Thursday, April 12, 2018

Dog Knee Injuries: My Two Cents on Cora-based Leveling Osteotomy (CBLO) Repair

If your dog injures their cruciate ligament, you have some serious homework to do. There are many treatment options out there, and the number continues to grow. You can explore everything from conservative management, holistic therapies, regenerative therapies, to surgical repairs.

Dog Knee Injuries: Cora-based Leveling Osteotomy (CBLO) Repair

Surgical solutions themselves include eight different techniques I know of at the time I'm writing this. That tells you something--there is no one perfect solution out there. Think about it.

Another thing to keep in mind is that out of all that, during a consultation, you are quite likely to be offered one or two.

Tibial Plateau Leveling Osteotomy (TPLO). is likely going to be on of them. It is the one most broadly recommended. It is not the latest one; it is just the one most popular with many veterinary surgeons.

The latest, and possibly greatest, is Cora-based Leveling Osteotomy (CBLO).


Logic would dictate that the best way to repair the knee ligament damage should be by actually repairing or replacing the ligament. That, however, is much easier said than done. There have been substantial difficulties with making this repair strong enough to hold up, though my veterinary friend in Australia says one of these techniques is still used there with comparable success. Australians seem to be freer thinkers when it comes to veterinary medicine.

Why is TPLO the number one recommendation and is it that great?


The funny thing is that the answer to this question is not really. At least, there is no conclusive evidence that it is reliably better than other interventions. Yet, it is undoubtedly the most popular. Why? Familiarity, perhaps. Don't get me wrong; familiarity does have its importance; you don't want a surgeon experimenting on your dog with a surgery they are not used to doing. However ...

The TPLO was originally developed in the early 1990's. While many surgeons think that it is the best thing since sliced bread, others had been trying to come up with different or improved solutions.

I confess that I never liked this technique much at all which is the reason why I keep up with what new surgeries are out there.

Tibial Plateau Leveling Osteotomy (TPLO)
Tibial Plateau Leveling Osteotomy (TPLO). Image Elizabeth Street Pet Hospital

Is Cora-based Leveling Osteotomy (CBLO) an improvement?


CBLO was developed to refine the TPLO procedure and address some of the issues that can cause complications with TPLO.

The idea behind all of the cruciate injury treatment options is to restore stability of the injured joint.

With TPLO, this is achieved by altering the orientation of bones within the joint--changing the slope of the joint surface. Which works, after a fashion. It has been found, however, that the dramatic change in the joint anatomy results in abnormal mechanics and often damage to cartilage.

"One of the issues with TPLO is that in a lot of dogs the end result is that the load bearing axis of the tibia is moved further away from the anatomical axis of the tibia. CBLO addresses this by inverting the rotation which results in the weight bearing axis being brought into alignment with the anatomical axis." ~Eurocast Veterinary Centre


Natural anatomy matters. I've been trying to come up with a good metaphor, but the best I can think of is walking on very high heels. You can do it, but you are going to pay for it.

Cora-based Leveling Osteotomy (CBLO)
Cora-based Leveling Osteotomy (CBLO). Photo United Veterinary Clinic

The CBLO aims to address this problem.


CBLO too cuts the top part of the shin bone but in a different location and alters the rotation to better align the weight bearing and anatomical axis. If you compare the CBLO and TPLO illustrations, which one of them looks more natural to you? I like this approach much better.

An additional advantage is that CBLO combines the benefit of TPLO and Tibial Tuberosity Advancement (TTA) which is a technique that stabilizes the joint by modifying the angle between the shinbone and the patellar tendon.

Tibial Tuberosity Advancement (TTA
Tibial Tuberosity Advancement (TTA). Image DePuy Synthes

To me, the CBLO looks much more sensible, elegant and sturdy as well as it seems much more logical. It is quite new, though, so finding a surgeon well-versed in doing it might be a challenge. It is also likely too early to have enough data to tell how much better it is or isn't.

