Wednesday, April 17, 2024

Lateral Suture Vs. Tplo Surgery On Dog

Why Choose Mmp Over Tplo For Cranial Cruciate Ligament Tear Of The Dog Knee

Cranial Cruciate Ligament Part 4: Comparing the TPLO versus the lateral suture technique!

The cranial cruciate ligament is the major stabilizing ligament that lies deep within the canine knee joint. Rupture or tear of this ligament is a very common injury in the hind legs of dogs. Rupture of the CCL causes a forward thrust, also known as a sheer force, of the tibia when the dog is in motion or even just weight bearing. The image below illustrates the nature and consequence of rupture of the CCL.

The sheer force causes inflammation and pain within the joint and causes significant lameness in the affected limb. CCL rupture will not heal without surgical stabilization. The longer a dog lives with a CCL tear, constantly shifting weight to the non-injured limb, it increases the chance of CCL tear in the other limb.

There are three main methods by which dog knees with torn CCLs are surgically stabilized. One approach involves running a suture between focal points of the femur and tibia. Suture procedures still have their place in CCL repair, but it is widely accepted that suture based CCL repair is not as effective for dogs over 35-38 pounds. At Maybeck Animal Hospital, we enjoy successful outcomes using the arthrex tighrope suture procedure for CCL tears in smaller dogs generally south of 35 pounds..

In 2005, a procedure known as the Tibial Tuberosity Advancement was developed in Switzerland, where the top part of the tibia, called the tibial tuberosity, is cut and advanced forward. The result is two fold:

Below is the post operative TTA x-ray:

What Is Dog Acl Surgery Or Dog Cruciate Surgery

There is no doubt that all of the scientific terminologies can get very confusing for any pet owner. Currently, there are three main surgery techniques that are commonly performed to treat dog ACL tears. Here they are:

On this page, we are discussing what is commonly referred to as the Lateral Suture Technique or Extracapsular Repair for the treatment of dog ACL tears.

98% of Pet Owners Say this Guide is a Must for Recovery

Lateral Suture Vs Tplo

The TPLO has caused tremendous debate among veterinary surgeons with regard to which surgical procedure is most appropriate for any individual dog. There are surgeons in the United States that recommend lateral suture as the best option for every patient, and others that recommend TPLO as the best option for every patient. It is Town & Country Veterinary Clinicâs opinion that each procedure has relative advantages and disadvantages, which owners should take into consideration when making their decision.

Advantages of the lateral suture include the fact that it is a relatively quick surgical procedure, which should minimize surgical and anesthetic risk . This procedure has been studied extensively and although not perfect, has a proven and well-defined usually good long-term result. Lateral suture is slightly less expensive to perform. The primary disadvantage of the lateral suture is that the great majority of dogs only recover to 85- 90% of normal and take longer to reach this level. There is almost always some progression of arthritis, and intermittent mild lameness persists, especially after exercise. Dogs do well, but they may not be particularly âathletic.â

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The Surgeon You Choose Matters If You Cannot Afford A Board Certified Surgeon Stick With A Traditional Knee Surgery

The overall success rate of dog knee surgery does depend largely on the skill of the individual performing the operation, particularly with procedures such as TPLO, Tight Rope, and TTA, the skill level of the surgeon wildly impacts the success rate of surgery.

While statistically speaking TPLO and Tightrope surgery have the highest success rate. If you cannot find a veterinarian who can reliably perform these surgeries then it is best to go with the lower cost traditional surgery.

This means choosing lateral suture or Extracapsular Repair, while this is both the oldest and most affordable type of dog knee surgery, has the highest rate of secondary rupture. During this surgery, no structural changes are made to the knee joint itself, but rather, additional support is inserted into the knee. Eventually this support wears down and another surgery will be necessary.

On a positive note, it will be easier to find a reliable veterinarian who can perform this surgery, so while not always the highest long term success rates, you can be sure that most vets know what they are doing. Whereas TPLO, TTA, and Tightrope surgery do require a specialist.

