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Tightrope CCL Procedure

Tightrope CCL ProcedureThe 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.

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105 Responses to Tightrope CCL Procedure

  1. Tim Wilkins October 17, 2008 at 10:37 am #

    Where can I find a Vet that is doing TightRope CCL? I live near Raleigh, NC. Or a vet that is doing LSS. I trying to find an something other than TPLO for my Dog.

    Thanks,

    • Josephine December 9, 2014 at 9:53 am #

      Hi. Did you find a vet in Raleigh that does Tightrope CCL?

  2. lisa koury October 21, 2008 at 11:20 am #

    I am also interested in finding a vet that does the tightrope. My dog needs cruciate ligament repair and plan to go with a TTA procedure but this sounds much less invasive. I live in Norhtern New Jersey and will travel anywhere in NJ, NY, or PA. I also would like the name of a vet in my area.

    • robin grover August 7, 2014 at 4:10 am #

      I am assuming that this is too late for you. However, my vet in Elverson, PA (near Reading, PA) is trained in the tightrope surgery. Our husky mix has had it in the past on her left rear leg and she healed quite well. Unfortunately, she is now scheduled for the right knee as she blew that out a few days ago. The vet’s name is Dr. Engler and he is at the French Creek Animal Hospital on route 23 in Elverson. The number is 610 469 9700 The cost was about $1700 for a 50lb dog.

      • donna November 18, 2014 at 4:22 pm #

        Hi Robin!
        I was wondering how your dog is doing? I live in Pa and was considering using Dr Engler. Thanks!!

  3. Rick October 24, 2008 at 12:21 pm #

    ANy vets in the Southwest (Phoenix, Denver, Las Vegas?) who perform this TightRope CCL procedure??

  4. donni October 25, 2008 at 10:53 am #

    There are vets all over who do this. I am going to University of Florida to see if my dog qualifies for this procedure. Vet Colleges are doing them. Also, I called the company who supplies the materials for this procedure. They cannot give you a list of people who perform the procedure BUT they can give you a list of people in your area who buy the material. The people who buy the material ARE the people who perform the surgery.

    • Megan January 3, 2016 at 5:04 am #

      I know it’s been quite a few years since you posted this, however I was wondering if you got any news/surgery from UF?

  5. Alyssa November 11, 2008 at 8:42 am #

    Has anyone had any experiance with the Tight Rope CCL procedure and what were the outcomes. How can I find a vet that will preform this procedure?

  6. Evelyn November 29, 2008 at 8:21 pm #

    My dog has torn both cruciate ligaments and my vet recommended TPLO surgery. After researching about the TPLO procedure, I discovered the Tightrope CCL techinique. I like that is much less invasive than the TPLO and TTA. There isn’t much info on the web, but here is what I have found thus far.

    The Tightrope is made by Arthrex Vet Systems. You can call them and ask the operator who they supply the product to in your area. The lady I spoke to was very nice and willing to give you info. The number for Arthrex is (888) 215- 3740. They also have a great brocure about the product and the Tightrope CCl procedure at this site: http://www.arthrexvetsystems.com/en/products/index.cfm Also, I emailed the Vet that invented the procedure, Dr. James Cook, and he gladly responded with a large list of vets that performed the procedure in my area. He teaches at the University of Missouri. Look up the vet school website and look under the faculty profiles. Click on his name and his email will be listed.

    After calling a few vets in my area that perform the procedure, I have learned that their experience with performing the procedure varies. This procedure is being taught to many vets, so depending on how long ago your vet was taught, experience in performing the procedure will range from a few to a few dozen. Hope this info helps.

    • Mark Freiberg November 20, 2014 at 10:45 am #

      Hi Evelyn,

      Excellent synopsis. I started doing TR repairs in 2009. The things I love as a surgeon about TR are, first, isometric placement of the implant, and second, minimal invasiveness compared to the bone cutting procedures. There are many who have done more than I (approx. 300 procedures) though my “n” number is large enough to have allowed me to have seen most of the complications.
      When I was most inexperienced the main issue I had was correct and precise placement of the implant. If placement is off, even by a few millimeters, the surgery doesn’t go as well. Dr. Cook’s numbers show that he has about a 95% good to excellent outcome result. My results mirror that and the outcome figure is equal to published material for TPLO, an excellent procedure in the hands of an experienced surgeon. It is important to note that no procedure has 100% good/excellent outcome. No one gets it right every time.
      TR takes about 18 precision steps and TPLO takes about 39 or 40. TR is usually about half as expensive. Bottom line is that I thank my lucky stars that I met Dr. Cook and Dr. Hulse (Texas A&M) in 2009.

      Mark Freiberg DVM, Dipl. ABVP
      Medical Director
      VCA Rose Hill Animal Hospital

  7. Karen January 7, 2009 at 8:57 am #

    Rick, Dr. Matt Rooney in the Denver area (actually up in Longmont) does the Tightrope surgery. My dog is scheduled to have it in a couple of weeks. I was really pleased with Dr. Rooney and his whole staff and I’ve gotten tons of good referrals for him, so if you are interested, check him out. He’s at the Aspen Meadows Vet Specialists in Longmont CO>

  8. sandy leath January 8, 2009 at 3:12 pm #

    I live in the Atlanta, Georgia area, and I am also looking for someone who performs the tightrope CCL surgery!! Any help will be appreciated

    Sandy

  9. Patricia January 12, 2009 at 7:36 pm #

    I’m in Oklahoma, and I need a vet here who does this procedure. I have already e-mailed the company for info, but if anyone in the state has had this procedure done on their dog and has a vet they recommend, I would really appreciate a recommendation. Thanks!

  10. Maria Dixon January 17, 2009 at 9:16 pm #

    Just had tightrope done at DeerCreek Vets in Johnson City, Tx (near San Antonio) honestly it went so well the dog is feel too good!

  11. Ina January 25, 2009 at 9:23 pm #

    My dog is 13 years old and has Cushings Disease.She is taking
    Trilostane 90 mg/D.She is a hound overweight due to her
    disease.She was diagnosed with Torn Ligament at one of her back legs and surgery suggested(TPLO)
    I am looking for some informations regarding complications due to her condition and her medication.
    I am not sure at her age and in her condition I should put her to such a traumatic experience.

  12. anne hall January 29, 2009 at 6:41 am #

    Is tightrope applicable to the ankle as well as the knee? What’s that called. Thanks from me and my beloved 1 year old Norwegian Elkhound.

  13. Cynthia February 8, 2009 at 10:03 am #

    I have a 5 year old lab, who has a partial tear in his r/knee. TPLO has been suggested. I am looking at the Tightrope, and have a consult on Feb. 18 w/the surgeon that is suggesting the TPLO. There are pros and cons, I think to both, as I am continuing investigating. Also, Cook is a paid consultant for Arthrex, and I do not know if that should be a concern or not.
    My dog had his left knee done, before he was a year old, when he was w/his breeder.
    The whole issue seems to be confusing, and which way is the right way??

  14. steve March 8, 2009 at 10:25 am #

    my 110 lbs malamute had TPLO done over about 2 years ago and now i think he needs it done on the other leg. does the tight rope procedure work on large dogs?how will it effect the other leg while he is healing

  15. Lori March 11, 2009 at 7:11 am #

    I have a 80lb Chessie (1 year old) who torn both CCL’s. We had the Right repaired with the Tightrope Procedue 6 weeks ago. We will have his Left repaired in early summer. Let me just say that the recovery from the Tightrope procedure is long. 1 week post op, He could bear some weight on his leg. At 6 weeks, he still does not bear all of his weight on his leg. He is still on activity restriction, and minimal leash walking. He takes anti-inflammatorys daily, and high doses of Glucosamine and Condroitin. I also think he is depressed as he wants to do more than we will allow. His appetite has decreased and he is down 10 lbs. (went from 80 to 70lbs)
    I am a little dissappointed, as I guess I was expecting more than I should.
    If you email Dr. Cook, he will send you a list of the vet’s in your area that perform the surgery.
    For those wondering about cost, it was approximately $2500.00 including pre-op and post -op xrays and blood work. Hope this inforation was helpful!

  16. Charlie March 14, 2009 at 7:23 am #

    My 8 yr old Lab Oliver is now 5 weeks out from Tightrope surgery and walking absolutely normally. He walked out of surgery and has consistently increased weight-bearing on that leg. We’ve adhered to the rehab guidelines quite closely — not an easy feat with an active dog — including PT/swim therapy, which is extremely worthwhile.
    I was told that it isn’t unusual for a dog to look like s/he’s responding faster when they’ve had TPLO because the tightness of the Tightrope makes them a little hesitant. In the long run, however, results are similar within just a few months.
    Our doc is Matt Rooney, Longmont CO, with a lot of assistance from his wonderful intern, Jeremy Trausdale.

