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Traditional Repair: Extracapsular Stabilization – Ellyot

This has been one of the most stressful decisions I’ve ever been presented with…

Elly is my 14 y.o. husky mix. He’s had generally good health; I’ve had him since he was a pup. I wanted to do the conservative maintenance, but the more I researched the more I realized that we needed to try the tightrope surgery (I think this is what he got although the surgeon did not call it a name?). He had fully torn his CCL and part of his meniscus. They drilled a hole in his tibia and wrapped a strong fibrous cord through that to a portion of his femur. Again, this was a hard pill to swallow; I did not want to see him in pain or go through the rehab.

The first 3 days were terrible: swollen leg, walking him around with a towel under his belly, frustration, pain, lots of tears on my part. But he wanted to eat, drink and get around!

Day 4 felt like a miracle: he started to put weight on the inflicted leg. I pretty much stopped using the towel at that point.

Day 5 and 6 post-op: again, he showed major improvement.

Now it is day 11: he’s doing two 15 minute or more walks per day, which is great! Still NO stairs, but life is better. Those first days were really stressful and it is good to have family/friend to help: it is so sad to see your animal in such a dire state. But they progress, so hang in there. We’ve got a long way to go but things get more normal each day!

He had the surgery done at the Animal Surgical Clinic in Shoreline, WA on 4/29/11. It was $3000. Let me know in the comments below if you have any questions:)

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26 Responses to Traditional Repair: Extracapsular Stabilization – Ellyot

  1. May 16, 2011 at 10:35 pm #

    I think that only those of us who’s been through this can truly appreciate how much it hurts to see our dogs go through it.

    But they do get better! From day one I was telling Jasmine, see, one day on the way to recovery. Two days …

    Glad that Ellyot is recovering well.

  2. May 26, 2011 at 11:28 am #

    My 7 year old Sheltie has deformity of the knees (both) and needs TPLO. At 6 months old she had a torn cruciate ligament and was limping terribly. I guess the vet did the tightrope ccl procedure and she did well for awhile. Now she started to limp terribly and yells out in pain if she moves the wrong way. She needs TPLO surgery which costs $4,200 where we live in Florida. I truly cannot afford this and hope anti-inflammatories and tramodol will suffice until I think of something I can do. It breaks my heart when she walks because she love to jump in the air and play ball which she can no longer do. What should I do?

    • May 26, 2011 at 12:07 pm #

      Hi Amelia, so sorry about your baby!

      There are two surgeries that are similar, but have some differences – the tightrope and the extracapsular repair. Similar but not exactly the same.

      I tend to think that the tightrope is not old enough and that she more likely had the extracapsular repair.

      I both of these repairs the joint is ultimately stabilized by fibrous tissue that forms and holds things together.

      The likelihood of the repair failing after 18 months post surgery is actually quite low. Lameness at that point is more likely due to suture irritation, if it gets to a wrong place and rubs against a muscle etc.

      This could be corrected by arthroscopy, less invasive and less costly.

      How it was determined that she needs TPLO, did your vet evaluate the knee?

      I’m not saying that it couldn’t happen that the repair would fail, but statistically it doesn’t seem all that likely.

      I think that a thorough evaluation of what really happened is needed.

      Anti-inflammatories could hold her over and manage the pain.

      If you’re low income, you could check out whether you’d be eligible for help of the AAHA fund.

  3. May 26, 2011 at 12:17 pm #

    Hi Jana,
    The vet that did the surgery took fishing wire and screws and somehow when up and around to stabilize the knee. I took her to an orthopedic specialist and said she needed TPLO surgery which is the only option that will help her. What is the AAHA fund? I never heard of it. Can you please tell me how to apply for that? I am so depressed over this. I love my girl and do not want to see her suffer. I would do anything I can to help her. Thanks so much for answering me so soon. You are great and hope your baby is doing fine. Everything you can tell me will be greatly appreciated. Sincerely, Amelia
    I want to include her picture but do not know where to start. Thanks!

