ACL Surgery for Dogs
Lateral Suture (Extracapsular) Repair for Cranial Cruciate Ligament (CCL) Tears
Antietam Valley Animal Hospital | Berks County, PA | Reading, PA
Understanding the CCL (“ACL”) Injury
Owners commonly call this the “ACL” because of the equivalent ligament in the human knee, but in dogs the correct term is the cranial cruciate ligament (CCL). The CCL is the primary structure preventing the femur from sliding forward over the tibia (“cranial drawer”). When it partially tears or fully ruptures, the knee becomes unstable, which causes pain, inflammation, limping, and, if left untreated, progressive osteoarthritis (OA) as cartilage wears down inside the unstable joint.
There are two main surgical strategies for stabilizing a CCL-deficient knee: changing the geometry of the bone (as with a TPLO) or replacing the torn ligament's job with a strong synthetic suture placed outside the joint (lateral suture / extracapsular repair). This page covers the lateral suture technique. If you'd like to compare it to TPLO, see our [TPLO page link] or ask us at your consultation — which technique is right for your dog depends on their size, age, activity level, and knee conformation.
Signs Your Dog May Have a CCL/ACL Injury
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Sudden or gradual hind limb lameness, often worse after rest or exercise
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Difficulty rising, jumping into the car, or climbing stairs
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Sitting with the affected leg held out to the side
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Audible clicking when walking (can indicate a concurrent meniscus tear)
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Thigh muscle loss on the affected leg
What Is Lateral Suture (Extracapsular) Repair?
In this technique, the surgeon places a strong synthetic suture from behind the femur to the front of the tibia, mimicking the stabilizing job the CCL used to do. Rather than cutting and rotating bone, the repair works by tightening the outside of the joint capsule, limiting the abnormal forward-sliding motion until the body forms its own scar tissue (fibrosis) around the joint over the following weeks — which becomes the long-term source of stability.
This approach is generally best suited to smaller, less active dogs (commonly under 25–30 lbs), and can be a reasonable option for older or more sedentary dogs of any size where a faster, less invasive procedure with a lower up-front cost is a priority. It is less invasive than TPLO, does not involve cutting bone, and typically has a shorter surgery and anesthesia time — but the suture is a mechanical device that can stretch or, less commonly, break over time, particularly in larger or more athletic dogs.
We'll always be direct with you about whether your dog is a good candidate for this technique versus TPLO — our goal is the option that gets your dog back to a comfortable, stable knee, not simply the lowest-cost option if it isn't the right fit.
Preparing for Surgery
Required Pre-Operative Workup
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Orthopedic exam — checking for cranial drawer motion, tibial thrust, and evaluating the opposite knee
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Radiographs (X-rays) of the affected knee to confirm the diagnosis and rule out other causes of lameness
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Pre-anesthetic bloodwork (CBC and chemistry panel) to confirm your dog is a safe anesthetic candidate; older or higher-risk dogs may need additional screening
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Weight check and physical exam the morning of surgery to finalize dosing and suture sizing
Preparing Your Home Before Surgery Day
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A confinement space — crate, gated room, or small area with minimal stairs
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Rubber-backed rugs or yoga mats over slick flooring
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A sling or towel to support the hind end on walks and stairs
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An e-collar or recovery suit ready to prevent licking
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A plan for short, frequent leash-controlled bathroom breaks the first few days
The Day Before Surgery
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No food after 8pm the night before; water is generally fine until the morning
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Bathe your dog if needed — the incision can't get wet for at least 10–14 days
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Confirm your confinement area and rugs are set up and ready
Surgery Day
Your dog is admitted in the morning for a pre-anesthetic exam, then placed under general anesthesia with continuous monitoring throughout the procedure. The surgeon places the stabilizing suture through small anchor points in the bone on either side of the joint and tightens it to the correct tension. The incision is closed in layers. Because no bone is cut, anesthesia and surgery time are typically shorter than with a TPLO.
We use a layered ("multimodal") anesthesia and pain-control protocol for every orthopedic surgery, designed to keep your dog calm and comfortable at every stage and to stay ahead of pain rather than catching up to it. Before surgery, your dog receives a combination of a calming sedative and pain-relieving medications (dexmedetomidine, midazolam, and methadone) to ease anxiety and provide the first layer of pain relief before anesthesia even begins. Anesthesia is then induced gently with propofol and maintained during surgery with isoflurane gas -- a well-established, closely monitored combination used in veterinary and human hospitals alike. Throughout the procedure, a dedicated team member continuously monitors your dog's heart rate, blood pressure, oxygen levels, and body temperature. At the surgical site, we use Nocita, a long-acting local anesthetic that numbs the area for up to 72 hours after surgery -- similar to a nerve block a person might receive after their own orthopedic surgery -- which meaningfully reduces how much pain your dog feels as they wake up and in the days that follow. We also give an anti-inflammatory pain medication (carprofen) during surgery to start reducing pain and swelling right away, and send you home with carprofen, gabapentin (a nerve pain medication), and an antibiotic to keep your dog comfortable and support healing over the following days and weeks.