  17. EA March 16, 2009 at 3:19 am #

    Dr. Garrett at the Animal Hospital of Fayetteville, NC does the tightrope surgery. Our 3 year old boxer had it done a few weeks ago and is now starting to put weight on her leg and walk again.

    Had her stitches taken out a few days ago. The knee looks fine, with no bruising now.

  18. lynn baker March 27, 2009 at 8:22 am #

    i live in fountain valley, ca 92708 i need a vet in my area that does the tightrope for my 6 year old lab.her knee is bad and i need to get surgery soon. please advise thank you lynn baker

  19. lynn baker March 27, 2009 at 3:35 pm #

    i live in fountain valley, ca 92708 i need a vet in my area that does the tightrope for my 6 year old lab.her knee is bad and i need to get surgery soon. please advise thank you lynn baker

    Leave a Reply

  20. kay March 28, 2009 at 11:53 am #

    does anyone have the list of doctors and locations that the tightrope ccl if so email to perdue9165@bellsouth.net thanks

  21. evelyn bencinich April 30, 2009 at 9:30 am #

    does anyone have the list of doctors and locations that the tightrope ccl is available in the northeatern us area. if so email them to bencinich@aol.com. my 11 year old 65 lb female chow has had a partially torn crucial ligament for 6 years (specialist claimed but my regular vet put her through on obstacle course and said no). but now she extends leg/can’t get in the car and walks to one side. she hyperventalates at the vet and i’m looking for the least invasive procedure since chows have problems w/anesthesia.

  22. Bryan Buescher May 8, 2009 at 5:39 am #

    If you’re looking for a surgeon in southern California to do the Tightrope CCL surgery check out Dr. Kelly Blackwood at Crossroads Animal Emergency and Referral Center in Norwalk. She’s their daytime surgeon and has been there about 14 years. Their web address is http://www.CrossroadsAnimal911.com

  23. Christy June 13, 2009 at 7:01 pm #

    You can email Dr. James Cook and he will email you back with surgeons in your area. I emailed him and responded the very next day. I now have a consultation with a vet on June 26th…. Wish me luck!

  24. Josh July 8, 2009 at 2:50 pm #

    Looking at alternatives to TPLO that was recommended for my 7 year old lab who weighs 80lbs and is very active prior to his injury, heard about tight rope and looking for some more information for large dogs as well as people who perform the surgery in the Northern California area.

  25. Bonnie August 11, 2009 at 11:37 am #

    I have a 9 year-old 18.5 lb Jack Russell very muscular and fit. Yesterday the vet diagnosed his limp of two weeks caused by a ruptured CCL/ACL in his left hind leg. Xray indicated that the angle was still about 90 to 93 degrees. The vet recomended the TTA procedure at a cost of $3000. Buddy puts some weight on the leg, but walks and runs on three. After investigating the pros and cons of this rather invasive surgery on bone and the risks of bone infection and frequent needs of repeated surgery,arthritis, etc. want to be sure of the best procedure for the best long-term prognosis. A 10-week recovery time seems too long for a active dog that is use to 1.5 mile walks 3 to 4 times a week. I think he would get depressed. Is it possible that with a brace on the knee and leg and restricted activity that the CCL/ACL legiment could heal without surgery? Is TTA or TPLO recommended for small dogs? I have read there are other procedures that are just as successful, but I do not know who to believe. Would the tightrope procedure work as well long term? $3000 seems like an excessive cost for a 30-45 minute procedure. We can pay the $3000, but what is most important is to prevent excessive risks when another procedure could be successful. I have read the 40% of dogs will rupture the other CCL if condition is not corrected quickly. Buddy has been limping for two weeks nad we are not aware of any specific injury. Please advise ASAP so I can decide what procedure is best for him. I live in Mission Viejo, CA and would like referral to a qualified Vet that will recommend the best procedure for Buddy’s size, breed and age. I will be most grateful to hear from you.

  26. Mark Freiberg, DVM,DABVP August 12, 2009 at 3:38 pm #

    While I have been repairing ACL ruptures for over 20 years and have been accepted by the TPLO course twice, I have stayed with the extracapsular repair techniques. It never made sense to me to learn the bone cutting surgeries. Then along came the tightrope procedure. I have been incredibly happy with it. The outcomes have been tremendous. What I am most happy about is that the dogs walk out of the hospital with a normal gait. I still recommend a strict 6-8 week recovery period but since the procedure is much less invasive I think they might recover faster. I practice at VCA Rose Hill Animal Hospital in Kirkland, Washington and wish there was a way for people to identify veterinarians in their areas that are as enthused about Dr. Cook’s tightrope surgery as I am!

    • Edelgard McAtee June 7, 2015 at 6:06 pm #

      Hi Dr. Freiburg, I live in Santa Rosa, Ca., is there anyone in my area that you could possibly recommend. Our Golden needs surgery and after much research we definitely want to do the tightrope repair surgery on her.
      Thank you for your feedback and thanks for doing surgery without bone cutting etc. on our beloved pets.
      Sincerely, Edelgard

      • Betsy October 21, 2015 at 8:47 am #

        Edelgard did you have the tightrope surgery done on your golden? I live in Nevada and am going through the tough decision and am looking at the tightrope but don’t know anyone in my area that performs it. Thanks Betsy

  27. Deana August 22, 2009 at 2:42 am #

    My 3 year old black lab mix, Rex, has had 2 ccl repairs on each knee with the most recent being the right knee. He had the tightrope procedure at the West Central Veterinary Service in Rockville, IN performed by Laura Couch, DVM on 8/6/09. I was amazed to see him walk out of the office the day after the sugery with vitually no limp at all! He is now 16 days post surgery and is doing wonderfully. He is still on restricted activity but really wants to go play with my other two dogs. I have not seen him walk this well in a very long time. We walk at least three times a day and he will be on a long recovery schedule due to the problems I’ve encountered with his previous knee surgeries. I want to give the tissue plenty of time to form and stabilize the knee. I highly recommend this procedure and West Central Veterinary Clinic. Dr. Laura has been awesome and has extreme talent performing orthopedic surgery.

  28. Suzanne Hedges August 30, 2009 at 1:15 am #

    Hi. I am considering the Tightrope CCL for my 8 year old lab/shepherd mix. I am doing the research and it seems the best for her. Two questions. First, I need to get it done in BOTH knees (one is 100% torn and the other is 80% torn). Can you do both at the same time? Second, I can’t find the contact number or email for Dr. James Cook. I would like to contact him so I can find a vet that can do the surgery. I am the San Fernando Valley/Los Angeles. Thanks in advanced!

  29. Sue Q. September 2, 2009 at 8:37 am #

    My 5 year old boxer had the TightRope procedure done on Feb. 20, 2009 by Dr. Jimmy Cook at the Univeristy of Missouri Vet school. We followed her post-op instructions to the T with crate rest for the first 2 weeks and very restricted activity for the next 6. (potty breaks on leash only)We also did a lot of range of motion exercises and massage. We increased her activity level very slowly and used low hurdles and weave poles to walk over and around to strengthen her muscles. She was not allowed to run freely for 12 weeks post-op. We also have successfully kept her weight down to a level that was recommended by Dr. Cook.
    Just last week, she became lame in her repaired leg and upon examination by an ortho-team at the Univ. of Mo. it was discovered the tunnel in her tibia had widened somewhat and was allowing the ‘rope’ to cycle through the tunnel. She is also rejecting the implant and has a small meniscus tear. She is scheduled for surgery to remove the implant and clip the meniscus tear next week. We hope both issues will be completed with a very small orthroscopic incision. It is possible that the knee will have to be opened up for more invasive repair work to be done.
    Fortunately, the tighrope has done it’s job in stabilizing the knee and sufficient scar tissue has formed to keep her knee stable. But I’m so disappointed to have to put her through another surgery AND spend another $1K or more,on top of the $2500 we’ve already spent, to fix the ‘fix’.

  30. question September 3, 2009 at 12:11 am #

    Question for Sue Q? If the tightrope has done tis job then why has the knee lossened and how did the meniscus tear. My understanding is that the mensicus can only tear if the knee is loose?