Instinctively, though, I'd be much more likely to choose CBLO over TPLO any day. I don't like that it is just as invasive and I don't think it's the last we will see of new procedures. But if the choice was between the two, I think the CBLO could be superior. That doesn't mean something better won't come along tomorrow.



Do your research.


The main purpose of this article is to introduce what is new in dog cruciate injuries repair so you know there is more than the one or two options you might feel stuck with. Personally, regenerative medicine is the top of my list of considerations. Whether or not that might work depends on a bunch of factors, but platelet-rich plasma therapy did work for Cookie's partial tear(s).

For fully torn ligament, surgery is likely the best option for most dogs. But there is still the pressure of the choice of a specific procedure.

I recommend you do your homework so you can make an educated decision about what treatment you believe is going to be best for your dog. Talk to a lot of different surgeons. Remember that none of them are likely having tried all of the options to offer full insight. They are likely to recommend what they are most familiar with and what they've seen work. That doesn't mean that something else wouldn't work better.

The best strategy is prevention.


The best-case scenario, of course, is your dog never rupturing their cruciate ligament in the first place. There are a few risk factors which you can try and avoid, such as acute injury, spaying and neutering too early, obesity, unaddressed thyroid dysfunction, insufficient or high-impact exercise, and others, but unfortunately, some dogs are simply genetically predisposed to cruciate ligament disease.


Related articles:
What Is That Limp?
Talk To Me About Dog ACL/CCL Injuries (I do need to update this one)
Triple Tibial Osteotomy (TTO)
Simitri Stable in Stride
Is There Such a Thing as a False Drawer Sign?
Preventing ACL Injuries in Dogs
Preventing ACL/CCL Tears Part I
Preventing ACL/CCL Tears Part II (All or None or Partial) 
Full Cruciate Ligament Tears
Ruptured Cruciate Ligaments and Early Spay and Neuter
ACL Injuries in Dogs: Non-Surgical Alternatives
Platelet-Rich Plasma (PRP) Treatment for Cookie's Bad Knee(s)
Cruciate Ligament (ACL/CCL) Surgery Post-Op Care Example Plan
Surviving the Post-Op After Your Dog's ACL/CCL Surgery

30 comments

  1. Wow what a thorough post, probably more information than a vet would give. I have never had a dog with a cruciate ligament injury, but I will definitely bookmark this as a resource should I, or anyone I know, be faced with it in the future.

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    1. Thank you, Hindi, I'm still working on a updated "Talk to Me about ACL/CCL Injuries" which will recap ALL options.

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  2. I wish I had known of all these options when my Lyla was younger. Her vet back when she had her knee injury was not as good as I thought he was. It wasn't until just a few years ago we found a great vet that told us how badly her knee was set and what could have and should have been done.
    I am so thankful for your articles and all the knowledge you help us with!
    Blogs like this truly give us understanding so we can communicate with our vets on a more intellectual level and not just blindly trust the way that I used to!

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    1. So sorry your baby didn't get her knee fixed properly. I hope she doing ok?

      This is one of the reasons I share my experiences and thoughts.

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  3. I've heard of TPLO but not CBLO. Are the costs comparable? Isn't it great how science and medicine are constantly advancing?

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    1. I would imagine the pricing should be comparable; it's about in the same ball park for all the osteotomies. The CBLO is relatively new; that's why I finally wrote about it.

      It is great how medicine is advancing; it would be even greater if there were more cures than treatments ;-)

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  4. I know I have to be careful with obesity with my dog; for some reason I just can't see it when she's a little too chubby (I guess love is blind), so I constantly ask my wife if she looks a healthy weight and weigh her every so often. She's around sixty pounds, so weighing her isn't easy!

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    1. There is an objective way of judging that using the body condition scoring. You can look it up but generally it involves being able to feel ribs easily, seeing waistline and seeing tummy tuck.

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  5. Wow I did not know all this information about dog knee injuries. I have never had a dog that had knee issues but it is good and important information to know! I definitely will bookmark this post!

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    1. I'm glad you never needed the information; hopefully you never will.

