What Happened to Your Dog’s Knee

Your dog’s knee (stifle) is stabilized by several ligaments, the most important being the cranial cruciate ligament (CrCL), the canine equivalent of the human ACL. When this ligament tears, partially or completely, the shin bone (tibia) can shift forward relative to the thigh bone (femur) every time your dog puts weight on the leg. This instability causes pain, lameness, and, over time, progressive arthritis and damage to the meniscus (the cartilage cushion inside the joint).

CrCL tears are one of the most common orthopedic injuries in dogs. Unlike a human ACL tear, which is usually a single traumatic event, most dogs experience gradual degeneration of the ligament over months or years, which is why many dogs have no clear “injury moment,” and why the other knee is at meaningful risk down the road (more on that below).

Why Surgery, and Why TPLO

Without surgical stabilization, most dogs do not regain normal function on the leg, and the joint continues to develop arthritis. Several surgical techniques exist; Tibial Plateau Leveling Osteotomy (TPLO) is widely considered the gold standard for medium, large, and giant breed dogs, and is also commonly used in smaller and athletic dogs.

Rather than replacing the torn ligament, TPLO changes the geometry of the joint so the ligament is no longer needed for stability. The top of the tibia (the tibial plateau) is cut in a controlled, curved osteotomy, rotated to a level angle, and secured in its new position with a stainless steel or titanium bone plate and screws. This eliminates the forward-shifting motion that caused the pain and instability, allowing the knee to function normally through muscle and joint mechanics rather than the damaged ligament.

During surgery, we also inspect the meniscus. If it’s torn (which happens in a meaningful proportion of CrCL cases), the damaged portion is removed or trimmed at the same time.

Day of Surgery

• Your dog is examined, and you’ll have a full conversation with Dr. Kapler about the plan before anything proceeds.
• General anesthesia is used, with continuous monitoring throughout (heart rate, oxygenation, blood pressure, temperature, and more).
• Pain control is multimodal: a long-acting local anesthetic (Nocita) is placed at the surgical site during closing, providing roughly 72 hours of local pain relief, in combination with systemic pain medication.
• Post-operative X-rays confirm implant position and the corrected joint angle before your dog wakes up.
• Your dog goes home the same day as surgery. We do not have overnight boarding or hospitalization.

Recovery Timeline

Bone healing in adult dogs takes a minimum of 8 weeks, and this timeline cannot be rushed regardless of how good your dog feels. Most complications happen when a dog “feels fine” too early and is allowed too much activity before the bone has healed.

Activity Restriction: The Most Important Part

More TPLOs fail from too much activity too soon than from any other cause. For the first 8 weeks:

• Leash-only bathroom breaks, 5–10 minutes, several times daily
• No running, jumping, playing with other pets, or off-leash time of any kind
• No stairs when avoidable; use a ramp or carry small/medium dogs
• Confine to a crate or small room when not directly supervised
• Non-slip footing at home: rugs or yoga mats over hardwood/tile is often worth doing temporarily

Home Physical Therapy

Gentle at-home exercises can support recovery once your dog tolerates them comfortably (typically started as directed at your discharge visit):

• Massage: gentle strokes along the lower back and thigh muscles to help your dog relax before range-of-motion work.
• Passive range of motion: slow, gentle “bicycle pedaling” motion of the hip, knee, and ankle, done without weight-bearing.
• Weight-shifting: gentle side-to-side rocking while standing to encourage use of the operated leg.
• A referral to a formal canine physical rehabilitation program is available if you’d like more structured support, just ask us.

Medications & Supplements

• Pain medication as prescribed, for the full course. Don’t stop early because your dog “seems fine.”
• Nocita provides roughly 72 hours of local pain relief starting at surgery; after that window, your dog relies on the oral medications sent home.
• Antibiotics, if prescribed, should be given for the entire course even if the incision looks healed.
• Joint supplements (glucosamine/chondroitin, omega-3 fatty acids) may help long-term joint health and are often introduced during recovery.

