TightRope Surgery for Dogs

If there’s one good thing about your dog having a torn cranial cruciate ligament (CCL), it’s that there are many effective ways of fixing it. One of those ways is with the TightRope system.

The TightRope system is a type of extracapsular fixation, meaning the entire stabilization takes place outside of the joint capsule. The idea behind this type of surgery for torn CCLs is that a specially designed implant, the TightRope, placed outside of the joint capsule, will mimic the function and stabilization abilities of the CCL.

The long-term goal is that the implant will talk the body into creating scar tissue that is stronger and longer-lasting than the implant itself. This scar tissue is what will stabilize the knee even if the implant stretches or falls apart.

Even though an injury to the CCL creates big problems for your dog, it’s actually a very small ligament with a very important job. If we look at a dog’s knee joint, it consists of the thigh bone, or femur, and the shin bone, or tibia. These bones are held together by various ligaments at the knee joint that helps to keep the bones together.

Inside of the joint capsule is the CCL and its partner the caudal cruciate ligament. These two form an X that helps to keep the thigh bone from sliding off of the shin bone when the knee bears weight. The CCL is mainly responsible for keeping the thigh bone from sliding backward and the caudal cruciate ligament keeps it from sliding forward. It’s a great system but it’s under a lot of pressure.

When the CCL gets injured, whether that’s a partial or complete tear, it allows that thigh and shin bone more wiggle room that creates inflammation, pain, and arthritis in the long run if left untreated.

What the TightRope Fixation system aims to do is create that cross joint stabilization with a durable and reliable implant all on the outside of the joint capsule. Think of it as a mini knee brace that is pinpointed directly at the joint.

The TightRope implant itself is extremely durable and is made up of Fiberwire, which is multiple strands of essentially very strong thread. On each end of this thread is a tiny toggle that helps to hold the implant in place.

When a dog tears its ACL, every time the dog goes to stand or put weight on the leg, the femur slides/rubs on the back of the tibia. This rubbing causes pain and inflammation, which is very uncomfortable. This is why most dogs with a torn ACL will not even put any weight on the leg, or if they do, they will just toe touch the leg to the ground.

The true beauty of TPLO surgery is that it completely alters the dynamics of the knee. Once the bone is cut and the tibial plateau is rotated, where the femur and the tibia communicate, no longer can the femur slide backward. The knee is immediately stabilized. Doing so, eliminates the need for the ACL ligament entirely and returns stability to the joint immediately.

The implant is placed by drilling tiny holes through both the thigh and shin bones. This may sound a bit scary and traumatic, but rest assured that the TightRope system comes with specially designed guides to help your veterinarian know the exact areas to drill. The TightRope implant is then threaded through the holes and held in place with little toggles that sit comfortably and securely against the bone.

Your veterinarian can adjust the tension on the TightRope implant to ensure that your dog’s knee will be as stable as it was before the injury.

If this procedure doesn’t quite sound like your dog’s cup of tea, there are plenty of other surgical alternatives to the TightRope Fixation. Those include both other extracapsular fixations and those that involve cutting bone.

Extracapsular methods:

• Lateral fabellar stabilization
• Ex-Cap suture
• Fishing line

All of these are similar to the TightRope method only using various types of heavy-duty suture material instead of the implant.

Bone-altering methods:

• Tibial Plateau Leveling Osteotomy (TPLO)
• Tibial Tuberosity Advancement (TTA)

Both of these methods involve cutting and repositioning parts of the shin bone in order to reorient the angle of the knee joint, decreasing the need for the CCL to hold the joint together.

On the other side of the treatment spectrum for CCL injuries is conservative or medical treatment. This means no surgery, no anesthesia, no special instruments. It also typically means fewer positive results.

Non-surgical treatments for CCL injuries include strict rest and exercise restrictions. We’re talking limited walks, no running, jumping, or playing. Along with this comes anti-inflammatories to help make a dog more comfortable. This type of approach doesn’t do a thing to fix the injury. Therefore, it works best for dogs with partial tears to the CCL rather than full ruptures as there is a chance of getting that partial tear to create scar tissue stabilization with enough rest.

Some dogs just aren’t meant to have CCL surgery due to other health issues, financial limitations, or what have you. Those dogs may benefit from a specially designed knee brace that offers support and stabilization. Further research needs to be done to determine if this is a sound option or not.

Advantages

Extracapsular fixation methods, like the TightRope option, are less expensive than TPLO or TTA surgeries. This is mostly because any veterinarian with the training and tools can get in on it. Surgeries, where bones are cut, involve board-certified specialists at referral clinics.

Along with that, you’ll also have an easier time finding a vet that will do the surgery instead of waiting to get into a referral clinic or specialist.

The TightRope system has the advantage over other extracapsular methods in that it uses a stronger, more durable implant than most single sutures. This makes it less likely to fail. It also allows for more accurate placement of the implant as opposed to other extracapsular techniques also meaning less chance of failure and complications.

As a side note, the TightRope Fixation system has been found to have similar outcomes to TPLOs six months following surgery.

