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Cranial Cruciate Ligament Repair: TightRope Procedure

Cranial Cruciate Ligament Repair: TightRope Procedure

Cranial Cruciate Ligament Repair: TightRope Procedure
One of the most common injuries to the stifle (knee) of dogs is tearing of the cranial cruciate ligament (CCL). This ligament is similar to the anterior cruciate ligament (ACL) in humans. There are actually two cruciate ligaments inside the knee: the cranial cruciate ligament and caudal cruciate ligament. They are called cruciate because they cross over each other inside the middle of the knee. For more information on these ligaments and how they can become damaged "Cranial Ligament Rupture in Dogs."
When the CCL is torn or injured, the tibia (shin bone) slides forward with respect to the femur (thigh bone), which is known as a positive drawer sign. Most dogs with this injury cannot walk normally and experience pain. The resulting instability damages the cartilage and surrounding bones and leads to osteoarthritis (OA).
What options are there for repairing my dog’s torn
Torn_CCL_Ligament_DOG-Canton_Animal_Hospital_Michigan
 
 
CCL? 
 
When the cranial cruciate ligament is torn, surgical stabilization of the knee joint is often required, especially in larger or more active dogs. Surgery is generally recommended as soon as possible to reduce permanent, irreversible joint damage and relieve pain.
"Surgery is generally recommended as soon as possible to reduce permanent, irreversible joint damage and relieve pain."
Several surgical techniques are currently used to correct CCL rupture. Each procedure has unique advantages and potential drawbacks. Your veterinarian will guide you through the decision-making process and advise you on the best surgical option for your pet.
For information on other types of surgery used to correct CCL injuries in dogs, check link “Cranial Cruciate Ligament Repair: Tibial Plateau Leveling Osteotomy (TPLO)" and "Cranial Cruciate Ligament Repair: Tibial Tuberosity Advancement (TTA)" and Extracapsular lateral suture (MRIT)
 
"Either traditional MRIT or the TightRope® procedure is considered adequate for most small- to medium-sized dogs."
 
 
Cranial Cruciare Ligament repair : TightRope Technique
The Tightrope technique is a modification of the fabello-tibial suture techniques ( MRIT). Essentially, a polyblend type suture composed of braided ultra-high molecular weight polyethylene polyester (FiberTape, Arthrex Inc., Naples, Fla.) is used in place of monofilament nylon and is anchored to the femur and tibia with suture buttons.
TightRobe_CCL_Repair_Canton Animal_Hospital
 The advantage of this technique is that the suture material is anchored at more isometric points, thus allowing for more normal range of motion while maintaining stifle stability.
The disadvantage of this technique is that the use of a large braided suture substantially increases the risk of serious infection.
Surgical Technique. As with all surgical techniques for stabilization of the cranial cruciate-deficient stifle, the joint is explored and meniscal injury is treated if present. The joint capsule is closed with an absorbable synthetic suture in a simple interrupted pattern.
A femoral tunnel is drilled craniomedially, from a point just distal to the lateral fabella- femoral condyle junction to the distal diaphysis, just cranial to the patella.
The tibial tunnel originates at the caudal aspect of the tibial extensor groove and exits medially at the insertion of the caudal sartorius muscle.
A guide wire is placed in position first for both bone tunnels to assure correct placement. A cannulated drill bit is then driven over the guide wire to make the tunnel.
The double stranded suture and proximal button are then threaded from distal to proximal via a pre-attached straight guide needle. Once the suture and proximal button have passed through both bone tunnels, the needle is removed and the suture is pulled taught to seat the proximal button squarely against the medial femur. The distal button is then placed against the medial tibia and the suture material is first tensioned with a mechanical suture tensioner and then tied.
 
Aftercare. The limb is not bandaged or splinted postoperatively. Only very restricted exercise is allowed for 8 weeks, followed by a gradual increase of activity during the following 4 weeks. Most animals will be partially weight bearing within the first week and walking comfortably with only a slight limp at 3 to 4 weeks. Pain management during and after stifle surgery is critical, so be sure to give all medications as prescribed and use them until they are gone.
Physical rehabilitation postoperatively will speed healing. Ask your veterinarian about incorporating rehabilitation into your dog's recovery plan.

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