Size & Weight Of Your Dog

  • As stated previously it is fairly well accepted that dogs less than 50 lbs. will do perfectly fine with the more conservative lateral suture technique for your dogs ACL surgery. On the other hand, dogs over 50 lbs. are recommended by board-certified orthopedic surgeons to either have a TPLO or TTA surgery. Again it is best to discuss with your veterinarian who knows your dog best.
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    Upping Your Lateral Suture Game

    Jason Syrcle, DVM, DACVSdvm360

    Lateral suture stabilization is a viable treatment option for cranial cruciate ligament injury in dogs. Here are key points for increasing success in these cases.

    Lateral suture stabilization is a time-tested treatment for cranial cruciate ligament rupture in dogs. Although tibial plateau leveling osteotomy and other osteotomy procedures are considered the gold-standard treatment for most patients, a lateral suture can also produce good results, especially with proper case selection. The lateral suture procedure is a more affordable option for owners and a less complex procedure that may be more accessible to general practitioner surgeons. However, a few critical steps are key to increasing the likelihood of success.

    Access To A Board Certified Orthopedic Surgeon

  • In many cases around the world, pet owners do not have access to board-certified veterinary surgeons. These individuals have specialized training in surgery for a minimum of 4 years after graduation from veterinary school. They are an unbelievable resource to the veterinary community but due to geographic location limitations in many cases, these specialized individuals are simply not accessible. That said many general practicing veterinarians have developed the skills and confidence to perform many of these procedures. RETURN TO TOP
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    Recovery From Knee Surgery At Westvet

    The knee is bandaged for the first 2448 hours after surgery to minimize post-operative swelling. Rehabilitation is generally instituted within the first 3 days after surgery to ensure early weight bearing on the limb and improve usage.

    Long-term prognosis is good for patients undergoing surgical stabilization. Complications include:

    • failure of the implant to stabilize the joint adequately
    • breakage of the implant requiring replacement
    • latent meniscal injury
    • progression of arthritis

    The board certified surgeons at WestVet have extensive training and experience with Lateral Suture Stabilization and other procedures used to stabilize the knee.

    Please see your family veterinarian for a referral for a consultation with a WestVet surgeon. If you have questions regarding knee surgery for your dog, feel to contact us at 208.375.1600.

    What Is Acl Surgery For Dogs

    TPLO – The #1 way to fix your dogs ACL (cranial cruciate ligament) tear

    In actuality, dogs dont have an anterior cruciate ligament the way humans do. Dogs have a complementary ligament called a cranial cruciate ligament, or CCL. This joint is very similar to an ACL in humans, so a lot of times theyll be used interchangeably.

    The CCL connects the bone above a dogs knee with the bone below the knee . When its torn, it results in the tibia sliding forward instead of backward like its supposed to. CCL surgery, or ACL surgery, can be performed to repair this ligament. The ligament may heal on its own, but it rarely heals to its full capacity, which could lead to limping, lameness, and further tears later in life.

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    Treatment Options And Procedures

    If a veterinarian determines that surgery is the best option for your dog, there are three main orthopedic operations to repair an ACL tear:

  • Lateral suture. Extracapsular lateral suture stabilization loops a suture through a hole made in the tibia and through the fabella and connects back to the tibia. This anchors the bones together to prevent the plate sliding that occurs in a torn CCL. Most of the time, this surgery is performed on small dogs under 35 pounds and the success rate is about 90%.
  • Tibial plateau leveling osteotomy . A TPLO procedure is the most common of the three surgeries and isnt dependent on your dogs size or breed. During this surgery, your veterinarian will make a curved cut to your dogs tibia and then turn their tibial plateau to level the tibia and femur. Your vet will then connect a metal plate to the knee to help it stabilize during recovery.
  • Tibial tuberosity advancement . If your vet chooses this surgery, they will cut inside the shin bone. They might remove some of the menisci to prevent further injury. A metal TTA plate will be attached to the tibia and a bone graft inserted to promote healing.
  • What Is The Cranial Cruciate Ligament

    There are four main ligaments in the stifle of a dog two outside called the collateral ligaments and two inside the joint called the cruciate ligaments. The cruciate ligament nearest the front of the joint is the cranial cruciate ligament , the equivalent to the anterior cruciate ligament or ACL in a human. The ligament attaches the femur and to the tibia , preventing the tibia from moving forward relative to the femur. It also helps to prevent over-extension and rotation. The caudal cruciate ligament is responsive for the opposing movement, principally stopping backwards movement of the tibial relative to the femur.