  4. May 26, 2011 at 12:43 pm #

    AAHA helping pets fund http://www.aahahelpingpets.org/

    It is quite common that orthopedic surgeons recommend TPLO, period. It may be that in your baby’s case it really is the only option. Did they take x-rays, drawer sign etc to confirm that the knee indeed is unstable?

  5. May 26, 2011 at 3:34 pm #

    yes they did everything. I found another place in HOllywood Florida which is my vet’s number one choice and they only wanted $2800. I read that AAHA and I don’t quite fit as far as salary goes. You need to be just about destitute. That I am not it would just make things alittle hard. I am having a hard time with the suffering she will be doing, I get flash backs from her first surgery when she was small. Now she is oldger and it scares me. I need to keep talking to friends like you. Thanks so much. I’m going to see if that CCL will work. Maybe he will try that and it can help until she is at the rainbow bridge. Jana you are so nice. That reinforces my thoughts that nice people are still out there. Thanks again I will keep you informed.

  6. May 26, 2011 at 4:02 pm #

    Hi Amelia

    You could also try applying for “Pet Card” or “Pet Credit” I think it’s called or something like that. It seems that the approval process is quite quick.

    Yes, the charge varies from place to place. If your vet trusts the other place and they are cheaper and with a good case record, that sounds like a place to go.

    We’ve been through this twice with Jasmine, once for each knee. The good new is that it does pass. Jasmine’s knees are good as new now.

    There is also conservative management option if you want to consider that one, using stiffle brace. Worth of looking into as well. Depends on your dogs age, age expectance and activity level.

    We decided for surgery given Jasmine’s age and zest for life at the time.

  7. May 26, 2011 at 4:51 pm #

    Hello All – I have 5 dogs and have always had 4+ dogs – it was not until four years ago that I heard of a cruciate ligament injury and until it happened to one of my 4 chihuhuas – he loved to fetch but those days are over – I never realized I had an option to surgery and went ahead – expensive as you all know but very successful until this year when he blew the other cruciate ligament in his left leg – within the same week a second dog of mine blew a cruciate ligament as
    well – my wonderful and fairlyh new country vet supported and encouraged my decision to try pain management, limited movement and they both healed nicely within a few months – no surgery. Now my Siberian Huskey Diego has blown both his cruciate ligaments one then the other within two weeks of each other – the earliest I could get an assessment at an orthopedic Vet as not all Vets do this type of surgery is Monday – it is awful to see his pain and he literally cried out . . . soon I will need to remortgage just to keep up with the mounting costs but it is my responsibility and committment to him that must take priority . . . however if his chances of recovery and normalacy are compramised I will have to re-visit the surgical decision – heart tugging – I have cried buckets over these injuries!!!!

  8. May 26, 2011 at 8:10 pm #

    Linda, wow, so sorry about all that. Conservative management can work, but it depends on number of factors, the most important of them being keeping the knee stable until healed.

  9. May 27, 2011 at 8:30 pm #

    Jana, I agree that we don’t know what it feels like until it happens to our pet, like many things in life. One month down and Ellyot is doing well. He will do a few stairs, but not more than 5, which limits him to the ground floor at my home. We are doing a VERY similar amount of walking that we were doing before his injury. I’m surprised he is walking this much! Still a ways to go (he’s not putting full weight on it) but it is interesting to see his progress and he is on the road to success.

  10. May 27, 2011 at 9:05 pm #

    Hi Julie, Glad Ellyot is doing well! Did you get a post-op rehabilitation program from your surgeon? Stairs should be as limited as possible, we actually built a ramp for Jasmine to get in and out of the house.

    We also lived on the main floor only for a long time πŸ™‚ Actually I slept with her on the kitchen floor so she wouldn’t feel left out.

    • December 13, 2011 at 4:05 pm #

      Jana, I had to chuckle about you sleeping on the kitchen floor. I have my baby Rigel, although she is 9, possibly needing a TPLO next Monday. I have built a ramp off my deck since she started limping three weeks ago and two days ago my mattress is now placed on my floor so she can still sleep with me. The things pet lovers will do. They are our kids and parents will do anything for their kids.

