The first step to take if your dog is diagnosed with 2 torn knee ligaments would be restriction. When I say restriction, I mean putting the dog in some sort of crate or pen that will drastically restrict movement. You don’t want the dog to have room to run and jump as sad as that is to say. While confined, icing the dogs knees can help reduce swelling and inflammation – if your dog will actually let you apply ice.

As the dog is confined, you’ll be left with some more questions to answer – Should we have both knees repaired at the same time, or should we do one, let it recover completely and then do the other. And then the next obvious question that comes after that is, can we afford it? I’ll address these questions together because they can tie directly into one another. We’ll look at these questions considering 2 cases. Case 1 – We get both knees operated on at the same time, and, Case 2 – We get one knee operated on, then wait for it to heal and then get the second knee operated on.

Option 1 – Repair both CCLs at the same time
I’m calling this option 1 because I think that this option will be the all around best option for both the dog and the owner(s). In terms of time commitment, this option will require less time because the knees will be recovering together, rather than waiting for one to recover, then waiting for the other. This option, though drastic, will be less harsh on the dog. With this option, the dog will only be required to be confined for 2-5 months (depending on the type of surgery, the veterinarians recommendations, etc.). This will essentially equate to half of the time as the other option. And the final reason that I think this is the better option is that there is greater potential for savings. If both knees are operated on at the same time, chance are you’ll be able to talk your vet into doing 2 for 1, or at least the second at a 50% discount.

Option 2 – Repair one knee at a time
With this option, you’ll be looking at strict confinement not just once, but twice. This was one of the hardest things when our dog had her knee surgery. There are many things that could come into play when deciding which option is best, age, activity level, attitude, etc, but if you have an active dog, I think that repairing one knee at a time would be absolute torture because it would lengthen the amount of time that the dog is penned up in a confined space. Though the possibility is there, I don’t believe the potential for savings is quite as large in this instance, because by spreading the surgeries out by 3-5 months, you’re in essence taking your dog back for an entirely separate surgery, and the veterinarian will probably want to bill you as such. It’s always worth trying to negotiate the price down a bit, but I would anticipate that the vet would be less willing to cut the price in this instance.

As terrible as this situation would be, it does happen, so I hope that this information helps in making decisions about how to treat a dog who does encounter a dual CCL rupture.

Related posts:

1. Cruciate Ligament in Dogs, Canine Cranial Cruciate Ligament (Crucial)
2. Dog Knee Surgery Costs – Cost of Repairing a Torn Dog Knee Ligament
3. Cost of TTA Surgery for Cranial Cruciate Ligament – Cost of Knee Surgery for Dogs

My first thought was that there was simply a misunderstanding between the patient and the veterinarian. External would imply that there wouldn’t be need for surgery, possibly just a brace or stabilizer that would be worn by the dog. After doing a little bit more research, I am pretty sure that this person meant Extracapsular rather than External Capsular. If that is the case, then that opens up the door for the very common Extracapsular Imbrication surgery (also known as the Lateral Fabellar Technique).

The extracapsular imbrication (fixation) happens to be the type of surgery that we went with for our dog. At the time that we got the surgery, it was the least invasive procedure. The surgery itself requires an incision in the leg that is a few inches long, but when compared to TPLO or TTA, it is far less invasive in that it doesn’t require any cutting of the bone. Since the time that our dog had her surgery, there has been some advancements in CCL surgeries and there is a new technique available called Tightrope Surgery that was developed by veterinarians at the University of Missouri and it actually mimics some of the procedures that are performed in human ankles. It is still a relatively new procedure, so it may not be widely available yet, but it is said to have great benefits.

If you happened to find this page while searching for External Capsular Fixation, and there actually is a procedure other than what I mentioned above, I’d love to hear about it. Please leave a comment below.

Related posts:

1. Lateral Fabellar Technique (Extracapsular Technique) – Cranial Cruciate Ligament Repair
2. Cost of Dog Knee Surgery – Are There Options to Reduce the Cost?
3. Tightrope Surgery in the Treatment of a Dogs Torn Cranial Cruciate Ligament

Technique Used in Human Ankle Injuries Modified to Treat Dogs’ Knees

MU veterinary clinician-scientist develops a minimally invasive method to treat torn ligaments

June 16, 2008

COLUMBIA, Mo. – A common sports injury in human knees is even more common in dogs. Each year, more than one million dogs suffer from cranial cruciate ligament (CCL) deficiency, which is comparable to the anterior cruciate ligament (ACL) injury in humans. The common method of treatment by many veterinary surgeons involves cutting the tibia bone to stabilize the CCL-deficient knee in these dogs. Now, a new minimally invasive technique with less severe complications than previous methods has been developed by a University of Missouri College of Veterinary Medicine researcher.

