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Extracapsular Imbrication Surgery, Traditional Repair Procedure

**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.

Cognac, Photo Copyright of Mab_DesignIn 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

Extracapsular stabilization involves stabilizing the stifle using some means external to the joint capsule. During the first part of the procedure a 3 to 5 inch incision will be made through which the surgeon will have access to the stifle. First, the damaged cranial cruciate ligament is completely removed. Second, the veterinarian will examine the mensicus to determine whether or not there has been any injury or deterioration of the tissue. At this point the doctor my decide to remove the meniscus depending on the amount of injury, only removing the meniscal tissue that has been damaged. A partial meniscectomy is preferable over a complete meniscus removal, and dogs left with some healthy meniscus intact tend to develop less arthritis later in life.

Placement of Monofilament Suture (Leader Line) in Extracapsular RepairDuring 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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56 Responses to Extracapsular Imbrication Surgery, Traditional Repair Procedure

  1. Paul Anderson January 12, 2009 at 7:43 pm #

    I am unable to link to the pen state article referred to above.

  2. admin February 4, 2009 at 12:48 pm #

    Thanks for pointing that out Paul – it looks like UPenn Vet has taken down the article; I re-linked it to another location.

  3. Hogan April 25, 2009 at 10:36 pm #

    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!

    • Hogan April 27, 2011 at 5:39 pm #

      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!

      • George Adams December 28, 2011 at 4:58 am #

        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

  4. Lynn June 8, 2009 at 7:50 pm #

    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

  5. Chris November 17, 2009 at 9:25 am #

    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.

  6. lesley December 21, 2010 at 4:02 am #

    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. 🙁

  7. Cartman January 5, 2011 at 7:31 pm #

    The link doesn’t doesn’t say anything about U of Penn not doing TPLOs.

  8. admin January 6, 2011 at 1:20 pm #

    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.

  9. Jackie February 15, 2011 at 2:18 pm #

    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.

    • admin February 15, 2011 at 2:48 pm #

      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!

  10. lesley February 15, 2011 at 3:28 pm #

    \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

  11. Chris February 16, 2011 at 9:55 am #

    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.

    • JennB March 14, 2012 at 8:40 am #

      Chris,

      Thanks for the info about the Rotties! I have a Rottie who is 90lbs and he tore his right ACL back in November and had TPLO done on him in January. It cost about $4000 (yikes!!), but had x-rays done yesterday (2months mark) and it seems to be doing really well.

      He now tore his left ACL..about two weeks ago, and I spoke to my Vet about different options for him as I do not want to do TPLO again (too expensive and too invasive!). He recommended a few options which one was ExtraCapsular. I am leaning towards this since it’s less expensive and way less invasive! My Vet will be using 120lbs rope to do it (normally it’s 80lbs rope) so I really hope everything goes well!

      I’ve heard so many stories about ExtraCapsular not working on big dogs, but I have faith for my Trigger boy that this will work for him! =)

      • Chris March 14, 2012 at 3:48 pm #

        Jen,
        My Rottie is still running like a puppy! I actually had (2) female Rotties. Both Rotties had the same surgery to both back legs early in life with no problems. My first female Rottie was 14 when we lost her and she was not showing signs if knee pain when she went. My current girl is going strong on double rear knee surgeries. My Vet says when one knee goes it puts stress on the good knee. If you are lucky the good knee hangs on until the 1st surgery is healed but it seems inevitable that when one knee needs surgery the second knee will need it also. I’m not sure what part of the country you are in but the Extrascapular surgery here in central Ohio is about $1k. Best of luck to Trigger and you ;^)
        Chris

        • JennB March 15, 2012 at 5:09 am #

          Thanks Chris!

          It’s going to cost me $1200 all in. I live near Ottawa, ON, Canada.

          I also have 2 female Rotties who are only 6 months…REALLY hoping they do not encounter this kind of problem!!! =)

          At least with Trigger being done with 2 different kinds of surgeries I can have an opinion on which I like best and would know what to do with Kona & Lexis (the pup rotties) if ever it came to it..

          Appointment booked for April 4th and hoping for the best! =)

  12. Emily February 18, 2011 at 1:04 pm #

    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???

    • Cartman February 19, 2011 at 6:20 am #

      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.

  13. Sue March 9, 2011 at 9:13 pm #

    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.

