ACL Repair

Repair of Ruptured Cranial Cruciate Ligament (ACL) by TightRope Ligament Replacement

Just as in the human knee, the most critical stabilizing structure in the canine knee is the cranial cruciate ligament (CCL). The primary function of the CCL is to prevent forward thrusting motion and inward rotation of the tibia during weight bearing, and to prevent hyperextension of the knee.

When the CCL is ruptured or partially torn, the abnormal, forward thrusting motion and inward rotation of the tibia during weight bearing results in an unstable, painful knee and ultimately, in debilitating, degenerative arthritic changes in the knee joint.

The newest procedure for repairing a ruptured CCL by ligament replacement is the TightRope Ligament technique. This procedure has been developed by James L. Cook, DVM, Ph.D., Diplomat of the College of Veterinary Surgeons. This procedure has been proven in more than 200 knees and has been shown to be highly effective.

The TightRope CCL technique is minimally invasive and more cost-effective in comparison to the TPLO or TTA. The data suggest that TightRope can be successfully performed in medium, large and giant breed dogs resulting in outcomes that are comparable or better than TPLO or TTA. A MiniTightRope is also available for toy and small breeds.

The TightRope CCL counteracts the forward tibial thrust and inward rotation resulting from CCL damage while providing an optimal joint range of motion.

This procedure mimics the natural cruciate ligament functions, perhaps better than any other procedure developed to date.

The TightRope Ligament is produced by Arthrex Vet Systems. It is an ultra-high strength, flat, smooth, braided, ribbon-like ligament composed of a multi-stranded long chain ultra-high molecular weight polyethylene (UHMWPE) core with a braided jacket of polyester giving it unsurpassed strength, virtually eliminating ligament breakage. The ligament provides an ultimate load of 225 lbs, approximately three times the strength of 80# nylon ligaments currently in use for CCL replacement. This procedure provides our clients another option when a less invasive, less radical and somewhat more cost-effective procedure that does not cut bone is desired by the pet owner.

Tibial Tuberosity Advancement (TTA) Procedure

Another commonly performed surgical procedure to treat cranial cruciate ligament rupture in the knee joints of dogs is tibial tuberosity advancement or TTA. The objective of TTA is to make the tibial plateau perpendicular to the patellar tendon in order to prevent the shin bone from moving forwards. It involves cutting the top of the shin bone, moving it forward, and stabilizing it in its new position through the use of slender, titanium implants. Following this procedure, the knee feels stable for the dog when weight-bearing despite the fact that the ligament has been ruptured and not directly repaired.

TTA surgery is only performed in dogs when the benefits of the surgery outweigh the risks, and when alternative treatments are less successful. It is most effective for dogs weighing more than 50 pounds. The best candidates for TTA surgery are young dogs with rupture of both of their ligaments that have persistent lameness and stifle joint instability.

It is better suited for young, athletic, larger dogs because the goal is to prevent the progression of arthritis when compared with other procedures. Some results have shown that TTA-treated dogs showed a faster recovery than those who undergo other procedures. It is not uncommon for dogs to begin to use the leg within 5 to 7 days after surgery, and postoperative weight-bearing is not unusual within the first 24 hours after surgery. It has also been noted that athletic dogs perform close to their pre-injury status during hunting and field trials and such following TTA treatment, which is not usually the case with other techniques.