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Lateral Suture vs TPLO: What's the difference?

Lateral Suture vs TPLO: What's the difference?

Lateral Suture

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Compare lateral suture vs TPLO surgery for torn CCL in dogs. Learn the key differences, pros, cons, recovery, and which option suits your dog best

By 

Sustainable Vet Group

Updated on

August 4, 2025

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Lateral Suture vs TPLO: What's the difference?

Overview of CCL Injuries in Dogs

A Cranial Cruciate Ligament (CCL) tear is one of the most common orthopedic injuries in dogs. The CCL helps keep the knee joint stable during walking, running, and turning. When it tears, the joint becomes loose, causing pain, limping, and long-term joint damage if left untreated.

Unlike humans, dogs rarely recover fully from a CCL tear without surgery. Without repair, the tibia shifts forward each time the dog moves, leading to more joint wear and early arthritis.

There are several surgical options, but the two most widely used are TPLO (Tibial Plateau Leveling Osteotomy) and lateral suture stabilization. Both aim to restore stability to the stifle joint, but they do so in very different ways. Choosing between them depends on your dog’s size, activity level, health status, and your vet’s recommendation.

What Is Lateral Suture Surgery?

Lateral suture surgery is one of the most widely used methods for treating a torn CCL in dogs, especially smaller or less active ones. It helps stabilize the knee without cutting into bone.

  • The surgeon places a strong synthetic suture outside the joint to mimic the function of the torn ligament.
  • The suture limits tibial movement, especially the forward slide that causes pain and instability.
  • Scar tissue builds around the joint over time, helping to keep it stable once the suture loosens.

This approach works best when joint forces are low and post-op care is followed closely. It’s less invasive than other methods and allows many dogs to return to daily life with reduced pain and good mobility.

What Is TPLO Surgery?

TPLO, or Tibial Plateau Leveling Osteotomy, is a more advanced surgical option for treating CCL tears in dogs. It’s often recommended for large, athletic, or high-energy dogs who place more stress on their joints.

  • The surgeon cuts and rotates the tibial plateau to create a flatter angle that stops the bone from sliding forward.
  • By changing the joint mechanics, TPLO eliminates tibial thrust instead of relying on a ligament or suture for support.
  • The cut bone is stabilized using metal plates and screws, which remain in place permanently.

This procedure allows the dog to bear weight more quickly and offers strong long-term stability, even for active breeds. While it’s more invasive and expensive than lateral suture, TPLO is often the best choice for dogs with steep tibial slopes or severe instability. Recovery takes time and careful rehab, but success rates are high when done properly.

Key Differences Between TPLO and Lateral Suture

TPLO and lateral suture are both effective ways to treat CCL tears, but they work very differently. The best option depends on your dog’s size, activity level, and how much support their knee needs.

  • Invasiveness and complexity
    Lateral suture is a less invasive procedure. It involves placing a suture outside the joint without cutting bone. TPLO is more complex and involves cutting, rotating, and plating the tibia.
  • Cost differences
    Lateral suture is typically more affordable. TPLO costs more due to specialized equipment, implants, and surgical skill.
  • Surgery and anesthesia time
    Lateral suture surgeries are shorter and require less time under anesthesia. TPLO takes longer, which may not be ideal for older dogs or those with other health risks.
  • Equipment and surgical expertise
    Most general vets can perform lateral suture surgery. TPLO requires advanced training, special tools, and is usually done by board-certified surgeons.
  • Biomechanical stability
    TPLO changes the way the joint works to eliminate tibial thrust permanently. It offers superior stability for large or active dogs. Lateral suture relies on external support and scar tissue, which may not hold up as well in high-stress joints.

Overall, TPLO is often better for large, strong, or athletic dogs. Lateral suture can be the smarter choice for smaller, calmer pets or when cost and recovery simplicity are priorities. Your vet will help you choose based on your dog’s specific needs.

Which Dogs Are Best Suited for Each Surgery?

The right CCL surgery depends on more than just the tear itself. Vets look at your dog’s size, energy level, age, joint structure, and even breed when deciding between lateral suture and TPLO.

