Cruciate Surgery In Dogs

A dog’s cruciate ligament usually ruptures in the course of normal activities. For example, a dog will be running along and suddenly lift the hind leg and start limping. Sometimes they will yelp but there is often no obvious cause.

If you aren’t yet sure your dog has torn their ACL, visit this page for other common causes of limping.

If you want to know more, click here to learn why some dogs are more likely to rupture their ACL than others.

Dogs that rupture one are very likely to rupture the second within a few years. Therefore it’s important to have the first leg back in full function before this happens.

Do All Dogs Need Cruciate Surgery?

No. Sometimes, usually only for dogs under 10kg bodyweight who aren’t especially active, there can be a return to normal leg use without surgery. If this is going to happen it will usually occur within 4 weeks.

If you wish to try this we strongly advise a course of pentosan polysulphate injections. However, please note that recoveries without surgery are rare, and there is an increased risk of meniscal cartilage damage in dogs when surgery is delayed.

Which Cruciate Surgery Is Best?

Our job is to:

  1. Stabilise the joint
  2. Treat the arthritis

Dogs under 10kg are recommended an extra capsular technique, which produces good outcomes. You can expect your dog’s limp to disappear once they recover from surgery.

At Walkerville Vet we use a modified De Angelis procedure employing Liga Fiba® materials.

Dogs over 10kg are recommended TPLO and other osteotomy procedures (see below). Emerging evidence such as Barnes et al (2016) suggests that TPLO will become the standard of care for all sizes of dog with cruciate injuries.

View estimated costs of De Angelis and TPLO cruciate surgery here.

The following cruciate surgeries are still in use in Adelaide. Here are our views on each technique.

Extra Capsular Repair or De Angelis Technique

An artificial ligament is placed around the outside of the joint in the same alignment as the cranial cruciate ligament. The material may be nylon, Liga Fiba or Tightrope depending on the vet.

ECR is technically the easiest procedure to perform, and results appear very good for small dogs. However active medium and large dogs appear to do poorly and rarely achieve full return to function.

Recent data supports this. In a clinical study using pressure plate analysis to measure leg use (rather than relying on owner and vet impressions), only 40% of animals treated with ECR improved and only 15% returned to normal function. Complications are more likely in younger and larger dogs.

TightRope Surgery

Sometimes also called Isometric Cruciate Surgery or LigaFiba Isotoggle, this is an artificial ligament placed via carefully positioned bone tunnels. Preliminary studies have produced good results.

The main limitations of this procedure are the high level of precision needed, and the limited evidence base. It is probably for these two reasons that it was only reported as being used by 3 of 221 members of the Veterinary Orthopedic Society of America (Von Pfeil et al 2018).

Tibial Osteotomy Techniques

The latest developments in improved surgical outcomes for dogs with cruciate ligament rupture are the techniques involving reshaping the proximal tibia. We believe that all dogs over 20kg should now receive one of these techniques. While most specialists now agree that the TPLO is better, any of these will produce good results in experienced hands.

Click here for a comparison of the evidence between the three common procedures.

Tibial Tuberosity Advancement (TTA)

dog tta xray

A cut is made in the front of the shin bone (tibia) and a wedge inserted to move the point of attachment of the kneecap tendon forward. This creates a force opposing the forward movement of the tibia.

MMP or Modified Maquet Procedure

dog MMP xray
X-ray of a dog’s MMP procedure performed 3 months earlier

This is a proprietary version of the TTA approach and is presumed to share its strengths and weaknesses.

Triple Tibial Osteotomy (TTO)

This is a hybrid procedure involving a degree of tibial tuberosity advancement together with the removal of a wedge of bone from the tibia to reduce the tibial plateau angle. A large plate and screws is necessary to hold the repair together. TTO is rapidly disappearing as an alternative.

Tibial Plateau Levelling Osteotomy (TPLO)

dog tplo surgery

The aim of TPLO is to reduce the angle of the tibial plateau. After successful surgery, tibial thrust and joint capsule stretching should not happen during weightbearing.

The surgery involves a curved or radial cut which avoids the patellar tendon but includes the entire tibia plateau. The plateau is then rotated by a pre-measured amount and a specially designed plate and screws are placed to hold the tibial plateau at its new angle.

These days TPLO has become one of the most researched surgical procedures in veterinary medicine. Based on the evidence, Walkerville Vet has been offering TPLO procedures to our Adelaide patients since 2016.

Visit our page on what to expect when your dog has TPLO cruciate surgery.

Managing Stifle Arthritis

No matter how good the surgeon or the technique, dogs who damage or rupture their ACL will always develop arthritis in that knee. It seems clear that the newer techniques reduce its severity, not prevent it.

Read about the treatment options for canine arthritis here.


Barnes, D. C., Trinterud, T., Owen, M. R., & Bush, M. A. (2016). Short‐term outcome and complications of TPLO using anatomically contoured locking compression plates in small/medium‐breed dogs with “excessive” tibial plateau angle. Journal of Small Animal Practice, 57(6), 305-310.

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(3), 329-334.

Gordon-Evans, W. J., Griffon, D. J., Bubb, C., Knap, K. M., Sullivan, M., & Evans, R. B. (2013). Comparison of lateral fabellar suture and tibial plateau leveling osteotomy techniques for treatment of dogs with cranial cruciate ligament disease. Journal of the American Veterinary Medical Association, 243(5), 675-680.

Krotscheck, U., Nelson, S. A., Todhunter, R. J., Stone, M., & Zhang, Z. (2016). Long Term Functional Outcome of Tibial Tuberosity Advancement vs. Tibial Plateau Leveling Osteotomy and Extracapsular Repair in a Heterogeneous Population of Dogs. Veterinary Surgery.

Von Pfeil, D. J., Kowaleski, M. P., Glassman, M., & Dejardin, L. M. (2018). Results of a survey of Veterinary Orthopedic Society members on the preferred method for treating cranial cruciate ligament rupture in dogs weighing more than 15 kilograms (33 pounds). Journal of the American Veterinary Medical Association253(5), 586-597