Extracapsular Imbrication Surgery, Traditional Repair Procedure
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 – What’s new in orthopedics? – The Canadian Veterinary Journal
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.
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. There is a new link directing you to a study which references the UPenn article.
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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!
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.