Lateral suture surgery is best for:

  • Dogs that weigh under 35–50 pounds (15–23 kg)
  • Older or less active dogs with moderate lifestyle demands
  • Dogs with mild to moderate instability in the knee
  • Owners who prefer a lower-cost, less invasive option

TPLO surgery is better for:

  • Medium to large dogs, especially over 50 pounds
  • Active or athletic breeds that run, jump, or work
  • Dogs with steep tibial slopes or more severe joint instability
  • Situations where long-term stability and high performance are needed

Other factors to consider:

  • Your dog’s overall health and ability to handle longer surgery
  • Joint shape and function, especially in breeds prone to instability
  • Your ability to manage recovery and commit to rehab

Choosing the right surgery helps reduce pain, avoid failure, and support long-term mobility. Work with your vet to match the method to your dog, not just the injury.

Recovery Experience and Timeframe

Recovery after CCL surgery is just as important as the procedure itself. While both TPLO and lateral suture aim to restore joint stability, the healing process feels different for each method—and knowing what to expect can help you plan better.

  • Lateral suture recovery
    Most dogs begin walking within a few days, but they may use the leg cautiously. Full recovery takes 8 to 12 weeks, with a gradual return to normal strength. Activity must be restricted for at least 6 weeks to protect the suture while scar tissue forms.
  • TPLO recovery
    Dogs often bear weight more quickly, sometimes within 2 to 3 days. But because bone healing is involved, crate rest is longer—usually 8 to 10 weeks. Controlled leash walks and strict supervision are essential during this time.
  • Rehabilitation matters in both cases
    Whether your dog had a lateral suture or TPLO, physical rehab is strongly recommended. It helps reduce stiffness, rebuild muscle, and prevent overuse of the opposite leg.

Recovery success depends on your commitment to rest, rehab, and regular follow-up visits. With patience and care, most dogs regain strong, stable movement no matter which surgery they receive.

Success Rates and Long-Term Outcomes

Both TPLO and lateral suture surgeries have high success rates when done for the right dogs, but their long-term outcomes can vary depending on factors like body weight, activity level, and post-op care.

Lateral suture success

In small to medium-sized dogs with low to moderate activity, lateral suture surgery has a success rate of about 85–90%. These dogs often return to normal function and remain pain-free for years. However, if used in large or athletic dogs, the suture may stretch or break, leading to failure or the need for revision surgery.

TPLO success

TPLO has a 95% success rate, especially in large or high-energy dogs. It offers strong long-term stability because it changes the mechanics of the joint instead of relying on a ligament replacement. Most dogs regain full activity, including running, jumping, or sports.

Arthritis progression

Studies show that TPLO tends to slow arthritis development better than lateral suture, especially in active dogs. Lateral suture may not fully prevent joint wear if the knee remains slightly unstable.

When chosen carefully and followed by proper rehab, both procedures can offer excellent long-term outcomes—but TPLO often holds up better under pressure.

Risks and Complications to Consider

Every surgical option comes with some level of risk, and understanding the possible complications can help you make a better-informed decision for your dog.

  • Lateral suture risks
    The most common complication is suture failure, especially in large or very active dogs. If the suture loosens or breaks, the knee can become unstable again, leading to lameness or the need for another surgery. Even in successful cases, mild joint instability may remain, which can increase the risk of arthritis over time.
  • TPLO risks
    TPLO has a different set of risks because it involves cutting bone. Complications may include surgical site infection, implant loosening, bone fractures, or even patellar tendonitis during healing. Though rare, these issues may require additional treatment or implant removal.
  • Vet experience matters
    Surgical skill and experience greatly influence outcomes. TPLO requires precise bone work, while lateral suture demands correct tension and placement. Choosing a vet with proper training—and a strong track record—lowers the chance of complications for both procedures.

While complications are possible, most dogs recover smoothly with proper care and monitoring. Following post-op instructions and attending follow-up visits will significantly reduce the chances of serious issues.

When Might Both Be Combined?

In very specific cases, a surgeon may choose to combine TPLO and lateral suture to give added joint support. This approach is not routine, but it may help in complex injuries with extra instability.