  31. Cindy September 9, 2009 at 9:22 am #

    Comment to Sue Q. Our dog underwent Tightrope repair in Sept. 08. We also followed the rehab protocol to the letter. Our dog went lame at the end of Dec. 08. After x-rays, it was found he had suffered an expanding bone tunnel, causing the metal buttons to collapse into the bone tunnel. The Tightrope was removed in Jan. 09. At that time, we were also told there was enough scar tissue built up & that the knee was stable. We continued to rehab for another 16 weeks, at which point we sought a second opinion from a board-certified ortho surgeon due to continued lameness. He found our dog’s knee was not stable & he underwent a TPLO in April 2009.
    Since that time, we have found numerous cases of this “expanding bone tunnel” problem as a result of the Tightrope procedure. I would caution anyone considering this procedure to do their research very carefully. There are far more complications than are being reported. Dogs are suffering as a result.
    The good news is that our dog healed up from the TPLO beautifully & is now back to regular doggy activities. No sign of lameness.

  32. James Rummel, DO September 27, 2009 at 12:47 pm #

    Dr. Sliker at Camboro Veterinary Hospital has been doing these for awhile. They are located in Edinboro, PA. He tells me they have had great results.

  33. Cindy September 28, 2009 at 11:10 am #

    Comment to James Rummel. Why not disclose that you are in fact a veterinarian who WORKS at the Camboro Veterinary hospital? It seems that the veterinarians promoting the procedure are the one having all the great results. However, those of us who have actually undergone the procedure have had many complications. It seems a little self-serving to promote a procedure without disclosing who you are or why you are promoting it. Is it all just a cash grab to you vets? Or are you actually concerned about the many dogs who have had to have follow-up surgery to correct the failed tightropes?

  34. Tyler October 1, 2009 at 7:49 am #

    Tightrope® CCL in Large Dogs? Has anyone had any experience using the Tightrope® CCL procedure with a Great Dane, St. Bernard, or Newfoundland?

  35. Mir October 10, 2009 at 11:15 pm #

    Add us to the list of failed Tightropes…first surgery January 2009, it failed, and we had to have it “redone”due to tunnel widening and then, my poor pup had to have a THIRD surgery because his patella luxated immediately after the 2nd surgery. (hmm, TR possible cause of patella luxation? idk..) UNREAL. tragedy, really- he just turned 4 years old and I think this has ruined his life. Still on leashed restriction, muscle atrophy is horrific, big time pain still, 3 leg hops more than not, he will probably never be functioning on that leg, how I wish we had NEVER had this Tightrope procedure.

  36. Art Kennedy October 22, 2009 at 10:45 pm #

    We researched the options for our English Mastiff (165lbs) for her CCL repair and had a fundamental challenge with TPLO. The TR procedure sounded better. We emailed Jimmy Cook and he sent us to a VCA surgeon in Sacramento (we live 2 hours away in San Jose). The surgeon was very excited because although he had done a lot of TR, he had not done one on such a large dog such as ours.

    Surgery was three weeks ago and we drove her back up to SAC last week for a 2 week checkup. Doc said she was “okay” but not as “tight” as he’d like to see. He gave us some range of motion PT to do for 5 mins a day. He said to give it another 2 weeks on extremely limited movement. If no improvement, then come back to see him again. If improved, come back in 4 weeks.

    Hoping we did the right thing. Our surgery was $3k.

  37. Kelly October 29, 2009 at 5:01 pm #

    We have been researching options for our 70 lb American Bulldog. She is 8 yrs old and fairly active. She likes her long walks and to run in the snow and with her sister in law (which is who she was running with when the injury took place). We had Xrays taken and have had three vets look at her and the concensus is that it is an ACL tear. It happened about six weeks ago and we thought it was just a mild strain and gave it some time to heal but when we were not seeing any improvement decided to take her in. I am between the TR and older CCL surgery. The TR seems to be about $1000 more in the Detroit Area but from what I have read holds up better for dogs over 50 lbs. I am not so much concerned about the price as outcome of surgery and recovery time. Thanks for all of the posts on this site as they have been helpful. It sounds as though alot of people have seen good success with the TR surgery but the price sure does vary. Right now our vet is saying it will cost around $2900 but I am hoping he is willing to work with us as it sounds as though that is on the high end for the TR procedure. I will keep you posted with what we decide and the outcome. I hope for a excellent recovery and many more fun filled years for our Hunter.

  38. John Galt October 31, 2009 at 8:37 am #

    Kelly…… Suggest you visit http://www.warrenanimalclinic.com for review of TR and also comments from pet parents with very large dogs

  39. Julie November 6, 2009 at 10:00 am #

    I am so sorry to hear about all the tragedys of the tightrope. Thanks so much for taking the time to post your stories cause I so thought that was the surgery for me but now not so sure. Hadn’t found anything bad about it til now. I have a very active boxer and I need the surgery that is going to get him back to doing what he loves to do, RUN RUN RUN. Well after all the recovery of course! Hope you all well. Would love to hear from someone who has had the TTA surgery on an active dog and is well past the recovery stage into and back to real dog life. I guess someone who had it a while ago. There is alot of great stories but they are all so recent. Good luck to you all and thanks again for any feedback

  40. Eric November 19, 2009 at 10:50 am #

    While i am not a doctor, it doesn’t really make sense that a solution to a deficiency of the CCL is to cut bone. I was told that we needed to have a TPLO done, but i have since discovered the Tightrope CCL and we have our appointment on Monday. Here is a list of Doctors in California.

    SAN FRANCISCO VET SPECIALTY 600 ALABAMA STREET SAN FRANCISCO CA 94110 415-401-9200
    VETERINARY MED. & SURG GROUP 2199 SPERRY AVENUE VENTURA CA 93003 805-794-3806
    JAMES ROUSH DVM 16420 BONNEY ROAD WATSONVILLE CA 95076 831-768-7085
    ABC ANIMAL HOSPITAL 9121 WALKER STREET CYPRESS CA 90630 714-995-8033
    VCA CENTRAL ANIMAL HOSP 281 N CENTRAL AVE UPLAND CA 91786 909-981-2855
    OAKDALE VETERINARY GROUP 20 SOUTH STEARNS RD OAKDALE CA 95361 209-847-2257
    INLAND VALLEY SURGICAL ASSC 281 N CENTRAL AVE UPLAND CA 91786 909-981-2855
    VET SURGICAL SPECIALIST 2965 EDINGER AVE TUSTIN CA 92780 949-936-0055
    VETERINARY SURGEON ON CALL 12351 GLACIER CIRCLE LOS ALAMITOS CA 90720 562-506-3573
    AMERICAN ANIMAL HOSPITAL 440 BRITTANY DRIVE CORONA CA 92879 951-515-5911
    CROSSROADS ANIMAL EMRG & REF 11057 ROSECRANS AVENUE NORWALK CA 90650 562-863-2522
    MISSION PET HOSPITAL 720 VELENCIA ST SAN FRANCISCO CA 94110 415-552-1969
    VET SPECIALTY HOSP 10435 SORRENTO VALLEY RD SAN DIEGO CA 92121 858-875-7500
    ALL PETS ANIMAL HOSPITAL 285 N. EL CAMINO REAL ENCINITAS CA 92024 760-634-2022
    DESERT VETERINARY SPECIALIST 42-065 WASHINGTON STREET SUITE D PALM DESERT CA 92211 760-772-2222
    EVENING PET CLINIC 6803 CHERRY AVENUE LONG BEACH CA 90805 562-422-1223
    VCA SACRAMENTO VET REF CTR 9801 OLD WINERY PLACE SACRAMENTO CA 95827 916-362-3111
    JACK HENRY SURG ASSOCIATES 1340 BAYSIDE CIRCLE OXNARD CA 93035 818-943-1924
    PARADISE PET HOSPITAL 5766 LINDERO CANYON ROAD WESTLAKE VILLAGE CA 91362 818-706-9661
    PETCARE VETERINARY HOSPITAL 1370 FULTON RD SANTA ROSA CA 95401 707-579-5900
    VET ORTHO & SURG SERVICE 1618 WASHINGTON BLVD FREMONT CA 94539 510-657-6343
    MIDTOWN VET 3333D KIMBER DRIVE NEWBURY PARK CA 91320 805-498-6694
    PARADISE PET HOSPITAL 1543 RAMONA DRIVE CAMARILLO CA 93010 818-706-9661
    PET HOSPITAL 3411 EAST CHAPMAN AVE ORANGE CA 92869 714-771-3261
    SANTA CRUZ VETENNARY HOSP 2585 SOQNEL DRIVE SANTA CRUZ CA 95065 831 475 5400
    ANDREW SAMS CLINIC 489 MILLER AVENUE MILL VALLEY CA 94941 415-380-0500
    DISNEY PET HOSP 3554 CONCORD BLVD CONCORD CA 94519 925-689-4244
    PET MED CENTER 621 W FALLBROOK AVE FRESNO CA 93711 559-436-4444
    PICO RIVERA ANIMAL HOSP, INC 9221 SLAUSON AVE PICO RIVERA CA 90660 909-964-3716
    TRAVELING SURGERY PMB 274 1346 THE ALAMEDA, STE 7 SAN JOSE CA 95126 408 268 3899
    V.I.P. VETERINARY HOSP 26111 BOUQUET CANYON RD # D-5 SAUGUS CA 91350 661-222-7387

  41. Cindy November 19, 2009 at 1:13 pm #

    Eric, if you contact alot of the vets on the list you provided, you will most likely find alot of them do not perform the Tightrope procedure. Arthrex is the company that manufactures the fibretape used in the Tightrope procedure & they are known to provide these lists claiming these are vets that perform the Tightrope procedure, when in fact it is simply a list of vets that have purchased any sort of product manufactured by Arthrex, whether or not it was fibretape. Also, many vets have discontinued offering the Tightrope due to the high number of complications & failures, especially the expanding bone tunnel.