Wound Care & Warning Signs

Check the incision at least once daily for redness, swelling, discharge, or opening. Keep it clean, dry, and protected from licking with the e-collar at all times. Call us right away if you notice:

• Sudden non-weight-bearing after previous improvement
• Significant swelling, redness, warmth, or discharge at the incision
• Fever, lethargy, or loss of appetite lasting more than a day
• Vomiting or diarrhea
• Any concern at all: we would always rather hear from you

What to Realistically Expect

The large majority of dogs return to full function after TPLO, including athletic and working dogs. That said, a few honest points worth knowing:

• Arthritis is already present by the time most CrCL tears are diagnosed, and surgery stabilizes the joint but does not reverse existing arthritis. Long-term joint support (weight management, supplements, controlled exercise) helps manage this over your dog’s life.
• The other knee is at real risk. Because CrCL disease is usually a degenerative process rather than a one-time injury, a substantial proportion of dogs (commonly cited in the range of one-third to one-half in published studies) will tear the ligament in the opposite knee within a few years. We’ll watch for early signs at rechecks, and you should call us if you notice any lameness in the other leg down the road.
• Complications are uncommon but possible, including infection, implant-related irritation, or (rarely) a late meniscal tear in an already-operated knee. This is why the recheck schedule and activity restriction matter as much as the surgery itself.
• Hardware occasionally needs to be removed after the bone has fully healed, if it becomes irritating, loosens, or develops an infection. This isn't common, but it's a real possibility worth knowing about.

Recheck Schedule

What Patellar Luxation Is

The kneecap (patella) normally glides in a groove at the front of the knee. In dogs with patellar luxation, the kneecap slips out of that groove, most commonly toward the inside of the leg (medial patellar luxation, or MPL). This can cause an intermittent "skip" in the stride, ongoing lameness, pain, and inflammation, and over time it increases the risk of tearing the cranial cruciate ligament in that knee. Patellar luxation is often present from a young age and is common in small and toy breeds, though it can occur in dogs of any size.

Luxation is graded 1–4 based on severity, from occasional slipping that pops back into place on its own, to a kneecap that stays permanently out of position. The grade, along with your dog's symptoms, guides whether and how surgery is recommended.

Why Surgery

Surgical correction addresses the underlying anatomy causing the kneecap to slip. This typically involves moving the point where the patellar tendon attaches to the shin bone (the tibial tuberosity) so it lines up properly with the groove, along with tightening loose tissue on one side of the knee and releasing tight tissue on the other. Together, these changes hold the kneecap in its correct position going forward.

Day of Surgery

• Your dog is examined, and you'll have time to talk through the plan and grade of luxation with Dr. Kapler before anything proceeds.
• General anesthesia is used, with continuous monitoring throughout.
• Post-operative X-rays confirm implant position before your dog wakes up.
• Your dog goes home the same day as surgery. We do not have overnight boarding or hospitalization.

Recovery Timeline

Like other bone surgeries, healing takes a minimum of 8 weeks, and this cannot be rushed regardless of how good your dog feels.

Activity Restriction

• Leash-only bathroom breaks for the first 8 weeks
• No running, jumping, playing with other pets, or off-leash time
• No stairs when avoidable; use a ramp or carry small dogs
• Confine to a crate or small room when not directly supervised
• Non-slip footing at home: avoid tile, linoleum, and hardwood if possible

Home Physical Therapy

Gentle exercises, once your dog tolerates them comfortably, can support recovery:

• Passive range of motion: gentle, controlled flexing and extending of the knee, done without weight-bearing, to maintain joint mobility.
• Weight-shifting: gentle side-to-side rocking while standing to encourage use of the operated leg.
• A referral to a formal canine physical rehabilitation program is available if you'd like more structured support.

Wound Care & Warning Signs

Check the incision daily for redness, swelling, discharge, or opening. Keep the E-collar on at all times. Call us if you notice:

• Sudden non-weight-bearing after previous improvement
• Significant swelling, redness, warmth, or discharge at the incision
• Fever, lethargy, or loss of appetite
• Any concern at all: we would always rather hear from you

What to Realistically Expect

• Most dogs do very well after surgical correction, with a substantial reduction in lameness and pain.
• The other knee may also be affected. Because patellar luxation often reflects the overall anatomy of the leg, it's not uncommon for both knees to be affected to some degree, sometimes requiring surgery on the second leg either at the same time or later on.
• Recurrence is uncommon but possible, particularly in more severe (higher-grade) cases, which is part of why the activity restriction and recheck schedule matter as much as the surgery itself.
• Hardware occasionally needs to be removed after the bone has fully healed, if it becomes irritating, loosens, or develops an infection. This isn't common, but it's a real possibility worth knowing about.

