**UPDATE 2/2011 - The information below regarding UPenn Veterinary’s stance on TPLO surgeries is no longer correct. UPenn is, in fact, performing TPLOs on dogs. I will keep up the link to the article below discussing their previous stance toward TPLO so that people may have access to all of the information. Everything else in this post regarding the way the extracapsular repair surgery for dogs is performed remains correct and up to date.
In the extracapsular imbrication, also known as the traditional method and lateral fabellar surgery, your dog will have a strong leader line placed within the knee to provide stabilization. Some veterinarians will only perform this procedure on small dogs and cats, while others will use the technique on dogs of all sizes. There is no definitive study evidence showing that tibial plateau leveling osteotomy, or TPLO, is superior to the extracapsular method in large dogs, in fact, the University of Pennsylvania, one of the nation’s leading veterinary hospitals, will not perform the TPLO procedure as the cost/risk risks do not outweigh the benefits. For more information see the article here – University of Pennsylvania Veterinary Hospital – TPLO Surgery
During the extracapsular imbrication a large, non-absorbable suture is placed in a figure eight pattern within the structure of the knee. The leader line is placed around the lateral fabella through a hole in the tibial crest, mimicking the course of the CCL and preventing forward movement of the tibia, also known as the clinical drawer sign. The monofilament nylon leader line has a range of tensile strengths, and depending on the size of your dog, your veterinary surgeon will select a size between 40-100 pounds. Over time scar tissue will develop on the side of the knee joint where the large suture was placed, providing stifle stability in the absence of the canine cruciate ligament.
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I am unable to link to the pen state article referred to above.
Thanks for pointing that out Paul – it looks like UPenn Vet has taken down the article; I re-linked it to another location.
My 8 yo Brittany has a partial CCL tear from an injury incurred 6 months ago. She weighs 38 pounds. Conservative management seemed to do the trick initially, and we were still restricting her walks to leash-only at 3 months when she re-injured it. She has again been diagnosed with partial tear and positive drawer test and we feel we should do surgery.
TPLO is always regarding large dogs on this site, so I’m thinking it’s overkill for a 38-pound dog. My preference is to go with extracapsular repair, given the lower risk for complications, less invasive procedure, and lower cost. However, the TPLO vets we’ve seen are adamant that their method is better. Has anyone had enlightening advice from a vet on choosing a method for a 38 pound high strung dog?
Thanks!
Here’s an update on my Brittany, in case it helps others making these hard decisions. We opted for the extracapsular repair once we found a very experienced vet who was confident it would suit our dog well, given her size and age. This vet came well recommended by other vets. It’s now been 2 years since surgery and we couldn’t be happier. The dog runs, jumps and ignores “whoa” as well as ever! She sits with her surgery leg sticking out, but otherwise uses it very well, evidenced by the good muscle tone. We see an occasional stiffness after an especially active hike, for which she gets 1/2 Rimadyl for a couple days. That’s all. She’s very happy.
Our 10-year old Springer (43#) completely tore his CCL and had the same surgery 2 weeks ago, without hesitation. We know what we’re in for with recovery this time; restricting activity isn’t easy with dogs bred for field work, even at the age of 10. They just don’t know what SLOW means. It’s something owners should be prepared for, like reading all they can to reduce the surprises.
For the Brittany, we were adamant about using a leash, enforcing the “walk”, no stairs or jumping, etc. until the vet released us; our goal was to build up muscle tone in the fixed leg, to avoid over-burdening the good leg. It took 6+ months on leash. We feel this really helped prevent that too-common injury of the “other leg”.
Good luck to all!
Hi Hogan,
I have a six year old male Springer 47#s that has been diagnoses with a 3/4 CCL tear. I rested him for two months and the joint has stabilized but shows some signs of arthritis on the xray and demonstrates positive drawer. I am happy to hear that you have good success with the extracapular repair. Am I correct that you also rested your Brittany for three months and then she reinjured the knee? As I am going through the same decision process please tell me why you elected to rest after the first injury and not go right to the surgical procedure.
