Tightrope CCL Procedure
The Tightrope CCL repair surgery is the newest surgical option available for dogs with cranial cruciate ligament injury. Unlike in humans, canine CCL tears and damage generally takes place over a period of months or years, rather than being associated with a single traumatic event. Because of the nature of these injuries, and their degenerative process over time, this new procedure focuses on a technique used in human ankle joints using bone to bone fixation in a minimally invasive way.
Tightrope CCL is an extracapsular technique using the lateral suture stabilization (LSS) procedure in conjunction with a material called FiberTape to provide bone to bone stabilization. The Fiber Tape is placed in the dog’s knee through a few small incisions which create tunnels through the bone. Once the implant is anchored to the bone it is able to control cranial tibial thrust, and provide correction for the canine drawer sign, all while allowing internal rotation of the knee joint and normal range of motion. Similar to traditional extracapsular repairs using monofilament sutures (similar to a leader line or fishing line), the Fiber Tape used in TR repair will degrade over time and is not meant to provide permanent stablization to the knee joint. Bascially, the Fiber Tape is there to hold the joint in place while the knee forms scar tissue around the knee to permanently stablize the joint.
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.
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.
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
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%
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!
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
Dawn,
See my post above. VOSM is less than an hour away from you!
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?
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.
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.