TPLO Procedure

Dr. John Koch

Dr. John Koch is a highly-trained veterinary surgeon who is well-known from St. Louis to Memphis for his expert precision, compassion and success rates in TPLO procedures. Call 573-334-5073 to refer a patient or to ask more about the relief your pet will feel after this procedure performed by Dr. John Koch.



(Tibal Plateau Leveling Osteotomy)

For Cranial Cruciate Ligament Rupture



  Rupture or tearing of the cranial cruciate ligament is the most common orthopedic injury affecting dogs.  This injury leads to pain, lameness, and arthritis in the affected joint.  The cranial cruciate ligament is located inside the stifle (knee) joint, and is one of the structures connecting the femur and tibia bones.  It stabilizes the joint by preventing forward sliding of the tibia relative to the femur (cranial drawer motion), and hyperextension of the joint, and by limiting internal rotation of the tibia.  Rupture of the cranial cruciate ligament results in instability that causes severe wear and tear on the cartilage of the joint as well as leading to secondary injury to other structures within the joint such as the menisci (cartilage pads).  The Tibial Plateau Leveling Osteotomy procedure has proven effective in returning injured stifle joints to full function.


Rupture of the cranial cruciate ligament results in pain, swelling and obvious lameness.  Partial tears of the ligament can cause similar but milder symptoms which sometimes come and go for some period of time, and in most cases will ultimately result in a complete tear.  Diagnosing the injury involves observing your dog's gait, palpating the joint for the telltale instability, and in many cases taking x-rays to look for arthritic change and swelling within the joint.  Sometimes mild sedation is necessary to carry out this evaluation.
Pre-operative x-rays are taken to measure the angle of slope of the weight bearing surface of the tibia (tibial plateau).  This angle is used to calculate how much rotation is needed to level the weight bearing surface.  During surgery, a specialized saw and blade are used to make a curved cut in the tibia freeing the upper segment of bone containing this weight bearing surface.  The cut segment is then rotated according to the earlier calculations, and a metal plate and screws are applied to hold the segment in this new position as the bone heals.  During the surgery, the menisci inside the joint are also inspected, and damaged portions removed if necessary.  


Effective pain management is important to your pet's recovery and comfort.  We take a careful and proactive approach to ensure that your pet is as comfortable as possible during the recovery and healing process.  Pain control measures are tailored to the individual, and generally include the use of pre- and post-operative narcotics, and non-steroidal medication to address pain and inflammation associated with surgery.
   As with any surgery, some complications may arise.  Most complications can be avoided by adhering strictly to recommendations regarding post-operative incision care and appropriate activity restriction.  Failure to observe these measures can result in delayed or poor healing.  Rarely, complications involving fracture of the narrow front part of the tibial crest or inflammation of the patellar tendon can be seen.  Infection and failure or breakage of the implant hardware can be seen, but are both very rare. 


Confinement and controlled activity are important during the healing process.  Allowing too much activity before the bone has healed can result in slow or poor healing, or in complications.  Detailed post-operative care instructions and rehabilitation regimen will be provided in writing at the time of release from the hospital.  T Typical time frames for recovery include weight bearing within the first 5-7 days after surgery, return to restricted exercise in two months, and return to full working activity in six months.  Arthritis is usually present at the time of surgery.  TPLO cannot reverse the arthritis, but can help to minimize its progression.  Compared to other techniques, TPLO typically results in:

  •  A more rapid recovery
  •  Better range of motion
  •  Development of less arthritis
  •  Better return to athletic or working activity

Dr. Koch was trained and certified in the TPLO procedure  by Slocum Enterprises, the company founded by Dr. Barclay Slocum, the surgeon who invented and patented the TPLO procedure.  At this time, Dr. Koch is the only TPLO certified veterinarian practicing in Cape Girardeau, and offering this procedure.

Dr. Brian Heuring and Dr. Loni (Littlepage) Patke have 18 years combined veterinary experience and are both well-known for their friendly, down-to-earth and highly-skilled care.

At Cape Small Animal Clinic, we greet you with a smile and strive to make sure you leave wearing a smile, no matter the situation, every time. We care about pets and the people who love them. We treat companion animals: big or small dogs and cats. Come experience why dozens of people are calling Cape Small Animal Clinic one of the friendliest vet clinics in Southeast Missouri. Call today: 573-334-5073!


Find us on the map

Office Hours

For an after-hours emergency, please call our clinic. Your call will be directed immediately to the on-call veterinarian: 573-334-5073


7:30 am

5:30 pm


7:30 am

5:30 pm


7:30 am

5:30 pm


7:30 am

5:30 pm


7:30 am

5:30 pm


8:00 am

12:00 pm