Disadvantages

The TightRope system can’t be all green grass and flowers or it would be the only surgery available for CCL injuries. Rather, there is a chance for implant failure, meaning that it breaks or the toggles fail in some way so that it comes loose from the bone. If this happens before enough scar tissue has formed, the knee will need to be fixed another way.

Other disadvantages are that a dog’s body might not like the implant and actually have an adverse reaction to it. This can show up as chronic swelling and discharge and off and on lameness. Infection, whether right after surgery or down the road aways, can always happen as well.

As a general rule, extracapsular fixations are meant more for smaller or less active dogs, basically those that are less likely to break the suture. While the TightRope implant is less likely to break than other sutures that are used, there still is that possibility for heavy, large-breed dogs or those that don’t have an ‘off’ button.  

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This is the time that can make or break your dog’s knee surgery. The post-op recovery phase is key to the success of the surgery and the lifelong comfort of your dog’s knee. The biggest problem seems to be that these dogs don’t want to take it easy for eight or more weeks while everything gets a chance to heal. During this time, dogs shouldn’t be allowed to run, jump, or play. They should go outside on a leash for potty breaks and short, controlled walks only. Any more strenuous exercise before these eight weeks can lead to the implant breaking.

After the eight weeks, leash walks for increasing times and distances will help rebuild muscle. Passive range of motion exercises and massage can be started immediately after surgery. If a professional rehabilitation clinic is available to you, use them. Otherwise, the Cruciate Home Rehab Guide can easily walk you through these exercises to ensure the best outcome.

Dogs will go home from surgery on antibiotics to prevent infection and anti-inflammatories to keep them comfortable. They may also have a soft bandage for a couple of days to protect the incision, and depending on the dog, a cone of shame to keep them from licking or chewing out all of the veterinarian’s hard work.

Weight loss may be a big part of a dog’s pre-or post-op regime. Excess weight doesn’t do an injured CCL any favors, even one that’s been fixed with a TightRope system. Dogs may have to go on a restricted diet in order to slim down to a mass that’s more favorable.

Another major player in the recovery process is joint supplementation. GlycanAid HA, Flexerna Omega Flexerna Essentials and MSM Joint Boost will cover all of your dog’s knee bases, providing them with glucosamine, hyaluronic acid, chondroitin, MSM, and omega fatty acids to naturally help rebuild joint cartilage and fluid as well as decrease inflammation. Use these in combination after a TightRope surgery or immediately following a CCL injury for the maximum benefit.

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We hit on this already, but they’re definitely worth repeating. No surgery is without possible risks and complications, that includes the TightRope system. The main downside to this surgery is the possibility of breaking the implant before it has time to create any scar tissue formation. This would mean a do-over of the TightRope or some other type of fixation method to stabilize the knee.

Also, there is the chance that your dog’s body will reject the implant. That material going in there is thick and strong, great things when you’re talking about durability, but not so great things if you’re talking about a body accepting something as its own. Dogs may have a localized reaction to the implant where they get chronic swelling and draining from the healed site. They may also show up with on and off lameness. Sometimes these symptoms can be managed, other times the implant will need to be removed.

Other possible complications are the same as those with any type of surgery. There is always anesthetic risks. Those can be drastically reduced by pre-operative blood work and exams to ensure that a dog is healthy enough to go under. Proper monitoring during surgery will also help prevent these complications.

Anytime there is cutting into skin and exposure of tissues that aren’t normally exposed, there’s a chance for contamination and infection. Even with sterile procedures, bacteria can still get into an incision and treat it like a rock star in a hotel room. Keeping the incision clean and giving your dog the prescribed antibiotics will help keep those bad bugs from setting up shop.

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With a successful surgery and a proper recovery period, TightRope Fixation can significantly improve a dog’s comfort and knee stabilization in 90% or more of patients. Those surgeries that are unsuccessful are most likely due to an implant failure, improper placement, or a mishap during recovery.

What this means for dogs is that they will be able to move like before without any discomfort or forward movement of the shin bone when the knee bears weight. However, anytime there is an injury to or inflammation in a joint, arthritis soon follows. While arthritis may be slowed or decreased with proper surgical fixation, there is still the realization that a dog will develop arthritis down the road following a TightRope surgery. This is where proper exercise and joint supplements come into play. Great supplements like GlycanAid HA, Flexerna Omega, Flexerna Essentials and MSM Joint Boost can all help to maintain and improve joint cartilage and fluid in order to keep arthritis at bay.

Again, weight management gets a nod since being overweight or obese is a huge risk factor for injuring a CCL in the first place. It also adds to a dog’s chance of developing arthritis post TightRope surgery and decreases the chance for a positive outcome.

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The TightRope Fixation system is another less expensive option for fixing your dog’s injured CCL. It provides durable stabilization of the knee without any cutting of the bone or veterinary specialists. However, it may not be for every dog, including those overly large or rambunctious types. With this information, you and your veterinarian should be able to make the decision on whether the TightRope system is right for your pup.

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