Unlike humans, CCL injuries in dogs typically do not occur because of a single trauma to the knee but are the result of a degenerative process that leads to early and progressive arthritis. For this reason, and the unique biomechanics of the canine knee, techniques used to repair the injury in humans do not work well for dogs.  The new technique, known as Tightrope CCL, is modified from a technique used in human ankles and allows placement of a device that stabilizes the CCL-deficient knee through bone tunnels drilled using very small incisions. MU veterinarian James Cook worked with Arthrex Inc. from Naples, Fla., to develop and test the Tightrope device for dogs.

“Other current techniques require major surgery that involve cutting the bone, which can potentially lead to severe complications, such as fracture, implant failure and damage to the joint,” said Cook, professor of veterinary medicine and surgery and the William C. Allen Endowed  Professor for Orthopedic Research. “This new technique is minimally invasive, relatively easy to perform and cost effective compared to other techniques. The dogs in the preliminary trial study experienced fewer and less severe complications with outcomes that were equal to or better than those seen with the bone-cutting technique.”

Cruciate ligament tears are five times more common in dogs than humans and cost U.S. pet-owners more than $1.3 billion each year. The new technique is not for every dog. Because surgeons must be able to drill tunnels in the bone, dogs must weigh at least 40 pounds for the Tightrope CCL method to be feasible.  In addition, dogs that cannot follow a physical rehabilitation protocol after surgery and dogs with limb deformities are not candidates for this technique. The 10- to 12-week rehabilitation period is very important for any surgical technique for CCL deficiency in order to optimize successful return to pain-free function and reduce complications, Cook said.

“The times the Tightrope CCL technique has failed are when owners did not give their dogs the full rehabilitation period and let their dogs run, play or traumatize the joint before the knees were ready,” Cook said. “A successful operation is dependent on postoperative care so that the dog can heal well and build muscle for long term function. The Tightrope CCL technique is designed to allow this to happen with less surgery and less risk of a major problem arising, and so far, it has been successful.”

The original article can be viewed here.

If any of you readers have had any experience with tightrope surgery, we’d love to hear about it in the comments. It’s still a relatively new procedure, so there really isn’t too much information available on it yet, and there seem to be even fewer stories from our readers (unfortunately). As I learn and hear more from our users, I’ll add new posts and updates about the applications of tightrope surgery, the costs of tightrope surgery and the recovery and rehab procedure involved with tightrope surgeries.

Related posts:

1. Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)
2. Diagnosing a Torn/Ruptured Cranial Cruciate Ligament in Dogs
3. Cost of TPLO Surgery – Cost to Repair Torn Cruciate Ligament in Dogs

Whichever surgical option you choose to go with, make sure that as the dog owner, you do your due diligence to learn which option will be the best for your particular circumstances.

• Read as much information as you can on each type of surgery, and try to talk with people who have had the same surgery. Compare your dogs activity level with the others.
• Consult your veterinarian and make sure you fully understand the options available. Ask why (why not) he/she is recommending certain options and not others.
• Be prepared to keep your dog confined. Activity levels need to be drastically cut down, and as we all know, Labrador Retrievers are generally very active dogs. Keeping the dog inactive will be crucial to the recovery process.

Image by OakleyOriginals.

Related posts:

1. Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)
2. TPLO vs. TTA vs. Lateral Fabellar Traditional Technique – Cranial Cruciate Ligament Repair
3. Cost of Dog Knee Surgery – Are There Options to Reduce the Cost?

The necessity of the cranial crucial ligament (CCL) can be compared to the necessity of the anterior cruciate ligament (ACL) that is found in humans. While there are people who have bypassed having surgery with a torn ACL, their knees are typically less stable for the remainder of their lives and their activity has to be severly limited. The same holds true for canines – should a torn or ruptured CCL be left untreated, the dog will survive, but may display lameness in the limb with the torn ligament, and the dogs activity level will not be the same as that of what it was prior to damaging the ligament.

Related posts:

1. Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)
2. Tightrope Surgery in the Treatment of a Dogs Torn Cranial Cruciate Ligament
3. Diagnosing a Torn/Ruptured Cranial Cruciate Ligament in Dogs

In a Lateral Fabellar (Extracapsular) procedure, heavy suture material (monofilament nylon cord) is passed from the lateral fabella to the tibial crest in order to eliminate joint instability (drawer movement). It is this nylon cord that will act as the CCL ligament in the future by holding the joint together and keeping it stable.

The lateral fabellar surgery will not stop the progression of arthritis that is already present in the joint. Your dog may have some stiffness of the limb and may have some lameness after heavy exercise.  Chondroitin sulfate and glucosamine may be given to help with stiffness.

Typical downtime and rehab:

• First 2 weeks, dog should be crated and only let out on a leash to go to the bathroom.
• After about 2 months, lameness should decrease significantly, but it was recommended by our veterinarian to keep our dog crated still.
• After 3 months, our dog had regained full use of her leg.