  • Used in rotational instability
    In rare cases where TPLO alone doesn’t fully control rotational movement of the tibia, a lateral suture may be added for extra reinforcement. This typically applies to dogs with unusual joint anatomy or multiple failed surgeries.
  • Lateral suture becomes a secondary support
    The main correction still comes from TPLO, but the suture acts as a backup to limit movement in directions TPLO doesn’t fully address.
  • Added risks and higher cost
    Combining both surgeries increases surgical time, anesthesia duration, recovery complexity, and overall cost. There’s also a higher chance of swelling, delayed healing, or stiffness if rehab isn’t managed closely.

Most dogs do not need both procedures. But in rare and difficult cases, your vet may recommend this combo to give your dog the best chance at long-term comfort and joint function. It’s a case-by-case decision based on detailed assessment.

Cost Comparison: Upfront vs Long-Term

Cost matters—but the cheapest option today may not stay that way over time. Here's how both surgeries compare financially.

  • Lateral suture is usually cheaper at first
  • TPLO costs more due to implants and specialist care
  • Lateral suture may need revision if it fails in large dogs
  • TPLO has fewer long-term complications in active pets
  • Extra costs like rehab, follow-ups, or repeat surgery add up

Choosing surgery based on initial price alone can be risky. A successful first surgery often saves more in the long run. Talk to your vet about what’s most cost-effective for your specific case.

Owner Preferences and Emotional Considerations

Your comfort and confidence in the surgical plan matter—just like your dog’s medical needs.

  • Some owners prefer lateral suture to avoid cutting bone
  • TPLO may feel “too intense” or invasive to some families
  • Lateral suture can offer peace of mind for simpler cases
  • TPLO is trusted for strong, lasting results in large breeds
  • Access to surgeons and budget often shapes the final choice

There’s no wrong feeling here—just make sure your decision blends emotional comfort with what your vet believes is safest and most effective for your dog.

Quick Decision Guide: Which Surgery Is Right for Your Dog?

Not sure which direction to take? Use this checklist to weigh what fits your situation best.

  • Dog weighs under 50 lb → Lateral suture
  • Dog is large, athletic, or high-energy → TPLO
  • Budget is limited → Lateral suture is more affordable
  • Willing to invest in long-term outcome → TPLO is more durable
  • Comfortable managing 6–8 weeks of crate rest → Either option
  • Need faster weight bearing for recovery → TPLO may help sooner
  • Local vet offers lateral suture but not TPLO → Discuss best fit
  • Access to board-certified surgeon → TPLO becomes an option

This guide doesn’t replace expert advice—but it gives you the right questions to ask. Match the method to your dog, your goals, and your ability to support recovery.

Final Thoughts

There’s no perfect surgery for every dog, only the one that fits your pet’s unique needs, size, and lifestyle. Both TPLO and lateral suture have helped thousands of dogs walk pain-free again, but success depends on choosing the right option for the right patient.

Lateral suture works well for smaller, calmer dogs and families seeking a less invasive, more affordable approach. TPLO is better suited for large, active, or athletic dogs needing strong long-term stability.

The most important step is an honest conversation with your vet. Discuss your dog’s health, your budget, and how much support you can provide during recovery. A well-matched plan leads to better results and fewer complications.

FAQs About TPLO vs Lateral Suture Surgery

Is TPLO always better than lateral suture?

Not always. TPLO offers stronger stability for large or active dogs, but lateral suture works very well for small, calm, or older dogs. The best option depends on your dog’s size, activity level, and joint structure, not just the method.

Can large dogs have lateral suture successfully?

In some cases, yes. Some large dogs with calm temperaments and low activity levels can recover well. However, the risk of suture failure is higher in heavy or athletic dogs. Your vet will decide based on joint condition and lifestyle.

Which surgery has fewer complications?

TPLO tends to have fewer long-term failures in large dogs. Lateral suture carries less surgical risk but may fail if the dog is too active. The outcome depends on choosing the right surgery for the right patient and having an experienced vet.

Is the recovery harder for TPLO?

TPLO requires longer crate rest because the bone needs to heal. However, dogs often begin walking sooner. Lateral suture recovery may feel easier early on but takes longer to rebuild full strength. Both need careful rest and rehab.

Can you switch from lateral suture to TPLO if it fails?

Yes. If lateral suture does not hold or the joint becomes unstable again, TPLO can be done as a revision. Many vets use TPLO when the first surgery fails or when the dog’s activity needs change over time.

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