a leg to stand on, part 3: surgical options for cruciate disease

Posted by Dr. Rebecca Jackson on Apr 29 2014

Although medical management (anti-inflammatories, joint supplements, rehabilitation, etc.) can benefit some cruciate patients, many will require surgical intervention in order to achieve pre-injury function and comfort.

As I mentioned in my last blog, surgeons use different techniques depending on their preferences, the patient’s size, and the degree of at-home care the pet parent is able to provide after surgery.

The four main surgical options are:

1) TPLO (tibial plateau leveling osteotomy)

2) TTA (tibial tuberosity advancement)

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3) Extra-capsular suture

4) Tightrope®

Let’s take a look at each of these procedures.


TPLO involves cutting the back of the tibia (shin bone), rotating the cut portion, and implanting a specialized plate to hold the cut portion of the bone in this new position. It creates a new angle within the stifle (knee) joint so that when your furry family member steps down, the femur (thigh bone) doesn’t slide. In short, the procedure changes the angle of the bones so that the joint becomes more stable.

TTA involves cutting the front of the tibia (called the tibial tuberosity and the place where the quadriceps muscles attach to the tibia), rotating the cut portion, and placing an implant (different from the one used in a TPLO) to hold the cut portion of the bone in this new position. Similar to TPLO, this technique stabilizes the stifle by changing the angle of forces within the joint.

TPLO and TTA procedures are used most frequently used in larger dogs, working/hunting dogs, active dogs, and dogs who have pet parents willing and able to provide at-home care for 6-8 weeks after surgery. Other considerations are proximity to a surgeon able to perform the surgery, finances and access to rehabilitation facilities. The main disadvantage is that both techniques involve cutting the bone; if the bone fails to heal properly or the implants fail, further surgery may be needed and the return-to-normal function may be lost.

Extra-Capsular Suture

Also called lateral suture, lateral fabellar suture stabilization, or fishing line technique. With this procedure, the surgeon does not have to cut any bones or go into the dog’s joint. Instead, the surgeon uses a thick suture material on the outside of the joint to serve as a “replacement” to the torn ligament. This technique is most frequently used in smaller dogs, less active dogs, or older dogs. The main disadvantage is that the suture can fail (break) requiring further intervention.


This technique uses a specialized toggle-suture implant that allows for more accurate placement of the suture material and a stronger fixation (as compared to the extra-capsular suture). Tightrope® can be used in larger and more active dogs than extra-capsular suture and does not require any bones to be cut (although it does involve holes drilled into the femur and tibia). The main disadvantages are implant failure and proximity to a surgeon that can perform the procedure.

Whether you opt for surgical or medical treatment, your dog’s stifle has suffered an injury and osteoarthritis is inevitable. The onset and degree of arthritis depends on each individual, but as with any joint, once damage has occurred lifelong changes within the joint develop. These changes can be managed with joint supplements, rehabilitation, medications, maintaining appropriate weight/body conformation, etc.

Finally, remember that your veterinarian/veterinary surgeon is your best resource for deciding how to address cruciate injuries. Don’t be afraid to be honest about your expectations and wishes, and together you can make the right decision for your furry family member!

To more waggin’ and purrin’. rwkj

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