TPLO vs CBLO vs TTA: Choosing a Cruciate Repair Technique

Cranial cruciate ligament (CCL) rupture is the most frequent orthopaedic problem seen in canine practice. Regardless of technique, the surgical goal is the same: remove the tibial thrust that the torn ligament can no longer resist, so the stifle can stabilise through fibrosis and muscle support.

TPLO, CBLO and TTA all achieve this by altering the biomechanics of the proximal tibia. They are not interchangeable in execution, however — each demands a different bone cut, a different implant, and a different level of preoperative planning.

The shared principle: neutralise tibial thrust

During weight-bearing, the tibial plateau is inclined caudally. That slope converts compressive load into a cranial shear force. The intact CCL resists this force. When it ruptures, the shear remains and the stifle becomes unstable.

TPLO reduces the slope by rotating a radial osteotomy of the proximal tibia. TTA advances the tibial tuberosity cranially so the patellar tendon line of action offsets the shear. CBLO applies the same slope-reduction principle as TPLO but with a closing-wedge osteotomy and a different plate geometry.

Practical differences that affect your OR

• Bone cut: TPLO uses a radial (curved) osteotomy; TTA uses a sagittal cut plus a tuberosity osteotomy; CBLO uses a biradial closing wedge.
• Guides and instrumentation: TPLO typically needs a dedicated saw guide and a set of stacked saw blades for rotation. CBLO uses a jig matched to its plate. TTA requires a cage and fork placement.
• Implant inventory: TPLO plates are size-matched to the tibial width; CBLO plates have their own geometry; TTA needs a cage plus fork. All three need a reliable screw range.
• Tuberosity handling: TTA creates a tuberosity fragment that must be secured. TPLO and CBLO avoid that fragment but demand accurate rotation control.
• Revision and conversion: the osteotomy patterns are not directly convertible, so implant availability matters when planning a revision.

How to select for the individual patient

There is no single correct answer. The choice usually comes down to the geometry of the patient's tibia, the surgeon's familiarity with the technique, and what the practice can keep on the shelf. The following decision axes are widely used in practice:

• Tibial anatomy — a very steep plateau or an unusually shaped tibia may favour one osteotomy over another.
• Patient size and bone quality — small and toy breeds are often managed with different hardware than large or giant breeds.
• Concurrent patellar luxation — if the tuberosity must be transposed anyway, a technique that already involves the tuberosity may simplify the plan.
• Surgeon experience — outcome is technique-sensitive; consistency with a familiar system usually outweighs theoretical advantages.
• Inventory and cost — case cost is dominated by implant and guide availability, not by the osteotomy itself.

What this means for implant sourcing

Because the three techniques need different plates, guides and screws, a practice that offers more than one technique carries a wider inventory — and inventory is where cost and shelf-life risk accumulate. Sizing that inventory to the case mix, rather than to a catalogue, is usually the fastest way to reduce per-case cost.

Otta Care manufactures TPLO plates, locking and non-locking bone plates, screws, K-wires and the instrumentation that goes with them, at standard AO dimensions so existing guides and screwdrivers remain compatible. Because we also produce human orthopaedic implants on the same ISO 13485 certified lines, the material and machining tolerances are held to a medical-device standard rather than a general machining standard.

Surgical technique selection remains a clinical judgement. The information here is intended for veterinary professionals evaluating implant options, not as a treatment protocol.