The extracapsular repair or LSS is the oldest surgical technique in use for the treatment of dog CCL tears.
The procedure comes under several names. Along with the terms I already introduced, if your veterinarian refers to a traditional technique, or external capsular repair technique (ECLS), they are all the same thing. Different surgeons might use various modifications of the technique.
Understanding the extracapsular repair
The goal of all the stifle surgeries is to stabilize the knee.
The extracapsular repair achieves this by running an external suture outside the knee capsule—hence extracapsular. At the top, the suture runs around the bony protrusion of the femur; at the bottom through a small hole drilled in the tibia.
As long as the suture holds, this is enough to prevent the forward thrust of the shinbone—drawer motion. You can think of it as an external ligament replacement of sorts. The placement and angle of the suture mimic the function of the cruciate ligament.
The suture secures things in place long enough for scar tissue to encapsulate the knee. The scar tissue is what ultimately provides stabilization after the recovery period.
While it looks rather flimsy, it can do the job quite well. It does mean, however, that the post-op period is more vulnerable to setbacks when the suture stretches or breaks.
Advantages of extracapsular repair technique
The first distinct advantage of this technique is that it is substantially less invasive than, for example, the TPLO surgery. That was what we liked about it when Jasmine ruptured her cruciate ligament.
Further, the suture technique doesn’t require any specialized equipment. That makes it more affordable and general practice veterinarians can perform this surgery in their clinic.
Dog CCL injuries extracapsular repair disadvantages
The reasons veterinary surgeons went on to explore other options to repair cruciate ligament tears is that the suture is nowhere near as strong as the original ligament.
The post-op recovery time requires strict exercise restrictions and control. Overall, this repair is more vulnerable to failure and less forgiving should a mishap occur.
This is especially true for active young and large-breed dogs. Small breed dogs usually make it through the recovery without complications.
Extracapsular repair complications
Swelling, bruising, seromas, and incision issues are not unusual—typically minor—complication with any surgery. Infections can become a big deal if they affect the joint or bone but not common at this time and age.
What can happen with this technique is sutures breaking before enough scar tissue develops to stabilize the joint. Clearly, even the strongest suture is not as strong as a metal implant and the post-op recovery is relatively more vulnerable to setbacks.
On the other hand, busted sutures, while not welcome, aren’t the end of the world. Compare that to busted plates and even fractured bones that you could run into with say TPLO.
While the TPLO can take more beating and is less likely to fail, when it does it can be substantially more dramatic. As well as even after the recovery period is over, there is the potential of the dog developing an infection at the implant site.
Recovery period
The recovery period after the extracapsular repair is six months—the same as with TPLO. It is, however, less forgiving—preventing mishaps is essential.
Your surgeon should provide you with a detailed post-op plan as well as recommendations for physical therapy. The larger and more active your dog is, the more you need to control their activity.
Example post-op plan: L Surgery Post-Op Care: Example Plan for Your Dog’s Recovery after Cruciate Ligament Surgery
Recovery expectations
Your dog will be reluctant to use the leg for roughly two weeks after surgery and might continue to hop on three legs just as before the procedure. However, eventually they will start toe-touching and gradually increase the amount of weight they’ll bear on the leg. By two months your dog should walk on the leg normally.
Here is the good news. When you make it through the recovery period, your dog’s knee will be just as good as it would be with any other surgical technique.
A study that scrutinized the different surgeries and outcomes a year post-surgery. didn’t find any difference including large-breed dogs.
For larger dogs, there is great controversy. For all the theory behind TPLO and TTA, results one year post-operative seem to be the same regardless of which of the three procedures the dog had performed.
Dr. Wendy Brooks, DVM
Large versus small dog breeds
Most veterinarians recommend using the extracapsular repair only for dogs under 45 pounds. Is it a bad idea for a large dog?
It depends. After much debating and sweating it, we selected this technique for our Rottweiler, Jasmine. She had the surgery on both knees—three months apart. We made it through both post-ops with just one minor setback. Jasmine’s knees healed, and she regained normal function.
I just couldn’t stand the idea of the invasive TPLO for her. She was older and we had confidence we’d be able to control her activity well enough to make it. Should we fail, we still had the TPLO option to fall back on.
Jasmine’s veterinarian did extracapsular on many large dogs with success.
That said, I doubt we’d have the same luck with our wilder Rottweilers. It is important to evaluate what the odds are for each individual dog.
Extracapsular Repair Failure
Any of the CCL surgeries can fail during the recovery time quite easily. That is why strict post-operative care is important. If the joint is subjected to too much stress too early, things fall apart. One unfortunate jump of the couch can be all that is needed.
One of the reasons we opted for the extracapsular repair was, that the worst-case scenario seemed to be starting from square one, should something go wrong. It is the least invasive option from the three.
If the repair does fail and the sutures break, you have some soul searching to do.
Unless the reason for the failure was an accident that is not likely to happen again, you might want to consider one of the other surgeries, TPLO or TTA. The recovery time after TPLO and TTA is a bit shorter and not as strict. Keep in mind that every surgery requires a diligent rehabilitation though and things can go wrong with either of the ACL repairs.
In closing
For small dogs, there is no clear advantage to opting for the newer, more invasive procedures.
If you have a large or very active dog, you need to consider your options carefully. The newer surgeries are relatively more forgiving and there is some evidence that recovery to normal function may be faster.
I even heard a veterinary opinion that the reason TPLO is touted as a superior option is the surgeons’ propensity for shiny tools.
It’s up to you to research all options and figure out which one is best suited for your dog. We did select the suture repair for Jasmine but with JD or Cookie, I’d consider the risk of broken sutures too high.
Related articles:
Tibial Plateau Leveling Osteotomy: My Two Cents on TPLO Repair
Cora-based Leveling Osteotomy: My Two Cents on (CBLO) Repair
Triple Tibial Osteotomy: My Two Cents on TTO Cruciate Repair
Simitri Stable in Stride Stabilization
Further reading:
Cranial Cruciate Ligament Repair: Extracapsular Repair and TightRope Procedure
Ruptured Cranial Cruciate Ligaments in Dogs