  14. Vikki June 27, 2011 at 4:14 pm #

    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.

  15. Sue June 27, 2011 at 5:42 pm #

    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.

  16. Vikki June 28, 2011 at 4:36 pm #

    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!

  17. helene July 17, 2011 at 8:40 am #

    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

    • Lynn July 17, 2011 at 6:13 pm #

      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..

    • Vikki July 18, 2011 at 7:49 am #

      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.

    • JennB March 14, 2012 at 8:50 am #

      Hi Helene,

      It is never easy to decide what is best for our babies! This is the way I did it for my Rottie when he tore his first ACL and had TPLO surgery done (I believe any surgery will have similar post-op obligations and restrictions).

      So for the first 2 weeks, my boy had to be bed rest and only go out for potty breaks..no jumping, pulling etc. Always help him with a towel up and down stairs also!

      After the 2-3 to the about 5-6th week mark, I could slowly start leash walking him, but only for 5 minutes at a time and about 2-3 times a day. Then from week 5-6, he could leash walk for about 10minutes at a time.

      Every week you add an extra 2-5 minutes…but never longer than 20 minutes and only about 3 times a day!

      After your about 4months post-op, if everything seems to be doing better, then you can walk longer (but always pay attention to his comfort). There is no loose running or rough playing or anything like that until 6+ months!

      I guess the most important is have him on leash for the first 6 months…gradually increase lenghts of walks about a few weeks..and NEVER let him go up and down stairs on his own until the 6 months mark!

      Good luck =)

  18. Vikki July 18, 2011 at 7:38 am #

    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.

  19. Tammy September 5, 2011 at 2:23 pm #

    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

  20. Vikki September 6, 2011 at 6:20 am #

    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.

  21. Tammy September 8, 2011 at 3:00 pm #

    Vikki,
    Im so sorry to hear of your loss. 🙁 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.

  22. Vikki September 9, 2011 at 5:17 am #

    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!

    • Dorian September 16, 2011 at 10:59 pm #

      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.

  23. Tammy September 9, 2011 at 3:19 pm #

    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…

  24. Tammy September 17, 2011 at 4:16 pm #

    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..

    • JennB March 14, 2012 at 9:02 am #

      Hi Tammy,

      How is your baby doing? I also have 3 Rotties…one of them who seems to always have problems..first came the elbows, then the right ACL and now the left ACL!

      For the first ACL I got TPLO done, which is SO expensive and invasive, but so far so good! He got his 2 months post-op x-rays done yesterday and seemed to have healed well =)

      For the left ACL, which tore about 2 weeks ago, I am not looking to do TPLO. Not that anything went wrong, but that it’s too expensive and invasive! I am now looking at ExtraCapsular ..which seems to have mixed-reviews for large dogs, but it seems to be a good option. Since he has one “solid” leg now, I’m less worried to get this method done. If it does ever break (God forbid), at least he’ll still have the right leg which is now of steel haha..a little more encouraging!

      How did you like TTA? I looked into TTA also, but it is also very expensive (I’m almost at $10,000 with my baby…I love him, but that’s ALOT of $$$)! so chose not to look into TTA more…

      How is her 2nd leg doing with conservative management?

      • Tammy September 27, 2012 at 3:29 pm #

        Our surgery with physical therapy and laser treatment 3 times a week for 5 weeks ended up costing around $4000.00. Now a year later her other back leg has gotten worse. It did already have a partial tare but im sure it is worse now. she only seems to limp when it gets colder or when she has laid around for a while. Typical just like humans. We dont move much we get stiff and sore. Comes with age..lol I liked the TTA but I would say the therapy is what made the big difference. I couldnt sit there and pull and twist on her leg knowing I was hurting her and I would of not kept up with it so it was best to let the proffesionals do it..We didnt do the conservative management cause our vet says by the time her new leg healed the other would be completely torn & it would not do any good by then.

        • Lucy October 1, 2012 at 5:06 am #

          How is your girl doing now? PT was a god send for me! I had 2 dogs each with TTO’s 9 weeks apart, last year. I was walking 3 miles a day between the 2 of them as it was. Hydrotherapy, laser treatrments, massage, cold packs, and warm packs were very helpful. There was no pulling or twisting tho.

