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
TightRope versus 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.
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.
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 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.
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?
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.