192 Surgical Treatment
(A) (B)Figure 25.3 Cranial (A) and lateral (B) illustrations of a stifle with a femoral bone anchor technique. Source: Tonkset al.
- Reproduced with permission from Schattauer.
The lateral fabello-tibial suture (LFTS) tech-
nique is based on Flo’s modification of the pro-
cedure described by DeAngelis and Lau (DeAn-
gelis & Lau 1970; Flo 1975). A monofilament
nylon leader line is passed from proximal to dis-
tal around the lateral fabella. Single or double
tibial bone tunnels for suture passage have been
described. The suture should be tunneled under
the cranial tibial muscle rather than coursing
over the muscle. The final suture pattern can
be a box or a figure-of-eight configuration. The
suture is fastened with knots or crimp clamps
near the lateral fabella. The medial and lat-
eral retinacular imbrication technique (MRIT) is
similar to the LFTS except that a medial fabello-
tibial suture is also placed.
The TightRope CCL®(TR) is a procedure
in which a multifilament suture (FiberTape®)
is passed through femoral and tibial bicortical
bone tunnels and secured on the medial side of
each bone using endobuttons. The femoral exit
site is 2 mm from the caudal edge of the lat-
eral femoral condyle at the level of the distal
fabella, and the tibial exit site is located at the
caudal aspect of the extensor groove; the tun-
nels diverge away from the stifle joint.
Multiple bone anchor systems have been
described for ES, where the anchors are used
to secure the suture at the femoral and/or tib-
ial attachment sites (Figures 25.3 and 25.4),
and a bone anchor at one site can be com-
bined with a button or bone tunnel at the
other site. Typically, multifilament sutures are
used because the pliability of multifilament
may be beneficial for use with bone anchors.
The suture ends are typically joined using
a knot. Anchor sites are chosen by the sur-
geon but should be based on isometry (see
below). Examples of bone anchor products that
have been used for ES include FASTak®and
SwiveLock®.FASTak®anchors are pre-loaded
with FiberWire®, whereas SwiveLock®anchors
can be threaded with a suture of the surgeon’s
preference.
The Ruby Joint Stabilization System is a
bone anchor system with multiple added inno-
vations. The Ruby system uses two titanium
alloy bone anchors with ceramic eyelets to
secure a multifilament continuous-loop suture
(Dyneema®) to the bone. One loop of suture
is associated with the femoral anchor and one
loop with the tibial anchor, and the two loops
are joined using a titanium link; the length of
the Dyneema®loops must be pre-determined,
but no knot or crimp is required. The ultra-
low-friction Ruby eyelet embedded in the bone