Extracapsular Repair vs. Tibial Plateau Leveling Osteotomy

December 24 4 Comments Category: Adventures with Dogs

As many of you know, we have been struggling for the past few months to help Tucker’s torn cruciate ligament (CCL) heal using conservative management. Unfortunately, despite all of our efforts to change his diet, add supplements, utilize a brace, prescription anti-inflammatory medication, joint-friendly exercise, and LOTS and LOTS of rest, Tucker’s knee has gotten progressively worse since June (at which point he was presenting with a partial cruciate tear). His arthritis is progressing and he now has a positive drawer sign, which is a test done by the vet during which he slides the tibia out. If there is positive forward motion of the tibia it is known as a positive drawer sign and is indicative of a CCL tear.

Since day one we have been weary of surgical intervention due to the inherent risks of surgery and anesthesia, along with our concerns about keeping Tucker quiet for a prolonged period after surgery. After lengthly discussion and multiple follow-up visits with our vet, we have slowly become more comfortable with the idea of possibly pursuing the surgical route in Tucker’s recovery. At our last visit at the end of November we learned that Tucker’s arthritis is progressing, the fluid accumulation and inflammation have slightly worsened, and the joint is getting less stable. With the decision as to whether or not to pursue surgical intervention upon us, and taking Tucker’s age and personality into consideration, we have decided to proceed with surgery.

The extracapsular technique is the one we have chosen to go with, as it is less invasive and requires less recovery time as compared to the TPLO method. Extracapsular stabilization techniques involve stabilizing the stifle (doggy term for knee) by some means external to the joint capsule. Most commonly this is done by placing a large, nonabsorbable suture around the lateral fabella and through a hole in the tibial crest. The suture, monofilament nylon aka fishing leader line, forms a figure 8 pattern around the knee joint, mimicing the action of the cruciate ligament and preventing the tibia from forward motion. It is this forward motion, known as the cranial drawer, that is causing Tucker’s arthritic and inflammatory changes, so the only way for Tucker to truly recover is to take steps to prevent the bone from moving in this manner.

Extracapsular Repair Showing Suture in Figure Eight Pattern

4 Responses

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  1. I have been strugling to find the best way to go for my 10 year old, 17 pound westie, who has a torn CCL. She’s scheduled for TPLO method in two weeks, but I’m worried because she’s not a brave dog, just one who likes to cuddle. This could be worse than walking around on three legs.

    mary hines 3 March 2008 at 5:35 pm Permalink
  2. Not sure how old this is. Can you tell me how it went? I have a similar situation with my 35 lb cockapoo.

    Gus 25 September 2009 at 11:31 am Permalink
  3. We are considering this surgery vs the TPLO. Our vet says the ECR may only last a short period of time. How is it working for your westie?

    Thanks

    Richard Citrin 20 January 2010 at 6:12 pm Permalink

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  1. Operation Tucker, Tucker's Extracapsular Repair Surgery, Traditional CCL Repair and TPLO - 16. Feb, 2008

    [...] sharp on February 13th, 2008 to let the vet work his magic. (To read about the procedure we chose click here – or read the post “Extracapsular Repair vs. Tibial Plateau Leveling Osteotomy“)I [...]

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