Recheck Schedule

How Fractures Are Stabilized

Most fractures we repair are stabilized with a bone plate and screws, which hold the bone in proper alignment while it heals. These implants are meant to be permanent and typically don't need to be removed unless they loosen, break, or become infected. Depending on the fracture, other stabilization methods (pins, external fixation, or a combination) may be more appropriate. We'll explain the specific plan for your pet's fracture.

Day of Surgery

• Your pet is examined, and imaging is reviewed to confirm the fracture pattern and that outpatient repair is appropriate.
• You'll have a full conversation with Dr. Kapler about the specific plan before anything proceeds.
• General anesthesia is used, with continuous monitoring throughout.
• Your pet goes home the same day as surgery. We do not have overnight boarding or hospitalization.

Recovery Timeline

Unlike some other orthopedic procedures, fracture healing time varies significantly depending on the bone involved, the fracture pattern, and your pet's age, and there is no fixed timeline. Healing is confirmed with recheck radiographs, not by how your pet is feeling or moving.

Activity Restriction

• Strict leash-only activity, no running, jumping, playing, or unsupervised time, until the fracture is confirmed healed on radiographs, not before
• Confine to a cage, crate, or small room whenever unattended
• Do not increase activity on your own, even if your pet seems comfortable. Excess stress on a healing fracture is the most common cause of complications
• Watch calorie intake during this confined period; we may recommend reducing food to prevent excess weight gain

Wound Care & Warning Signs

Check the incision daily for redness, swelling, discharge, or loose sutures. Keep the E-collar on at all times. Call us if you notice:

• Sudden non-weight-bearing after previous improvement
• Significant swelling, redness, warmth, or discharge at the incision
• Fever, lethargy, or loss of appetite
• Any concern at all: we would always rather hear from you

What to Realistically Expect

• Most straightforward fractures heal well with appropriate stabilization and strict adherence to activity restriction.
• Timeline is patient- and fracture-specific. Unlike a standard procedure with a predictable recovery window, fracture healing can take longer than expected, and that's monitored with radiographs rather than a calendar.
• Complications are possible, including implant breakage, re-fracture, delayed healing, or infection, which is exactly why the recheck schedule and strict activity restriction matter as much as the surgery itself.
• Hardware is meant to be permanent and typically doesn't need removal unless it loosens, breaks, or becomes infected.

Recheck Schedule

Why Remove a Mass

Lumps and bumps are common in pets, and not all of them are cause for concern, but many benefit from removal, either because they’re bothering your pet, growing, or because the only way to know for certain what a mass is, is to remove it and send it to a pathologist for evaluation.

Whenever possible, we remove a mass with a margin of healthy tissue around and beneath it. This is the single biggest factor in preventing the mass from coming back. A smaller, more conservative removal is sometimes an option, but it carries a higher chance that abnormal cells are left behind. We’ll talk through the right approach for your pet’s specific mass and location.

Day of Surgery

• Your pet is examined, and you’ll have time to talk through the plan with Dr. Kapler before anything proceeds.
• Most mass removals are done under general anesthesia with continuous monitoring throughout.
• The removed tissue is sent to a diagnostic laboratory for pathology: this tells us exactly what the mass was and whether it was completely removed.
• Your pet goes home the same day as surgery. We do not have overnight boarding or hospitalization.

Recovery Timeline

Recovery from mass removal is typically much shorter than orthopedic surgery, and most pets are back to normal activity within about 2 weeks.

Activity Restriction

• Leash-only activity for dogs, or confined/restricted activity for cats, for 2 weeks
• No running, jumping, playing, or unsupervised activity during this time
• Avoid interaction with other pets until the incision has healed

Wound Care & Warning Signs

Check the incision daily once any bandage is removed. Keep the E-collar on at all times to prevent licking or chewing. Call us if you notice:

• Redness, swelling, discharge, or opening at the incision
• Loose or missing sutures
• Fever, lethargy, or loss of appetite
• Any concern at all: we would always rather hear from you

Understanding Pathology Results

Every removed mass is evaluated by a pathologist, who identifies the type of growth and, importantly, checks whether the surgical margins are clean (no abnormal cells at the edge of what was removed). We’ll call you with results, generally within 7–10 days, and explain exactly what they mean for your pet: whether no further action is needed, or whether additional treatment or monitoring is recommended.

Why This Type of Surgery

Surgery on the stomach or intestines is most often needed to remove a swallowed foreign object, a mass, or a damaged section of tissue. The surgeon opens the affected organ, removes what needs to be removed, and closes the repair carefully in layers to restore normal function. Potential complications include leakage from the surgical repair, inflammation of the pancreas (pancreatitis), delayed stomach emptying, wound healing issues, and risks of anesthesia.

