ACL Repair (Lateral Fabellar Suture)

Lateral fabellar suture repair is a well-established technique best suited for small dogs (typically under 25–30 lbs), cats, and low-activity pets where the demands on the joint are manageable. It is also considered when a patient's overall health makes a longer, more involved procedure less desirable. Because the approach is less invasive than tibial-osteotomy methods, recovery can be smooth and uncomplicated in the right candidate. Pets with concurrent patellar luxation may need additional steps at the same surgery — see the combined repair page for details.

The surgery is performed under general anesthesia with continuous monitoring. The key steps are:

• A small incision is made on the outside of the knee to access the joint
• The joint is opened and examined; any torn meniscal (cartilage) tissue is addressed
• A large-gauge nylon suture is passed around the fabella bone behind the knee and anchored to a bone tunnel or pre-drilled hole at the front of the tibia
• The suture is tensioned so the knee no longer shifts forward abnormally (tibial thrust)
• As the suture gradually stretches over weeks, the peri-articular scar tissue that forms takes over the stabilizing role

The procedure typically takes less time than tibial osteotomy techniques, which can be an advantage for older or higher-risk patients.

Before surgery, your pet will have a full orthopedic examination, X-rays of the affected knee, and pre-anesthetic bloodwork. For dogs with a known cruciate ligament tear, the consultation is the right time to discuss technique choice, anesthesia risk, and realistic recovery expectations. You will be instructed to withhold food the night before surgery (water is generally allowed), and the team will review any current medications. Arranging a quiet, non-slip recovery space at home before the appointment means your pet can rest comfortably from the moment they return.

Most patients begin touching the toe down within a few days of surgery. The recovery progresses in stages:

• Weeks 1–2: cage or pen rest; short, leashed bathroom trips only; pain and anti-inflammatory medications as prescribed; incision checks
• Weeks 3–6: gradual increases in controlled leash walks; no jumping, running, or stairs; gentle passive range-of-motion exercises if recommended
• Weeks 6–10: a recheck exam assesses stability and comfort; activity is slowly normalized as scar tissue matures

Keeping your pet at a lean body weight takes stress off the healing joint and significantly improves long-term comfort. The opposite leg should be monitored, as cruciate disease can be bilateral.

The lateral fabellar suture technique has a strong track record in appropriate patients. The suture material may stretch or occasionally break before sufficient scar tissue forms — this is more likely in larger or very active dogs, which is one reason the technique is matched carefully to patient size. Other possible risks include infection, joint swelling, and late meniscal injury. The majority of small-breed dogs and cats return to comfortable, normal movement. Honest discussion of any individual risk factors happens before you consent to the procedure.