what are the evidence-based criteria for choosing TPLO versus conservative management for cranial cruciate rupture in dogs?

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Bodyweight is the primary criterion separating surgical from conservative management, with dogs weighing more than 15 kg having substantially worse outcomes without surgery and dogs weighing 15 kg or less showing reasonable functional recovery with conservative care.247 The quantitative case for surgery in dogs over 15 kg is compelling. Among dogs managed non-surgically, only 19% of those weighing more than 15 kg were considered clinically normal or improved after an average follow-up of 3 years, compared with 86% of dogs weighing 15 kg or less.7 Conservative treatment in overweight dogs over 20 kg carries a documented risk of treatment failure severe enough to result in euthanasia.2 Surgical management leads to reduced lameness and reduced analgesic prescription requirements compared with non-surgical management across the full range of body sizes.4 In dogs weighing 15 kg or less, conservative management is a defensible first choice. Among small-breed dogs managed non-surgically, 86% were clinically normal or improved at 3 years, and one historic report found 90% of small-breed dogs had no owner-detectable lameness following conservative treatment.7 The probability of surgery in UK primary-care practice reflects this: surgical management was chosen in 56% of dogs weighing less than 10 kg versus 86% of dogs weighing 40 kg or more.7 Only 15.5% of UK veterinarians supported immediate surgical management for dogs under 15 kg.7 When surgery is chosen, TPLO is the preferred technique for dogs over 15 kg. Among Veterinary Orthopedic Society members, 78.6% preferred TPLO for dogs over 15 kg, compared with 13.9% for tibial tuberosity advancement (TTA), 5.9% for lateral fabellotibial suture (LFS), and 1.6% for the tightrope procedure.3 This preference was independent of board certification status.3 The available literature suggests TPLO provides better long-term outcomes than TTA and LFS.3 TPLO results in superior limb function and owner satisfaction compared with LFS.5 Addi