Learning curve for Tibial Plateau Levelling Osteotomy based on tibial plateau angle

The objective of the study was to assess a single surgeon's learning curve for Tibial Plateau Levelling Osteotomy (TPLO). The criterion was the accuracy of achieving a planned tibial plateau angle (TPA) immediately after surgery and comparing it with TPAs achieved by two experienced surgeons. The research was performed in using the keywords TPLO, learning curve and training. No similar studies have been described for TPLO surgery. The study was designed as a retrospective blinded case series with two case controls based on dogs with cranial cruciate ligament disease that had TPLO surgeries (n = 140). Medical records and radiographs of the first 100 TPLO surgeries performed by surgeon A (author) without direct supervision were reviewed, and consecutive numbers from 1 to 100 were allocated (November 2017-July 2020). Records and radiographs for the last 20 cases of two experienced surgeons B (RCVS Diplomate) (March 2019-June 2020) and C (ECVS Diplomate) (October 2019-June 2020) were used as two comparison groups (further numbers were allocated). Statistics were calculated, and a graph was created to show the learning curve. Improvement in the accuracy of achieving the desired TPA was seen after the first 40 cases, but the learning curve plateaued after around 60 cases and TPAs were comparable with those achieved by more experienced surgeons. The clinical relevance of this study is that supervision during TPLO surgeries should be considered for at least the first 40 cases.