At The Hometown Veterinarian, we no longer perform the extracapsular lateral suture (ECLS) stabilization technique for cranial cruciate ligament (CCL) injuries. While this method was once common, Dr. Jacobson stopped performing ECLS surgeries over 15 years ago due to the development of more reliable alternatives like tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA). ECLS was not a bad idea at the time, it simply no longer measures up to modern treatments for for cranial cruciate ligament injuries.
What is ECLS?
Extracapsular lateral suture (ECLS) ECLS surgery is probably the oldest known method of surgically treating cranial cruciate rupture in dogs.
The surgery involves placing a suture outside the knee joint to mimic the stability provided by the CCL. The suture is tightened to stabilize the knee, but this method has significant limitations.
The surgery's name comes from the method of repair where a suture or other heavy line is placed outside of the stifle's (knee's) joint capsule. The line is tightened with the intention of replacing the stability that the cranial cruciate ligament was meant to provide. There are several variations to the procedure but the suture line is usually tunneled through a channel drilled through the front of the tibia at the level of the shin and another on the lateral (outer) side of the end of the femur. The line is then placed under tension and is either tied or secured with a metal crimp clamp.
Sometimes, the line might be passed between the fabella and the femur but studies have shown that even when performed by an experienced surgeon, often they failed to place the suture in the correct location and do not actually provide support.
Why ECLS is No Longer Recommended
In the 1990's, ECLS was what we had to help a dog with a ruptured cranial cruciate ligament, extracapsular stabilization surgery was considered state-of-the-art. We were aware of some flaws but there just wasn't anything better widely available at the time.
- Implant Failure: Success requires exact placement of the implant but the anatomy of the area can often be misleading and many surgeons who thought they had the line positioned properly later found out that it was pulling free of the tissues that it was supposed to be locked through.
- Slower Recovery: Dogs take longer to return to function after ECLS surgery than a surgery like TTA.
- Failure Over Time: ECLS will eventually fail. The heavy lines used will not hold up to a lifetime in a dog. They fatigue and either break or will loosen enough to no longer provide support. The concept of the surgery accepted that the line would break but the hope was that there would be enough thickening of the joint tissues that the dog can walk. The problem is that once the support is gone, the dog will eventually return to painful lameness. This usually means a second (or even a third) surgery to help relieve the problem.
- Arthritis Development: Lateral suture joints continue to become arthritic. When ECLS surgery was our only option, we thought the progressive arthritis was just normal. With modern procedures such as TPLO and TTA, that progressive deterioration of the joint just doesn't commonly appear.
Why TPLO or TTA is Superior
When it comes to cranial cruciate ligament (CCL) injuries, tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA) represent modern, effective solutions that eliminate many limitations associated with the ECLS method. Both TPLO and TTA surgeries stabilize the knee by modifying the tibia itself, creating a permanent solution without relying on artificial ligaments. This approach significantly reduces the risk of arthritis and avoids the eventual implant failure common with ECLS.
What is TPLO Surgery?
Tibial plateau leveling osteotomy (TPLO) surgery transforms the knee's function by reshaping the top of the tibia, allowing it to bear weight naturally without the need for the damaged ligament. Our practice uses the Securos PAX Polyaxial Locking TPLO system, which offers superior stability through titanium implants that resist infection and allow for a faster, safer recovery. Once healed, the knee is naturally stable, offering lasting relief and a quicker return to mobility. Learn more about TPLO surgery here.
What is TTA Surgery?
Tibial tuberosity advancement (TTA) surgery stabilizes the knee by shifting the position of the tibial tuberosity, or shin bone, so the joint operates smoothly without stress on the injured ligament. This method provides a permanent solution, allowing dogs to return to their active lives with minimal chance of long-term complications. Dr. Grant Jacobson’s extensive experience with TTA has led to excellent outcomes for our patients, providing fast recovery and strong, reliable knee function. Learn more about TTA surgery here.
Choosing TPLO or TTA means opting for a solution that addresses the root cause of knee instability, offering a faster, pain-free recovery with less risk of progressive joint issues. If you’re interested in learning how these advanced procedures could benefit your dog, explore our detailed pages on TPLO and TTA surgery for more information.
Does ECLS Cost Less Than TPLO or TTA?
While ECLS may initially cost less, it should not be viewed as a long-term solution. The eventual failure of the suture often leads to costly follow-up surgeries. Procedures like TPLO or TTA may have a higher upfront cost but offer a permanent correction, reducing the likelihood of needing future surgeries.
Why Small Dogs Shouldn’t Have ECLS
The idea that ECLS is suitable for smaller dogs has been debunked. Small dogs experience the same joint deterioration and implant failure as larger dogs. Modern procedures like TPLO and TTA are now successfully performed on small and toy breeds, providing better results and fewer complications.
Consider the Long-Term Benefits of TPLO or TTA
If cost is a concern, it’s essential to consider the long-term benefits of TPLO or TTA. While the upfront cost may be higher, it’s more affordable to solve the problem correctly the first time than to address complications from ECLS surgery later.
For general information about cranial cruciate ligament and disease in dogs, see our overview page: Cranial Cruciate Injury in Dogs
*In the United States, TPLO (and TTA) are considered "standard of care" for the treatment of CCL rupture in dogs. While ECLS surgery may have a lower up front cost, chances are very high that the dog will return to suffering from cruciate disease. This will likely mean additional surgery and the need for life-long pain relief. It might be tempting to go for the "cheap" option but strongly consider how much more affordable it is to repair a problem correctly the first time. Removal of broken extracapsular implants and osteotomy to support the cruciate rupture are a surgery that is not uncommon at our hospital.