Related posts:

1. TPLO vs. TTA vs. Lateral Fabellar Traditional Technique – Cranial Cruciate Ligament Repair
2. TPLO – Tibial Plateau Leveling Osteotomy – Cranial Cruciate Ligament Repair
3. External Capsular Fixation (Extracapsular Imbrication) Knee Surgery

The cost to repair the CCL in a dog (equivalent of an ACL in humans), will fluctuate based on the state that you live in, the experience of the surgeon, the weight of the dog, the invasiveness & complication level of the surgery, etc.

Through my experience, and from talking to a few of my friends whose dogs had cranial cruciate ligament repair surgeries, I believe that you should expect to spend somewhere in the range of $1,500. You may end up paying a little more or less depending on the above criteria, but go in expecting somewhere around $1,500.

Don’t forget about the “hidden” costs of a cranial cruciate ligament repair surgery.

Related posts:

1. Cost of TPLO Surgery – Cost to Repair Torn Cruciate Ligament in Dogs
2. Tightrope Surgery in the Treatment of a Dogs Torn Cranial Cruciate Ligament
3. Hidden Costs and Unexpected Costs of Cranial Cruciate Ligament Repair in Dogs

TTA is said to be a newer, less invasive procedure with a quicker recovery time, so if you have a highly active dog, this option may be better for you and your dog should you be able to find an orthopedic surgeon who is willing to perform this technique.

Related posts:

1. Lateral Fabellar Technique (Extracapsular Technique) – Cranial Cruciate Ligament Repair
2. TPLO – Tibial Plateau Leveling Osteotomy – Cranial Cruciate Ligament Repair
3. Surgical Options for Torn/Ruptured Cranial Cruciate Ligament (Cranial Crucial Ligament)

Cranial Cruciate Ligament (CCL) Surgery Options

• Traditional Repair – Lateral Fabellar Technique
  This technique is typically recommended for smaller dogs (we went with this option on our 60lb pit bull). With this technique, a monofilament nylon cord of about 80-100lb tensile strength is passed from the lateral fabella to the tibial crest, in what was explained to me as a figure 8 pattern, basically wrapping the knee joint to eliminate and prevent joint instability (drawer movement). Scar tissue will, over time, develop around the joint, which will further stabilize the joint, but will also begin to restrict range of motion.
• Tibial Plateau Leveling Osteotomy (TPLO)
  The TPLO CCL repair technique is generally recommended for larger breeds of dogs, as well as active dogs, such as agility dogs. This technique is also thought to cause less degenerative arthritis around the stifle joing. Key things to note about the TPLO surgery are a quicker recovery time, better range of motion, less arthritis and a return to athletic (working) activity levels. TPLO surgery involves cutting the bone and slightly rotating it before re-attaching it with a plate. By rotating the top of the bone, less pressure is put on the joint.
• Tibial Tuberosity Advancement (TTA)
  This is a new, less invasive option to the TPLO surgery, but will not be an option for all dogs. Since this surgical option is less invasive, it allows for a quicker recovery time. TTA also puts a cut in the tibial bone, however it shaves off the front of the bone and extends it with a spacer. Also like the TPLO surgery, the TTA option depends on the angle of the stifle joint and is not recommended for dogs with a steep angle in the stifle.
• Tightrope Surgery (Tight Rope Surgery) (Updated June, 2009)
  Tightrope surgery is a very new procedure that is based on a similar procedure performed in human ankles. It is far less invasive and is performed through small incisions in the skin, and woven through small holes drilled in the bones of the stifle joint. Tightrope surgery is an arthroscopic procedure and thus far seems to have very positive results.

As you can probably tell, each option has advantages and disadvantages, and all options should be discussed with your veterinarian after x-rays are taken of your dogs knee joint.

Related posts:

1. Cruciate Ligament in Dogs, Canine Cranial Cruciate Ligament (Crucial)
2. TPLO vs. TTA vs. Lateral Fabellar Traditional Technique – Cranial Cruciate Ligament Repair
3. Tightrope Surgery in the Treatment of a Dogs Torn Cranial Cruciate Ligament

In a TPLO procedure, the tibial plateau, the portion of the tibia adjoining the stifle (knee), is cut and rotated so that its slope changes to approximately 5 degrees from the horizontal plane, forever changing the biomechanics of the dogs movement. This prevents the femur from sliding down the slope of the plateau. It is rumored that TPLO surgery generally results in faster recovery times compared to other procedures to stabilize the knee joint. Most dogs (over 90%) are expected to regain a very active and athletic lifestyle with no post-operative complications and without the need for any pain relieving medication.

Related posts:

1. TPLO vs. TTA vs. Lateral Fabellar Traditional Technique – Cranial Cruciate Ligament Repair
2. Cost of TPLO Surgery – Cost to Repair Torn Cruciate Ligament in Dogs
3. Lateral Fabellar Technique (Extracapsular Technique) – Cranial Cruciate Ligament Repair