The supporters of each seem to think that there is, but according to one study it's six of one, half dozen of each other. That said, a particular approach might work better in a particular dog, depending on the specific damage to his/her ACL.
Personally we went through this decision process when Jasmine's ACL went. We decided to go with extracapsular repair, because it is much less invasive. We did a combination of that and stem cell therapy (there is more info about that on my blog).
It is believed that extracapsular repair has lower success rate in larger dogs. Our vet--the most amazing vet on the planet--however does extracapsular repair on large dogs all the time with very good resuls. He however uses two sutures instead of one for larger dogs.
I think these would be determining factors:
1) extracapsular repair is substantially less invasive than TPLO
2) the tibial plateau angle is an important factor to consider when deciding between the extracapsular repair or TPLO
3) long term knee stabilization after extracapsular repair it provided by scar tissue--the sutures are meant the stabilize the joint for the time of recovery only
4) long term knee stabilization after TPLO is provided by altered tibial plateau angle (thus tibial plateau leveling osteotomy)
5) age and activity level should be considered
Jasmine is now a 6.5 old Rottweiler female, and she is a big girl. Her first knee was operated on December 2008 and the second in March 2009. Her knees are holding great, and she is back to where she was when she was 3 years old.
The TPLO seems to be the most popular surgery these days. But we tend to lean towards less invasive solutions. The TPLO is believed to be more reliable. But we are happy with how Jasmine's are doing and have no regrets.
I imagine though, that using single suture only would increase the risk of the sutures rupturing before recovery in larger dogs. That is not to say that things cannot go wrong during the recovery from the TPLO. That is why our vet is using double that.
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