The cranial cruciate ligament (CCL), often called the ACL, is an important stabilising ligament inside the knee joint (stifle). It helps prevent the shin bone (tibia) from sliding forward beneath the thigh bone (femur).

When this ligament weakens, stretches or tears, the knee becomes unstable and painful. Dogs may develop limping, stiffness, difficulty rising, reluctance to exercise or progressive arthritis.

Cruciate disease can develop gradually through degeneration of the ligament or occasionally following an injury. Partial tears can be difficult to diagnose and may progress to complete rupture.

Diagnosis begins with a veterinary consultation to assess your dog’s lameness, knee discomfort and possible joint instability.

At PAH, we generally recommend a more thorough examination under general anaesthesia, allowing the veterinarian to carefully palpate the knee and perform cranial drawer and tibial thrust tests without muscle tension or discomfort interfering with the assessment.

While your dog is anaesthetised, we also take X-rays to assess the joint, look for arthritic changes and assist with surgical planning.

These X-rays are sent to our specialist surgeon, Dr Eugene Buffa, for review. Once he has assessed the images and agrees with our diagnosis, we can proceed with planning TPLO surgery.

The initial diagnostic procedure includes general anaesthesia, a thorough examination and palpation of the knee, and X-rays which are sent to our specialist surgeon for review.

This is a separate diagnostic fee, rather than part of the surgical package.

We will send you an estimate for this initial procedure before booking your dog in.

Once the diagnosis is confirmed and Dr Buffa agrees that TPLO surgery is appropriate, we will provide a separate all-inclusive estimate for the operation and follow-up care.

Not every painful knee requires immediate surgery. Some dogs have mild ligament injuries, partial tears or other causes of knee discomfort.

A minor injury may improve with restricted activity, anti-inflammatory medication and appropriate joint support.

However, partial cruciate tears can progress, and persistent knee instability can lead to increasing arthritis and pain.

We may recommend weight management, Cartrophen injections, physiotherapy and careful monitoring. If discomfort or instability continues, surgery may be the best long-term solution.

TPLO (Tibial Plateau Levelling Osteotomy) is a specialist surgical procedure that changes the angle of the tibia to provide knee stability without relying on the damaged cruciate ligament.

The bone is carefully repositioned and secured with a permanent metal plate and screws.

At PAH, TPLO surgery is performed by specialist surgeon Dr Eugene Buffa.

The aim is to reconstruct the mechanics of the knee, reduce abnormal movement and provide a comfortable, stable joint for long-term use.

Once your dog’s initial diagnostic X-rays have been reviewed by specialist surgeon Dr Eugene Buffa, and he agrees with our diagnosis and surgical recommendation, our reception team will arrange a surgery date.

We will provide a separate, all-inclusive surgical estimate covering:

• Pre-anaesthetic blood tests
• General anaesthesia and specialist TPLO surgery
• Intravenous fluids, pain relief and appropriate antibiotics
• Dedicated veterinary nursing and hospital care
• Pre- and post-operative X-rays on the day of surgery
• Post-operative medications and home care instructions
• Veterinary wound check and suture removal at approximately 10 days
• Four weekly Cartrophen injections
• Six-week sedation, X-rays, sedation reversal and specialist review
• All routine follow-up appointments at PAH

The initial diagnostic examination and X-rays are charged separately before surgery.

Most dogs return home on the evening of TPLO surgery, provided they have recovered well from their anaesthetic and are comfortable.

We provide detailed home care instructions and an individual medication plan to help you manage your dog’s first night.

If your dog needs additional monitoring, or you are concerned about looking after them at home, we can arrange overnight care at NEVS in Terrey Hills.

Overnight care is available when needed but is not routinely recommended for every dog.

The first six weeks are particularly important, as the bone needs time to heal around the surgical implants.

We recommend crate confinement when your dog is not directly supervised, with short, controlled lead walks and no running, jumping or rough play.

