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Lateral Suture FAQ
 
 
My dog has been diagnosed with a rupture of the cranial cruciate ligament.  This is one of the most common problems in dogs today causing lameness in the rear limb of the dog. Chances are your pet dog has been limping off and on for some length of time, perhaps several months, and you have been putting off a trip to the vet because you hope it will get better on its own.
 
The cranial cruciate ligament (CCL) is located in the knee of the dog; you have the same part, but it is called anterior cruciate ligament (ACL). In humans, athletes usually tear this ligament acutely during extreme sport injuries resulting in severe pain in the knee. Dogs more likely tear the ligament as a chronic injury, resulting from disproportionate growth in the leg, obesity, or some event that has compromised the blood supply to the ligament in the knee. If you tear your cruciate ligament, your doctor can brace your leg, put you on crutches, and advise you to get surgery or severe rehabilitation to strengthen the knee. Dogs only stay off the leg when the pain goes away from rest or the administration of pain medications, then they use the limb again and further exacerbate the injury.
 
What are my treatment options?  When looking at treatment options, it is important to remember that veterinary medicine (and surgery) is an "art" more than a "science". One veterinarian might offer a "TPLO" (Tibial Plateau Leveling Osteotomy), another might offer the "TTA" (Tibial Tuberosity Advancement) or the Modified Maquet Procedure, and many will offer you the "lateral suture" surgery for your pet. Veterinarians tend to offer you the procedure they have the most experience with, which may not necessarily be the right procedure for your particular pet. Your pet's doctor should also offer rehabilitation therapy and weight reduction as a potential treatment option, and inform you that the potential that the other rear limb may do the same thing is about 50% within 5 months for some breeds of dogs.
 
What is the lateral suture technique?  The lateral suture repair method has been around in veterinary medicine since the 1960's. The procedure is fairly simple, and should not take more than one hour for your veterinarian to perform. It historically involved placing a strong piece of suture (often fishing line) across the knee joint in a location similar to the torn ligament. This suture would stabilize the knee for about 12 weeks while your pet "heals" the knee with fibrous or scar tissue around it to stabilize the knee, something like a permanent knee brace. Because of the way the suture is placed in the knee, it inhibits normal range of motion of the knee, and will result in the onset of serious osteoarthritis in the knee, as well as chronic damage to the joint surface and cartilage. This suture will eventually break, and in some instances can break too soon before this scar tissue develops or get infected. Often this suture breaks too soon and your pet may not get any of the benefits of the procedure. Patients that do the best with this procedure are smaller dogs, and those that keep the leg in a splint for a week or two. The lateral suture works for some dogs, but not all. A small percentage of them can become infected and require removing. 
 
What's new for the lateral suture technique?  Your veterinarian might be well trained and familiar with some of the newer philosophies in utilizing the lateral suture in repairing your pet's knee such as (1) isometric positioning of the suture, and (2) bone tunneling (the theory behind "Tightrope"). When the attachment sites are placed in these newer locations in the knee, we see better results postoperatively, though this is not a consistent finding because these "positions" are not the same in every dog. It is also important for you to ask what type of suture the veterinarian is using to replace the torn ligament, as one of the recent innovations has resulted in an increase in infection rates. Also, attaching these sutures to the knee using a bone tunneling method or bone screw and protecting the holes in the bone from erosion (see below) has resulting in much improved clinical results from this procedure. Further, rehabilitation has become increasingly important in veterinary medicine as part of the treatment plan in helping your pet recover (see www.topdoghealth.com) that your veterinarian should discuss with you.
 
What procedure should I choose for my pet?  No surgical procedure will return your pet to 100% pre-injury function. Surgical intervention, even using the most current technology, will not correct the body of the arthritic changed caused by orthopedic injury without the intervention of stem cell therapy. The lateral suture is generally a less effective procedure for CCL repair, but may be the best financial option for some owners (especially those with smaller breed dogs). As the size of the dog increases, the procedure is more likely to result in progression of osteoarthritis and loosening of the suture implanted. If you are looking for your pet to once again be the super athlete he/she was prior to the injury, I urge you to consider TTA (or TPLO). Finances often dictate what procedure a dog may get performed, so keep in mind that some pets have to continue to receive pain medications off and on throughout their life after surgery, particularly if osteoarthritis has set in. To determine which procedure is the best fit for both you and your pet, please contact Mayo Veterinary Services at info@jeffmayodvm.com for a consultation.
 
Is rehabilitation therapy important?  Absolutely. For more information on procedure-specific rehabilitation, visit our page labeled "Rehabilitation."