          It takes a long time! My dogs are both healthy and strong and limp free!! It was well wroth the effort and additional expense for me. My dogs have theri life back! While theri injuries were not agility related… they enjoy it so! We are back at work. ;~))

          So! Hopefully your girl has come along nicely?

  25. George Adams December 28, 2011 at 5:09 am #

    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

  26. JennB March 14, 2012 at 9:16 am #

    Hi,

    I have a 90lbs Rottie which tore his right ACL back in November and had TPLO surgery done on him in January 2012. Yesterday was his 2 month post-op x-rays and everything healed well. I still have 4 months of recovery to do with him regarding that leg, but the “critical part” is done and over with, THANK GOD! =)

    NOW…his left ACL is torn (tore about 2 weeks ago) and I am not looking to get TPLO done…too expensive and invasive!!! I spoke to my vet and he feels comfortable doing ExtraCapsular OP on him with 120lbs rope.

    I’ve seen a few stories about large dogs getting this procedure done, but was wondering if there were more.

    The thing that worries me the most is that SOOO many people have said this procedure isn’t good on large dogs. Other than that, I feel comfortable with this OP instead of TPLO or TTA!

    Any comments for dogs that weight over 90lbs??

    • jackie September 24, 2012 at 6:23 pm #

      Jenn,

      Did you have the ExtraCapsular surgery on your Rottie? We are considering the surgery for our 95lb lab and wanted to get your feedback on recovery.
      Thanks

      • Lesley September 25, 2012 at 7:06 am #

        Hi

        Yes he did have that surgery done his recovery was ok but 4 months in it failed due to him jumping so you have to keep
        them calm for 6 months. He had second surgery and I made sure he stayed calm and after the six months I started walking him
        further etc. He also went swimming once a week to get his muscle back up and we did this for a year and his limp got better
        and now nearly 2 years in he is great on that leg no limp and running great on it.

        But noticed he is now limping slightly on other leg so im hoping that hasn’t gone now 🙁 if it has I will use same surgery on that one
        Hope all is ok with it like but time will tell if its his knee or not.

        But generally I found it to be a good recovery.

      • Tammy September 27, 2012 at 3:21 pm #

        I had the TTA (Tibial Tuberosity Advancement) surgery done on my Rottie a year ago. She is 124 pounds and 6 yrs old. It was quite costly because we also did the physical therapy after her surgery and they also did laser therapy to reduce pain and swelling. Her therapy was 3 days a week for 5 weeks and the vet kept her all day while we were at work. The therapy was well worth it. They ran her on a treadmill in the water and she took very well to that. The total cost ended up being about $4000.00 that is including the therapy and laser treatment. She still has an occasional limp but that is also because the other knee already had a tare in it but this knee was torn all the way through and if she lays around a lot it tends to stiffen up on her. She still likes to play and jump but we try not let her jump to much because of the other knee. I would say if she were younger we would definitely get the other knee done now but were are still paying on this one..good luck. I hope my information was a little helpful!!!

        • Lucy October 1, 2012 at 5:13 am #

          Hopefully your girl is doing well now? PT was a god send for me! I was walking 3 miles a day with my 2 (9 weeks apart TTO’s) last year this time as it was. PT saved me so much! Hydrotherapy, laser, massage, cold packs, warm packs… WONDERFUL!

          It takes a long time. Here we are a year later and they are enjoying life again, limp free and very strong. We are back doing agility (the injuries were not agility related)!! YAY! They are so happy again!

          Keep up the good work.

  27. mike April 10, 2012 at 10:25 am #

    Our 2.5 year old pit-beagle (?) “Short-cut”; MONA is having BOTH knees done today. Our surgen is using lateral suture with extracapsular imbrication. Vet said doing both will help overall healing process.

    Same office in Catonsville, MD took care of our pit-boxer “too-tall”; VINNY using only Lateral suture. One knee then the other went about 1.5 years later (common). Vinny is now 9 years and doing great. We have kept him on the lean side and think it helps.

    We understand the rehab and lucky Mona is only 36 lbs Vinny is 65!!