      • December 13, 2011 at 10:09 pm #

        Bonnie, I see that you can understand me πŸ™‚ Our bedroom is upstairs, I couldn’t bear leaving her alone, particularly since she was unable to go up with us. She truly is my kid πŸ™‚

  11. June 5, 2011 at 7:59 pm #

    Hi I found this site when searching for information on CCL tears in dogs. My baby girl Hope my 9 1/2 year old husky was running and let out a cry and then was limping. She does not cry. So I called a vet in my area (not my vet I had gone to for 20 plus years because he is semi retired so I thought I needed to search for a closer vet as I travel 1 1/2 hrs to see him when he was there) ANyway the “new” vet said to keep her quiet and give her meloxicam for a few days and I ended up going to see her at the end of the week. Well she twisted and pulled and poked my poor girl, she was so sore, I was so upset. Then she said that she needed an xray to determine if she did tear her CCL and if she was sedated she could tell better. Well I surely did not want Hope to suffer and wanted to find out for sure. Against my intuition of not bringing her in for the xrays we went on Thursday, they sedated her did the xrays and again she poked and pulled etc after I told her she was sore and asked if she was doing more damage. I then asked her to stop. She still did not give me a diagnosis, said she may have surgery in a few months then said to call her in a few weeks. Well I got a hold of my “old” vet and he will be looking at her xrays and at her but I am so very upset that the vet seemed to make it worse by all the pulling and pushing on her leg. From the sounds of it these surgeries are very painful on dogs? I am so upset and scared for my girl. She is everything to me, I lost her “sister” last January to cancer and can not lose her. I have also been out of work and we have one income and it sounds like it is a very costly surgery? I will do anything to help her I just do not want her to hurt. After this experience with the “new” vet I just feel so terrible to put her through that, she is worse not then before we went in. So sad. Maybe I should pursue animal law. Thanks for listening to me.

    • October 5, 2011 at 9:30 am #

      Hi Cindy,
      I hope all is going well with your little girl. I would like to know what has happened with her over the last few months? My Husky mix did a similar thing the other night and I am now under the debate as to what to do. She was running in our back yard (like she always does)and she let out this yelp, the next thing I know she is limping back to me…. I took her to the vet the next morning and the poked and prodded her, tried to take X rays but she was crying so bad from the pain they were causing her that I made them stop. I let them keep her for a few hours while they sedated her and took more X rays. Now they aren’t sure if the problem is a stretch, or a tear in her knee but they are now referring me to a specialist that I’m sure will want to do more poking and prodding around. She is my little (9 year old) girl and I hate to see her suffer! It sounded like we are now going through something similar and I would love to hear more of your story.

      • October 5, 2011 at 5:02 pm #

        Hi Amy,

        Sounds like your precious baby is going through the exact same thing. I looked for a link to email you directly but did not see one on this forum. I know exactly how you feel. When I went to the “new” vet she over did the pulling and poking and prodding and she was worse off after seeing her, I can see doing it once but it was more like ten times she did it. I took her to see my old vet (which I am glad to say he is now back and I will NEVER be going to the other one again) and he had looked at Hope’s xrays and said everything was fine no hip dysplasia or arthritis or anything wrong with her bones. He said it was a soft tissue injury and restricted her activity which I already did and he put her on meloxicam and tramadol and said we would try that for a few months. Last month I took her in for her dental and while she was under anesthesia they took more xrays and saw no change in those which was good but she also has not progressed to where he wanted her to be. He said he would refer me to a specialist for orthopedic surgery but recommended where she was stable and the meds were helping plus her age to wait unless it really bothers her allot. I have been researching different rehab routes like massage therapy, light therapy etc as I have heard those avenues work sometimes but the state I live in there are very few. So people I have spoken to said that this type of rehab they have seen work which is the avenue I am going to pursue and I also know how invasive the knee surgery is and I don’t want my girl to have to go through that unless absolutely necessary and as the last resort. I really do not think she would do good with the rehab period and she has a hard time with anesthesia.She is still walking around on it and the meds help her and she is not in any pain with them but I also want her quality of life to be better and for her to be able to run around again if she wants to. It is heartbreaking, I know she is not in pain with the meds and if an alternate route will work I would rather try that first then surgery. Now the “new” vet I first went to would have had her in surgery the following week, just shows the vets that want money compared to the vets that want to do what is best for your dog. It is so hard and of course I want to do what is best for her.