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    Surgery Comparison: Mmp Vs Tplo

    MMP surgery for dogs is far less invasive than a Tibial Plateau Leveling Osteotomy procedure. It is also less expensive, quicker to perform, and boasts shorter recovery times.

    However, in terms of fundamental efficacy, both the TPLO and MMP are effective procedures. Depending on the size, breed and age of your dog, an experienced vet could recommend either.

    I Have Heard That Little Dogs Dont Need Surgery

    Tibial Plateau Leveling Osteotomy (TPLO) For Cranial Cruciate Ligament ...

    This is a frequently uttered statement with very little information to support it. The evidence supporting this statement dates back to the 1970s and 80s, when the techniques and expectations of owners and veterinarians alike were very different. Little dogs are not better of without surgery. We are strong proponents of early surgical management using techniques that get optimal outcomes. TPLO is recommended for small dogs of all weight ranges at QVS.

    Some surgeons claim that it is not possible to perform a TPLO on small dogs, or that is is inherently risky. This is fundamentally incorrect. We regularly perform TPLO on dogs 3kgs and up with excellent success and very low complication rates. They rapidly return to normal activity.

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    What Is My Takeaway Message

    Your veterinarian will discuss your dog’s condition and which procedure is best. There is no right or wrong answer when it comes to choosing your pet’s surgery, only what is most likely to achieve the desired outcome.

    Pain management during and after stifle surgery is critical, so be sure to give all medications as prescribed and use them until they are gone. Physical rehabilitation postoperatively will speed healing. Ask your veterinarian about incorporating rehabilitation into your dog’s recovery plan.

    Contributors: Tammy Hunter, DVM Robin Downing, DVM, CVPP, DAAPM

    What Is Included With My Investment For Tplo At Vss

    Our all-inclusive fee provides:


    Before surgery, you and your dog will have a consultation with a VSS board-certified veterinary surgeon, which includes a physical exam, discussion of the causes of a cruciate ligament tear, an explanation of options , a viewing of an animation of the TPLO procedure, and of course, answering any questions from you.

    At the initial consultation, our staff will provide an estimate for pre-operation, the procedure, and post-operation, and also includes all exams, medications , post-op X-rays, and day-of-surgery bloodwork.

    During Surgery

    At VSS, your pets surgery is performed in a sterile, dedicated surgical environment by the same surgeon you meet with during your initial consult. Medications and anesthesia required by your pet during surgery are included, as well as anesthesia monitoring both during surgery and through recovery by a registered veterinary technician who has extensive experience with anesthesia. Your dogs leg will be bandaged and he or she will recover in a bed with supplemental heat.


    The staff at VSS are available for you to call for updates on your pet any time during their stay with us, 24 hours a day, 7 days a week.

    Pain Management

    The surgery fee includes all the medications your pet needs to come home and be comfortable during their recovery. For TPLO patients, we often use long-acting regional anesthesia, which has greatly decreased the need for narcotics.



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    How Much Does Dog Acl Surgery Cost

    Depending on the type of operation, dog ACL surgery ranges from around $1,000 to up to $5,000. Heres how it breaks down:

    Extracapsular Lateral Suture Stabilization $1,100 $2,500
    Tibial Tuberosity Advancement $3,500 $4,500

    These prices will vary depending on the vets office, and may or may not include pre-operation procedures such as bloodwork or postoperative physical therapy. Many surgeries and post-surgical rehabilitation are covered by pet insurance.

