Our ten year old Husky, about 75 lbs. went lame in her back leg after repeatedly climbing our new chain-link fence and chasing neighborhood cats. Our vet recommended the new tightrope surgery to repair her torn CCL as less costly and less invasive. To keep our options open he did tell us about all the procedures currently being done. However, since he did not actually preform TPLO and we’d have to go to a board of surgeons to have this more expensive TPLO surgery done we opted to have the tightrope procedure done at the end of March ‘10.

We thought we were prepared for the restrictions, and had no idea the extent of the complications, as we had not done our homework. We just took the word of the expert. Statistically, I think we had all the bad Tightrope surgery complications, and then some.

At the end of the 2nd week post-operatively we discovered when we went to get her stitches out, there was instability in the leg again. Something about the tightrope had failed and failed quickly. In addition, three, what appeared to be seromas or limpomas, had formed at various places along the incision. One on the upper inside, one on the outside just along the stitch, and the final further back on her outside hip. The one along the stitch continued to grow.

The vet at week 3 post-op recommended a second surgery saying, “Let’s go in see what is happening with the tightrope and look at the seroma”. (it turned out not to be a sermoa as it was not fluid filled and must be something else) We prepared for a 2nd tightrope ligament repair surgery, in case it was needed. Sure enough the first tightrope was “loose” with no explanation. It had been tight during surgery and one week post op. The buttons were fine and the knots tight. It was just loose. He removed the loose tightrope, drilled new holes at a slight angle this time, put in the 2nd tightrope and removed the largest growth – a golfball sized granuloma laying along the lateral side of the tightrope but not directly encasing it.

The granuloma was caused by a foreign body (triggered by either the suture material or tightrope) and it had a highly resistant staph infection in it. We found out 7 days after the second surgery when the pathology report came back. All the little antibiotics we’d given her for the past month had no effect. We had to start her on clindemycin which was one of two antibiotics that the staph was not resistant to. My concern was the whole week the new tightrope was in, and we did not know a staph infection was present.

Three weeks out after this second surgery her leg again tested with a draw sign that it had become unstable again. Why? The vet recommended a third surgery. He went in and the tight rope was secure and tight, so what was the instability? Her menicus on one side in her knee had torn and flipped. She’d not exhibited the normal pain this should have caused so the vet had no reason to suspect prior to this 3rd surgery. This slight damage to this cushion is what had shown up as instability when he did the drawer sign before the 3rd CCL surgery.

He was also glad that at surgery #2 he’d not opened the knee joint to look because for sure he would have spread the staph infection to the joint when so far it had been along the surface of her leg. We didn’t know that at the time, but looking back it was probably a good thing. He cut and removed the damaged menicus and released the lateral one. Then he also put in another stabilizing feature – the original Extracapsular Technique, also known as a traditional repair. This would give our girl two stabilizing features: the second tightrope that was still intact and the new lateral stabilizing suture (extracaspular) and they would not interfere with one another. We had high hopes.

For another month (this would be two months of antibiotics, a total of 3 different kinds before we got to the 4th for the staph infection) we had her on antiobitics following this 3rd surgery. At week 3 post op, of the 3rd surgery, she was still stable but she developed a horrible yeast infection in her ears that we also had to begin treating her for. We think this was probably caused by all the antiobitics. We finished the third and final round of antibiotics at week 4, believing the staph infection totally destroyed. How could it not be after that hit with antiobitics… 30 days?!

However, one week after she went off antibiotics in week 5 the instability seemed to be coming back, and each day we watched her use that leg less and less. She walked in a stilted way with a hitch and thunk look (no sound). It began to shake as she lifted it. Day after day we watched this get worse… thinking surely not, surely it’s just today. Finally we called and the vet said only time, let’s give it more time. Week 6 post-op of the third surgery she refused to use the leg at all and it was a little puffy. The next day it was more firmly swollen from the hock to the crest of her knee. She hiked it up and hopped on the other… something she had not done since before the first surgery.

Back to the vet who said that the leg was again more unstable and that apparently both stabilizing features had failed. We put her back on antibiotics and steroids for the swelling.

Our options going forward:

1) TPLO
We don’t have an additional $3500 for a more invasive surgery on a less than pristine leg that has already had 3 surgeries and known complications from infections including staph. I don’t know that bone healing or foreign body reaction would be any better with metal plates and cutting her bones.

2) (Another) Tightrope
Why do another tightrope surgery when we’ve failed each one. No one can tell me why it failed and failed quickly. She’s remained totally restricted, very very very little activity… walks to eat and leash walking to the bathroom. There was some talk about her soft tissue not healing well and that’s just her so that’s the cause of the failure and instability. That’s the guess. It still seems strange that soft tissue could cause an fibrous material like the tightrope which is supposed to be so strong and durable to weaken after a couple weeks in her body more than once.

