Front Matter

Chapter 14 Disorders of the Pelvic Limb: Diagnosis and Treatment 373

to the stifle until the body can form organized
scar tissue around the suture material that
ultimately provides the long‐term, functional
stability. The major limitations of this technique
are that the monofilament has relatively low
tensile strength and a fair amount of creep, and
the points of implantation are nonisometric to
the cruciate ligament. These factors can lead
to  joint laxity during the initial 4–8 weeks of
healing that may result in either too much scar
tissue formation, which decreases functional
range of motion of the stifle, or too little scar
tissue, which can lead to persistent instability.
These limitations become more obvious in
large, giant, and active performance dogs.
Several bone anchor and suture combina­
tions are also available for use in extracapsular
repair. With these procedures, a bone anchor
may be used both in the femur and tibia to
anchor mono‐ or multifilament material.
Other systems use only one bone anchor or
bone tunnel in the tibia. To date, no clinical
comparisons of these various techniques have
been published.
The TightRope® CCL technique differs from
conventional extracapsular stabilization in that
it can be performed in a minimally invasive
manner, provides bone‐to‐bone stabilization,
and more accurately mimics the natural orien­
tation of the CCL, using a suture material that is
stronger and has less creep than conventional
ones (Burgess et al., 2010) (Figure 14.24). Using
specific landmarks, bone tunnels are drilled
through the femur and tibia. The material is
passed through the tunnels and is secured
using stainless steel buttons. The procedure
relies on the formation of organized scar tissue
around the implant for long‐term function.
Early literature suggests a high level of success
with a relative low level of morbidity when
compared with osteotomy procedures (Cook
et al., 2010b; Christopher & Cook, 2011).

Corrective osteotomies

Tibial plateau leveling osteotomy (TPLO). The
TPLO is a common procedure of choice for
active, large and giant‐breed dogs (Priddy et al.,
2003; Lazar et al., 2005; Cook et al., 2010b;
Kowaleski et al., 2012). The procedure involves
making a curved osteotomy through the upper
portion of the tibia (Figure 14.25). The articular

component of the tibia is rotated to achieve a

lower angle of the tibial plateau relative to

the long axis of the tibia. The amount of rota­

tion is based upon the tibial plateau angle as

measured on preoperative radiographs. After

rotation, a plate and screws are applied to hold

it in position. This procedure alters the biome­

chanics of the stifle, placing additional reliance

on the caudal cruciate ligament and active

muscle stabilizers of the stifle.

This procedure can be used in any size dog

with any tibial plateau angle, it has a highly

reproducible outcome, and because it relies on

bone healing, is easily assessed radiographi­

cally. The procedure may also have a slower

progression of OA than the LFS procedure

(Lazar et al., 2005). Recent prospective, blinded

studies have shown the TPLO to have a high

success rate with high client satisfaction

(93%) when compared with LFS stabilization

(Gordon‐Evans et al., 2013; Nelson et al., 2013).

Force plate analysis has also shown TPLO to be

Figure 14.24 Postoperative radiograph of the

TightRope® CCL technique.