        I am so sorry for what you are going through with your girl and it does sound exactly the same. I just don’t know why your vet would attempt to do xrays without sedating her, that wouldn’t sit well with me either and I would have stopped them too. They are our girls and we need to protect them and go with our guts if we don’t feel something they are doing is right. It is hard when they are suppose to be the professional and would think they would only do right by them but I found out the hard way from the “new” vet that some are only in it for the money and could care less about our beloved family members. I know I wish I could take it all away and make my baby girl better. I hope I gave you some info. I would send you my email if I could so we could talk more but I really do not want to publish it here. I hope you and your little girl will be doing better soon.

      • October 5, 2011 at 7:55 pm #

        Hi Amy, sudden rear leg lameness that doesn’t go away and nothing else was found (such as a foreign body, snake bite …) is quite likely a cruciate ligament injury.

        X-rays don’t really show much as far as the ligament is concerned; true evaluation of the cruciate ligament would have to be done by MRI or arthroscopy. Cruciate tear is usually diagnosed based on symptoms, physical exam, the “drawer sign” and the supporting x-ray might show fluid in the joint.

        It doesn’t really matter a whole lot whether the ligament is stretched or ruptured, either way it cannot do its job and the knee becomes unstable which leads to lameness, inflammation, pain and in a long run degenerative changes in the joint.

        The knee needs to get stabilized (whether through surgery or brace) so it can heal; and the inflammation and pain addressed.

  12. June 7, 2011 at 12:12 pm #

    Hi Cindy. Well, I didn’t see what the vet did, some “handling” is normal when the vet is looking for the “drawer sign”.

    Cruciate tear itself doesn’t really show up on the x-ray, it is the secondary signs that are visible there.

    I guess the vet also wanted to see whether hip might be a problem and was searching for joint laxity. IF the lameness wasn’t typical (and doesn’t have to be – wasn’t in Jasmine when her tear was only partial), it is not as easy to determine what exactly is going on.

    An x-ray would show hip joint problem. I’m assuming the hip looked fine and that’s why the vet was trying to get the drawer sign again. (With Jasmine it was impossible to elicit also).

    Any surgery is painful, some more than others. With the modern pain management options though, minimal pain is felt by the dog.

    The cost is another story. Extracapsular (suture) method is cheaper and can be very successful (was for Jasmine).

    Depending on the individual case, conservative management and brace is also an option.

  13. August 22, 2011 at 7:11 am #

    Jana – I have a Rottie named Charley who is 3 1/2 and recently tore his CCL. Also has hip dysplasia, and right before his scheduled knee surgery formed a huge abscess and bacterial infection in his neck. It’s been a rough go the last few weeks – he is my baby boy and I’ve been devastated. After going through bad Vet experiences and then great ones, I’m torn between recommendations for his cruciate surgery. I have one surgeon that is saying stabilization with the help of artificial ligaments (tightrope I’m guessing) would be okay for him (he weighs 90lbs)… and then another Vet saying “no way – TPLO is the ONLY way to go”. I think you and I have many things in common and would love your feedback and to hear your experience with Jasmine. Can we get in contact somehow?

  14. August 22, 2011 at 4:38 pm #

    Oh, no, poor guy!

    artificial ligaments per se aren’t really used any more.

    Tightrope and extracapsular repair are two rather similar “suture techniques

    We were presented with TPLO as only option also, but it isn’t. There is TPLO, TTA, TTO, extracapsular repair and tightrope option.

    Besides the surgery itself, other criteria is experience and record with the particular surgery of the respective surgeon and post op care (about as important for success as the surgery itself)

    Jasmine had the extracapsular repair and did great with it. The only thing is that the post-op period is more sensitive with that. On the other hand potential complications are less severe.

    Since hip dysplasia is also an issue, combination of either surgery with stem cell therapy might be very beneficial if not cost prohibitive.