3) Conservative Management – Rest and Medication
Time and medicine we can do, but the problem is her leg, the bone to bone action is again unstable. So give her antibiotics for two weeks and fix the swelling or infection. But when she goes off of it the instability is still there to again cause damage that would cause swelling again requiring more medicine. The endless cycle. I also wonder if the tightrope itself does not now have staph in it and will continue without constant antibiotic to infect her leg every time.

I don’t know that it would have been any different if we’d gone with the TPLO first. Our vet has helped us with the cost of the second and third surgeries, but the cost to our family emotionally had been huge. As someone else in here said… any surgery has risks. My vet has done 10 tightropes in the past spring and ours was the only failure… 10% chance doesn’t sound like much until your dog is the 10% one.

It is disheartening. It has taken time off work. Patience from everyone in the family who have had to pitch in to help. It hurts to watch your dog-companion in pain, not understanding and restricted. A friend told me my dog was tough and just to hang in there. She said if my dog has to be a lap dog and hang out in the house for the rest of her life that’s okay. Besides she’s just about to turn 11 so she’s not in the prime of her life. And I worry… what if she’s in the 50% who blow out the other leg? My mother would say I’m borrowing trouble to even think about it. She’d also be one of the first realistic ones to say it may come to putting her down. Gosh it would be easier to not have to go through this. But we love our furry friends. And that’s not so easy. We don’t give up that easy do we? It has been one of the most horrible long-term experiences of my life.

We are at 6 weeks post-op surgery #3 with a swollen, infected and mostly useless leg. But we’re giving medicine, food, love and prayers. I believe the medicine will help. I’m not sure what next steps will be. But today. That’s all we’re really promised anyone. Today – we’re hanging in there together.

UPDATE – 7 Weeks Post Op
During the third surgery, they did add the Extracapsular repair. When we talked with the vet this week he believes the Tightrope & Extracapsular are still intact, but that the isometry of her leg causes a shift that keeps them from holding the knee completely stable. It will make the scaring, tightening process slower. Her swelling has gone down on this round of antibiotics and steroids, which we’ll decrease over the next week. She’s walking on it a little more in this post op week #7 and resting a lot.

Tightrope Surgery Complications – Husky is a post from: Dog Knee Injury

Overall, this has been a good week and not as terrible as I imagined. By the third day, he no longer dragged his toes and was actually putting some pressure on the leg. We applied a cold compress to ice his knee area four and five times a day, but are not doing any passive range of motion exercises yet. He is able to lay himself down much more easily. His incision is healing nicely, he is leaving it alone so far.

However, we did have one mild setback. On the fourth day post op, I noticed his ankle was slightly swollen and bruised. By the end of the day, it was very swollen. We were worried he’d somehow managed to sprain it, but a check in with the vet indicated that he had edema, a fluid build up just like a pregnant woman in her ninth month! The treatment for this was massaging around the fluid areas and cold compresses on the area. The edema was resolved in just a couple of days. Throughout the week, we continued to sedate him with the Acepromozine and relieve pain with Metacam and Tramadol. Due to the edema, we also added an antibiotic since the fluid would be a breading ground for infection. These medicines, combined with the thyroid medicine he has been taking for some time, take some work to keep straight. I hate giving him so many drugs and can’t wait to be done with that part.

We are also learning that Beau is not going to be a good patient when it comes to following doctor’s orders. He desperately wants on the couch and succeeded one time when someone forgot to put back the big blockades we have rigged. Although he “never” goes upstairs unless we do, he tried when we weren’t looking…. so now that is blocked off too. He made it up the first three steps before my husband caught him and scooped all 79 lbs of him off the step. When the Acepromozine wears off, he’s ready to be in full blast mode. What are we going to do when he starts feeling better?

Beau’s CCL Repair – One Week Post Op is a post from: Dog Knee Injury

Check the incision for signs of infection daily which include swelling, pain, discharge and redness. This is obviously not possible if your dog came home with a modified Robert Jones (or similar) bandage, but the same rule applies – check the area around the cast each day, making sure to check for any swelling, discoloration or infection. When checking the surgical site, a cold compress can be applied to the stifle three times daily, 10 minutes per session for the first 2 days to help reduce the swelling. Starting on the third day after surgery, a warm compress can be applied to the stifle in order to soften the connective tissues. Your veterinarian will instruct you as to whether to also pursue range of motion exercises or physical therapy at this time – this will depend on which procedure your dog underwent.