Day of Surgery

• Your pet is examined, and you'll have a full conversation with Dr. Kapler about the findings and plan.
• General anesthesia is used, with continuous monitoring throughout.
• Your pet goes home the same day as surgery. We do not have overnight boarding or hospitalization.

Recovery Timeline

Reintroducing Food

Offer a small amount of water a few hours after arriving home. If that stays down, feed a bland, easily digestible diet for about a week (either a home-prepared option like boiled chicken and rice, or a commercial low-residue/GI-support diet if we've recommended one), in smaller, more frequent meals (3–4 times daily) rather than one large meal. Some decreased appetite the first day is normal, but call us if your pet hasn't eaten at all within 24 hours, or vomits after eating. After about a week, you can resume a normal diet as long as there's no vomiting or regurgitation.

Activity Restriction

• Leash-only activity for dogs, or confined/restricted activity for cats, for 2 weeks, or until the incision is fully healed
• No running, jumping, or anything that strains the abdominal muscles
• Confine to a crate or small room when unsupervised

Warning Signs: Call Us Right Away

• Repeated vomiting
• Marked lethargy or weakness
• Refusing food for more than 24 hours
• Abdominal pain, a swollen or tender belly
• Fever, or an incision that looks red, swollen, or is draining

With this type of surgery specifically, don't wait until the next business day if something seems wrong. Call us first; if we're not reachable, AVL Urgent Care (12pm–10pm, 828-369-7369) or VEG Asheville (open 24/7, 828-470-7802) can see your pet right away.

What to Realistically Expect

• Most pets recover well and are back to totally normal life within about 2 weeks.
• The first several days require real vigilance, and this is the trade-off for a generally excellent long-term outcome.
• Complications are uncommon but serious if they occur, which is exactly why we ask you to call early rather than wait and see.

The first evening home is often the hardest part of the whole process for owners: your pet may seem "off" in ways that are worrying to watch, but are a completely normal part of recovering from anesthesia and surgery. Here's what to expect, and how to tell the difference between normal and something we should know about.

What's Normal Tonight

• Vocalizing: whining, crying, or seeming unsettled. This is often disorientation from anesthesia rather than pain, though we manage pain proactively regardless.
• Reduced or no appetite: many pets don't want to eat the evening of surgery. Don't force food; offer a small amount later and try again in the morning.
• Urinary or fecal accidents: residual sedation can affect bladder and bowel control temporarily. This is not a training regression.
• Wobbliness or uncoordinated movement: residual anesthesia effects that typically resolve within several hours as the medication clears.

Setting Up a Safe Recovery Space

Before you bring your pet home, set up a small, confined area, such as a crate, pen, or small room:

• Good footing: non-slip surface (a rug, yoga mat, or bath mat) so a wobbly pet doesn't slip
• Cleanable bedding: washable blankets or disposable pads, in case of an accident overnight
• Away from stairs and furniture your pet could fall from while still uncoordinated
• Quiet and low-stimulation: away from other pets, young children, and household noise, so your pet can rest undisturbed
• E-collar on at all times: even overnight and even if your pet seems unbothered by the incision. It only takes a moment of licking or chewing to cause a real problem, and it's much easier to prevent than to fix.

Medications Tonight

We'll send you home with specific instructions on pain medication: what to give and when. A few general notes:

• Give medications as directed, even if your pet seems comfortable. Staying ahead of pain works better than catching up to it.
• Don't double up on a missed dose; if you're unsure what to do, call us.
• If your pet seems painful despite medication (restless, panting, unable to settle), call us. We can usually help over the phone.

Food and Water

Offer a small amount of water first. If that's tolerated, a small amount of food is fine if your pet is interested, but don't worry if dinner is skipped entirely. Most pets are back to a normal appetite by the next day. Avoid a large meal the first night.

When to Call Us Tonight

Most of the above is expected and will improve by morning. Call us if you notice any of the following, and if we're not reachable, AVL Urgent Care (12pm–10pm, 828-369-7369) or VEG Asheville (open 24/7, 828-470-7802) can help:

• Your pet is unresponsive or cannot be roused
• Unable to stand at all several hours after arriving home
• Continuous crying that pain medication doesn't seem to help
• Repeated vomiting
• Pale or blue-tinged gums, or labored breathing
• Any seizure-like activity
• Anything about the incision or surgical site that concerns you