Postoperative rotational instability after tibial plateau-leveling osteotomy is associated with acute cranial cruciate ligament rupture and meniscal injury.

Dogs with acute, complete CrCL rupture and meniscal injury are at highest risk for postoperative rotational instability after TPLO.

This retrospective cohort study evaluated the prevalence and risk factors of postoperative rotational instability following tibial plateau-leveling osteotomy (TPLO) in dogs with cranial cruciate ligament (CrCL) rupture. A total of 312 stifles from a single referral institution (2018–2025) were analyzed. Rotational instability was defined as persistence of a positive tibial pivot test (TPT) after TPLO, necessitating placement of an antirotational suture. Postoperative rotational instability was identified in 77 of 312 stifles (24.6%), indicating a clinically significant prevalence. Multivariable logistic regression identified several independent risk factors: complete CrCL rupture (OR 23.48), meniscal tear (OR 2.68), and increasing lameness severity (OR 1.54 per grade increase) were each associated with significantly higher odds of rotational instability. Conversely, chronic presentation was associated with reduced odds of instability (OR 0.41), suggesting that acute injuries with greater structural disruption are at higher risk. Age, body weight, osteoarthritis score, and preoperative tibial plateau angle were not independently associated with instability after multivariable adjustment. These findings suggest that rotational instability after TPLO is primarily driven by lesion severity and acuity rather than patient-level or radiographic variables. The authors recommend heightened intraoperative vigilance using the tibial compression pivot test in dogs presenting with acute, complete CrCL rupture and concurrent meniscal injury, as these patients may benefit from adjunctive antirotational stabilization to optimize surgical outcomes.

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