Cranial Cruciate Ligament Repair: TightRope

In most cases, surgical stabilization of the knee joint is necessary, particularly for larger or more active dogs.

Surgery is generally recommended as soon as possible to minimize permanent joint damage and relieve pain.

• Various surgical techniques exist for repairing CCL injuries, each with its own advantages and considerations.

• Your veterinarian will guide you in selecting the most appropriate surgical option based on your pet's size, activity level, and overall health.

Other common surgical techniques for CCL repair include:

1. Tibial Plateau Leveling Osteotomy (TPLO)

2. Tibial Tuberosity Advancement (TTA)

3. Extracapsular Lateral Suture Stabilization (MRIT/LSS

"Either traditional MRIT or the TightRope® procedure is considered adequate for most small- to medium-sized dogs."

What is the TightRope® Technique?

The TightRope® technique is a modification of the fabello-tibial suture techniques (MRIT). Instead of using monofilament nylon, this method employs a polyblend suture composed of braided ultra-high molecular weight polyethylene polyester (FiberTape, Arthrex Inc., Naples, Fla.), which is anchored to the femur and tibia using suture buttons.

Advantages and Disadvantages of the TightRope® Technique

Advantages:

• The suture material is anchored at more isometric points, allowing for a more natural range of motion while maintaining stifle stability.

• Provides superior stabilization compared to traditional extracapsular techniques.

• Minimally invasive compared to osteotomy-based techniques.

Disadvantages:

• The use of a large, braided suture significantly increases the risk of serious infection.

• Requires precise surgical technique and specialized equipment.

Surgical TightRope® Technique

As with all surgical techniques for stabilizing a CCL-deficient stifle, the joint is explored, and any meniscal injury is treated if present. The joint capsule is then closed with an absorbable synthetic suture in a simple interrupted pattern.

1. A femoral tunnel is drilled craniomedially from just distal to the lateral fabella-femoral condyle junction to the distal diaphysis, just cranial to the patella.

2. The tibial tunnel originates at the caudal aspect of the tibial extensor groove and exits medially at the insertion of the caudal sartorius muscle.

3. A guide wire is placed first for both bone tunnels to ensure proper placement.

4. A cannulated drill bit is used over the guide wire to create the tunnel.

5. The double-stranded suture and proximal button are threaded from distal to proximal using a pre-attached straight guide needle.

6. Once the suture and proximal button pass through both bone tunnels, the needle is removed, and the suture is pulled taut to seat the proximal button against the medial femur.

7. The distal button is placed against the medial tibia, and the suture is tensioned with a mechanical suture tensioner before being tied.

Expected Recovery Period

• 2 weeks post-surgery: Your pet should begin placing weight on the limb.

• 8 weeks post-surgery: Lameness should be mild to moderate.

• 4-6 months post-surgery: Most dogs regain full mobility and resume normal activities.

Postoperative Care

• Strict exercise restriction is necessary for the first 8 weeks, with a gradual return to normal activity.

• Follow-up veterinary visits will ensure proper healing and rehabilitation.

• Pain management, joint supplements, and physical therapy may be recommended to support long-term joint health.

Prognosis

• The TightRope® procedure has shown excellent success rates in restoring knee function and reducing pain.

• With proper rehabilitation, the majority of dogs experience significant improvement in mobility.

• Some degree of arthritis may still develop, but joint supplements and anti-inflammatory medications can help manage symptoms.