  42. Eric November 20, 2009 at 10:01 am #

    Cindy,

    I asked Dr. James Cook (who invented the TightRope) for a list of doctors that perform the tightrope procedure in California and this is what he emailed to me. It may very well be a list from Arthrex, but the one place i called, closest to Los Angeles, does offer this procedure.

    My feeling is that if it doesn’t work, you can also do the more invasive TPLO.

    Do you have info on the Vets that have discontinued offering Tighrope, I would like to call them.

    Also, what does a complication & failure in the expanding bone tunnel mean? Are you a Vet who performs TPLO?

  43. Cindy November 20, 2009 at 3:17 pm #

    Eric,

    No, I am not a vet. I am simply a dog-lover who had the Tightrope procedure performed on my beloved dog. Unfortunately, it failed miserably. The fibretape caused the bone tunnel to expand to twice the original size. It had to be removed during a second surgery. We were never given a satisfactory answer as to why the bone tunnel expanded. It was speculated that the fibretape is too abrasive & rubbed. Or the weave of the fibretape harbors bacteria, causing infection. We did culture a sample of the fibretape that was removed from our dog & it was found to contain staph. We ended up having to do a TPLO. In subsequent resarch, I have become aware of numerous dogs who have suffered the same outcome. Incidentally, Jimi Cook does not consider the expansion of the bone tunnel to be a complication of the Tightrope procedure when he gives his stats on complication rate.

  44. Eric November 23, 2009 at 4:41 pm #

    Cindy,

    Thanks so much for sharing that information. I went to a vet today, an hour from my home, only to learn that she had only performed 2 tightrope procedures…not enough for me. On my drive home I contacted another vet who had performed 8 procedures and has since stopped because he is not certain that he can get the “tightrope” tight enough. He said, until they figure out a way for the tightrope procedure to be “tight” he is no longer doing them.

    Cindy, how is your dog doing now?

  45. Cindy November 24, 2009 at 3:08 pm #

    Eric, I am SO happy you decided to do further research. Even though I felt I had researched extensively, if I knew then what I know now, I would have NEVER put my dog through the Tightrope. Our dogs are far too precious to be used as guinea pigs. The surgeon who performed my dog’s Tightrope had done over 40 of them & was involved in teaching the procedure alongside Jimi Cook. In fact, it was Dr Cook himself who referred us to our surgeon. So our dog’s failure was not a lack of experience with the procedure. In my opinion, there have been FAR too many failures & complications (eg. slackening of the fibretape, infections, bone tunnels, synovial leaks, etc).

    As for how my dog is doing now, he is doing GREAT. He had a TPLO performed in April 2009. He is back to 100% his old crazy self. I was terrified of the TPLO, but to be honest, the recovery was faster & seemed less stressful than the Tightrope.

    Eric, all the best to you & your dog. I hope you are able to find a surgical procedure you are comfortable with & that your dog is back to 100%.

  46. Heidi November 26, 2009 at 9:36 am #

    I have a newfie girl (150lbs). She had a TPLO done on her right leg which went well, though the hardware had to be removed after a year since it was rubbing on her bones. Most recently, she underwent a tightrope procedure that went horribly wrong. About 1 week after the surgery, her knee became infected and the tightrope became lose. Though I followed all of the instructions given to me, crated her, potty walks on leash only, etc. The tightrope had to be removed and for 7 days in a row she had to have a flush of the knee each requiring anesthesia. After she healed from all of this, she had to have a TPLO done to finally repair the torn ACL. The TPLO has never caused an infection, not when it was done on her right leg, and not this time. Unfortunately, she is still limping almost 7 months after the TPLO. I took her to underwater treadmill treatments for 3 months. I still put heating pads on her leg and massage 3 times a day. The other side-affect she is suffering from is that she continues to vomit. She started to vomit during the many joint flushes and she had lost about 15 lbs. There were many times that I thought I would lose her. It took a long time to finally get a canned food that she wouldn’t throw up. I started with baby food, then royal canine (recommended by the vet) to cooking for her all of which failed. In addition, the vets were trying to figure out what was wrong with her. She underwent several procedures that revealed nothing, they took biopsies of her stomach, intestines, checked her esophagus, etc. She vomits about every two weeks. I have stopped going to vets for this. Seems there is nothing wrong with her. Though I am not a vet, I know my dog. She has changed a lot. She is not the happy-go-lucky girl she used to be. In my opinion, the many anesthesia she has had is the cause of the vomiting though the vet says that there is no medical proof of this. Well, I’m tired of hearing about the scientific statics since they are not helping my dog. I miss her ever endearing personality and her zest for life. I’m currently looking to adopt another dog to see if this will help her have a happier life.
    She was treated by Dr. Rooney of Aspen Meadows Vet in Longmont. And yes, they were great, especially Jeremy Trysdale, while she was going through all of the procedures, I will no longer have her treated there for any reason. I have lost trust with them.
    My question really has been, are the vets in this for science or are they in this for the health of a dog.
    Sounds bitter? I am.

  47. amy December 5, 2009 at 7:27 pm #

    Hello! I really appreciate all this info. I was starting to think TR might be the answer for my 90 lb rottie, 5 yrs old, with torn CCL in right leg, possible tear in left. I am not a fan of tplo- just the idea behind it and how very intrusive it is. Did anybody here consider extracapsular? Eric you seemed to have some of the same feelings as I do about tplo. What did you end up doing and how large is your dog?

    Thank you!

  48. Artt Kennedy December 10, 2009 at 10:34 pm #

    Follow up to my Oct 22nd posting: All is really going well with our English Mastiff and her TR repair/recovery. At the first checkup (3 weeks PO) the surgeon was somewhat disappointed at the “movement” still in the joint. He said most smaller dogs tighten up by now and he was not very pleased with the results. Well, as with most thing large breed, they just take a bit longer to hold. It has been another 6 weeks and the knee is really getting better. LaJolla is getting up quickly, gently climbing on her couch and in general not limping much at all. She saw the vet today who couldn’t say enough good things about her condition. The road to recovery continues, but we are becoming another TR success story – just not as quick as the smaller breeds. We too took issue with TPLO and would rather put her to sleep than alter her bone structure for the rest of her life. It is just fundamentally not right in our mind, but hey, to each their own. I just wish LaJolla could talk and then make her own decision. 🙂 Until then, we are all happy about our tough call to go TightRope. It was all good to this point.

  49. John Lanan December 20, 2009 at 1:43 pm #

    Our dog Maggie, an Australian Cattle Dog/German Sheppard mix had the Tightrope procedure performed one year ago. The procedure was performed at the Colonial Vet. Clinic in Richmond, VA. As with many cases Maggie also had to have some miniscus repair during the operation. We were extremely careful with her rehab. taking it VERY slow. I’m happy to report that at this time Maggie is back to “normal”. We still try to keep her from getting too ambitious when chasing squirrels or playing in the yard. At this time I must give the Tightrope CCL procedure a double thumbs up. It has brought Maggie back from almost lame to happy and energetic. I firmly believe that being overly cautious and patient during the rehab. period is the key.

  50. SDL December 21, 2009 at 12:07 pm #

    John, your post was like Godsent!! I’ve been searching high & low locally for a practitioner in the Richmond, VA area that does TightRope. Thanks for your info! I just called Colonial Veterinary at Pump RD and got a confirmation that they do perform TightRope knee surgery. I was about to drive up to Baltimore, MD to have the TightRope done.

    I’m glad to hear that your dog is doing well. Mine is a 7 year old 80 lbs. Labrador Retriever. He was diagnosed with cruciate tear 2 months ago through x-ray & drawer movement test. The vet said that it’s not really that bad (since he still walks on all fours, just not bearing much weight on his injured knee), but does recommend surgery. I like how the TightRope procedure is less-invasive. The way I see it is: If TightRope doesn’t work out, there is still the TPLO & TTA option. But if I start out with the latter, then it’s a point of no-return if complication arises. Plus TightRope is less expensive. My plan is to also get him a custom-fabricated knee brace (about $600~700) to use during rehabilitation and just use it on and off as needed.