Anesthesia and Pain Management
The First 12 Hours: Going Home (Outpatient Recovery)
As a general practice, we don't have overnight staffing on-site, so all of our surgical patients — including amputations — go home with their owners the same day, once they're comfortable, stable, and recovered enough from anesthesia to travel. In our experience, most pets do just as well, and often better, resting overnight in the comfort of home with their own family rather than in a hospital kennel, as long as you follow the aftercare instructions below closely. In the rare case that a pet needs a higher level of overnight monitoring than we can provide, we'll coordinate a direct transfer to a 24-hour emergency/specialty hospital such as BluePearl Pet Hospital in Wyomissing or Metropolitan Veterinary Associates, and stay in close contact with both their team and you throughout.
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Grogginess from anesthesia and pain medication for several hours — keep confined and supervised
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First walk: short, leash-controlled bathroom breaks only, with sling support if needed
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Icing: towel-wrapped ice pack to the knee for 10–15 minutes, 2–3 times the first evening
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Pain medication given exactly as prescribed, on schedule
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A reduced appetite the first evening is common; a dog not eating or drinking at all by the next morning should be reported to us
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Mild swelling, bruising, and a small amount of clear or blood-tinged discharge from the incision is normal for the first few days
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Overnight confinement so your dog can't jump, slip, or attempt stairs unsupervised
Recheck Appointments & Healing Timeline
1. 14 days post-op: Suture/staple removal and incision check.
2. 6 weeks post-op: Recheck exam and radiographs assess range of motion, and adjust the rehab plan.
3. 4–6 months post-op: Full activity clearance for most dogs, with continued gradual strength building.
Home Rehabilitation Program
Weeks 0–2: Foundation Phase
• Strict confinement between exercise sessions
• Passive range of motion (PROM) and gentle massage 2–3 times daily once cleared
• Short, slow, leash-controlled walks for bathroom purposes only
• Ice therapy after activity; gentle heat to the surrounding muscles can begin around day 4
• E-collar worn at all times to prevent licking — the most common and most preventable cause of infection
• No jumping, off-leash activity, unsupervised stairs, or play with other dogs
Weeks 3–8: Strength & Balance Phase
• Longer, varied controlled leash walks — gentle inclines, figure-8 patterns, stepping over low obstacles
• Weight-shifting and three-legged standing exercises
• Sit-to-stand “doggy squats” and cookie stretches
• Controlled wading in water once sutures are removed
Months 2–4: Return to Normal Activity
With a good recheck and consistent, confident use of the leg, most dogs progress toward normal off-leash activity by around 3–4 months. Because the repair relies on a mechanical suture and the body's own scar tissue, staying within your surgical team's activity guidelines during this window is what protects the repair long-term.
Incision Care: What's Normal vs. What Needs a Call
Normal
• Mild swelling and bruising for the first week
• A small amount of clear or blood-tinged discharge for the first few days only
• Mild discomfort and warmth around the leg
Contact Us Right Away If You Notice
• Swelling that lasts longer than a week, or new swelling appearing later
• Large amounts of discharge or active bleeding
• Discharge that is white, green, or thick/sticky
• Pain that doesn't improve with medication and icing, or sudden new lameness after initial improvement
Frequently Asked Questions
How much does ACL/lateral suture surgery cost?
Lateral suture (ACL) repair: $2,500 for dogs up to 80 lbs, $2,900 for dogs over 80 lbs — includes pre-operative examination, anesthesia, surgery, local anesthesia and intra-operative pain management, and recovery with nursing care. Rechecks are included; follow-up radiographs/sedation are at an additional cost.
Is lateral suture repair as good as TPLO?
For the right candidate — typically a smaller, less active dog — outcomes with lateral suture repair can be excellent. For larger or more athletic dogs, TPLO generally offers more predictable long-term stability because it changes the joint's underlying mechanics rather than relying on a suture. We'll help you weigh this against your dog's size, age, and lifestyle at your consultation.
How long until my dog walks normally again?
Most dogs show meaningful improvement in weight-bearing within 2–4 weeks, with continued improvement over the following 2–3 months as strength and confidence rebuild.
Will my dog need surgery on the other leg too?
Dogs who tear one CCL have a meaningfully higher chance of tearing the other at some point. Maintaining a healthy body weight and staying consistent with rehab are the best ways to reduce that risk.
Will my dog need to stay overnight after surgery?
No — as a general practice, we don't have overnight staffing on-site, so all of our surgical patients go home with their owners the same day. In our experience, most dogs recover just as well, and often more comfortably, resting at home with their family than they would in a hospital kennel overnight. On the rare occasion a pet needs a higher level of overnight monitoring, we'll arrange a direct transfer to a 24-hour facility such as BluePearl Pet Hospital in Wyomissing or Metropolitan Veterinary Associates.
Can I do this surgery at your general practice instead of a referral hospital?
Yes, Dr. Lee and his team perform this procedure in-house. As a general practice rather than a large corporate referral center, we're able to offer this level of orthopedic care with less overhead, which often makes it more accessible for families, without cutting corners on anesthesia monitoring or aftercare.
What if my dog doesn't seem to be improving?
Contact us any time during recovery. If your dog plateaus, regresses, or you're simply unsure whether something is normal, we'd rather hear from you early.