancement)

TTA advances the tibial tuberosity cranially to change the angle of the patellar tendon relative to the tibial plateau.

This achieves mechanical neutralization of cranial tibial thrust through a different geometric approach than TPLO.

TTA is appropriate for large breed dogs, similar to TPLO. Studies show comparable outcomes at one year.

DVM360 notes that TTA recovery may be faster in the early post-operative period than TPLO, though TPLO tends to show better objective outcomes in size-matched longer-term comparisons.

For the full TTA vs TPLO comparison, see TPLO, CBLO, and TTA: a guide to cruciate surgery options.

Extracapsular repair (DeAngelis/lateral suture/ELSS)

Extracapsular repair uses a heavy suture outside the joint to stabilize the stifle.

It is the oldest and most widely available CCL repair technique and is appropriate for small dogs under 15 to 35 lbs.

Simon Veterinary Surgical confirms extracapsular repair achieves excellent results in appropriately sized patients (typically under 50 lbs), with many dogs living full, active lives.

In larger, more active dogs, the suture eventually stretches or fails, and outcomes are consistently inferior to TPLO.

Today's Veterinary Practice confirms TPLO produces higher peak vertical force and higher owner satisfaction at one year compared to extracapsular repair in size-matched dogs.

For the full comparison, see DeAngelis vs TPLO surgery for dogs.

Tightrope procedure

Tightrope uses a synthetic fiber-tape passed through bone tunnels in the femur and tibia to stabilize the stifle.

It is more anatomically positioned than extracapsular repair and achieves comparable outcomes to TPLO at 6 months in published comparative studies.

Tightrope is appropriate for small to medium dogs and as a less expensive alternative to TPLO. Dr.

Buzby's rehabilitation veterinary guide lists Tightrope among the established surgical options alongside TPLO, TTA, ELSS, and CBLO.

For the full comparison, see Tightrope vs TPLO surgery for dogs.

Modified Maquet Procedure (MMP)

MMP is an evolution of TTA that uses a porous titanium foam wedge instead of a cage to advance the tibial tuberosity.

It is less invasive and faster than TPLO, with comparable 6-month outcomes in the primary randomized study.

MMP is appropriate for medium and large breed dogs in the hands of surgeons trained in the technique.

For the full comparison, see Modified Maquet Procedure vs TPLO surgery.

CBLO (CORA-Based Leveling Osteotomy)

CBLO is a newer osteotomy technique that applies a different geometric principle to achieve tibial plateau leveling.

Rather than a radial osteotomy (as in TPLO), CBLO uses the CORA (center of rotation of angulation) to guide a wedge osteotomy.

Published success rates of 85 to 95% good function have been reported.

CBLO is an emerging alternative with growing evidence. For the full comparison, see CORA-based leveling osteotomy vs TPLO in dogs.

Zlig

Zlig is a synthetic implant placed inside the joint to replace the function of the CCL.

It is a less commonly discussed alternative with limited long-term veterinary evidence compared to the established osteotomy techniques.

For the full comparison, see Zlig vs TPLO: which surgery is better for dogs?.

Non-surgical alternatives

Conservative management

Conservative management refers to non-surgical approaches: strict rest and activity restriction, physical therapy and rehabilitation, weight management, NSAIDs for pain and inflammation control, and joint supplements.

Vetamac confirms: the main non-surgical treatments for CCL rupture include restricting activity, promoting weight loss, and physical therapy.

NSAIDs help manage pain and inflammation, although lameness persists as long as joint instability remains.

Simon Veterinary Surgical's guide notes: non-surgical outcomes are described as achieving "pasture soundness" comfortable for daily activities but the dog may not return to high-impact sports.

Consistency with physical therapy and weight management is the biggest predictor of good conservative outcomes.

When conservative management is appropriate:

• Dogs with serious concurrent medical conditions that make anesthesia high-risk
• Small dogs (under 10 to 15 lbs) with partial CCL tears
• As a temporary bridge to surgery when surgery is delayed
• Dogs whose owners cannot afford surgical options

When conservative management is not appropriate:

• Complete CCL rupture in dogs over 15 to 20 lbs lameness persists, arthritis progresses faster, and meniscal injury risk remains
• Active working dogs or dogs with high functional demands

For the full non-surgical guide, see non-surgical alternatives to TPLO surgery for dogs.

Orthopedic knee braces

Custom orthopedic braces provide external support to the stifle. They are sometimes used in dogs that cannot undergo surgery or during the waiting period before surgery.

Vetamac notes directly: current studies do not show significant benefits from orthopedic braces for CCL rupture.

They may improve comfort for some dogs but do not restore joint stability or prevent ongoing meniscal damage and arthritis progression. They are not a reliable substitute for surgical stabilization.

Regenerative medicine

Platelet-rich plasma (PRP) and stem cell therapy are emerging adjuncts.

Evidence for repairing a ruptured CCL is limited. These approaches may reduce inflammation but cannot restore the structural integrity that surgery provides.

Choosing between alternatives

For the lateral suture detailed comparison, see lateral suture vs TPLO: what's the difference?. For the full surgical options guide, see TPLO, CBLO, and TTA: a guide to cruciate surgery options.

Frequently asked questions

What is the best alternative to TPLO for a large dog?

TTA and MMP produce comparable outcomes to TPLO in large breed dogs and are appropriate alternatives.

Tightrope is less commonly recommended for very large dogs due to concerns about long-term stability at high joint forces.

The best choice depends on the individual dog, the surgeon's training and preference, and the specific clinical findings.

Can small dogs avoid surgery altogether?

Sometimes. Small dogs under 10 to 15 lbs with partial CCL tears sometimes achieve acceptable function with conservative management. However, surgery produces better outcomes even in small dogs.

If conservative management is chosen, strict weight management and physical therapy are essential.

Is a knee brace a good alternative to surgery?

Not as a primary treatment for complete CCL rupture. Braces may provide comfort and are sometimes used as a temporary measure or for dogs that truly cannot undergo surgery.

Vetamac confirms that current evidence does not support braces as an effective alternative to surgical stabilization.

How do I know which surgery is right for my dog?

A board-certified orthopedic surgeon (ACVS diplomate) is the most qualified person to advise on surgical selection for your specific dog.

Factors include body weight, tibial plateau angle, activity level, surgeon experience, and cost. General practitioners often refer to specialists for this decision.

Can a dog have a different surgery if the first one fails?

Yes. TPLO is a common revision option when extracapsular repair fails.

Different surgical approaches can be used as revisions depending on the original procedure, the current clinical state, and the degree of healing that has occurred.

Resources

• Vetamac. TPLO Surgery for Dogs: Success Rates and Alternative Options. vetamac.com
• Dr. Buzby's ToeGrips. Dog Torn ACL Treatment Without Surgery. toegrips.com
• Simon Veterinary Surgical. Alternatives to TPLO Surgery for Dogs. simonvetsurgical.com
• Animal Outpatient Surgery. Alternatives to TPLO Surgery for Dogs. animaloutpatientsurgery.com
• ACVS. Cranial Cruciate Ligament Disease. acvs.org