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 and is considered by most doctors to be the gold-standard surgery for the cruciate tear. The downside is cost. At our clinic, the total cost is $3,500.
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. This surgery is well-suited for dogs that are still growing and ones with an excessive tibial slope. At our clinic, the overall cost of this procedure is $3,500.
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. While short-term results put this option on par with the TPLO, long-term results have favored the TPLO surgery. We no longer offer this surgery at our office.
IsoLock CrCL: Another variant of this surgery is known as the Tightrope CCL technique. This technique has been around for about 10 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 benefit to this surgery is that no bones are cut, so the procedure is less invasive or painful. The downside is a higher infection risk. Because of the higher infection risk but similar outcome to the TPLO surgery, we no longer offer the IsoLock surgery at our office.
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. In the past, this was the most common way to fix a torn ACL. The results are not quite as good as the TPLO in larger pets, but it’s still a reasonable option for smaller patients - perhaps dogs under 30lbs. The overall cost at our clinic is $1,800.