Tight Rope Procedure

For cranial cruciate ruptures, the patented Tight Rope procedure is applied in which specialized braided bands are fixed from the caudal lateral femoral epicondyl to the proximal cranial tibia to provide a balanced isometric knee support throughout the entire range of motion.  This is an extremely strong and comfortable repair for our canine athletes.

Tightrope Cranial Cruciate Ligament (CCL) Repair Technique

Treatment of cranial cruciate ligament (CCL) deficiency is the most common surgical procedure performed in veterinary orthopedics. Tightrope CCL is a veterinary orthopedic surgical method developed to provide a minimally invasive procedure for extracapsular stabilization of the canine cranial cruciate ligament-deficient stifle joint. The CCL stabilizes the dog knee much like the anterior cruciate ligament (ACL) does in humans.

There are several modalities currently being used in the treatment of CCL deficiency, which is a common and costly problem in dogs and sometimes cats. While numerous techniques have been investigated, there is no perfect procedure in terms of balancing safety and efficacy for patients, and no technique has been proven superior to others in terms of functional outcomes. The Tightrope CCL technique was developed in hopes of addressing some of the perceived shortcomings of others, with reduction of complication rate and severity as the primary priority.

The Tightrope CCL technique utilizes a very strong suture material called FiberTape and isometric placement of small bone tunnels to provide bone-to-bone fixation while not causing the trauma of cutting through the bone of the tibia like a TPLO – Tibial Plateau Leveling Osteotomy or TTA – Tibial Tuberosity Advancement procedure. The objective of TightRope CCL is to counteract cranial tibial thrust, drawer, and internal rotation while providing optimal joint range of motion.

Material, Fiber Tape for CCL repair

The Tightrope CCL technique is based on the lateral retinacular imbrication suture (LRIS) principle. The theorized advantages of the Tightrope (TR) over the LRIS include bone fixation at both tibial and femoral attachments, more accurate isometric placement, minimally invasive capabilities and the strength, stiffness and creep characteristics of the implant. The Tightrope CCL technique has been determined to be minimally invasive, and cost effective in comparison to the TPLO.

Because the Tightrope technique helps ensure optimal isometric placement, counteraction of abnormal cranial drawer, thrust and internal rotation, the maintenance of stifle range of motion can be accomplished and maintained in the long term when proper physical rehabilitation is implemented post-operatively. Data suggests that Tightrope is a minimally invasive technique that can be successfully performed in medium, large, and giant breed dogs with CCL deficiency and result in 6-month outcomes which are as good as, or better than TPLO, in terms of function, progression of osteoarthritis seen on radiographs, and overall strength.

Article excerpt and illustration from Arthrex Vet Systems, Dr. James Cook  “Tightrope CCL for Treatment of Cranial Cruciate Deficiency in Dogs: Technique and results of a prospective comparison to TPLO using validated outcome measures.” James L. Cook, et al.