TPLO, TTA or lateral fabellotibial suture: which technique to choose
4-year-old Labrador Retriever, 38 kg, a very active hunting dog, with complete rupture of the right cranial cruciate ligament. The tibial plateau angle measured on radiographs is 26°.
Which surgical option is most appropriate?
chevron_right Show answer and explanation
A. An osteotomy that neutralises cranial tibial thrust (TPLO, or TTA as an alternative)
Correct. In large, active dogs, osteotomies give faster recovery and better long-term function than extracapsular techniques. With a normal slope (26°) both TPLO and TTA are reasonable; TPLO is the most studied.
B. Lateral fabellotibial suture, because it exactly reproduces the function of the ligament
The suture is not isometric and tends to loosen or break; its long-term efficacy depends on periarticular fibrosis. It works well in small dogs and cats but fails more often in large, active dogs.
C. Conservative management for 6 months, with surgery only if there is no improvement
In dogs over 15 kg, conservative management usually gives a poorer outcome, and meanwhile osteoarthritis and the risk of meniscal injury progress.
D. Intra-articular reconstruction with a fascia lata graft, which is now the reference technique
Intra-articular autograft reconstructions were used in the past, but the graft weakens during revascularisation and they do not outperform osteotomies. They are rarely used today.
lightbulb Key takeaway
Osteotomies do not rebuild the ligament: they change the geometry of the stifle so that the tibia does not slide cranially during weight bearing. The fabellotibial suture is still a good option in dogs under 15 kg and in cats.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.