TightRope® CCL

Surgical Technique

The patient is placed in dorsal recumbency and prepared for surgery of the affected stifle. Strict adherence to aseptic technique for patient preparation and surgery is critical to success. Preparation and draping such that the limb is exposed from proximal thigh to below the hock is recommended to allow for adequate stifle palpation and manipulation during surgery.

A lateral or medial parapatellar approach with arthrotomy, or stifle arthroscopy, is performed to allow for complete exploration of the stifle joint and visualization and palpation of the menisci. Pathology of ligament and meniscus should be treated appropriately. The joint is thoroughly lavaged and the joint capsule closed. The caudolateral aspect of the stifle is exposed by caudal dissection and retraction of the lateral fascial incision when an arthrotomy has been performed or by mini-incision through the skin and fascia from the lateral fabella to the tibial tuberosity after arthroscopy has been performed.

TightRope CCL

The TightRope CCL technique was developed to provide a minimally invasive method for extracapsular stabilization of the cranial cruciate ligament-deficient canine stifle. TightRope CCL seeks to optimize the lateral suture stabilization technique by employing bone-to-bone fixation, an implant with superior strength and stiffness designed specifically for ligament repair, and a method for consistent isometric implant placement. As such, TightRope CCL can counteract cranial tibial thrust, drawer, and internal rotation, while providing optimal joint range of motion.

A simulated joint specimen showing the isometric sites for suture anchorage in the femur and tibia. In the femur, the isometric position is located caudally below the level of the distal pole of the fabella (F2). In the tibia, the isometric site is located 2-4 mm caudal to the bony protuberance, which forms the caudal wall of the sulcus for the long digital extensor tendon.

Insert the Guidewire 2 mm distal to the lateral fabella and within the caudal portion of the lateral femoral condyle. With the stifle held in extension, advance the Guidewire at 45˚-60˚ angle proximally. The Guidewire traverses the distal femur and exits at the cranial-caudal midpoint of the distal diaphysis of the femur on the medial side immediately caudal to the vastus medialis muscle and at the level of the proximal patella.

The Cannulated Drill Bit is inserted onto the Guidewire and advanced through the femur until it exits through the medial side of the femur. Carefully ream the femoral tunnel back and forth with the drill bit.

Place the Guidewire within the tibial extensor groove proximally and resting against its caudal ridge. Advance the Guidewire through the tibia at a 45˚-60˚ angle to exit medially within the footprint of the caudal sartorius insertion. Drill over the Guidewire with the Cannulated Drill Bit (protect the soft tissues).

The TightRope needle is inserted through the tibial tunnel in a medial to lateral direction. As tension is applied to the needle and FiberTape, the toggle button will lay down to allow it to advance through the tunnel.

Advance the TightRope needle through the femoral tunnel in a lateral to medial direction.

Once the toggle button has exited the femoral tunnel, the button is flipped by pulling the white suture in a slight upward direction and by pulling back on the FiberTape strands laterally. Ensure that the toggle is flipped and seated fully on medial femoral bone by direct visualization or palpation.

Advance the 4-hole button over the FiberTape strands and seat it firmly and completely against the medial tibial bone. Advance the two blue strands of FiberTape into the tensioner and tension to 10-12 lbs. Check drawer, internal rotation, and range of motion (ROM) of the stifle. Cycle the joint through a full ROM 20-30 times.

Remove the blue strands from the tensioner, advance the two white strands of FiberTape into the tensioner and tension to 10-12 lbs, confirm ROM, internal rotation, and drawer are optimized.

Put the stifle at a weightbearing angle (ie. ˜140˚) and tie a knot (single throw) with the blue strands of FiberTape. Reinforce the knot with 4 to 5 throws.

Remove the tensioner from the white strands of suture and recheck the ROM, rotation and drawer. If satisfied, tie the white strands of FiberTape.

Cut the limbs of suture, leaving about ¼ inch of suture limbs.

After final assessment of the TightRope placement and function, cut one limb of the white suture attached to the lead needle. Pull the needle away from the skin and the suture will come with it.

Guidewire

The 1.24 mm (.049 in.) Guidewire is a helpful guide in obtaining the proper orientation before drilling through the canine bone.

Cannulated Drill Bit

The reusable 3.5 mm cannulated drill provides an aggressive head to drill through tough bone.

Suture Tensioner with Tensiometer

The redesigned Suture Tensioner allows the surgeon to quickly set and control the desired tension on FiberWire and FiberTape suture. The open design allows for better visualization of the suture during suture capture and the easy to read tension markings allow the surgeon to accurately dial-in the appropriate tension setting.

ORDERING INFORMATION

TightRope CCL	VAR-2800
Mini-TightRope CCL	VAR-2801
FiberWire Scissor	AR-11796
Suture Tensioner with Tensiometer	AR-1529
Cannulated Drill Bit, 2.7 mm	AR-8911DC
Cannulated Drill Bit, 3.5 mm	AR-8920DC
Guidewire, TightRope	AR-8920P