    You can email me at grade3699@rogers.com

  15. August 24, 2011 at 6:03 am #

    I was told my sheltie neede TPLO on one knee and would probably need it on the other shortly thereafter. I was ready to do it until I was given pain and antiinflamatories. I have her on 25mg. tramadol and 50 mg. of Deramaxx. She lost weight from 35 lbs to 27 lbs and is doing absolutly fantastic. Sometimes when she steps back she screams but that happen very seldom now and only when she is a maniac running through the house and playing with her brother. Maybe you can try medication first and see how that works. Seems to me vets all want to do that surgery and I feel there is an epidemic of that surgery everywhere. Ask your vet about medication first. So sorry to hear about your baby. I feel the same as you do. Sincerely, Amelia

  16. August 24, 2011 at 6:21 am #

    My belief: while anti-inflammatories and pain meds help the dog feel better, they don’t solve the original problem.

    Knee remains unstable, arthritis keeps worsening. Should at least consider conservative management to give the knee a chance to heal.

    Of course pain management is needed and helpful, the original problem does need addressing as it won’t go away on its own.

    When Jasmine busted her first knee, surgery was the last thing I wanted to do. But the vets are right in respect of having to get the knee stable again. Whether with surgery, or conservative management (with or without brace).

    Knee with torn ligament isn’t stable. Arthritis progresses very fast.

    In young active dogs I believe surgery is the best solution (question remaining which one you want to go with, as there are many options).

    With older and quieter dogs, or dogs who cannot undergo anesthesia, conservative management is a solution.

    Pain management TOGETHER WITH, not by itself. Sorry. I strongly believe that.

    Unstable knee doesn’t just equal pain, but also friction in the joint. Friction = arthritis. Things don’t get better from there, just worse.

  17. September 16, 2011 at 11:52 am #

    My husky was 4 years old when her first knee went out. My vet who I trust told me to wait at least 8 weeks and see if she improves. She did a x ray and blood work and she put her on duramax. The knee did not improve so we had the TPLO surgery done. I went on the internet to read all I could on it. What I read just made me cry and worry more. It was a very long rehab period but her new knee seemed to heal really well. Now at 6 the othe knee has gone out. More tears…I just hate to see her in pain. She is back on medication and the waiting has begun. I’m almost 100% sure that another TPLO will have to be done. The only problem is I wonder if I made a mistate. Will it be worse for her–who knows. I worry about arthristis, plate slipping, infections, etc. I just want what is the best for my best friend. So may web sites are against TPLO surgery but what do you do when someone that is trusted and I feel a lot smarter than I am recomends it?

  18. September 16, 2011 at 3:17 pm #

    Hi Jill, sorry about your girl’s knee.

    1) Please describe what do you mean by waiting, I take it she’s on controlled exercise and bunch of rest during the wait? Please look up articles on conservative management.

    Conservative management can work. Waiting does not. Sorry I have to disagree, but if the ligament had been confirmed to be torn, the ligament is not likely to heal. With conservative management the knee stabilize itself by the means of scar tissue. Unstable knee will develop more arthritis. I would not go with waiting as one of my options. Please talk to your vet whether he means conservative management when he says wait.

    2) TPLO isn’t really the only option out there. It is the most popular ones these days, particularly by the surgeons. There are other options also though. If you’re not liking the TPLO option, do research the others (TTA, TTO, extracapsular repair, tightrope)

  19. October 21, 2011 at 7:20 am #

    my sweet 2-year-old pitbull has partial tears in both her cruciate ligaments and i have been advised to have the traditional repair done on each (one at a time, with the one that’s worse first)

    i am a little freaking out because I live in a second-floor apartment with no elevator and 23 stairs to get to the apartment…doggie is 60 pounds and I cannot lift her

    my dog will HAVE to do stairs just to go out and pee…i am planning on getting the Ruffwear harness for her…maybe also doggie diapers for the first couple of days/weeks?

    any other suggestions would be very helpful…i can handle all of this except i’m SO nervous about her on the stairs…she is used to going up and down very slowly and only with me right by her side

  20. October 21, 2011 at 12:04 pm #

    Hi Deb, I think you might want to look into the product http://www.bottomsupleash.com/. It’s designed specifically for rear support. I think that might give you the best chance

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