    How much did you have to pay for your dog’s TightRope procedure and is it all-inclusive? Also, how old is your dog now? And how much does she weigh?

  51. John Lanan December 23, 2009 at 2:21 pm #

    We paid a little over $1500.00. This included everything plus a follow up to have the stitches removed and an exam. We were very pleased with the entire experience. I can’t emphasize the SLOW rehab. I would say Maggie’s rehab. was an entire year long. Maggie is 5 years old and weighs 85 lbs.

  52. SDL January 1, 2010 at 4:11 pm #

    John, are you located in the Richmond, VA area? I’m interested in meeting you and Maggie to see personally the result of the surgery as well as to learn more about it. Right now I’m torn between the traditional fishing line method ($1200–least expensive one I found so far) or the TightRope ($1500). I’m trying to weigh the pros & cons of each. My main concern about the TightRope is the case discussed when the drilled holes enlarges, ‘causing permanent damage to the bone.

    Whatever surgery I end up getting him, he still getting a set of custom-made knee brace from Animal Ortho Care (Arlington / Vienna, VA). I’m getting one for each knee in case the other one goes out. The cost (including shipping) is $650, I was quoted. I just have to cast his legs myself (did the first one last night) and send it in to them. Not too bad, considering the stifle brace would be my dog’s to keep for the rest of his life! I’ll have him wear them during the day time and whenever he goes out. And this is also the reason why I’m thinking the fishing line technique is all he needs. I’m just trying to find a local place where they sell casting tape so I can get to work on the other leg. I ordered two rolls of casting tape online and it takes a week to ship by the ultra-unreliable UPS. I messed on with the first roll. I want him to have the knee braces available to him prior to going to surgery.

    My email address is: KUNGFU_RIDER@YAHOO.COM
    I would look forward to meeting speaking to you and seeing how your dog is doing post-ops. Below are a list of resources I used to based my decision on less-invasive procedures…

    CUSTOM STIFLE BRACES
    http://www.sungazette.net/articles/2009/05/25/arlington/news/nw562.txt
    http://www.animalorthocare.com/

    ADVOCATE OF CONSERVATIVE TREATMENT FOR STIFLE INJURIES IN DOGS
    http://home.earthlink.net/~tiggerpoz/id3.html

    FISHING LINE vs. TPLO
    http://www.youtube.com/watch?v=-1pxxX4TXko

  53. Darren S. January 2, 2010 at 5:45 pm #

    We had the tightrope surgery performed at VOSM (http://www.vetsportsmedicine.com/) in MD and it went better than expected. After little over a month, he was already doing better than he was prior to surgery, going on 20min walks with our other dog and can pee standing on the “bad” leg. VOSM was NOT cheap ($3k), but we were paying for the expertise/experience of the surgeon (Dr. Peter Lotsikas) who’s done a ton of BOTH types of operations.

    I chose the TR over TPLO for a few reasons. As mentioned, was it’s a much less invasive procedure. I personally didn’t like the idea of cutting bone and re-inventing the knee. I’m sure it works, but not keen on the concept, let alone the fact that Vets have to “sell” a lot of TPLO’s in order to pay for the “privilege” of performing this patented procedure. The office where I took my dog performs ALL methods of CCL repair, so I didn’t feel there was a conflict of interest. Dr. Lotsikas has performed hundreds of TPLO’s but was excited that I was leaning towards the TR, as he had also participated in the results-study for TR, done many of them, and thought that my dog would be a good candidate for either.

    The TR is similar to the CCL repair method that’s been used forever, only it uses the same high-strength material that’s used on humans for (typically) ankle repair.

    Max, though 8yrs old, is quite active and is a bit high-strung. I get up, he gets up, he likes to go on long walks, and plays a serious tug-of-war with his bully-breed sis. Just 2 months after the surgery, he was doing all of this like nothing ever happened. I have to say I didn’t confine him at any point, either, except to make sure he didn’t have access to stairs (for the first few weeks). I didn’t use the Queen Anne collar on him, either. The 4″ incision was just covered by a bandage, and by the time the bandage fell off in 5 days, the wound was completely closed (internal stitches helped greatly), so he never bothered it.

    Max had his final checkup last month and I am really happy with the outcome (except the hurt it put on my wallet!). He was actually offleash today and did a short 50yd run just like his old self, which put a smile on my face. I’d say that 4mo. after the TR procedure, he is at 90% of his pre-surgical abilities, and I’d bet that as he continues to get back the full musculature of the bum leg, he will get to 100%

    • Lynn March 11, 2015 at 10:20 am #

      Darren, I have a consult at VOSM for the tightrope procedure tomorrow for my 100 lb lab – who also has a bully breed sister to play with (the cause of her torn ACL – playing in the snow with her sister) – are you still happy with this procedure?

  54. Dawn January 5, 2010 at 5:59 pm #

    I am looking for a surgeon to repair the CCL for my 4yr old Lhasa. I live in Rockville, MD. Can anyone recommend some one in Montgomery County?
    Thank you!

  55. Kim January 28, 2010 at 7:18 pm #

    My dog had TR done 4 weeks ago, he is doing great. If anyone is interested in this procedure and you live in WA state. I would reccomend it. The vet I used is located in Kirkland WA, he has been great for us and he really cares about his work and your animal. If you want to contact me here is my email holy2001@yahoo.com

  56. Darren S. February 3, 2010 at 9:17 pm #

    Dawn,
    See my post above. VOSM is less than an hour away from you!

  57. Paula March 1, 2010 at 12:12 am #

    My dog is almost 11 yrs old and tore her cruciated ligament. TR seems to be the best option considering her age. Can anyone recommend a vet in the Portland Oregon area?

  58. Sue March 2, 2010 at 9:05 am #

    My Lab, 6 yrs old and weighing 73# had the TR done last Thursday. She was already putting weight on it Friday and is doing extremely well. She is restricted for the next 8 weeks, no running, playing, jumping and stairs. She does stay in her crate when we are not here to supervise her, otherwise, she spends her time resting on her doggie bed. We also have a 5 yr old Lab who seems to sense that his playmate can’t play right now. We were told it is more important what you do after the surgery than the surgery itself. I contacted Dr. James Cook at the University of Missouri, Columbia who was the doctor who developed the tight rope procedure. He sent me a list of qualified doctors as well as post op information. His email is CookJL@missouri.edu.

  59. Barbara June 16, 2010 at 10:50 am #

    There have been many instances of tightrope failure due to the bone tunnels collapsing where the tape goes through. The way I understand it, the material may be so strong and or abrasive that it wears through and damanges the bone. The repair has to be removed. These failures are not considered failures in the statistics kept by Dr. Cook, who owns the patent. He considers it a problem with the surgeon or the lax rehab of the owner. There are also problems with infection hiding in the tape. If I were considering this procedure, I would make sure my surgeon was not having these problems. I know of this because I am on orthodogs list on yahoo groups. It is documented in the list archives.

  60. heather November 12, 2010 at 2:29 pm #

    I am looking into the tightrope procedure for our 7 year old, 70 lb yellow lab. She is still putting weight on it, but with the cold weather of winter coming, she has a tougher time.
    Any recomendations in the San Jose, CA, South Bay area?
    Thanks!

  61. Rich November 19, 2010 at 12:47 pm #

    I had tightrope done on my 5 year old German Shepherd back in March, and two months ago, we had to remove the implant due to failure. I believe that TR is an option, but it has it’s drawbacks. It seems more prone to infection than lateral suture, and it is more invasive to the bone than LS (drill holes, anchors, etc). I would just remember to ask the right questions about failure rates and risks.

  62. Susan November 23, 2010 at 6:37 pm #

    Hello,

    My yellow lab Britney tore her ACL 3 times since May 2010. She was scheduled for Tightrope surgery today, but I chickened out. After reading these posts about the high failure rate and complications from this surgery, I decided not to go through it. Instead, I ordered an A-Trac Dynamic Brace from Wound Wear. It is a custom made brace to fit on your dog’s knee/leg. I hope this works. I will let you all know if it helps my dog.

  63. marlon January 20, 2011 at 6:08 pm #

    Just remember we are allowing the dog to injure themselves through overfeeding and placing them in “jump now” situations every day(and stairs! oooh nooo). For partial Acl tear – “crate” for 2 mos. And MAKE your dog lose 10 lbs. My dog just had surgery (tightrope ccl) & guess what – I have to crate him for 2 mos. and he NEEDS to LOSE 10 lbs.