Thanks.
George and Gus
Just read your post and it sounds like we are going down that same path. We are presently trying conservative management but just in case I am checking into surgery options and it seems as if I am leaning towards the extracapsular repair too. Any advice for me? We live in NJ. Thanks
I have experienced this situation with a couple of my own dogs. My 1st Rottweiler had both knees done with this surgery and she was 14 when she died of old age. I noticed no problems with her knee surgeries. I have a new 18 month old Rottwieler with one knee done using this procedure. We are scheduling her 2nd knee later this week. My vet said he would not advise using it on our English Mastiff but we have good experience with our very active Rottwielers. The cost is about 1/3 of a TTA or TPLO in the Central, Ohio area.
My rotty had the Extracapsular Repair 4 months ago he is 2 years old. Recently he was showing signs of limping again, i took him to vets and he said maybe to re-operate. I took him in but the vet did not peform the operation. He said he is showing signs that he has the drawer method but also has alot of fibrosis (fluid) on the knee. SO he is under complete rest for 3 weeks when the vet wants to re-asses him. Cant believe we may have to do this on same leg again only 4 mon ths in.
The link doesn’t doesn’t say anything about U of Penn not doing TPLOs.
Hi Cartman –
This can be found about half way down the page – “Many respected academic veterinary experts believe that TPLO offers a faster and fuller return of function. But published proof of that theory is lacking, prompting some to avoid the procedure. For instance, surgeons don’t perform it at the University of Pennsylvania School of Veterinary Medicine, says Gail Smith, chairman of the department of clinical research. He calls TPLO “a fashionable procedure.”"
That article, however, is from 2006 – so they may have changed their tune since then and started doing TPLOs. I’ll do some research to find out and post an update on what I find.
This article in not up-to-date. I recently had an orthopedic consultation with a surgical resident at the U Penn Ryan Vet Hospital in Philadelphia. My dog’s surgical recommendations included both the lateral suture technique and TPLO.
Hi Jackie,
You’re correct – as you can see above, I wrote this article in 2008. Things have definitely changed in the field of veterinary surgery since then. Thanks so much for updating us with your experience at UPenn. I will adjust the beginning of the post to let people know this is an “aged” post, so to treat it more as historical information.
Thanks again!
hi my boy had the surgery yet again and had a little cartlage tear this time too. My vet did escaoular again and all is well at minute, we are 6 weeks in post op so fingers crossed this one will work
Update, my 3 year old Rotty is still doing very well with both her Extracapsular stabilization knee surgeries. Her energy level is amazing and she runs everywhere. She does have a barely noticable stiff legged style to her knees when she runs. Not sure if that is genetic but I assume it is a result of the surgery. The alternative woudl have cost 3x and I have no guarantee it would be better. I am told she is at the high end for size of dog (90#) that this surgey would be successful for.
We adopted a mutt from a local shelter with a completely torn ccl in her left leg and a partly torn in her right. The left leg had the traditional surgery 10/6/2010 and is all healed up. About 1 and a half months in healing she completely tore the right. Wanting to do surgery right away is what we did. So 1/12/2011 she had her second leg done. But this leg had a lot more arthritis and a small cartilage tear as well. This leg is not healing as quickly. He started the under water treadmill at physical therapy and after her second visit- limping and holding her leg up has started. Now we are two weeks out on complete bed rest to try and rest knee. Has anyone else had this set back?? If so what happened- surgery? Or healed on own win rest???
You noticed an acute lameness on the right leg, but in reality there was chronic instability which is why there was so much arthritis present already. Also having to remove the torn meniscus (which I hope they did) means she had to create a fibrous cushion for the bone to set on which is not as ideal (but better than a tear).