    How Does A Torn Cruciate Ligament Cause Knee Pain

    Lateral Suture Recovery

    If your dog has a torn cruciate ligament, pain arises from the knee’s instability and a motion called ‘tibial thrust’.Tibial thrust is a sliding movement caused by the transmission of weight up the dog’s shin bone and across the knee, causing the shinbone to thrust forward in relation to the dog’s thigh bone. This forward thrust movement occurs because the top of your dog’s tibia is sloped, and your pet’s injured cruciate isn’t able to prevent the unwanted movement from occurring.

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    What Is The Cost Of Dog Acl Or Dog Cruciate Surgery

    This particular technique for fixing a torn ACL in dogs is considered the most conservative of all the approaches. The most important thing is that it addresses the main problem with the dogs ACL injury, it stabilizes the joint. Depending on who does the surgery, meaning a board-certified orthopedic surgeon vs. a general veterinarian who has experience with this surgery, the cost can vary significantly. The cost of dog ACL surgery is also to some degree dependent on geographic location. From TopDogs research, this surgery for dog ACL tear can cost anywhere from $1100-2,500. Again it all depends on the region and who is performing the surgery. By far this is still the most cost-effective surgery to repair dog ACL injuries. RETURN TO TOP

    Evaluating The Success Rates Of Dog Knee Surgery

    Statistically speaking the safest type of dog knee surgery is TPLO or TIghtrope if you can afford these options and find an experienced veterinarian to perform the surgery.

    As the owner the importance of keeping the incision point clean and free from infection cannot be underestimated. Furthermore, many surgeries may be prevented by keeping your dogs joints healthy to begin with, and certainly maintaining healthy joints after surgery will help to ensure the success rate of the surgery.

    If you cannot afford or find a doctor who can perform TPLO or tightrope surgery, then traditional Extracapsular Repair is an option, but be prepared to have to re-do the surgery every few years, potentially.

    Yes, most dog knee surgeries can be successful, but the success rate will depend not only on the skill of the dog, but how actively the owner is involved with post operative care, and the ongoing preservation of the knee joint in their dog.

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    Is Your Dog Calm Or Active

  • You may ask yourself why this should be part of the consideration when choosing the right surgery for your dog. The reasoning is this. Surgery is only one part of the equation. What you do after surgery, in many cases, is even more important than the surgery itself. If you have a very active dog who is difficult to control then you have to consider this concept. Would it be better to have your dog compromise a less invasive surgery or a more invasive surgery? A less invasive one. When it comes to the TPLO or TTA surgery, both of these surgeries involve bone cutting and implanting metal plating. If your dog compromised one of the plates then the implications are more significant. On the other hand, if your dog had the lateral suture surgery to stabile the torn ACL then if the dog breaks the implanted suture it is fairly simple to just replace the suture. Again it is best to discuss all of these considerations with your trusted veterinarian.
  • Cranial Cruciate Ligament Rupture: Causes And Risk Factors

    Tibial Plateau Leveling Osteotomy (TPLO) For Cranial Cruciate Ligament ...

    The CCL provides valuable stabilization for the stifle or knee, serving a number of distinct purposes. It prevents stifle hyperextension, limits internal rotation, and prevents the tibia from sliding cranially during weight-bearing.

    Cranial cruciate ligament rupture is one of the most common orthopedic injuries in dogs. Some cases occur acutely, due to trauma caused by a fall, hit-by-car injury, or other high-force injuries. However, most CCL ruptures are caused by slow, gradual degeneration of the ligament. In many cases, a CCL injury begins as a partial tear, progressing to a full-thickness CCL tear over time.

    Cranial cruciate ligament injuries are most likely to occur in older, large breed dogs. Spayed or neutered dogs are thought to be at higher risk of this condition. Cranial cruciate ligament rupture is also associated with obesity, poor physical condition, genetic influences, and conformation.

    Certain breeds are predisposed, including Rottweilers, Newfoundlands, Staffordshire Terriers, Mastiffs, Akitas, Saint Bernards, Labrador Retrievers, and Chesapeake Bay Retrievers.

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