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  6. "The best strategy is preventative" really caught my eye. Since Happy-Go-Doodle Chloe has never had any injuries, I was interested to learn how to prevent dog knee injuries. Thanks for providing this information and for sharing such an informative article about treatment methods. It looks like we're on the right track for prevention!

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    1. Sounds like you're doing great. Of course, there are multiple factors. I have included links to articles about prevention.

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  7. Wow, you have provided one of the best posts I've seen for pet parents to provide what I like to call "Research-Based Pet Parenting". I have shared this EVERYWHERE. Thank you!

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    1. Thank you, Denise, this is a humbling amount of praise :-)

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  8. A very informative post as always. Keeping a dog healthy and strong with good core strength, fresh foods, avoiding foods that cause inflammation is so important. Thanks for sharing.

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    1. Yes, we owe it to them to take all measures that are in our grasp to try and keep them healthy.

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  9. As a person without a medical background is confusing trying to figure out different treatment options. I think getting additional opinions is always a good idea.

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    1. Hubby has no medical background either yet he can see the mechanics of things. So going just on that one can see the differences between the techniques.

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  10. Thank you for sharing the details! Seems like CBLO implants a shaft/plate at the joints. How good is this and are there any side effects to the implant?

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    1. All of these techniques involve implants one way or another. The potential issues are about the same for all, such as potential infectious plaques. Sometimes the implant can break, sometimes the bone can break ... these are not very common. Eventually the bone "grows into the repair" so infection at the implant site is the most common complication that can crop op after the rehab period.

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  11. I never realized it was so common in dogs until a few years ago when a friend said his dog tore his jumping out of the car. Yikes! Then again, I have a human friend who tore hers while golfing and another who tore hers while walking down the stairs and slipping. This is very helpful. It’s good to know the options. Pet insurance covers this treatment as well, I believe.

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    1. Usually one doesn't know about such things until they have to deal with them. Blessed are those who were able to remain clueless.

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  12. This was one detailed post and so helpful to anyone whose dog is dealing with this issue. Knees are really delicate and it is so easy to damage them. I can even speek from my own experience. I bumped into something with my knee and there you have it, pain that wont go away for over a year.

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    1. Yeah, I messed up me knee too, a few years back now, comes and goes.

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  13. This is a very informative post on an issue that is quite common in big dogs. I am not familiar with CBLO, but if it repairs the joint in a more natural position, I have to believe this method will begin to have more support soon. One of the issues with the dogs I know who have undergone TPLO surgery, is that they almost always require it on the other side eventually. I don’t know if it’s because of the way the joint is repaired and possibly out of alignment that causes too much pressure and destabilization to the other side? This fact alone would cause me to want to find an alternative!

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    1. Yes, this procedure isn't well known yet; it IS quite new. It does feel much more right to me than the TPLO, though.

      The reason why the other knee often goes is not really automatically fault of the procedure - most dogs end up with a busted cruciate because of progressive degeneration so the odds of the other knee going sooner or later are relatively high. The better the already injured leg is, though, the better chance the other one has.

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  14. All the surgeries look pretty brutal. I am just recovering from trying stem cells and PRP on both knees using stomach fat. Much harder recovery than I anticipated after 3 weeks but I am optimistic about the potential on my partial ligament tears, my cartilage tears, arthritis and inflammation. I think they have done a lot of testing on dogs and horses in Australia and it just became available more recently here in Toronto. I'll let you know.

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    1. Yes, they are pretty brutal. That's why regenerative medicine is my first go-to to consider. Naturally, if the ligament is fully blown, there is nothing to regenerate.

      So exciting you used stem cells and PRP! I hope you share your story!

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  15. Thorough post is an understatement. That actually made me cringe to look at in places. I'm only sensitive that way. I try very very hard to make sure my wee one has core training and warm ups before we hit the trails. And a very good STAY command to avoid leaps and jumps he should not take.... because this...yikes.

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    1. LOL, sorry. I am working on one even more thorough that this; this one mostly just highlights the new procedure :-)

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