CCL Tears TightRope Repair: My Two Cents on the TightRope® CCL Fixation System

The TightRope fixation technique is an update on the traditional suture repair.

The modifications were to address concerns about safety, effectiveness, and availability of the surgical CCL repairs available at the time.

The TightRope fixation differs from the traditional suture stabilization in the following ways:

  • stronger material
  • bone anchors
CCL Tears TightRope Repair: My Two Cents on the TightRope® CCL Fixation System

TightRope versus extracapsular repair

Extracapsular repair

The traditional suture repair achieves joint stabilization by running the suture across the knee if a figure-eight pattern. On top, it is anchored around the bony protrusion of the femur. At the bottom, the suture runs through a small hole drilled at the top of the shinbone.

Dog CCL Injuries Extracapsular Repair: Lateral Suture Stabilization
Traditional suture technique. Image Helping Hands
TightRope stabilization

The RightRope stabilization replaces suture with a stronger material and anchors bone to bone.

The surgeon drills two bone channels through both the tibia and femur. They then run what is more of a cord rather than a suture through. Metal anchors secure the cord, which reduced the amount of suture material needed.

CCL Tears TightRope Repair

The repair does look sturdier and more elegant. It is still minimally invasive compared to the other types of surgeries that involve cutting bones. Is it a substantial improvement to the traditional repair then?

The cord offers greater durability and strength which might make this repair less vulnerable to failure. This veterinary surgery is an adaptation of human fixation for ankle injuries.

CCL tears TightRope repair advantages

The TightRope technique shares advantages with the traditional repair with the additional perk of being stronger. At least on paper. The TightRope repair should be strong enough to work effectively even for large dogs with minimal complications.

TightRope complications

TightRope procedures shares common complications with the extracapsular repair as well, and they include:

  • surgeon errors
  • swelling, bruising, seromas and incision issues
  • the potential of an infection
  • irritation from suture
  • suture laxity or failure
  • meniscal damage

The strong band should make suture failure less likely but it can, of course, fail too. About 10 percent of dogs will experience complications that will require further surgical or medical treatment. Serious complications, however, are rare.

Source: TightRope® CCL

When I was considering TightRope option for Jasmine’s knees, her veterinarian brought up a potential complication nobody seems to mention. He seemed aware of some cases where the band worked its way through the bone. It was a reason why he continues to stick with the extracapsular repair instead. I have not found any articles to confirm this. It did, however, influence my decision for Jasmine.

Further, according to a survey of 187 veterinary surgeons, it is the least popular technique—the main reason being complications related to the suture cord.

The TR procedure was perceived to have the highest incidence of complications, and the multifilament braided material used in this procedure was considered the material most likely to be associated with major complications.

Kate Boatright, VMD

So there is that.

Source: Veterinary Surgeon Preferences for CCL Repair Methods


I have to admit that this technique would be likely my last choice. Yes, I am biased by Jasmine’s veterinarian’s concerns because I trust his opinion.

It looks very elegant and a theoretical improvement on the traditional suture repair. But it hasn’t become as popular as one would expect from an improved technique.

Dr. Rammy Hunter, DVM, and Dr. Robin Downing, DVM of VCA consider the two techniques roughly equal. If they are roughly equal, where is the improvement?

In closing

As with everything, I recommend you do your homework. Research and discuss options with your veterinarian. And then make up your own mind about what you feel is the best option for your dog.

To check out some experiences of dog parents whose dogs who had the TightRope surgery, you can visit DogKneeInjury website.

Related articles:
CCL Injuries Extracapsular Repair: My Two Cents on the Lateral Suture Stabilization or LSS in Dogs
Talk To Me About Dog ACL/CCL Injuries

Further reading:
Cranial Cruciate Ligament Repair: Extracapsular Repair and TightRope Procedure
Surgery STAT: Tightrope CCL

Categories: CCL injuriesCruciate ligament injuriesDog health advocacyJoint issuesKnee issuesTightRope

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Jana Rade

I am a graphic designer, dog health advocate, writer, and author. Jasmine, the Rottweiler of my life, was the largest female from her litter. We thought we were getting a healthy dog. Getting a puppy from a backyard breeder was our first mistake. Countless veterinary visits without a diagnosis or useful treatment later, I realized that I had to take Jasmine's health care in my own hands. I learned the hard way that merely seeing a vet is not always enough. There is more to finding a good vet than finding the closest clinic down the street. And, sadly, there is more to advocating for your dog's health than visiting a veterinarian. It should be enough, but it often is not. With Jasmine, it took five years to get a diagnosis. Unfortunately, other problems had snowballed for that in the meantime. Jasmine's health challenges became a crash course in understanding dog health issues and how to go about getting a proper diagnosis and treatment. I had to learn, and I had to learn fast. Helping others through my challenges and experience has become my mission and Jasmine's legacy. I now try to help people how to recognize and understand signs of illness in their dogs, how to work with their veterinarian, and when to seek a second opinion. My goal is to save others the steep curve of having to learn things the hard way as I did. That is the mission behind my blog and behind my writing. That is why I wrote Symptoms to Watch for in Your Dog, which has turned out being an award-winning guide to dog owners. What I'm trying to share encompasses 20 years of experience.

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