    • Darren S. January 21, 2011 at 4:38 pm #

      While I did help my Max lose about 10lbs, we did not crate him or otherwise restrict his movements (except for stairs) post-op. Not the best analogy, but if you tore your ACL, hopefully your Dr. wouldn’t advise sitting around or lying in bed for 8wks. I just walked him without our other dogs for a few weeks, and he slowly built up his stamina and strength at his own pace. It might have helped that he was 8yrs old, but he is a very nervously active dog (you get up, he gets up, follows everywhere, etc.). It’s now been 18 months or so since he had the Tightrope procedure and watching him, you would never know. Still pulls me around on the leash, plays tug-o-war with the other dogs, and tries to catch rabbits…

  64. rl January 21, 2011 at 4:04 am #

    Marlon,

    I do not find the Tightrope aftercare that restrictive. I like 6 weeks of reduced activity but have never recommending crating or post-surgical bandaging. I feel the motion improves results and recover time.

    The beauty of the TR is that it is relativly non-invasive and the implant is strong. I think the problem is that the skill level required to get good results in this procedure requires considerable experience.

    In my practice life I have used many procedures for ACL/CCL repair. Tightrope gives outstanding results for me.

  65. Mark Freiberg, DVM, DABVP January 21, 2011 at 4:16 pm #

    What great comments!!! I have been doing TR repairs since 5/2009 when I attended the NAVC conference in Orlando, FL. The “magic” of the procedure is in correct isometric placement of the implant. I have done close to 75 of them and not had an infection yet (knock on wood). I routinely send my post-op radiographs to Dr. Cook (the inventor) and he is gracious enough to promptly give me a critique. Complications? Yes we definitely have them. My rate is about 1 complication for every 7 surgeries. Every once in awhile I have had to do a second surgery (at my own expense). I had one dog die from cancer and another from malignant histiocytosis. I have not had a bit of trouble with the braided implant material or with the tunnel collapsing. After all, the material was tested on thousands of human ankles before it was ever used on dogs. I just sent a post-op home today and she was already bearing weight!
    When I have to re-explore a joint it is usually a subsequent tear in the medial meniscus though I haven’t had one of those in awhile. Bottom line is that I love doing the procedure and I love the results!
    Mark Freiberg, DVM, DABVP

    • Barbara January 24, 2011 at 3:42 pm #

      I’m glad to hear some vets are having good success with the TR. My vet refers out all knees. He refers the big dogs to the specialty practice and the small dogs to a colleague who likes to do surgery. I spoke with the colleague a couple of months ago. He is now doing the tightrope and had not had any problems. He said he had been doing it about a year and had had no failures. I hope the problems get worked out as there is a genuine need for a better, more affordable repair for dog knees.

      Before I would ever allow the TR on my dog, I would like to know what causes the expanding and collapsing bone tunnels and that they have solved the problem. As I understand it, Dr. Cook does not acknowledge the problem and dismisses it as a surgeon or owner problem. It’s said they are not counted as failures in Dr. Cook’s statistics. YOu know the old saw, about you can’t fix it if you don’t know something is wrong.

      The studies on TR would be more believable if they were done by some college or group that was not affiliated with Dr. Cook as is Missouri State. A vet in my neighborhood said the TR has been dismissed as a viable option by Texas A%M vet school, which I know is very conservative.

      So, in my opinion, there’s still some proving to do before I would choose the TR over the traditional repair, even on a big dog. If anyone is curious about the results of TR surgery, go to orthodogs, a yahoo group. Search for tightrope and see how man successes you see and how many failures. These are just random people who joined a group to learn more about their dog’s orthopedic problems. Most of the ortho problems are knees. All repairs and all parts of the country (and the UK) are represented.

      • Mark Freiberg, DVM, DABVP January 24, 2011 at 5:21 pm #

        Barbara,
        Interesting comment on the bone tunnels. I have discussed it with Dr. Hulse (Texas A&M) and Dr. Cook (University of Missouri). It seems that sometimes the angle of the tunnel through the femur can be too steep. The implant is really sturdy and does not break. It wears on the bone and could cause an enlargement of the tunnel. I have seen that issue discussed within the group that is contributing to the current study and have seen radiographs of it. I have found Dr. Cook to be very open to discussing and documenting any issues with the procedure Since I learned tightrope from Dr. Hulse of Texas A&M (5/2009) and attended a wetlab taught by him (2/2010) I think he might have missed that memo. He does do a slightly different surgery but the concept is the same. Hope this helps!

  66. Barbara January 21, 2011 at 4:45 pm #

    Everyone should be aware that the study comparing the tightrope to the TPLO was a six month study. It concluded that the results were equal at 6 months. The problems with tightrope show up at about 9 months.

    • Mark Freiberg, DVM, DABVP January 22, 2011 at 12:54 pm #

      Actually, there is an ongoing multicenter study study on tightrope results. There are approximately 2000 case reports so far. I am not sure when the study will be completed and published by Dr. Cook at the University of Missouri.
      When I have complications it is usually in the first 90 days, though they are few and far between. All published material shows one year positive outcomes on TTA, TPLO, TR, and lateral fabellar suture to be about the same at 92-95%. The first question is how many complications are you comfortable with. The second question is how severe of a complication are you comfortable with. The next question is how much do you need to pay.
      Please note that no procedure is foolproof. There is no published result of 100%.

  67. Char January 21, 2011 at 6:14 pm #

    We’re two years out and everything’s perfect.
    We followed very stringent guidelines for rehab, as difficult as that was. This is a dog who lives in a three story house, has a doggy door and yard. Instead of the usual freedom we were taking 5 and then 10 min walks and using a sling to take him upstairs in the evening and downstairs in the a.m. He also had PT, both manipulations and walking on a treadmill in water.
    I was recently told that dogs have both CCLs and ACLs and that TR has better results with CCL, which is what his was.. Also, his was a traumatic tear, not a result of genetic malformation and I wonder if that has a bearing on outcome.

  68. Mark Freiberg, DVM, DABVP January 24, 2011 at 12:38 pm #

    Char,
    Actually the outcome may rely on the progression of osteoarthritis. Dogs get this form of the disease and people do not. It is chronic, progressive, and non-cureable. If your dog had minimal osteoarthritis then you have a fantastic chance at a superior outcome. The last two surgeries I did (last week) had tremendous amounts of arthritis. I expect a full recovery from both. I was very happy post-op both times. Both dogs walked out of the hospital limping and able to bear weight. As long as the post-op instructions are followed these two should turn out really well!
    I am having a bit of trouble with CCL and ACL. Are you referring to cranial cruciate ligament and anterior cruciate ligament?

  69. Char January 24, 2011 at 1:00 pm #

    Initially, I was told that what we call an ACL is a CCL in dogs.
    Then recently was told that dogs actually have both: ACL & CCL, and that the tightrope tends to be more successful when it’s the CCL involved.
    Is that true, or was I given wrong info?

  70. Barbara January 24, 2011 at 3:17 pm #

    Your info was originally correct. The ACL and CCL are the same. It prevents the forward motion of the femur and keeps it in place to form the knee. There is another collateral ligament that prevents the backward motion of the femur, which is rarely damaged. I think it’s called the PCL or posterior collateral ligament.

    Your informant was apparently telling you that the TR was more successful as a repair to the ACL than the PCL, but I believe that is true of all the knee surgeries.

  71. Rich January 24, 2011 at 5:41 pm #

    Our 5 year old German Shepherd had the TR implant removed after about 3 months due to tunnel collapse. She is now doing very well without a CCL or implant, but it was a long road, a torn meniscus, and about $6500 in surgeries to get her there.

  72. Sue Q. January 24, 2011 at 8:16 pm #

    Our 6 year old boxer was one of Dr. Cook’s ‘failures’. She had a partially/mostly torn CCL and we opted for the TR procedure in Feb. 09. We followed Dr. Cook’s recommended post op care/rehab precisely but by July, it was apparent she wasn’t very sound. The implant had worn the tunnel and was ‘cycling’ through it. It was removed in August. Our girl did recover and regain quite a bit of mobility but we were never able to allow her to run full out like she had before. The scar tissue that formed did stabilize the joint somewhat, at least allowing her to move about without pain for the most part. Unfortunately, she developed lymphoma and passed away in Feb. 2010. Her leg and joint was donated to Dr. Cook’s ongoing research in hopes these types of ‘failures’ can be understood and eleminated. I really hope this procedure can be perfected and more successes at a lower cost becomes feasible for more owners.