    Mike

    • mike April 10, 2012 at 12:20 pm #

      ..revising Monas procedure description:

      Fascial graft with Lateral suture stabilization

  28. mike April 10, 2012 at 11:27 am #

    Found an interesting site with more info..

    http://www.mobilevetsurgeon.com/cruciateruptureinfo.html

  29. Kristin April 11, 2012 at 3:45 pm #

    @Mike. Hope the surgery went well. We have a 4 1/2 yr old female boxer (Ginger). She is having TPLO surgery on BOTH knees at the same time on 4/17. We agonized over the decision, especially to do both at once, but after much consultation with her doc, he assured us we were doing the right thing. She has reached a point of not bearing weight on either of her rear legs. He left was the worst, and the right was showing arthritis already, but now it seems to be just as bad as the left.
    So, even though Mona is having a different procedure, I am curious to hear how the double knee procedure goes for you guy.
    Good luck!

  30. Kim July 23, 2012 at 8:42 am #

    My 8 yr old Husky had extracapsular acl repair on 7/19/2012 and is now having an odd complication that my vet has no clue of the cause or how to fix.

    She did well for the first two days in the leg wrap but after the leg wrap came off the severe spasms started. It happens when she is sleeping or just laying around. The entire leg, mostly the thigh and groin area, will tighen up and spasm causing her to be in excruciating pain, tuck the leg really hard under the belly, she screams blood curdling screams, her eyes roll into her head, she pees a little, claws at everything, buries her head and tries to pull her body away from the leg. The spasms wont stop until we grab the thigh and straighten the leg. To try to prevent this we’ve been sitting with her holding her thigh 24 hrs a day but some spasms will be so strong that holding the leg isn’t helping. The Tramadol and Metacam are not touching this pain nor stopping it. Anyone else have this kind of issue and if so, did you find a cause or a fast fix?

    • Lucy July 26, 2012 at 12:59 pm #

      I’m certainly not a vet, but I have had two dogs with knee surgery and subsequent PT.  Ask your vet about ultra sound would help or a nice soothing muscle massage to help her relax.  My vet and PT had me doing cold wraps the first two weeks or so.  After the suture line closed, warm moist heat was particularly soothing!  My dogs LOVED the warmth and would raise their leg… both for the initial cold, but later for the warm wraps, which I did at least twice a day.

      At some point the PT showed me how to do deep tissue massage to help keep the muscles relaxed, facillitate good circulation, and promote recouperation.  After several weeks we graduated to ROM (range of motion) exercises.  Your vet will know when.  You can ask his recommendation.
      If there is Physical Therapy for dogs in your area, get a recommend from your vet.  I truly believe my PT guided me, gave directions, made recommendations, worked hard, was well informed and knowlegable!  She made recovery possible… earlier! 
      Vets have great ideas and have their own area of expertise.  But my vet swore this PT knew her stuff better than he did himself.  He trusted her… and so did I. 

      You mentioned her surgery was only on the 19th this month. Initially, it was not tramidol (pain) mine were on. It was an anti inflamitory which helped bring the swelling down. The cold pack will help, but talk to him/her about an anti inflamitory (Derramaxx or Rymadyl) for now.

      • Kim July 26, 2012 at 1:09 pm #

        We are doing laser therapy which is helping the surgical location tremendously. She was walking on the leg after the first round of laser and has had three more since Monday and is pretty much walking as normal. I am doing PROM, Stretching, was doing ice packs and then moved to warm packs, and I am doing massage. She previously did hydrotherapy so we’ve learned many theraputic tips and tricks from that.

        Unfortunately, we have something else going on. Either a nerve is pinched or she has some kind of nerve/muscle/tendon swelling from what we don’t know. She is on Metacam for the inflammation. Today I found that she has colitis so we just did subq fluids. Hoping its the colitis causing the major spazing. We’ll see in the next day as she goes back for laser and fluids again tomorrow. Thanks for your info!

        • Kim July 29, 2012 at 9:57 am #

          Even though my vet disagreed with me, I figured out our problem. She was dehydrated and the drugs were causing constipation and colitis. After FIVE miserable horrifying days of her screaming episodes, I insisted he give her subcutaneous fluids. It was the magic fix! We’ve been doing the subq fluids daily now and will continue until she’s off Tramadol and drinking normally again. We’re 9 days post surgery and she’s acting like she stubbed her toe. With the laser therapy she is walking on the leg with a limp but it doesn’t seem to bother her. I highly recommend the laser!!! And Fluids!!!!!

