The cranial cruciate ligament and the flexor muscles of the stifle normally oppose this force. Like the cranial drawer it is present when the cruciate ligament is abnormal. The CWO, like the TPLO, attempts to neutralize these forces by turning tibial thrust into tibial compression. Prior to surgery multiple radiographs of the stifle are taken to determine the angle of the tibia plateau. A bone plate is applied to the ostectomy to allow healing.
Postoperative care is similar to that of traditional repair techniques.
The CWO has a number of advantages over traditional cranial cruciate ligament repair techniques. A complete halt of arthritis progression in stifles treated by tibial plateau angle alteration is reported. This is significant since dogs with traditional surgical repair may develop debilitating arthritis. Since the CWO does not rely on periarticular fibrosis, with less stifle thickening with better range of motion is expected. Indications for the CWO include patient parameters that put a traditional repair at risk for failure.