Lateral Fabellar Suture Stabilization for Dogs

When you first hear mention of the lateral fabellar suture stabilization surgery for torn cranial cruciate ligaments (CCL) in dogs you may think that your veterinarian is making it up, that they’re trying to pull a fast one on you. But in fact, the lateral fabellar suture stabilization surgery is a very common procedure performed to get those dogs with CCL injuries back on all fours.

Lateral fabellar suture stabilization is an extracapsular method of stabilizing the knee joint following a CCL injury. This means that all of the fixation takes place outside of the joint capsule. This surgery uses various heavy duty suture materials, including heavy weight fishing line, to mimic the action of the CCL outside of the joint capsule.

While you may be thinking that any type of suture is going to have a short lifespan, you’re absolutely right. The actual goal of the suture in this procedure is to encourage the body to create scar tissue around it that will be stronger and longer-lasting than the suture material itself. This creates a more permanent fixation even if the suture stretches or breaks.

The cranial cruciate ligament is a tiny little piece of connective tissue that plays a starring role in keeping the knee joint stable. That knee joint is made up of two major bones: the thigh bone, or femur, and the shine bone, or tibia. These bones are held together at the knee by some ligaments on the sides and the cranial and caudal cruciates in the middle.

These tiny ligaments are oriented crossways in the joint to form an X. The cranial cruciate is responsible for keeping the thigh bone from sliding backward during movement and weight bearing, and the caudal cruciate’s purpose is to keep it from sliding forward. It’s a great partnership but is under a lot of strain, especially in overweight or very active dogs.

The cranial cruciate ligament is the most likely to be injured, and when this happens, it allows for more wiggle room in that joint. This extra motion leads to instability of the joint, inflammation, pain, and arthritis.

In human medicine, the injured ligament itself if often repaired or replaced in order to return the knee joint to a stable and pain-free state. However, veterinarians and their furry patients aren’t offered this option since animal CCLs are so tiny and the cost is just too astronomical. That causes them to get creative and instead use other methods that will work the same as a CCL.

The lateral fabellar suture stabilization is one of those methods. It utilizes a sterile nylon suture of different thicknesses depending on the size of dog, or in some cases a heavy weight fishing line, to keep the thigh bone in place.

A small hole is drilled through the shin bone. The nylon suture is then passed through the hole and then around the fabella, which is a tiny bone located just behind the end of the thigh bone just above the knee. The fabella is embedded in the tendon of the large calf muscle, so it has a strong backdrop that works well to secure the suture to. Think of it like throwing your boat’s tether rope over the pylon of a pier.

The suture is then tightened and tied or crimped to create a loop that forms a figure eight across the knee joint. This anchors the thigh bone to the shin bone, decreasing the amount of slide when weight is put on it.

The nylon suture is not meant to last forever. It may stretch with time or even break, but the idea is that it will create a mold for the body to lay down scar tissue that will serve your dog for the rest of their life.

The lateral fabellar suture method isn’t meant for every dog; rather it’s reserved for smaller dogs, say under 35 pounds, or those couch potato types since they are less likely to break the suture.

If stringing fishing line through your dog’s knee isn’t quite what you had in mind to fix their injured CCL, there are other options out there. All of these procedures have their advantages and disadvantages, so be sure to fully discuss your options with your veterinarian in order to choose the method that is right for everyone.

There are two main classes of surgeries when it comes to stabilizing the knee following a CCL injury: extracapsular techniques and bone-cutting techniques.

• Extracapsular techniques: The lateral fabellar suture surgery is a type of extracapsular technique because it doesn’t involve going into the joint capsule. Another option of this type is the TightRope Fixation System. These methods are generally less expensive but don’t often carry the success rate that bone-altering methods do.
• Bone altering methods: These are the surgeries that you’ll go to a referral or specialty clinic for. That is because they require special training and tools to perform. The two types are the Tibial Plateau Leveling Osteotomy (TPLO) and the Tibial Tuberosity Advancement (TTA). Both methods are based on the idea that repositioning parts of the shin bone will change the angle of the knee joint so that the thigh bone can’t slide forward. This basically cuts out the need for a cranial cruciate ligament.

Not every dog is cut out for surgery. There may be other health issues or financial constraints that keep a dog from going under. While surgical fixation of CCL injuries carry the best outcomes, conservative or medical treatment options are available.

Dogs with partial CCL tears may do ok with rest and anti-inflammatories. The idea is that keeping a dog’s quiet for six or more weeks will achieve the scar tissue stabilization that a surgery like the lateral fabellar suture method does. Complete tears usually don’t fair as well due to the amount of instability in the joint. Anti-inflammatories are given to reduce discomfort and encourage healing.

In order to properly compare CCL surgeries, you’ve got to see an advantages and disadvantages section, so here you are:

Advantages

The cost-it’s less expensive than any surgery that involves cutting bone and realigning the angle of the knee. It’s also generally less expensive than the TightRope Fixation option. And while most of us don’t want to put a price tag on our dog, the fact of the matter is finances make a lot of decisions in veterinary medicine.

