The following was submitted by an owner whose dog had a failed Tightrope CCL repair procedure:
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:
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.
13 thoughts on “Tightrope Surgery Complications – Husky”
So sorry to hear your story. As if the injured knee wasn’t enough trouble to start our with.
We also considered the Tightrope along with other options, but decided to go with extracapsular repair instead. Also minimally invasive, quite similar to the Tightrope.
You didn’t list this option, you might not be aware of it. It is often presented as unsuitable for larger dogs, but it is not really true.
Our Jasmine did great with it and so did some other dogs I know about.
Studies are showing that once healed, there is no difference between a knee treated with extracapsular repair and TPLO
It almost sounds like there was a bit of physician error. Who would, after two failures, recommend the same thing a 3rd time? BTW >80% of staph infections originate in the OR, or hospital.
If a surgeon hasn’t done at least 100 prior surgeries of the exact procedure I want done, that surgeon isn’t touching a knife to my dog. It’s also extremely important to have a board certified vet!!
Thanks for sharing your experience. Wondering if you can provide an update? Our male Puggle just had his third surgery for a failed extra capsular suture and tight rope repair. He now has a torn collateral ligament and infection in the joint:( his original injury was August
How is your dog doing from the complications of the tightrooe? I just had one for my dog and I regret it. I had read these forums and I don’t know how I missed all of these horror stories
I have a ~25 lb miniature poodle male who has had both CCLs repaired–at different times–with this operation. We have the fortune of having a fantastic vet surgeon in our area. He is now 11 and is as sprite as a pup. I know that arthritis is in his future because of the trauma to his joints but I have no regrets.
He was clear why my pet was a candidate for this operation: size and weight. He would not even offer this option to a larger animal.
TIGHTROPE GONE WRONG!
My dog, Bruizer, (Lab-mix, 100lbs, 8 years-old) had a tightrope surgery on his right knee, about 6 years ago, and a year after TPLO on the left. For 5 years, we considered the right his “good” knee. No one ever suggested that it could or should be removed a later date. We were impressed. It healed and worked well. Until it didn’t. Last year, his tightrope broke…and exploded the knee from the inside out. Immediate removal of the hardware discovered that his body did not lay down the supportive scar tissue that was expected, so it was relying on the kevlar thread in every movement. It egged out the bone through the buckles, and stretched the thread. The vet explained that the process worked “too well” so that the body didn’t need to respond with scarring.
Then the infections! More antiboitics, no use of the leg at all. Something is still in there, causing pain. There is no stability. A month later we did another surgery to explore. It was very invasive. The specialist says he’s never seen a knee that bad…dead muscle, bone and tissue scraped and removed, two more pieces of kevlar an inch long were found. Meniscus removed. It was hamburger in there.
A another month, and the infection won’t go away. Cultures taken, different antibiotics tried. 6 months later…and the knee is still infected, with MRSI this time. A drainage that won’t go away, unless the knee is bandaged, which closes the outer hole until the pressure builds and explodes out again. There has to be something still in there, but even the specialist is reluctant to go in again, cause he doesn’t know where to look.
We don’t know what to do now. I have spent over $12000 already, wanting him to be able to run and play. Cut off the leg? His left ankle is not in the best shape. Put him down? We love him, of course. His pain is manageable at this time, the infection is not, and he has regressed in the use of his right leg, slightly just to balance. We still go to the park for walks. He seems happy enough. For $3500 more, we could do a CAT scan to try to locate the foreign material to give the surgeons a game plan. Maybe. There would still be no stability. Any new ideas would be appreciated, as even our vet is at his wits end, it seems.
Hi Cory, our dog had a similar story. We had to amputate his leg. Three failed surgeries and MRSI. He is doing well as a tripod but it is important to know he never was able to bear any weight on his affected leg so it was nessesary. We were told any further surgery on the leg may spread the MRSI to his hip or blood stream. We vetted with a local guy here in SD then went finally to Iowa State for their recommendation which was amputation.
Hope this helps, It is a heartbreaking decision..
Cory I read your heartbreaking story with that TR. What ever happened? I’m so so sorry for you and your poor dog. I would have died from anxiety
Please let me know how you guys are doing.
