We would expect TR costs to be substantially lower than TPLO or TTA, but slightly higher than a conventional Lateral Suture Surgery (extracapsular imbrication, traditional repair).  Reported Tight Rope costs have ranged from $700 to $2500, and seem to depend mostly on geographic location and type of facility where the surgery was performed.  At a private practice in North Dakota an owner paid $1108 for everything, which included exam, diagnostics, anesthesia, scope, surgery, FiberTape implant, post operative monitoring, bandages, and medications (TPLO was $1900 at the same practice). At one major US state university vet facility, the total bill for TR done by top ortho surgeons including was in the $2200-2500 range.

The materials used in TR are a lot less expensive than those used in TPLO/TTA, and the surgery itself is a lot less complex. A typical TPLO procedure takes about one hour, whereas TR is completed in about 20 minutes. Less time under anesthesia, less surgical time, a simpler procedure, and fewer materials should translate into a lower cost for dog owners. I expect in the future we will see the prices for Tightrope repair somewhere in the $1000 range as more veterinarians become trained and proficient in this technique.

Remember, when looking for a veterinary surgeon, a higher price does not necessarily mean a better surgeon or superior procedure.

Unfortunately, not every dog is a good candidate for the tightrope procedure.  Below you will find some general criteria that excludes certain dogs from tightrope surgery.  Remember - This list is in no way conclusive or exhaustive, your veterinarian will take into consideration many factors including your dog’s age, weight, health history, onset of injury, and physical conformation when making a treatment recommendation for your pet.

Who is not a Candidate for Tightrope CCL Repair?

1)  Dogs weighing less than 30-40 pounds.

2)  Dogs (and people) that cannot follow a physical rehabilitation protocol after surgery.

3)  Canines with limb deformities of any kind.

4)  Dogs with a steep tibial plateau, usually an angle of more than 30 degrees.

The major difference between extracapsular imbrication/traditional repair methods and tightrope ccl is the way in which the knee joint is stabilized.  In a traditional CCL repair, a leader line (suture, or you can also think of this as a fishing line) is woven across the knee in a figure-eight pattern, connecting a bony protrusion on the femur to a small hole drilled in the top of the tibia.  The veterinary surgeon is able to access the knee through an incision on the knee a few inches long.   During the healing process, the leader line serves as a temporary way to stabilize the knee while scar tissue forms.  Eventually the leader line will break, and the scar tissue is solely responsible for providing knee joint stability.

In tightrope repair, a stronger material called Fiber Tape is used to connect bone to bone.  The FiberTape is held in place on the bone via metal anchors and small holes drilled through the bone.  The surgeon makes a few small incisions to access the points of attachment to the bone.  While the Fiber Tape will eventually degrade and possibly break over time, it is thought of as a superior material for larger dogs due to its greater durability and strength - buying your dog more recovery time.  While in place the Fiber Tape will act to control tibial thrust and prevents the cranial drawer sign, while allowing your dog to maintain full range of motion.

Both traditional repair and tightrope are considered to be minimally invasive procedures when compared to other surgical options like TTA and TPLO, which both involve cutting and changing of bone angles.

At 4 weeks post op, most veterinarians will instruct owners to begin introducing their dog back to walks, particularly walking uphill in an attempt to rebuild loss muscle mass.  It is a good idea to start out by taking a few short walks every day, gradually working up to longer and less frequent walks.  This will prevent strain on the knee joint, which can hinder the healing process.  Post operative exercises need to be controlled, leashed walks, as any running, jumping, or roughhousing during the first 8 weeks can be detrimental to the stability of the knee and recovery process.

Upon his arrival home, your dog will need to take a number of medications for pain, inflammation, infection prevention, and possibly sedation.  If your buddy is not a willing pill taker, it is a good idea to try to get them into the habit of taking a small snack such as a piece of cheese, peanut butter, or a hot dog slice after their meals.  Each dog is different with regard to how long they need to be on a particular pain, inflammation, antibiotic, and sedation regimen, but usually the antibiotics are taken over 10 days, with the pain/inflammation/sedation used on an as needed basis.

As a general rule, just pay close attention to your dog and be sure to tailor their recovery to their particular needs.  There is no such thing as having a post operative dog rest too long, but there is always the risk of damage to the repair if your dog tries to do too much, too soon.  Tightrope CCL, like other traditional repair methods (lateral suture, extracapsular imbrication), is simply a way to stabilize the joint while scar tissue is being formed, it is not a replacement ligament.

