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Step by Steps


The Lateral Button Suture for Cranial Cruciate Ligament Rupture

A Step by Step Guide to the procedure using LigaFiba® and button by Hamish Denny FRCVS

The placement of a non-absorbable suture between the lateral fabella and the proximal cranial tibia has been routine treatment for cranial cruciate ligament rupture since the procedure was first described by DeAngelis in1970.

    Although there have been variations on his original procedure it still remains the extracapsular technique of choice today for management of cranial cruciate ligament rupture. The ideal lateral suture joins points of isometry between femur and tibia so that the suture remains the same length throughout the whole range of joint flexion and extension.

    During placement of standard lateral sutures there is a tendency for the proximal strand of the suture to drift up to the straight patella ligament. This reduces isometry of the suture and the suture can become intra-articular which is undesirable. A toggle button on the medial side of the proximal tibial tunnel provides an anchor point for both strands of the lateral suture as they pass through the tunnel from medial to lateral and isometry is maintained.

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