Walking duration and gentle strengthening exercises are gradually increased according to comfort and veterinary advice.

At six weeks, X-rays are taken under sedation and reviewed by our specialist surgeon. If healing is satisfactory, we can progress to the next stage of rehabilitation.

Full recovery generally takes three to six months, with most dogs having a strong, stable knee by approximately six months.

For detailed guidance, read our TPLO Aftercare Page.

Our TPLO surgical package includes a course of four weekly Cartrophen injections to support joint health.

The first injection is generally given at your dog’s veterinary wound check, approximately 10 days after surgery.

The next three injections are given at weekly appointments with our veterinary nurses.

These visits also provide a useful opportunity for our nursing team to check your dog’s comfort, mobility and general progress during the important early stages of recovery.

Read more about Cartrophen.

At approximately six weeks after surgery, your dog returns to PAH for sedation and follow-up X-rays to check bone healing and implant position.

This is usually an 8 am appointment lasting approximately 60–90 minutes, with you remaining at the hospital.

Your dog is sedated for the X-rays. Once they are completed, the sedation is reversed and your dog is brought back to the consultation room, where you can watch them recover before taking them home.

Our reception team will organise the appointment and explain all the preparations beforehand, including fasting requirements.

The X-rays are sent to Dr Eugene Buffa for specialist review. Once we have his assessment, we can advise you on how to progress your dog’s rehabilitation.

This important appointment is included in the all-inclusive surgical package.

The first six weeks require careful confinement, generally using a crate when your dog cannot be directly supervised.

Short, controlled lead walks are encouraged as part of the rehabilitation program, but running, jumping, stairs and boisterous play must be avoided.

At approximately six weeks, we take follow-up X-rays to assess healing. Exercise may then gradually increase if the specialist is satisfied with your dog’s progress.

Rehabilitation continues over several months, with most dogs returning to normal activities by approximately six months.

Dogs can begin short, controlled lead walks for toileting during their early recovery, with support from a belly sling if necessary.

As your dog becomes more comfortable, walks of approximately five minutes, two to three times daily, can gradually increase.

By three weeks, some dogs may comfortably walk for up to 15 minutes on lead.

Further increases, including strengthening exercises and hill walking, should follow your dog’s individual recovery program.

Your dog will have follow-up X-rays at approximately six weeks to assess bone healing and implant stability.

If the specialist is happy with the healing, some dogs may be ready to begin very short periods of controlled, supervised off-lead walking during the following weeks.

This must only begin after veterinary approval, and should not include running, chasing balls, jumping or playing with other dogs.

Vigorous activity remains restricted until later in recovery, with most dogs approaching full activity by six months.

Our all-inclusive TPLO surgical package includes the routine postoperative care required during recovery.

At approximately 10 days, your dog returns for a wound check and suture removal.

A four-week Cartrophen course is provided if recommended, usually commencing at the first postoperative check.

At approximately six weeks, your dog returns for sedation and X-rays. These are sent to specialist surgeon Dr Eugene Buffa for review.

We then advise you about the next stage of rehabilitation based on your dog’s healing and progress.

Because activity is greatly reduced following TPLO surgery, your dog may need fewer calories to maintain a healthy weight.

Some dogs require a substantial reduction in their usual food portions during confinement.

Our veterinary team can advise on an appropriate amount for your dog’s weight, body condition and individual requirements.

Maintaining a healthy weight is particularly important as excess weight places additional strain on both knees.

The first 8–10 weeks following TPLO surgery are particularly important, as the bone needs time to heal around the surgical implants.

Activity must be carefully restricted during this period. Running, jumping, rough play and uncontrolled exercise must be avoided.

We provide detailed home care instructions and can prescribe calming medication when required.

At approximately six weeks, your dog will return to PAH for sedation and X-rays to assess bone healing and implant stability. These images are reviewed by our specialist surgeon.

Controlled exercise is gradually increased according to your dog’s progress.