Just remember to listen to your dog. They will make you aware of their comfort level, and let you know when they are ready to start using the injured limb more. No one is perfect, and we have all had those “oops” moments when our dog tried to do too much too soon, but just stay positive. Your dog has a keen sense of what you are thinking and feeling, and this ultimately will have an effect on their recovery.

What to Expect After CCL Surgery is a post from: Dog Knee Injury

So which is better, TPLO or TTA?

Well, if your veterinary surgeon has no experience performing TTA’s, as it was only introduced to US surgeons starting in 2004 so many vets do not, you will want to opt for the procedure with which your vet can demonstrate proficiency and results. Many veterinary surgeons perform both TPLO’s and extracapsular imbrication techniques, but there are not many who perform all three. If you have the option of choosing between a surgeon that does a TPLO and a TTA, and have an active, large breed dog that would not do well with a traditonal, or extracapsular imbrication, repair, you will want to weigh all the characteristics of both procedures.

Which is less invasive?

The TTA is surgically less invasive than the TPLO. The amount of stifle angle shifting that takes place during a TTA is minimal when compared to that of a TPLO, where the tibia (the weight bearing part of the knee joint) is surgically cut and altered. In the TTA the osteotomy is made into the tibial tuberosity (not a weight bearing part of the knee joint), not the tibial plateau itself, giving dogs a greater ease in healing, recovery and overall success of the procedure.

Which has a shorter recovery time?

The TTA, because it is a surgically less invasive process, has a shorter recovery time than the TPLO. While most TTA and TPLO dogs are able to begin weight bearing within the first 24 to 48 hours postop, TTA dogs continue to improve with time, whereas TPLO dogs often demonstrate a more gradual healing process taking place over months instead of weeks.
Which has less risks of complications?

What does each procedure cost?

The least expensive method of cranial cruciate ligament (or CrCL) repair is always going to be the extra capsular imbrication method, as it does not require the use of any implants or an osteotomy procedure, and you can expect to pay between $700-$1100 to have a traditional repair done. This procedure can be a great option for many dogs, and I encourage all owners to read more about its risks and benefits when considering surgery for a CCL rupture.

When comparing the TTA and TPLO, the TTA is less expensive, and this is due to the simpler nature of the procedure as well as the fact that it does not require as much equipment, despite the fact that titanium costs more than stainless steel. A typical price for a TTA will run between $1500-$2000 vs. a TPLO ranging between $2200-$2700, which usually includes all of the pre-operative testing, postop medications and post-op visits for suture removal, bandage removal (if applicable) and radiography.

TPLO vs. TTA for Cranial Cruciate Ligament Repair is a post from: Dog Knee Injury

Complications and risks associated with tibial tuberosity advancement surgery:

• Swelling around incision site – happens in about half of all dogs
• Dirrhea, nausea or loss of appetite during post operative recovery
• Incisional dehiscence – spontaneous separation of the incision site
• Severed long digital extensor tendon
• Tibial crest failure – this most often requires re-operation as the stability of the implant is compromised
• Patellar luxations – dislocation of the knee cap; this can range from moderate to severe
• Implant rejection and/or infection
• Meniscal pain and post-op tearing of the meniscus

TTA Repair Complications is a post from: Dog Knee Injury

Complications and risks associated with traditional repair techniques for cranial cruciate ligament surgery are as follows:

• Adverse reactions to anesthesia including nausea, vomiting, fatigue and in rare cases – death.
• Infection of the surgical site.
• Seroma – a build up of fluid at the surgical site which must be drained (aspirated).
• Allergic reaction to sutures or medications used.
• Allergic reaction to leader line, making re-operation for removal necessary.
• Patellar luxation – knee cap dislocation.
• Entrapment of the peroneal nerve – which can lead to paralysis and/or loss of the limb.
• Blow out of stifle joint, tearing of leader line. This requires surgical intervention and a TPLO is often used for repair.
• Tearing of mensicus.

Extracapsular CCL Repair Complications is a post from: Dog Knee Injury

Possible complications associated with Tibial Plateau Leveling Osteotomy (TPLO):

• Anesthetic death (very rare)
• Poor healing of the bone and/or breakage of plates and screws
• Straining of patellar ligament
• Fracture of tibial crest
• Blow-out fracture of the tibial plateau (requires re-operation)
• Loosening of screws and shifting of tibial slope
• Shifting of bones
• Arthritis
• Tearing of meniscus
• Allergic reaction to sutures
• Seroma formation
• Bleeding or bruising of the surgical site
• Implant failure
• Deep infections of the bone, joint or implant
• Angular/Torsional limb deformity

TPLO Complications is a post from: Dog Knee Injury