  73. Mark Freiberg, DVM, DABVP January 25, 2011 at 6:49 pm #

    I do not know how other surgeons handle complications. I have the discussion up front. An independent investigation by Dr. Rich Evans using number needed to harm and number needed to treat analysis showed tightrope to have the highest safety to efficacy ratio of all CCL procedures commonly used based on available data. I expect one complication for every seven surgeries and my numbers mirror the results of the multi-site data on tightrope. I tell owners to expect that if there is a complication I will assume it was surgeon initiated, not an aftercare error. Every repair I have had to do is on my ticket. I do not believe in charging for a complication even if I have to surgically repair the knee again. My reasoning is that if an outcome is less than ideal I really want to know why, and more importantly, how to correct it. I cannot do that if I lose track of the case.
    Keep in mind that the underlying disease process is chronic, progressive osteoarthritis. We cannot cure osteoarthritis but the dogs do much better when the knee is stabilized correctly. I have had tunnel issues, usually related to less than desireable placement of the femoral tunnel. I have never had a tunnel “collapse” though I have seen them get wider. Actually, I have not heard the definition of “tunnel collapse”. I will ask Dr. Cook what that is exactly and let you know what he says. Hope this helps!!

  74. Rich January 26, 2011 at 8:48 am #

    Tori had expansion of the bone tunnel, and the stainless steel button at the top of the implant had burrowed into the bone. Also, her meniscus had torn. The surgeon charged more than half the original price of $4K to do the second surgery. My only concern now is what will will do if the other leg CCL fails. My previous shepherd had lateral suture and had limited range of motion, and now this issue with TR with Tori. Not sure how to proceed if her other leg fails.

    • Barbara January 26, 2011 at 9:58 am #

      I’m just another dog owner. I’m pretty informed about dog knee repairs, but by no means an expert. I would say to go back to the LSS. The limited range of motion could probably have been solved with physical therapy. When my dog had the repair, we were to start primary range of motion (PROM) exercises at the end of week 2. The vet gave us a sheet and showed us how to do it. Basically, what you are doing is bending and stretching the knee so that the scar tissue is flexible. We did 20 of each exercise twice a day. I’ve heard of the vet requiring up to 75 of each exercise twice a day. But that’s what keeps the scar tissue from limiting the range of motion.

      Also, for $4,000, you should be able to get a TPLO or TTA (my preference of the two high dollar repairs). It’s my opinion that both procedures are too invasive, and I would still choose the LSS. The advantage of those two procedures is that they are healed with little chance of problems after 8 to 10 weeks (once the bone is healed).

      Dr. Freiberg is unique in that he doesn’t charge for a follow up surgery if the first oen fails. That’s EXTREMELY unusual. Most all healthcare professionals (DVMs, MDs and DDSs) charge for every procedure whether or not the failure is the failure is their fault.

      I would suggest you inform yourself on dog knees. Two Yahoo! groups are dedicated to dog ortho issues – Orthodogs and conservative management.

      I would also suggest you stay away from the tightrope procedure. It’s my totally uninformed opinion that some dogs are allergic to the tightrope material

      • Cindy January 26, 2011 at 2:25 pm #

        Sadly, I am also a dog owner whose beloved dog suffered a failed Tightrope due to expanding bone tunnels, causing the metal buttons to collaps into the bone tunnel. We originally chose the Tightrope procedure because it was supposed to be less invasive than the TPLO or TAA, yet give the same results. We thought we had done our homework — we had several long email conversations with Dr. Jimi Cook himself & chose a surgeon personally recommended by him, who had done many Tightropes & was involved in teaching the procedure to other surgeons.

        Although we followed the rehab instructions to the letter, we had concerns about our dog’s recovery from day one. He developed a large seroma & when we cultured some of the fluid from the seroma, our vet found staph & synovial cells, most likely from leaking joint fluid. When we contacted the surgeon who had done the original Tightrope, he was unable to explain how our dog could be leaking joint fluid.

        After the expanding bone tunnel was discovered, we had the fibretape removed. At that time, we were told there was adequate scar tissue built up to stablize the joint. After many more weeks of rehab & becoming increasingly concerned about our dog’s lack of progress, we consulted another ortho surgeon. We were told that his knee was still unstable & would require a TPLO.

        After doing the TPLO, we were amazed at the difference in recovery. For a procedure that is supposedly more invasive than the Tightrope, the recovery was like night & day. He used the leg from day one & just got better & better with each passing week. No seroma, no infection, just steady improvement. He also seemed to be in much less pain this time around. Considering it was the 3rd surgery on that knee within a 6 month period, we couldn’t get over how much smoother his recovery went with the TPLO.

        Incidentally, the surgeon who did the Tightrope charged us more for the removal than the original Tightrope surgery cost ($2800 vs $2300). He also stopped all follow-up with us the minute the Tightrope was removed. I suspect our complication was never reported in the literature. In fact, we were told the complication was unique to our dog & had never been seen before.

        Since that time, I have been in contact with numerous people who experienced similar complications from the Tightrope & who were also told they were the only ones experiencing complications. None of them had any follow-up from the surgeons who had performed the Tightrope. I don’t know how Dr Cook can claim such a low complication rate when it would appear that adequate follow up is not being done with those experiencing the complications? It makes me suspicious that the complication rate numbers are horribly skewed.

        I wish with all my heart that we had just done the TPLO from the beginning. We spent over $5K on the Tightrope & removal & ended up having to pay for a TPLO as well. But at the end of the day, it isn’t the loss of money that is most distressing — it is having to watch your beloved dog suffer needlessly.

    • Mark Freiberg, DVM, DABVP January 26, 2011 at 3:26 pm #

      Hi Rich,
      I have seen both of those things you describe. The issue for me was difficulty identifying the F2 site, or the place where the drilling starts in the femur. I had two cases similar to Tori’s. Both dogs responded well to either removal or removal and replacement of the TR. So far, the TR study shows a 5.6% rate of subsequent meniscal tears. When that happens to one of my patients they usually respond extremely well to arthrotomy and excision of the torn material.
      About the other leg, the literature says that the off leg will rupture 50-60% of the time. I have not seen anywhere that high of a percentage in my practice. It is therefore not a certainty that the other leg will act up.
      I seem to have fewer and fewer issues the more TR’s that I do. That is not skill, luck, training, or anything except that I now have the right equipment and I have seen a bunch of knees!

      • Mari Mortensen February 10, 2011 at 3:02 pm #

        Our newfoundland had a TR done by Dr. Wright in Springfield, Il in 11/2010. Recouperation went well. Now I am concerned about the menescus in the repaired knee as the dog is walking lightly and sometimes has a bit of toe drag. I may be imagining things, but he also seems to be having trouble with the other leg. The dog struggles to get up,pulling instead from his front legs. If the meniscus is torn, is there a reason to remove it as opposed to letting it heal? Also, what are the chances that the other leg has a tear? How long should I wait for xrays if there is no real lameness?

        • Barbara February 10, 2011 at 6:48 pm #

          I don’t think toe drag has anything to do with an acl/ccl tear. I would call the doc about it. (When I re-read this before posting it, I remembered that Dan dragged his toe for a short time after surgery, Someone suggested that I walk him over objects, say a 2X4 or a pipe that would make him raise his leg to step over the object. I might try that, but I would call the vet to be sure).

          As I understand it, the meniscus won’t heal on it’s own. It’s like a flat gasket between the bones that cushions the knee. When it gets injured, the edge flips up – like a curled edge. It’s very painful. The doc trims the edge (the flipped up part). It may or may not grow back. My vet said it would. Other people’s vets say it won’t. The only thing I could find on the internet was about human meniscus which said it would regrow if it had blood supply to the affected area. Not all areas have blood supply. My vet said he could feel the torn meniscus when he examined my dog.

          X-rays won’t tell you if there is an injury. It will show other problems, not a torn ACL/CCL, such as arthritis, bone cancer, etc. The x-ray is done to rule out other problems, not to diagnose a tear.

          Whatever problems your dog had that made the first tear happen are present in the other leg. It’s statistically probable that the other leg will tear. However, some never do, or sometimes many years later. My dog’s other leg tore almost exactly a year after the first.

          I would not do x-rays without symptoms, and maybe not then if you’ve done them before. I don’t know about your area, but here they run $400 to $600 and most docs will want new ones before surgery.

          Good luck.

  75. Rich January 26, 2011 at 5:39 pm #

    Tori actually responded well after the implant was removed. Both after the initial TR surgery, and after the implant removal we worked closely with a vet specializing in rehab. We did extensive range of motion, muscle strengthening, stimulation and cold laser. At this point she is about 90 to 95% with her only issue being that she takes the steps more slowly than she did before the injury. I am glad to hear that she may not end of with a second injury. We are working hard to protect her during the icy winter, and continue to build muscle in both hind legs. Funny thing is, I tore my ACL last year and had it repaired. It is so much easier for a human, and the surgery makes much more sense. Different anatomy does make a difference.

