Tightrope Surgical Procedure, its History and Research

Last Updated on 2022-07-10 by Admin

2 Months after Tightrope Surgery Annie is having a good time

The Tightrope procedure is a knee surgery performed on dogs requiring knee surgery because of a torn ligament. Each year Millions of dogs require knee surgery. That is how common dog knee injuries are. Dog knee surgery is the most common surgery performed on dogs.

I want to clarify that I’m a dog owner, not a veterinarian. The value of this article is that my dog had the Tightrope procedure. And the content is based on my experience as a dog owner.

Lets look at why the Tightrope procedure got developed. Understanding this aspect becomes very important when other dog knee surgery procedures are compared or under consideration for correcting a dog’s knee problem.

Why the Tightrope Procedure got Developed

Dr. James Cook DVM, PhD, DACVS, around 2006, developed the TightRope® CCL fixation technique. His goal at the time was to address his strong concern about the safety and availability of surgical treatments for dog-joint issues. Dr. Cook wanted a safer, less invasive, and more straightforward procedure to reduce the number of severe complications that sometimes arise from knee surgeries.

A simpler procedure allows many more Veterinarians to learn the process, and therefore the availability for care and safety of such surgeries would increase. Its worth remembering that each year millions of dogs require knee surgery.

You can learn more about the origin of the procedure by Dr. James Cook himself in the following two articles.

How the TightRope® CCL Fixation Technique was Developed

MU veterinarian develops ‘TightRope’ surgical technique

What Distinguishes the Tightrope Procedures from Others?

Tightrope surgery is the only surgery suitable for medium to large dogs not requiring bone cutting to repair the knee. Other more common knee surgery procedures like TPLO, TTA , MPP all require bone cutting and are more complex to perform.

The central distinguishing part about the Tightrope Procedure are:

  • Less intrusive procedure \ no Bone cutting
Tigthrope Incision
See how small the Tightrope Incision is

Tightrope Surgery – Animated Video

Because this article is about the Tightrope procedure, I won’t cover the other methods here. Instead, refer to that my article about cruciate ligament surgery.

Tightrope Surgery and Arthroscopy are Often Performed Together

Arthroscopy is performed to inspect the inside of the knee. It also is a tool to remove the ends of the torn ligament. Often other corrective measures as performed during Arthroscopy. For example, with my dog Annie the meniscus required some work. During surgery, inspecting the knee with Arthroscopy is beneficial because the dog is already under anesthesia.

With Arthroscopy, the surgeon has a magnified view of the inside of the knee. That is something that x-Rays or other external procedures don’t provide. The combination of knee surgery and Arthroscopy is considered the “Gold Standard” for knee surgery.

While most dogs with torn ligaments will already have or will develop Osteoarthritis, the visual inspection can indicate how advanced the condition is, allowing for early treatment.

Osteoarthritis is Common for Dogs that Have or Had a Torn Ligament

The reason dogs that have torn ligaments very often will get Osteoarthritis is that while the ligament is torn, there is too much movement on the joint. Causing wear and tear on the bones and other parts in the knee, like the meniscus.

There is no cure for Osteoarthritis. It only can be managed. In my email to Dr. James Cook, I asked about Osteoarthritis and how to manage it best. After all, this is something that I will have to deal with Annie, my Boxer girl as well. Dr. James Cook was kind enough the provide me with some great feedback.

For clarity reasons, I like to provide the full name of the acronyms used in his email.

  • TR – TightRope Procedure
  • OA – Osteoarthritis
  • CCLD – Canine Cruciate Ligament Disease
  • PRP – Platelet-Rich Plasma
  • NSAID – Non-Steroidal Anti-Inflammatory Drugs
  • joint “clean up” means Arthroscopy

Now to Dr. James Cook reply,

” Certainly a good joint “clean up” and a procedure like TR is key part of the management of OA secondary to CCLD. And then, a comprehensive multi-modal plan is the best we can do, and I recommend:

– Optimize body conditioning via weight management/diet and muscle building activity

– Evidence-based supplements such as fish oils and or Dasuquin

– Orthobiologics such as PRP if/when needed

– NSAID and or analgesics if/when needed“

Platelet-Rich Plasma treatment (PRP) is not something most veterinarians perform. If my experience is any indicator, only a few progressive Animal Hospitals offer PRP treatment.

Benefits of the Tightrope Procedure

I spent over a year addressing my dog’s knee injury with conservative treatment. That gave me time to research various other types of treatments, including surgery. I spent many hours reading research articles and available treatments.

Plus I had lengthy phone consultation with the surgeon that performed the Tightrope procedure on my dog. I concluded that the Tightrope procedure offered some important benefits are important to me and benefit Annie.

  • Tightrope procedure is a Simpler procedure than many others
  • Shorter initial Recovery time for the dog
  • Surgery and long-term outcome is very good
  • No Bone cutting
  • Less invasive surgery
  • if later, another type of knee surgery is required, it can be done. The reverse is not the case
  • if there are hardware issues in the future, or the dog does not tolerate the hardware, it can be removed. The built-up scar tissue will hold the knee in place.

Research Studies on the Tightrope Procedure

While researching the Tightrope procedure outcomes and comparing it to other procedures, I found that only older articles were available to the public. That led me to contact Dr. James Cook DVM, PhD, DACVS, to thank him for the procedure and mention that Annie got treated with the Tightrope procedure.

In that email, I also asked Dr. Cook if there were studies or research articles other than what I was able to access.

He was kind enough to send me many articles that I was not aware of. And I have yet to see a study where the Tightrope procedure does not perform well. And by performing well, I mean, it performs in the top 2. Often it ranked as the top procedure. Unfortunately, all the studies I came across were five years old or older.

I hoped to present a recent study about the Tightrope procedure. But unfortunately, the most recent study is from 2020.

Treatment Options for Cranial Cruciate Ligament Rupture In Dog – A Literature Review By Cornel Igna* and Larisa SchuszlerBanat’s University of Agricultural Science and Veterinary Medicine Timisoara, Faculty of Veterinary Medicine, Romania Received: March 06, 2018; Published: March 20, 2018

Bologna Healing Stifle Injury Index: A Comparison of Three Surgical Techniques for the Treatment of Cranial Cruciate Ligament Rupture in Dogs By Pinna S, Lanzi F, Grassato L. Bologna Healing Stifle Injury Index: A Comparison of Three Surgical Techniques for the Treatment of Cranial Cruciate Ligament Rupture in Dogs. Front Vet Sci. 2020;7:567473. Published 2020 Oct 28. doi:10.3389/fvets.2020.567473

Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs By Scott A Christopher  , Jodi Beetem, James L Cook

A list of older study results can be found here.


There are not many options for dog owners interested in knee surgery that does not cut bone. For small dogs, there is another option, as far as I know. But for medium to large dogs, the Tightrope procedure is the only one.

What is surprising is that not one Veterinarian I talked to ever mentioned the Tightrope procedure as an option for knee surgery. I had to do my research and then find a surgeon to perform the Tightrope procedure.

The hard part with surgeries and dogs, in general, is that dogs have no sense of taking it easy. They will want to be active till something hurts. That is what a dog owner needs to manage. And that is not easy. The best one can do is follow the recovery instructions and control the dog till fully healed. For the Tightrope procedure, that is six months.

We are now five months past surgery with Annie, my Boxer girl. She is doing very well, we can go for long walks, and she won’t limp, even have let her run in the park when none was around. In February 2022, she can run and play with other dogs. I’m very please with the outcome, and so is my Boxer girl Annie.

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