Cruciate ligament disease, also known as cruciate ligament rupture, is a very common condition in dogs. The cruciate ligament plays an important role in stabilising the knee joint. Any injury or damage to this ligament can cause a great deal of pain, making the knee joint very unstable. Both the pain and the instability can lead to significant lameness in our dogs. 

There are a number of different surgical techniques that are carried out by vets to treat cruciate ligament disease. Two of the options are a Lateral suture stabilisation method and Tibial plateau levelling osteotomy (TPLO). Both of these have the shared aim of restoring the stability of the joint, however, they work in very different ways. The two surgeries are usually considered alternative options as they are so different. Carrying out both of these surgeries concurrently is generally not recommended.

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What do the two Surgeries Involve?

The lateral suture technique aims to counteract the instability in the knee joint by placement of a hard-wearing piece of suture material around the outside of the knee joint. The idea is that it acts in the same way as the cranial cruciate ligament does inside the joint. The suture material behaves as a substitute ligament and restores stability to the joint. 

Tibial Plateau Levelling Osteotomy (TPLO) is more invasive and involves changing the anatomy of the knee joint to achieve stability again. In a TPLO operation, the top part of the tibia (named the tibial plateau) is cut and rotated. This procedure changes the angle of the bone and how the femur (the thigh bone) moves with the tibia (the shin bone). 

The cut and rotation of the tibia are done in a way to reduce the amount the tibia moves forward when the dog is walking. The surfaces are realigned and this provides stability for the joint when it is in motion. This reduces the mechanical stress on the joint. This in turn means that inflammation in the joint and the development of osteoarthritis is reduced. 

Can the Two Procedures be Carried Out Together? 

These two surgeries are not usually performed together for a few different reasons. 

1) Creating a redundant structure 

A successful TPLO surgery eliminates the requirement for a functioning ligament inside the knee. Performing a lateral suture alongside a TPLO is arguably just creating a structure that is redundant inside the joint. 

2) Increased anaesthetic and surgical risks 

To perform both procedures alongside each other would mean a much longer surgical time. This requires a longer anaesthetic and therefore increases the risk for post-operative complications such as infection and wound breakdown. 

4) Lack of research 

There have not been any studies that demonstrate a clear advantage to combining these two procedures. One study suggests that a lateral suture may provide additional stability, and may be advantageous in the early stages of healing. However, the potential drawbacks mentioned above outweigh this benefit. 

However…

One study, however, has suggested a combined approach might be useful in specific circumstances. For dogs experiencing significant rotational instability alongside the ligament tear, a TPLO surgery can be combined with a specific type of lateral suture designed to address rotational instability and provide additional joint stability.

Choosing the Right Technique for Your Dog 

Your vet will have a detailed discussion with you about which surgery is the most suitable for your dog and your unique situation. Factors influencing the decision include the breed and size of your dog.

TPLO is the more favourable option for most larger dogs due to its high success rates and reports of good long-term stability. The lateral suture technique is sometimes chosen for smaller dogs that weigh less. Cases where there are financial constraints (as the lateral suture is usually a cheaper option), may be treated with a lateral suture technique as this is the best option the owners can afford. 

Conclusion

Lateral suture and TPLO are both effective surgical techniques for addressing cruciate ligament disease in dogs. The two procedures alter the mechanics of the knee joint and achieve stability in different ways. They aren’t typically combined, except in one very specific (and unusual) situation. To decide on the best option for your dog, your vet will carefully consider their breed, size, health status, and activity level as well as any financial constraints. Your vet will always choose the most appropriate surgical approach for each individual case. 

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