Extracapsular repair is an old technique, but it can work, and it is the least invasive surgical technique to date.
It is not recommended for large dogs, but it can be done successfully. It is, however, more vulnerable during the post-op recovery.
Thank you, Luanne, for sharing Sandy’s story.
Sandy’s conservative management of her ACL injury had to be abandoned. While the brace was helping with Sandy’s knee, it was causing problems with her ankle. The decision has been made, and Sandy had her extracapsular surgery.
Despite Luanne’s worries, the surgery went well, and Sandy was recovering. Sadly, it turned out that Sandy’s meniscus suffered substantial damage and a large portion had to be removed. It didn’t seem apparent at the time of the injury, and it was possible that the meniscus got damaged since.
A joint that is not stable is also more vulnerable to arthritis. The possibility of further joint damage is something that you need to consider when making a decision about your treatment options. I know dogs that did well with conservative management, but this was not in Sandy’s cards.
The good news was that Sandy got the surgery and recovered well. Finally, she got her life back.
A note on the extracapsular repair
It is very likely that if your dog injured his ACL, you will be presented with TPLO (or TTA in some cases) as the only viable option, particularly for a large breed dog. If you do some online research, the information you’ll find will only confirm that.
I even talked to an owner who felt terrible for choosing extracapsular repair because all she could find were expert opinions preaching against it. A setback caused by an unfortunate slip on ice made her question her decision. Setbacks can happen with any surgery. The more you learn about your treatment options beforehand, the more confident you can be about your choice.
Extracapsular repair is an older type of ACL surgery, and it is now often presented as inferior. We opted for this type of surgery for our Jasmine because it is the least invasive and because we believed it has an excellent chance of succeeding. We are over a year post-surgery, and Jasmine’s legs have full function and are as good as new.
Jasmine got extracapsular repair
Our vet has been successfully using it for many years for both small and large breed dogs. Coincidentally I was also talking to another veterinarian who believes that once healed, there is no difference between the two.
Extracapsular repair TPLO comparison
Here are two example studies comparing the TPLO and extracapsular (lateral suture) repair:
Comparison of short- and long-term function and radiographic osteoarthrosis in dogs after postoperative physical rehabilitation and tibial plateau leveling osteotomy or lateral fabellar suture stabilization.
So if the results are the same, why is TPLO often presented as the only suitable option?
There can be several reasons, one of them being that the residents at teaching hospitals have to perform a certain number of TPLO procedures to graduate. Then, after their graduation, the TPLO is the surgery they are most comfortable doing.
It seems that the TPLO might be more forgiving during the post-op. On the other hand, though, if there are TPLO postoperative complications, they can be much more serious.
Often it is simply a question of preference. Of course, you want your surgeon to be experienced and comfortable with the type of surgery he will perform on your dog. But you don’t want to limit your options.
Some more anecdotal reasons came up during our discussion, quite likely also true, but I am not going to go there.
Getting familiar with all your ACL injury treatment options will help you make the best choice for you and your dog.
This policy doesn’t apply only to ACL injuries, but to any health issues you and your dog might be facing. So always know and understand your options!
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