  76. Mark Freiberg, DVM, DABVP January 27, 2011 at 11:19 am #

    Yikes! We really do have it easier. We bear weight almost perpendicularly while dogs have a 10 to 20 degree angle. Makes the ACL much more important for them. We are also spared the progressive osteoarthritis that dogs have to live with. Happy that Tori is well. Yesterday I did a 3 month post-op exam on a boxer that limps slightly on the non-operated leg. 3 months is a little early to see such good stabilization but I thought I would pass it along

  77. Wendy S. Pearson February 1, 2011 at 1:25 pm #

    I’m sad to hear some of these horrible stories of recovery. i know how heartbreaking it is. It sounds as if you did everything you could to make it better. As i explained in my other story profiled on this site, my 5 year old 65 lb Pointer mix Neva’s Tightrope surgery was successful and we are 5 months out. She has issues w/ her hips but evidently always has.

    Her doctor was named Dr. Luck. He does NOT have an office but is a roaming vet who works in other Colorado vet clinics who do not have an onsite facility. My vet is named PetsVet in Arvada, CO if anyone wants to talk with them. I felt strange actually never really getting to talk w/ Dr. Luck as all the communication was through my vet. This i did not like but the results are solid. Total cost was under $2k.

  78. Rich February 14, 2011 at 5:00 am #

    My strongest suggestion is to make contact with a trained rehab facility, even before any surgery. They can help you evaluate any changes after surgery, including pain, range of motion, etc. When Tori’s meniscus tore after the TR, there was a distinct clicking sound in her knee.

  79. Patricia August 10, 2014 at 6:25 pm #

    Thanks for the response to my inquiry. I did find a vet who performed this surgery on our Lab, but I have mixed feelings about the result. Yes, she is walking better now, but she developed infection after surgery that took several courses of antibiotics to cure. She refused to eat for a while (and if you knew our Lab, you would know that is highly unusual!) and lost a fair amount of weight.

    Now she is 11 years old and has the same problem in the other leg. I am really hesitant to do this again. Our vet said there is an even newer procedure but she didn’t elaborate except to say it is even more expensive. I am not willing to try anything now until it has been proven for many years, so we will manage our dog’s condition conservatively and hope for the best.

    This site has interesting pros and cons on surgery. I am not endorsing it, just an FYI.
    tiggerpoz.com/id8.html

    • Nancy August 13, 2014 at 7:02 pm #

      Patricia – Did you do tightrope for your Lab?

      • Patricia December 14, 2014 at 1:22 pm #

        Whoa, I am way late on replying. Sorry. Yes, we had the tightrope procedure done on our Lab. I have heard since that time that a rare complication of the procedure can occur where the implant or whatever it is can work its way through the gone. When that happens, it’s really bad. I’m not trying to discourage anyone, you just need to do your research and weigh the pros and cons. There are risks in everything.

        Our Lab is almost 12 now. She seems to have the same problem with the other rear leg or it could be arthritis. She is better when she has been confined for several days when she stays at a kennel for when we are gone at a holiday or something. Considering the problems she had with infection with her first surgery, the cost, and her age, we will not opt for surgery on this leg.

        • Lynn March 11, 2015 at 10:36 am #

          How old was your lab when you had the tightrope done? How much did she weigh?

          • Patricia March 11, 2015 at 5:22 pm #

            She was approximately 6 years old and overweight, because she came to us with undiagnosed hypothryroid. She initially weighed 98 lbs., but I think her weight had come down considerably before she had the surgery.

            Now she weighs about 78-80. She still limps at times and sometimes it’s her front legs more than her back ones. When we took her to the vet, the vet said she has “crunchy” knees due to her age and arthritis. 🙁 I would not put her through another surgery at her age, and I think arthritis is pretty much inevitable in dogs as it is in humans. Wear and tear, you know.

            I recently started giving her GNC’s Ultra Mega Hip & Joint supplement, and it seems to be helpling quite a bit. Is it coincidence that the weather is also warmer? I don’t know, but as long as it helps her, I’ll keep giving it to her. I give her Deramax on occasion, when I think she needs it. It works better for her than Rimadyl, and I’m a little wary of that medicine anyway.

            Hope that helps.

          • Patricia October 21, 2015 at 9:07 am #

            Well, it’s time for an update, and my view of things has changed quite a bit. First of all, I am sorry I gave good reviews to GNC’s joint supplement for dogs. I discovered it has some bad side effects, and I believe it was responsible for giving my dog a severe bladder infection.

            Next, surprise, surprise! When our vet checked our Lab’s back legs she found that the dog is worse on one leg, but when she checked the records, that is the leg that had the Tightrope TTL done on!

            If I had it to do over again, I would NOT have opted for surgery. I wish I had followed this man’s suggestions for dealing with the problem. http://tiggerpoz.com/ I think surgery is being oversold as a solution.

            The bottom line is, do a lot of research before you make a decision.

  80. Lov April 5, 2016 at 2:08 pm #

    HI Patricia, My dog is also diagnosed with a full tear on left hind leg, and the doctors are all suggesting TPLO, I;ve been researching on alternatives. I am currently following the protocol on tiggerpoz. Do you really believe your dog would have been better off without surgery? My husband believes that having surgery will just make things worse when we can slowly help our dog.

    • Patricia April 6, 2016 at 8:15 am #

      Lov,

      I wish I could answer that definitively. Yes, if I had it to do over again, I would have tried the non-surgical route. However, I don’t know if our dog had a full tear like your dog does. I don’t remember. Does the tigger site address that particular injury? I believe you can email him (her?) and ask questions.

      Our dog did experience some weakness and knee “crunchiness” (as the vet called it) in her later years in the knee that did not have surgical repair, but I couldn’t see where it was worse than the knee that had surgery. All surgery comes with risk, and if other means are available, I always believe in trying the less invasive option. Our dog had infections after her surgery that required 2 courses of strong antibiotics. I understand that this surgery comes with a risk of the material weakening the bone and possibly causing a fracture, too.

      During the last month before she died, our Lab was on joint supplements, but I wonder now if those, too, didn’t cause problems. Almost exactly one month ago, our beautiful, sweet, smart 13-year-old girl had to be put to sleep. We think she had a stroke. Perhaps some of the weakness in her back legs was the result of a series of mini-strokes. Dogs can’t tell you what’s wrong, but we did suspect all was not well with her in the 2 or 3 months before she died. Did the joint supplements contribute to the stroke problem? I really have no idea. I guess I’m just suspicious that every treatment comes with possible side effects. I still cry over the loss of our Belle. She was a once in a lifetime kind of dog, and I miss her so much.

      My personal opinion is if you find that your dog does well on the more conservative protocol, I would keep doing that as long as the dog is getting better. Will your dog have arthritis later on? Probably. Don’t we all as we get on in years? Whether the dog would have less arthritis after surgery is up for debate. Vets who favor surgical intervention think so, but there have been no definitive studies to prove that. I am not anti-vet. I love them and think they truly care for animals, but like all doctors, they always want to “do” something. They are trained to help. Also, I think owners usually want vets to “do” something. We are not a society that is keen on watchful waiting or conservative measures that might take more time to show results.

      I’m sorry I can’t give you better answers.When it comes down to it, you will have to use your own judgement based on your research, experience, and knowledge of your dog. If you’re like me, you will probably always second guess your decision, no matter which way you decide. Our sweet pets only live a short time, especially the large dogs, so if your beloved dog makes it into the second decade of life, it had a good run. We can only do so much to stave off the inevitable decline that comes with age. Praying for your dog’s health and for your decision. If you have any more questions that you want to ask me, feel free.

      • Lov April 7, 2016 at 4:03 pm #

        Thanks so much for your reply. Maxwell is only 1. I feel so sorry for him. he loves to play and I just have to restrict him for his own good. We are taking supplements, bone broth, and find acupuncture for now. I know my vet has good intentions for Max. But from what I’ve been reading, they either limp with or without the surgery. The complications scare me, Max has a very sensitive tummy and it’s taken us till now to correct his digestive issues, I know he won’t do well with all the antibiotics, pain killers and other medication. He even gets sick on his heart worm medicine. Yes i always second guess myself if I am making the best decision for him.Ince he is only 1, I feel I have to do more. But will I cause him more problems by taking a risk with the surgery. It tears me apart having to decide. Max weighs 61 pounds, so upon further research, they want to do a TPLO which involves bone cutting. They said the tightrope won’t hold. I am so confused.

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