If you can drive to either Ohio State vet college or Iowa State vet college, I would recommend it. My dog has had bi-lateral TPLOs via Iowa State College of Vet Medicine. 5 years post bionic knees and my dog runs and plays like nothing ever happened. No complications either. Knock on wood! They are experts and can give you a prognosis. Good luck! I hope your baby gets well soon.
UPDATE!! Bruzier’s TightRope Saga
Sorry I hadn’t seen all these responses, and I so appreciate the support!
Well, after posting here, I was able to get a hold of a TightRope “superstar” surgeon, who was glad to do another procedure. It would be minimally evasive, because he had the tools and the know-how of installation. He sounded so confident, I was thrilled to go to Chicago. Dr. Cook removed 5 MORE INCHES of festering Kevlar thread, and the metal buckle that the first guy failed to remove. To the tune of $2000 more dollars.
By this time though, so much damage and bone loss from a year-long infection meant no stability, degraded bone-on-bone contact, and chronic pain. We were just excited to get rid of the infection-causing material, and not cut off the leg. He could walk, at least 50% use of the right leg.
But the incision wouldn’t close. Dr. Cook kept poo-poohing the idea that there was STILL thread in there, and we were back to anxious frustration, about the right antibiotics and care for a dripping, festering wound.
2 more months, and FINALLY… Dr. Riemer,( the specialist from Des Moines who had been in there the second time and was connected to our Sioux Falls vet) offered to have us come to Des Moines FREE OF CHARGE for a CAT scan and dye exploration. He removed 3 MORE inch long pieces…one of which was completely mangled, twisted into muscle. OMG!!
SO……I am HAPPY to announce that we finally got all the frickin material that was used in his tightrope correction 7 years ago. Bru’s knee is hamburger, and doesn’t look like a knee, but it is not dripping ooze, and he does walk with 70-80% use of this leg. He can run. He is down to a meloxicam in the morning, and some tramadols at night. He chases the squirrels from the bird feeder for us, so we are good!
So, everyone has said that Bruizer is such a special case, and they’ve never seen anything like it. But I feel I have become some-what of an expert on knee surgeries, meds, and vet protocols over this “case”, and I see arrogance, money-hungry, ineptness as the main culprit here, by at least 3 of the six surgeons to touch my dog. Then I see that the fear-mongering about MRSI is ridiculous, since he never had it, and each culture was irrelevant when there is still foreign material.
In Summary, this is what I have learned.
1. Extracapsular is almost the same as a Tightrope except that they use a nylon “thread” suture, which is not as strong. Not recommended for big dogs. (Which I didn’t know at the time, so Bru’s left knee failed, and we did a TPLO a month later).
2. TPLO needs very long, careful recovery. (Bruzier’s needed removal 2 years later, but healed, initially and after removal, to be the “good” knee he used to get through all this other shit with the right) More expensive, more tried-and-true.
3. Tightrope can be successful, if size and activity of the dog is considered. When they go wrong, it goes horribly wrong and is almost impossible to remove. There is a new thread in process, that is a solid strand of Kevlar, (instead of the braided string used on Bru, which allowed the bacteria to hide from antibiotics and fester.) I hope this will make a difference, as TR’s do seem to be the least invasive and simplest recovery.
5. There ARE BRACES that can be used instead of surgeries, or to help with recoveries. (We were told no such thing existed) orthopets.com I wish we had known…
6. Ask questions, research every drug and procedure. And keep asking for help.
7. Dogs are amazing creatures!!! They endure and heal. They may not even need the “repair”, if given proper rest and exercises.
8.. If your dog needs meds that are also prescribed for humans, always ask the vet to send the script to your pharmacy, and get generic.
I am thrilled to let you guys know that Bruizer CAN walk and play again!
Yay, so happy for you and Bruzier!
Our Dog had left knee surgery 2 years ago and recovered great! The right knee had the same tightrope, by same good Bet surgeon, and she slipped on the floor, we think, and on day 18 she was holding knee up 70% of the time. Vet said side ligament had broken stitches, and he wen back in to repair. Was good up to 5 weeks
and now has a notieable limp when she first takes a dozen steps, and reappears after a 200 yard walk. There is what appears to be a small 1 inch protusion on the outside of the joint. In the morning it is barely noticeable. I don’t want her to have a 3rd surgery. If she has a small limp, after excecrise, I think she, and we can live with that as she is almost 9
years old now.