Secondly, the lateral fabellar suture surgery is one that just about any veterinarian is willing to do. It’s almost a right-of-passage surgery. What this means for you is no long-distance trips to a referral clinic or specialist. What this means for your dog is no long wait periods for a specialist to squeeze them in.

Most dogs accept the suture as their own better than other types of implants. Any time you put something foreign into a dog’s body, it’s up to their immune system to accept or reject it. It’s not that uncommon for dogs to have a minor, localized reaction to TightRope or other implants. However, there doesn’t seem to be a big problem with reactions to these nylon sutures.

Disadvantages

Here are the reasons why every dog with an injured CCL doesn’t have a lateral fabeller suture surgery. The main disadvantage is that it has a higher failure rate in large or very active dogs. This is simply because the suture can’t withstand that much strain. While your vet will choose a larger suture size for their larger patients, there is still a limit to how much it can take. If the suture were to prematurely break or stretch before adequate scar tissue formed, it would mean a redo for your dog.

Strictly following a proper recovery and rehab protocol can help increase the chances of success for larger or Energizer Bunny-type dogs, but that risk is still out there.

The recovery period from a lateral fabellar suture surgery is every bit as important as the actual procedure. During this time, it’s important that your dog strictly follows the veterinarian’s orders or they could risk breaking that stabilizing suture.

First thing’s first, dogs will go home the day after surgery with antibiotics, anti-inflammatories, possibly a light bandage, and even a cone of shame if they’re the licking type.

For the first six weeks, it’s important that your dog doesn’t jump, run, or play. They can have short walks on a leash and should start passive range of motion exercises. If you have access to a professional rehabilitation clinic, get an appointment, otherwise, the Cruciate Home Rehab Guide can teach you how to safely do these exercises at home to increase strength and flexibility.

Anytime a joint experiences trauma or inflammation, arthritis should be on the radar. The progression of arthritis can be drastically reduced with a proper fixation and supplementation with products like GlycanAid HA, Flexerna Omega, and MSM Joint. These products provide your dog’s joints with good stuff like glucosamine, chondroitin, MSM, hyaluronic acid, and omega fatty acids to help maintain and improve joint cartilage, fluid and to decrease inflammation. All of this equals prolongation or reduction of arthritic discomfort. These supplements can be started immediately after surgery or even before to achieve the best outcome.

Now let’s talk about a sensitive subject that can really affect your dog’s recovery period-weight loss. Nobody likes to hear that their pup is overweight, but the fact of the matter is excess weight has a huge impact on joint health. Reaching a slim, trim, and healthy weight can really improve your dog’s chances at a successful lateral fabeller suture surgery and a longer, healthier life.

If only there was a such thing as a surgery without risks or possible complications. Until that is made a reality, all surgeries carry a risk of anesthesia. This risk is drastically reduced with pre-anesthetic blood work and exams to determine if your dog is healthy enough to go under. Anesthesia monitoring is also a must during the procedure to keep tabs on how a dog is handling everything.

Another potential risk anytime there is cutting of skin is an infection. Even with sterile procedures, such as the lateral fabellar suture surgery, bacteria can still find their way in and create a mess of a veterinarian’s hard work. Post-op antibiotics and keeping the incision area clean will drastically decrease this possibility.

Now, potential complications to the lateral fabellar suture surgery specifically would be premature breaking or stretching of the suture that allows that wiggle back into the knee joint. This means a do-over surgery for your dog. There is also the possible complication that your dog’s body won’t like the suture material and tries to combat it with a localized reaction of swelling, redness, drainage, and even some pain. This may happen weeks down the road, even after the incision is completely healed.

A successful lateral fabellar suture surgery and recovery period leads to a more comfortable and stable knee in 90% of patients. Unsuccessful surgeries are often the result of premature suture stretching or breakage or infection. Both of these issues can be decreased by following your veterinarian’s recommendations for rest and rehabilitation.

Even with proper stabilization of the knee and a recovery that slowing builds back your dog’s strength, arthritis is a real concern. Preemptively giving your dog the joint supplements GlycanAid HA, Flexerna Omega and MSM Joint is your best bet in prolonging the formation of and decreasing the discomfort of arthritis.

Weight management gets another mention because it’s that important. Fixing an overweight or obese dog’s knee may be a waste of time since the added stress on the opposite knee during the recovery period can cause it to break down as well.

The lateral fabellar suture stabilization surgery is a very common fixation for CCL injuries. It is one of the least expensive and most widely done procedures since just about any veterinarian can do it. This method has the best success on smaller or less active dogs since the more weight and energy that a dog has, the more likely the suture is to prematurely break. Use this information to talk over this procedure with your veterinarian so that together you can choose the method that is the right fix for your dog.

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