  31. Heather July 29, 2012 at 7:49 am #

    My 4 year old (87lb) lab had TPLO surgery 2 weeks ago on both knees. I used a board certified surgeon who recommended doing both – but did say it would take longer to recover. My vet who is very conservative told me he would keep her for at least one week if not two! I just picked her up Friday after staying in vet care for 13 days. One of her incisions looks good, but the other has a small hole at the top and a quarter size inflammed red bump on the bottom that is seeping fluid. The vet said she finished her antibiotics and directed me to apply neosporin and just watch it for a few days. She puts weight on both legs (one more than the other) but only for a few steps and then sits. I take her out on a leash to use the restroom, using a towel under her belly to help with support. She is stil on pain medication 1 time a day and is very happy to be home! She wants nothing to do with the crate (I think she fears being back at the vet) and she is too large for me to pick up and put her in. She mostly lays on blankets around the house, walking maybe 5 times a day to a different spot – sleeping in my daughter’s room (where she used to sleep before surgery).
    I am hoping that being home will help her to heal more comfortably. It is hard to see the light at the end of this – that she will be walking normal again – but I am hopeful. Topdog.com has been a good site to guide recovery. We go back to the vet in two weeks for laser therapy and follow up.

  32. Nitesh November 10, 2015 at 10:11 pm #

    SuzanneOur 3.5 y.o. boxer/pit/? mix had the TPLO surgery in Sept 09. She made a truly amzniag and surprisingly fast recovery and runs with me almost every day. However, the period of very limited activity was harrowing for us all. We had a board certified surgeon perform the procedure in Nthn NV and the staff were great but this was very expensive and $1K more than the above ref’d we shopped around for up to 8hrs travel! Today we very much suspect that the other back knee has a stretched CCL. Our dog seems to require activity for behavioural balance (our trainer told us someone else would have just killed her if they got her) and we’re concerned that if we don’t do the TPLO, or even one of the other surgeries, her quality of life will be pretty awful. We don’t earn a lot and work full time (at the moment!). We are also concerned about getting thru the trauma of the first 2 months after surgery it was truly heart breaking and we wondered if we’d done the right thing. Are there any others who’ve had the second back CCL stretch or tear? (BTW the stats our surgeon threw out were that if one tears there is a 50% chance of the other going within 6-18month of the first )Thanks for any help or advice this will be a tough choice.

    • Lucy November 12, 2015 at 6:34 am #

      Whoa… you’re running with her? Hoping I misunderstood… as a TPLO takes a good 6 months of slow going short distances at first. Increases are gradual. At 8 weeks you should be doing no more than a few blocks of walking and back again.

      Moving forward with her exercise too quickly has precipitated a problem with the second knee, if I’ve understood correctly. It really does take six months for that first knee. Otherwise the second knee is unduly stressed and over worked.

      Still, I have every hope this can be remedied. If the tendon is stretched you could do critical management in am attempt to prevent a full tear. A brace might be helpful. Then… s-l-o-w-l-y rebuild the muscles in BOTH legs. It will require a great deal of patience and long suffering. She is young and probably wants to be very active.

      No jumping, no long flights of stairs, no quick turns. Animal PT would be useful if it is available in your area. I did an underwater treadmill weekly with my dogs for 8-10 weeks, and cold laser therapy (to break up scar tissue).

      If the ligament is torn and it were my dog, I’d do the second surgery. In my experience partial tears have always become full tears. I don’t see why you couldn’t rehab both legs concurrently, but it would also not be unwise to rehab one before the other.

      I’ve done both knees on 2 dogs. We had some flooding and slippery mud was the cause of the first knee tear on both dogs 9 weeks apart… despite all precautions. Two years later, another flood and sadly one other knee. I was with the dog was on lead due to the rain. =(

      I went thru a second surgery for him and we rehabbed again. This dog is phenomenal and was able to attain his previous agility abilities. He came thru that well! His story is here. His name is Stetson.

      So you have some deciding to do. I would never put an animal down because of a knee. Critical management works for some, and it can be a cost factor. There are no wrong or right decisions. It’s fully up to you.

      I’m sorry you might be facing this again. Think it thru and take it slow. Just know a second surgery does happen, from time to time, and you CAN have your dog back to full ability. It takes patience, and work. IMHO? I could have done nothing less for mine.

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