To know if surgery is needed or not depends on what your veterinarian is finding on the exam. If the knee is unstable and this is a large dog, then you either need to have the lateral suture repeated (and/or they may need to look for cartilage pieces left behind) or you need to consider another type of repair. HOwever the knee will never likely be as good as the other b/c you can’t reverse the arthritis.
My 12 dog had this surgery last Feb. & began having problems a few mths later. It had been found through x-rays that his cartilage is almost gone & this is one of the possible complications from this surgery. He will now be lame for the rest of his life.
My 10 yr old dog Bentley just has Extracapsular Imbrication surgery 12 days ago. Until Sun he was going for short walks on the leash and putting weight on the injured leg. As of Sun he developed a redness at the incision and has started pulling it up and not using it. We took him to the vet today and they put him back on antibiotics again-he didn’t have a temp but it is very swolen. We are also doing hot compresses 3 times a day before the Dr. rechecks him on Wed. Does anyone know why an infection would set in after he was doing so well. Could it of been over use too soon after surgery??? Any comments would be appreciated.
Vikki, infection is one of the possible side effects of surgery. The after surgery antibiotics are usually enough to keep infection away, but not always I guess.
My 12 lb Maltese/poodle just had his surgery redone in April by a different surgeon & is doing well. He has a minor limp & stiffness after resting, but he’s getting aound good. Different materials were used for this repair as the other surgery had failed. His patella was also repaired this time. I can’t stress enough how important a good qualified surgeon is when having this surgery or any surgery done.
Thanks Sue for your response. Maybe since Bentley is a bigger dog he needs additional. We are going to Dr again tomorrow-the leg is still swolen and so the Dr will recheck and then do the laser therapy (possibly for the infection) we have used lazer therapy since the surgery to get the leg stronger but we’ll see. I feel like our Dr. is well qualified and I hope it all works out for Bentley. I feel bad and like I may have let him move around too much after surgery. We’ll know more tomorrow.
Thanks again for commenting!
My 9 year old mixed breed has a torn acl and I am considering Extracapsular stabilization method.. I’ve seen 2 vets for their opinions where one vet recommends after a few days rest that the dog become active and the other vet recommends 8 weeks of restrictive activity in order for scar tissue to form… i feel that both vets are good but not sure who is correct about post op treatment. any advise
Our dog has now had extracapsular surgery on BOTH back legs..The first two years ago and the other 6 months ago..she is nine years old too..and is doing fine..we took her to an orthopedic surgeon who was wonderful at the red bank animal hospital in nj..for the first two weeks she just went out to go to the bathroom..she didn’t put her foot down until after that time so when she slowly walked around the house it was on three feet..after that we started slow leash walks building up each day in length..if she hiked her leg up it meant that she went too far..and we would cut back..for three months or so she had no off leash activity and we carried her up and down the steps which was difficult but we somehow managed..it was all worth it because she can now run if she chooses…she does have arthritis in both back legs and i give her glucosamine and chondroitin tablets that really seem to work..especially in the winter months..well good luck and don’t rush activity..
Once we took Bentley home the day after surgery they told us to have him up every hour to avoid that leg getting stiff. I did every two hours and it was hard on him. My biggest concern was him putting too much pressure on the other leg and it going out. I think I over did it with Bentley and should of restricted him more than we did within the first two weeks. One note of caution is the staph infection that Bentley got post surgery-be sure your dog does not lick the wound and be prepared to use the cone around the head if you have any concerns that your dog will tend to lick the wound. We are not sure if the staph infection came as a result of the surgery or if it in deed was from him licking it. One thing for sure is that the staph infection was a much bigger deal than the surgery itself.
Hope this is helpful.
Your information is encouraging although I can’t imagine Bentley going through another surgery. It seemed as if he was in a lot of pain but that was nothing compared to the staff infection that he got. It has only been 1 month since the surgery and he is still holding the left leg up and only putting it down here and there. We may opt for some more laser therapy since he is not a swimmer and will not let us give him that kind of therapy.
