Cruciate Ligament Surgery for Dogs – Various Dog Knee Surgery Types

Last Updated on 2022-01-19 by Admin

Cruciate Ligament Surgery X-Ray

Annie has been limping for a while on and off. When we had Annie spayed, the vet did some x-rays and inspected the affected knee. As it turns out, Annie has a torn ligament and needs a Cruciate Ligament Surgery. The veterinarian recommended a TPLO surgery.

Unlike the time when I was dealing with other health issues with Annie, I made sure to get a second opinion. The second opinion confirmed that Annie needs a TPLO surgery. There are no plans to rush into any surgery on my part. Some research is in order in such situations. I like to share the resources and findings with other dog owners in a similar predicament.

I am a dog owner, not a veterinarian. So please keep that in mind as You read this article.

But I spent a lot of time researching the topic of dog knee injuries. And I used scientific research to get the best possible information. At the end of this post is a reference section with the scientific research articles that helped me get a better understanding of the issue. I hope this dog owners guide to dog knee surgery will be of use. At the very least it will help to make an informed decision.

If you are in a similar situation as me, find a Veterinarian that can give You advice and answer all questions related to treatment. Be aware most veterinarians will only perform a limited selection of available Surgeries. You can always ask for a referral to a Veterinarian orthopedic surgeon. It might make sense to have a specialist do this surgery instead of the veterinarian you frequent.

TPLO Surgery

After reviewing this surgery, I have to ask myself a couple of things. Why do we cut the bone to fix a ligament issue? Would they do that kind of surgery on me if I had a torn ACL? It somehow seems wrong to me to cut a bone to fix this issue. So I investigated alternatives to the TPLO surgery. The video below shows three types of procedures. One of them is the TPLO procedure. The TPLO procedure is generally the one most common and also the most costly.

TPLO Surgery Alternatives

When I investigated the alternatives, it became clear that cutting bone seems to be how to deal with a torn ligament in dogs. Never the less, it seems wrong to me, but understand what they try to do.

TTA Surgery

TTA is a newer knee surgery then TPLO but also requires cutting bone. Complications and recovery time from this surgery are similar to the TPLO surgery.

MMP Surgery

MMP surgery is similar to the TTA but is supposed to be simpler to perform. Complications are similar to TTA and TPLO surgery. But recovery seems to be a little faster. This surgery still cuts bone. I emailed about a dozen veterinarians in my area in Canada, and none of them does this procedure. Found one Veterinarian in Saut St. Marie, which is too far away from where I live. See the video below for details on the MMP surgery.

Extracapsular Knee Surgery for Dogs

The Extracapsular procedure is the only surgery that I found that does not cut the bones. Instead, a hole or more gets drilled through the bone. Then a suture is inserted to try to perform the function of the original ligament. This surgery has also been around for a very long time. Many none specialized clinics have done this type of surgery. For many years this was the primary surgery performed for a ligament tear.

Most articles I read state that this surgery is for small dogs. And most veterinarians recommend TPLO or TTA if a dog is over 40 pounds as the knee is made stable via a cable. Large dogs would put to significant pressure on the line. And that increases the chance of the cable breaking.

After doing some research on this particular surgery, I found several variations of this procedure. Over time, like with most things, it got enhanced. The sutures have become much better and stronger. Extracapsular surgery is also the least invasive of all the listed ones and something to consider for any surgery. It also has fewer complications, and recovery time is similar to the other procedures. This procedure also costs the least.

Tightrope Procedure

This surgery also does not cut the bone, but several holes are drilled through the bone to hold the hardware in place. It looks similar to the Extracapsular procedure. Based on the research, I found this is comparable in quality and durability with a TPLO surgery, even on large dogs. See links in the research section below. See the video below for details on the Tightrope surgery.

Update 2021-08-14

Read about about my experience with Conservative Treatment and why, after one Year of conservative Treatment for my dog’s knee injury, I decided on surgery. The Tightrope procedure was chosen for Annie. You can read about our experience with the Tightrope surgery and recovery here. Another interesting read is an article about the history and research on the Tightrope procedure.

Preparation for Surgery

When considering any type of surgery it is a good idea to look into the pre-surgery requirements. While this is often only provided on as needed bases, meaning late in the process. There is lots to consider. My experience has been that there is an almost total lack in getting information on all the things that need to be considered.

Fore that reason I created and post that provides a checklist for before and after dog knee surgery. All based on my experience with Annie.

Recovery Time

Please also consider the recovery time of the surgery. How long will it take for Your dog to be able to run and play with other dogs? Annie is an active Boxer. It is hard to keep her from jumping or from having one of her crazy five minutes. You and Your dog will be dealing with the recovery time, not the veterinarian.


As a dog owner, the research does not help me as much as I hoped. The recommendation for TPLO somehow is not supported by science, in my opinion. The number of dogs in the studies is tiny. I was not able to find long-term studies comparing all types of surgeries with complication rates and arthritis status years after the surgery. One thing that stares me in the face is that the most costly operation is TPLO. It is the most recommended surgery for larger dogs. Hard as a dog owner to justify the cost of it without supporting good scientific evidence. Most research articles I found are also rather old.

To me, it seems the Tightrope procedure offers pretty much the same results as TPLO with less cost and is less invasive on top of it. The Tightrope procedure has performed well on large dogs based on what I read. At this point, I don’t know which Cruciate Ligament Surgery I will pick for Annie. I have made an appointment with a third veterinarian for an other opinion.

What did we do for dogs with this condition before we had surgery? How did those dogs heal this injury? I will also look more into none surgical options.


Cranial cruciate ligament injury in dogs ‐ are we really making any progress?

Long term comparison of TPLO and TTA surgeries

Complications for TPLO and TTA in dogs over 50 Kg

Tightrope vs TPLO

Tightrope 3 D Modeling

Treatment Options for Cranial Cruciate Ligament Rupture In Dog – A Literature Review

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