Extracapsular repairs: Tightrope and Corkscrew
The tightrope technique is a type of 'extra-capsular' cruciate ligament repair surgery, developed by Dr James L Cook in the USA. It is a refinement on older techniques such as the 'De-angelis' or 'fabello-tibial suture' techniques.
Dr Chris Franklin was one of the first vets in Australia to be regularly performing the tightrope surgery, and teaches the technique to other vets both within our clinics, and also in seminars run by Device Technologies - distributors for Arthrex medical equipment within Australia.
Essentially rather than the bone cutting surgeries (which replace or support the function of the damaged cruciate ligament by changing the bio-mechanics of the knee joint so that it is stable without the cranial cruciate ligament) this surgery places an implant to act as a stabilising force for the knee.
The implant material used is a very strong braided fibretape which is secured in the bone by titanium toggles. The material runs through bone tunnels within the femur and tibia, which allow the material stabilise the knee in as close to 'iso-metric' a manner (meaning similarly tensioned when the knee is in extension and flexion) as possible. Being Iso-metric means that the patient is comfortable and has an equally stable knee in all positions of movement.
We have found the tightrope technique to be a large improvement over previous extracapsular techniques, and is our most popular <15kg dog cruciate ligament repair method.
The main advantage of the tightrope surgery over the previous generations of extra-capsular repair surgeries are the accurate placement of iso-metric anchor points, the strength and reliability of the nylon material. This in the hands of Dr Chris Franklin has led to a dramatic reduction in the complication rates of small dog cruciate ligament surgery. At our clinic a series of 145 (2012-2014) <15kg dog cruciate ligament surgeries performed by Dr Franklin had a complication rate of 8%, 3 % of which were infections, requiring implant removal. This is a very low number.
For larger dogs (>15kg) the complication rate in Dr Franklin's hands increases, to a point close to 20% in 45 patients - in surgeries performed in the same period of time (2012-2014). It is for this reason that we only choose tightrope for large dogs in specific cases, or finances don't stretch to a TPLO surgery.
The stages of the surgery are detailed on a separate webpage.
As with the bone cutting surgeries - it is important for a cruciate ligament surgeon to have range of surgeries at their disposal - so that you can be sure the surgery suggested is not purely suggested due to the fact that the surgeon can only perform that one surgery.