The Tightrope CCL repair surgery is the newest surgical option available for dogs with cranial cruciate ligament injury.  Unlike in humans, canine CCL tears and damage generally takes place over a period of months or years, rather than being associated with a single traumatic event.  Because of the nature of these injuries, and their degenerative process over time, this new procedure focuses on a technique used in human ankle joints using bone to bone fixation in a minimally invasive way.

Tightrope CCL is an extracapsular technique using the lateral suture stabilization (LSS) procedure in conjunction with a material called FiberTape to provide bone to bone stabilization.  The Fiber Tape is placed in the dog’s knee through a few small incisions which create tunnels through the bone.  Once the implant is anchored to the bone it is able to control cranial tibial thrust, and provide correction for the canine drawer sign, all while allowing internal rotation of the knee joint and normal range of motion.  Similar to traditional extracapsular repairs using monofilament sutures (similar to a leader line or fishing line), the Fiber Tape used in TR repair will degrade over time and is not meant to provide permanent stablization to the knee joint.  Bascially, the Fiber Tape is there to hold the joint in place while the knee forms scar tissue around the knee to permanently stablize the joint.

This procedure is substantially less invasive than other canine knee repair surgeries, especially TTA and TPLO, which involve the cutting and repositioning of bone.  The Tightrope CCL is also easier to perform than these other procedures, making the risk for complications and infection substantially lower.  The Tightrope CCL has been shown to be very cost effective when compared with TTA, TPLO, and even traditional repairs, and the estimated cost is $1000 less than a TTA or TPLO.  Dogs that were involved in the clinical trial for Tightrope CC, “experienced fewer and less severe complications with outcomes that were equal to or better than those seen with the bone-cutting technique.”

The cases of failure in the study were related to incidences of not properly following guidelines related to physical therapy in the post operative period.  A recovery period of 10-12 weeks is recommended for all dogs recovering from CCL repair surgery, and this is the same guideline used for the Tightrope surgery.

Right now this surgery is still in the clinical phases, but with such encouraging preliminary results, I expect to see much more on this procedure in the very near future.

One way I found to save some cash when Tucker had his CCL repair was to order his medication and other pre and post surgery needs (like Kong toys, bully sticks, and pet bedding) online.  I purchased his collar, glucosamine and chondrointin supplements, pet pads, and special treats using PetCareRx.  My veterinarian even ok-ed his antibiotic orders through their site, easily saving us a couple hundred dollars!  Their web interface is really simple to use, and there was not a single product I needed that I could not find on their site.  I highly recommend using them if your dog is going into surgery or is recovering from surgery, their prices are absolutely unbeatable.  Plus, any order over $35 qualifies for free shipping - I have NEVER seen that on any of the other pet sites out there.

Owners beware, obtaining health insurance for a dog with a known cranial cruciate injury is next to impossible, and most pet insurance companies will not pay for a CCL repair surgery if your dog has not been an incident-free, premium paying, member of their policy for at least one year.  Even dog owners with pet insurance often have a difficult time seeking reimbursement for the surgery, and this is something every pet insurance holding dog owner should be aware of.

Some plans, such as VPI, say they accept post-operative CCL dogs after a period of one year following recovery, but dogs with pre-existing conditions are often subject to higher monthly premiums and higher per visit or per service deductibles.  If you and your pet are faced with a surgery and you do not already have a pet insurance policy, you would be better off in the long run paying for the surgery out of the pocket and trying to obtain coverage after your dog has gotten out of the recovery window.  The last thing you want to do at this difficult time is to burden yourself with disputes with your insurance company, or wait for an insurance company to dictate when your dog may have his surgery performed.

Accidents happen, and this is certainly the case in post operative dogs.  Sometimes, despite our best efforts and watchful eye, dogs can remove their surgical staples.  Unless your dog has done this within a few days of returning home from surgery, or you notice pus, excessive bleeding, or a large, open wound where the staple is missing, your dog should be just fine.  If either case is true in your situation, contact your veterinarian for assistance.

The best thing to do if your dog is able to get his/her staples out is to contact your veterinarian and check to see what their protocol is for an accidental staple removal.  Again, be sure to let them know if you notice and sort of infection around the surgical site.  Most likely your veterinarian will just have you place a butterfly bandage or steri strip over the places where staple(s) were removed, and to check your dog’s feces to be sure the staple(s) have passed.  If at all possible, it is advisable to have your dog eat some bread or soft cheese after ingestion so the soft food binds to the staple to allow for easy passing through the digestive tract.

