The difference between TPLO and lateral suture techniques

When a dog suffers a cranial cruciate ligament (CCL) rupture, two of the most commonly recommended surgical treatments are the TPLO (tibial plateau leveling osteotomy) and the lateral suture technique, also known as extracapsular repair.

While both aim to stabilize the stifle joint and restore function, they differ significantly in their approach, biomechanics, and expected outcomes. Understanding these differences is crucial for pet owners who are trying to make an informed decision about which procedure might be best for their dog.

The lateral suture technique is typically considered less invasive and is often performed in smaller dogs or those with lower activity levels. In this method, a strong synthetic suture is placed outside the knee joint to mimic the function of the torn ligament. The suture helps prevent the forward sliding of the tibia relative to the femur, which is the hallmark of CCL deficiency. This procedure doesn’t require cutting the bone and is usually faster and less expensive than TPLO.

Recovery tends to be straightforward, with many dogs returning to comfortable function within a few months. However, the mechanical stabilization provided by the suture is subject to eventual degradation, and long-term outcomes can be less predictable in larger or more active dogs.

On the other hand, the TPLO procedure involves cutting the top of the tibia and rotating it to change the angle of the tibial plateau. This alteration eliminates the shear forces that cause the tibia to shift forward during weight bearing, making the knee more stable without relying on the CCL. TPLO is a more invasive and technically demanding surgery, often reserved for medium to large breed dogs or those with high activity demands.

While recovery may take longer and require more intensive post-operative care, studies have shown that TPLO often results in superior long-term limb function and a lower incidence of degenerative joint disease when compared to lateral suture repairs.

Each technique has its indications, and the decision should be based on several factors, including the size, age, activity level of the dog, and the surgeon’s experience. Some veterinarians may also consider the presence of other orthopedic conditions or the health of the opposite limb. While the lateral suture may suffice for a small dog with low physical demands, the biomechanical advantages of TPLO often make it the preferred option for achieving full athletic recovery, especially in larger dogs.

Ultimately, both procedures aim to restore mobility and comfort, but their success depends not only on surgical technique but also on proper diagnosis, post-operative care, and rehabilitation. Owners should discuss the pros and cons of each with a trusted veterinary surgeon to determine the best path forward for their pet.

References:

1. Bergh, M. S., Sullivan, C., & Drobatz, K. J. (2008). Outcomes of tibial plateau leveling osteotomy for cranial cruciate ligament rupture in dogs. Veterinary Surgery, 37(1), 21–26.
   

2. Christopher, S. A., Beetem, J., & Cook, J. L. (2013). Comparison of long-term outcomes associated with three surgical techniques for treatment of cranial cruciate ligament disease in dogs. Veterinary Surgery, 42(7), 721–728.

About the autor

Felipe Garofallo is a veterinarian in Brazil, specialized in orthopedic and neurosurgical care for dogs and cats.

He is also the founder of Ortho for Pets – Veterinary Orthopedics and Specialties.