Full recovery generally takes three to six months. By the six-month mark, most dogs have a strong, stable knee and can return to normal activities.

For more detailed information, please read our TPLO Aftercare Page.

As with any major orthopaedic surgery, there are some risks, including infection, delayed bone healing, implant complications, meniscal injury or anaesthetic complications.

TPLO is a well-established procedure with a high success rate, particularly when performed by an experienced specialist surgeon.

Careful post-operative management is essential. Excessive activity before the bone has healed can compromise the surgical repair.

Most dogs recover very well and regain excellent use of their operated leg.

Without surgical stabilisation, dogs with cruciate ligament rupture continue to have an underlying knee problem.

Some dogs become more comfortable with rest, medication or physiotherapy, but these treatments do not restore the damaged ligament or normal knee stability.

Ongoing instability can cause progressive arthritis, chronic discomfort, meniscal injuries and reduced mobility.

For suitable dogs, we strongly recommend TPLO surgery because it addresses the underlying mechanical problem rather than simply managing the symptoms.

Following surgery and rehabilitation, most dogs have a much stronger, more stable and comfortable knee.

Yes. The degree of pain depends on the extent of ligament damage, inflammation, instability and whether other structures inside the knee have been injured.

The meniscus is a cartilage cushion within the knee. If it becomes torn, it can cause significant pain, sometimes resulting in sudden worsening of lameness.

During TPLO surgery, Dr Buffa assesses the knee and treats any meniscal damage identified.

Addressing both the instability and associated injuries helps improve comfort and long-term function.

For dogs where surgery is not suitable or owners elect not to proceed, we can develop an individual management plan.

This may include:

• Anti-inflammatory or other pain-relieving medication
• Weight management
• Cartrophen injections
• Joint supplements where appropriate
• Physiotherapy or hydrotherapy
• Controlled exercise and muscle-strengthening programs
• Environmental changes to reduce strain on the knee

These treatments can improve comfort and quality of life but do not provide the same mechanical stability as TPLO surgery.

Some smaller dogs, particularly those under 10 kg, can improve with rest, medication and careful non-surgical management.

However, even if the lameness settles, the underlying cruciate injury may still cause joint instability and progressive arthritis.

Many small dogs also benefit considerably from surgery.

We assess each dog individually, considering their size, age, activity level, degree of knee instability and general health before recommending the most appropriate treatment.

Yes, unfortunately cruciate ligament disease can affect both knees.

Dogs that develop cruciate disease in one knee are at increased risk of developing the same problem in the opposite knee, sometimes months or years later.

TPLO surgery stabilises the affected knee but cannot prevent cruciate disease developing in the other leg.

Maintaining a healthy weight, good muscle strength and appropriate exercise can help reduce unnecessary stress on both knees.

Yes. We work with local physiotherapy and rehabilitation providers when additional support is required.

Physiotherapy can assist with rebuilding muscle strength, improving mobility and restoring confidence in the operated leg.

Hydrotherapy may also be beneficial once the surgical site has healed sufficiently and your veterinarian has approved this activity.

We can recommend an appropriate rehabilitation plan based on your dog’s recovery and individual needs.

Dr Jill King manages our cruciate consultations at PAH, coordinates the initial diagnostic investigations and works closely with specialist surgeon Dr Eugene Buffa.

Dr Buffa performs the TPLO surgery here at Pittwater Animal Hospital.

Our experienced veterinary nursing team provides careful anaesthetic monitoring, pain management and post-operative care.

We continue to look after your dog throughout recovery, including wound checks, suture removal, follow-up appointments and six-week X-rays.

If your dog is limping or you suspect a cruciate ligament injury, book an appointment with Dr Jill King.

We will assess your dog, explain the diagnostic procedure and provide an estimate for the initial general anaesthetic examination and X-rays.

Once the specialist has reviewed the X-rays and confirmed the surgical recommendation, our reception team can arrange TPLO surgery and provide the all-inclusive surgical estimate.