Thanks so much for commenting-it is really a great help to get information from others.
My 4 1/2 year old Rottie about 125 lbs has been diagnosed with this problem also last December. We put off surgery to get her lose weight she has dropped only 10 pounds but its a start. Well her left leg has gotten worse in the past week. I’ve been doing so much reading and trying to figure out the best procedure to pick that I think im just confusing myself. Ive been to 3 different vets and all 3 want to do 3 different procedures. Im so confused but I want whats best for my dog. She is now completley confined to downstairs and we even carried her queesn size mattress down stairs also. YES she has her own bed..She is our kid and we want whats best for her..Any help or advice would be appreciated…Thank you
I wish I could tell you that everything worked out okay for our dog but Bentley had his surgery on June 15th, 2011 developed a MRSA infection-recovered or so we though and then out of no where, died on August 19. We are devastated-if I had it to do over again I would of done a natural method of therapy-conservative management I think they call it. This surgery was really tough on our dog but he was 9 1/2 yrs old so I don’t know what would be the best for your dog. We are unsure why our dog died, we decided not to do an autopsy so we will never know-we knew knowing wouldn’t bring him back so this is what we are dealing with.
Vikki,
My vet wants to do the TTA & now he has raised his price since december that is now making it a difficult decision. He want $2700 per knee & therapy would be another $500 for 5 weeks twice a week. I can not believe how they feel they can charge like that knowing people will break there own bank to pay for there pets.
Im so sorry to hear of your loss.
Our fees for Bentley’s surgery were $750.00 which included medication right after the surgery and (6) laser therapy treatments. Your vet sure seems to be charging a lot and it is very difficult to afford that amount. Have you read any on the “Conservative Mgmt” approach? I know that can be very time consuming but it is an option that does not involve surgery. Again, the surgery itself for our dog was very tramatic for him and with the infection and all after it was really tough. Give yourself time and just weigh all your options.
God luck!
In reading this site and others it gets more confusing by the day. Our nearly 3 year old puggle came into the house last friday limping. We thought it was a muscle or something as he roughhouses with our 9 year old boxer-rhodesian mix. The doc did Xrays and the drawer test and says it’s his CCL is completely severed and wants to do the Extracapsular Imbrication Surgery. We’re on our way to Hawaii sunday and have been just going nuts over this. We’ve changed our mind so many times, but at this point, we’re going to try conservative managment for now. The puggle (Zephyr) is already putting weight on the leg, which from others we’ve talked to points to no way it can be a full tear.
We dont have the time now to try the conservative management. She originaly got diagnosed with this in December and it has gotten ALOT worse in the past 2 weeks. Im afraid of putting it off any longer. She is limping now & I dont like to see her in pain.. its so heart breaking..Thank you…
We just found out that our Rotties is completley torn. The conservetive management is to late now for her left knee & she is going through surgery Tuesday. She is getting the TTA done at my vet. She is walking on it but still limping. The doctor did xrays and did the drawer test and he didnt understand how she could be walking on it the way she is. She is 123 pounds & 4 yrs old. He assumed she must have a high pain tolerance. Her right knee is not completly torn thru yet so we will be the conservetive management with that one after the surgery. She originaly got diagnosed in Decemeber so it took 9 months for a complete tare..
As the owner of a six year old hunting Springer I am thinking that the conservative management approach which I have been on for two to three months will stabilize the knee. My observation after this approach is that Gus’ limp is gone and that he runs freely with no demonstrate pain. Recent xrays show some arthritis has developed and he has a positive draw test. My concern is that not fully stabilize the ccl with one method or the other will lead at least worsening arthritis due to the rubbing of the joints; and/or another ligament failure in the future. I have not reached a final decision yet. I appreciate all the comments in this discussion. It is very helpful, especially to read the concern for your dogs in your words.
Thanks and Happy Holidays.
George and Gus, Merrimack, NH