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

Cranial Cruciare Ligament Repair: TightRope Technique

The Tightrope technique is a modification of the fabello-tibial suture techniques ( MRIT). Essentially, a polyblend type suture composed of braided ultra-high molecular weight polyethylene polyester (FiberTape, Arthrex Inc., Naples, Fla.) is used in place of monofilament nylon and is anchored to the femur and tibia with suture buttons.

The advantage of this technique is that the suture material is anchored at more isometric points, thus allowing for more normal range of motion while maintaining stifle stability.

The disadvantage of this technique is that the use of a large braided suture substantially increases the risk of serious infection.

Surgical Technique. As with all surgical techniques for stabilization of the cranial cruciate-deficient stifle, the joint is explored and meniscal injury is treated if present. The joint capsule is closed with an absorbable synthetic suture in a simple interrupted pattern.

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

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

A guide wire is placed in position first for both bone tunnels to assure correct placement. A cannulated drill bit is then driven over the guide wire to make the tunnel.

The double stranded suture and proximal button are then threaded from distal to proximal via a pre-attached straight guide needle. Once the suture and proximal button have passed through both bone tunnels, the needle is removed and the suture is pulled taught to seat the proximal button squarely against the medial femur. The distal button is then placed against the medial tibia and the suture material is first tensioned with a mechanical suture tensioner and then tied.

Aftercare:

The limb is not bandaged or splinted postoperatively. Only very restricted exercise is allowed for 8 weeks, followed by a gradual increase of activity during the following 4 weeks. Most animals will be partially weight bearing within the first week and walking comfortably with only a slight limp at 3 to 4 weeks. 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.