We know that there is a lot of confusing or conflicting information out there on how best to fix a torn ACL ligament in a dog, and so we've summarized the options below for you:
TPLO: The Tibial Plateau Leveling Osteotomy surgery has been around for about 20 years. The idea behind it is to change the angle of the tibia so that the femur above it no longer slips backwards. The ACL is supposed to prevent this from happening but when it tears, the femur tends to slip backwards from the tibia and this causes pain and inflammation. This surgery has a very high success rate. The downside is cost. At our clinic, the total cost tends to be $3,500 to 4,500.
CBLO: The Cora Based Leveling Osteotomy surgery is one of the newest ways of repairing a torn ACL. It has the advantages of both the TPLO, by leveling the tibial plateau, and the TTA, by moving the patellar tendon forward. The downside is that there is not as much information out there on this procedure since it is so new. For this surgery, we call in Dr. Randall Fitch, a boarded surgeon who primarily works out of Beacon Veterinary Specialists. At our clinic, the overall cost of this procedure is $4,800.
TTA: The Tibial Tuberosity Advancement has been around for over 10 years. The idea behind this surgery is to move the patellar tendon forward so that the forces acting on the knee cancel out - the backwards slope of the tibia pushing the femur backwards is counteracted by the patellar tendon pulling the femur forwards. There is currently a controversy among surgeons as to which surgery (TPLO or TTA) is better. We do not currently offer this surgery at our office, believing that the TPLO has given us better overall results at the same price.
IsoLock CrCL: Another variant of this surgery is known as the tightrope technique. This technique has been around for about 5 years. The idea behind this surgery is to recreate the torn ligament with an artificial one. The material used is high-strength and is used extensively in human surgeries. It is resistant to stretching or breaking. The artificial ligament is passed from the femur to the tibia in a location that is isometric - meaning that it is under equal stress when the leg is flexed or extended. The reported complication rates and clinical outcomes are similar to the TPLO surgery. The benefit to this surgery is that no bones are cut, so the procedure is less invasive or painful. Also, it tends to be less expensive. The overall cost at our clinic is $2,500.
Extracapsular Technique: Other words for this include lateral fabellar suture, lateral suture stabilization, and "fishing-line technique". This surgery has been around for about 50 years. This tends to be one of the more common ways to repair an ACL tear because some general practitioners feel comfortable performing it and it tends to be less expensive overall. In the past, results have been mixed due to flaws in the nylon implant - causing it to stretch or break. We now use a FiberWire implant that doesn't have these flaws, and so the results have been much better. This tends to be our recommended surgery in pets under 30lbs. The overall cost at our clinic is $1,500.