Cranial cruciate ligament (CCL) rupture is the most common orthopedic problem in dogs and also occurs in cats. The lateral suture technique, also known as extracapsular lateral suture stabilization, is an effective and well-established surgical method where the knee joint is stabilized with synthetic support material placed outside the joint. The technique is excellent for small and medium-sized dogs and cats. At our clinic, the surgery is performed by veterinarian Pamela, who has extensive experience in orthopedic procedures.
How Does Lateral Suture Work?
During surgery, the knee joint is opened and examined: remnants of the torn cruciate ligament are removed and the menisci are checked for damage. A strong monofilament nylon suture is then placed outside the joint — it is routed around the back of the femur (fabella) and secured through a drilled tunnel in the tibia. The suture is tightened and locked with metal crimp clamps. This stabilizes the knee joint and prevents the tibia from sliding forward — just as a healthy cruciate ligament would. The suture acts as a temporary support structure until the body's own connective tissue (periarticular fibrosis) forms around the joint and provides permanent stability.
Who Is Lateral Suture Suitable For?
Lateral suture is an excellent choice for small dogs (under 15 kg) and cats — with a success rate exceeding 90% in these patients. The technique also works well for medium-sized dogs (15–25 kg) and for older, calmer large dogs. In cats, the lateral suture is the standard method for cruciate ligament repair, as cats' light body frame is perfectly suited to the technique. For active and large dogs (over 25 kg), we recommend TTA surgery, which permanently alters knee biomechanics.
Recovery
The first 6 weeks after surgery are critical: activity is strictly restricted to allow connective tissue to form around the joint. The dog is taken on short leash walks (5–15 minutes) and jumping, running and stairs are prohibited. Sutures are removed at approximately 2 weeks. At the 6–8 week follow-up, healing is assessed and walks are gradually extended. By approximately 12–16 weeks, most patients have returned to normal activity. Rehabilitation — such as an underwater treadmill — significantly speeds recovery.
Risks and Complications
The complication rate is low (5–17%), and most complications are minor: swelling, seroma formation, or mild infection. A rarer but clinically significant complication is late meniscal injury (approximately 7%), which can present as sudden lameness weeks or months after surgery. Suture failure can occur particularly in overweight dogs or those returned to activity too early. The best way to prevent complications is to follow recovery instructions carefully.
Lateral Suture or TTA?
At our clinic we use two methods for cruciate ligament repair. The lateral suture stabilizes the joint with a synthetic suture without cutting bone — it is a shorter procedure, more affordable, and an excellent option for small and medium-sized patients. TTA permanently alters knee biomechanics by advancing the tibial tuberosity and is a better choice for active and larger dogs. We always assess individually which method is best suited for your pet.
When Should You Contact Us?
A cruciate ligament injury should be suspected if your dog or cat is limping on a hind leg, reluctant to jump or climb stairs, stiff after rest, or the leg "gives way" during activity. Symptoms can start suddenly or develop slowly over weeks. Early diagnosis significantly improves the prognosis — book an orthopedic examination and we will assess the situation and recommend the most suitable treatment option.
Price
The price for lateral suture surgery at our clinic is 950 euros for cats and 1,200 euros for dogs. The price includes the pre-operative examination, anesthesia with monitoring, the surgery itself, and immediate aftercare. For comparison, TTA surgery is 1,700–1,800 euros.