Owner: ________________________ Patient: Date:
Referring Hospital: ___________________________ Veterinarian:
Surgery to be performed: ___________________________________

I have discussed the aforementioned surgery and the importance of pre-surgical blood
testing with the referring veterinarian. I understand that there are risks and hazards
involved with the recommended surgical procedure, including anesthetic risk. I
realized that no guaranty or warranty can ethically or professionally be made regarding
the results or cure.

Your pet has been diagnosed with a torn anterior cruciate ligament that will benefit from
a tibial plateau leveling osteotomy (TPLO) procedure. Other techniques are available for
treating this condition, however based on the size of your dog and the expected results of
this procedure based on strictly following the recommended post-operative treatment
protocol, your referring veterinarian and I believe the TPLO procedure is most
appropriate for your pet. To relieve the pain associated with the torn cruciate ligament
and accompanying inflammation, the top portion of the tibia (lower leg bone) is
osteotomized (cut) and rotated to a position that will produce less stress on the knee.
Sometimes the medial and/or lateral meniscus (a shock absorber cartilage in the knee) is
torn as well and must be removed or trimmed. When this cartilage is torn, arthritis
develops more rapidly, even after removal. After surgery, your pet will need to go
through periods of recovery to allow the bone to heal and rehabilitation to regain strength
and flexibility in the affected leg. In most dogs, the recovery and rehab periods can be up
to 4 to 6 months before full return to unrestricted activity. As with any surgery, there are
complications that can occur.

I consent to the following surgical procedure(s): Tibial plateau leveling osteotomy of the
LEFT or RIGHT (please circle the correct leg to be repaired) rear leg.

Surgical Risks Include:
1. Infection , which may require additional testing and medication at an additional cost.
2. Hemorrhage, especially from the popliteal artery.
3. Bruising and edema postoperatively.
4. Implant breakage or failure, requiring additional surgery at an additional cost.
5. Fractures of the tibia or fibula.

Strict adherence to post-surgical care and medicating of your pet will minimize these
potential complications and serious problems are very uncommon in most cases. Your pet
will need to be under exercise restrictions until healing of the osteotomy is shown on
radiographs. Please do not return to full activity, bathe, allow to run or play or swim until
released by Dr. Sharp or your regular veterinarian.