More and more veterinarians are starting to recommend post operative physical therapy for cranial cruciate ligament repair patients.  While opinions differ from one veterinary surgeon to another, proponents of canine PT believe that physical therapy in the post-op CCL repair dog can help bring a dog back to full function in a shorter amount of time vs. traditional rest following surgery.  Veterinarians are presently conducting studies to show the efficacy of PT in animals, and to prove that it has a similar restorative mechanism as PT in humans. 

There are two parts to canine physical therapy, the first covering the period immediately following surgery, and the second is begun when inflammation has subsided and there is evidence of healing.  The first part of PT in the dog patient consists of icing, passive ROM (range of motion), and early wound mobilization. The goal of PT during this time is to minimize inflammation and pain, preserve joint range of motion, and to prevent or further minimize muscle and soft tissue atrophy that has already taken place.

The second part of canine PT is begun as inflammation has started to resolve, and healing begins to be the predominate theme in the wound. During this time pro-PT veterinarians believe that enough stress should be applied to healing tissues to stimulate and optimize healing without threatening the stability of the joint. Ideally, phase two activities should parallel the gradual increase in tensile strength observed in the wound. If one is too aggressive with PT during this period, failure can occur; conversely, if one lags in PTH activities, the goal of early return to function is not accomplished.

Exercises included in canine PT:

1.   Sit and stand.

2.   Corner stands.

3.   Figure-eight walks.

4.   Wheel barreling.

5.   Stretching of hamstrings, quads. (without stimulation).

6.   Decline treadmill followed by incline treadmill.

7.   Leg weights.

8.   Unbalancing activities..

Right now PT is favored in dogs with working backgrounds such as agility or hunting, but it has begun to pop up amongst other owners as well.  Not all veterinary offices offer PT services, and you should check with your vet prior to CCL repair as to whether or not it is something your doctor recommends. None of these exercises should be attempted on your dog by anyone other than a trained professional, and premature movement of the joint in a post-op CCL repair dog can compromise the stability of the joint and ultimately cause the repair to fail. Always follow the direction of your veterinarian when exercising your dog during the post operative period.

Many dogs can not tolerate the large, conical, Elizabethan Collars that most veterinary offices provide following canine surgery. If you are dealing with a dog that is able to get their e-collar off, refuses to lay down with the e collar on, is marking up the furniture with the collar, unable to eat, sleep, or rest with the collar in place, or is acting in an aggressive manner toward the ecollar, there are options available.

The ProCollar has an inflatable inner bladder made of a plastic vinyl that is inflated through a two-way air valve much like a beach ball. When the Pro Collar is inflated, the size and thickness of the ProCollar function as a soft deterrent to biting. The inner bladder is protected by a pliable plastic outer jacket lined with a durable canvas material to resist bites and scratches. While wearing the ProCollar, pets are able to eat, sleep and play at ease while staying protected. The ProCollar is held in place by inserting the pet’s everyday collar through the ProCollar’s three inner rings, and the velcro strap should be placed at the back of the neck and then adjusted for a perfect fit.

The Neck’s Best Thing Collar is also another option for your dog instead of an E-Collar. The collar will not block your pet’s vision, allowing them to be more comfortable during the recovery process. The collar comes in a flat sheet of 12″ X 28″ non-toxic ribbed foam that can be cut down into a variety of custom sizes to fit just about any pet. A soft backing and velcro make the collar easy to attach and remove. Using scissors you can make a splint, a wound covering, a neck brace to keep them from getting at wounds or whatever else you can think of. All from one 12″ x 28″ piece. The Neck’s Best Thing will not prevent your dog from licking its front lower legs or paws so you’ll need something else for that, but it can be used as a wrap around the front leg. It gives your pets the freedom to go about daily activities with fewer distractions while still providing time for wounds to heal. The Necks Best Thing collar is weatherproof and hand washable.

There is also a soft E-Collar on the market, which simply looks like a life preserver worn around your pet’s neck. The Soft-E-Collar is a lightweight foam pillow covered with a durable, attractive vinyl. It is an effective alternative to the plastic elizabethan collar (”E Collar”), and is easily cleaned and stain resistant. The pillow passes over the pet’s head and ties around the neck with a drawstring. The Soft-E will prevent a dog or cat from licking or biting most parts of his body.

Another alternative to an E-Collar is PetSleeves Rx. Pet Sleeves are disposable pet wear that are perfectly suited to the post operative canine, made from human-quality surgical gown material. PetSleeves Rx provides a wide range of sizes and fits, allowing owners to avoid using their own shirts, pants, towels, or having their pet wear an uncomfortable collar. This product is not commercially available and must be ordered by your veterinarian, so it would be wise to contact them as far as possible in advance to surgery to make sure you have the PetSleeves available.