External Fascial Strip – EFS

a method for repairing ruptured cruciate ligaments in dogs.


Cranial Cruciate Ligament disease affects dogs of all breeds and sizes, and can occur at any stage in life. There is no single cause for cruciate ligament rupture, and it can occur due to physical injury or deterioration of the ligament over a period of time. Regardless of the reason, the condition causes stifle instability which can lead to a variety of other orthopedic problems if not corrected, including cartilage degeneration, meniscus injury, and the progression of degenerative joint diseases. If the cruciate ligament is repaired soon after symptoms present, the possibility of further injuries to the joint can be reduced or eliminated.

The diagnosis of a ruptured cranial cruciate ligament can be suggested by your general practice veterinarian, and ultimately determined by consulting with a board certified veterinary orthopedic surgical specialist, who will physically manipulate the joint and evaluate radiographs to determine whether the ligament is fully or partially ruptured.



– Lameness upon injury

– Crepitus (a grating sound or sensation)

– Decreased Range of Motion (ROM)

– Hind leg outstretched while sitting

– Weight shift while standing



The fascial strip surgery is a method designed to use fascia, which is the strong connective tissue that envelopes muscles in the dog’s knee, to stabilize the stifle (or knee). The fascia is a thin but very strong connective tissue that when placed properly can restore proper placement of the stifle and prevent further degenerative joint disease from occurring.

Most cruciate ligament fixation procedures that use the fascia to repair cranial cruciate ligament rupture in dogs place the strip of fascia through the joint to stabilize the stifle. The joint is actually an inhospitable environment for any material that does not belong in it. With this method, the joint can weaken the fascia and fail to prevent further degeneration of the joint. Ultimately, the procedure repairs the instability but has little probability for preventing further injury.

Dr. Dew, board certified veterinary orthopedic surgical specialist, has developed an alternative method for fascial strip repair of cranial cruciate ligament rupture. With this method, the fascia is placed around the fibula, which is a small bone that resides behind the lateral condyle of the femur. This keeps the fascia outside the joint, which is the naturally preferred environment for connective tissue. The likelihood of damage to the fascial strip from the joint is virtually eliminated, and this method allows for tissue regeneration as well as increased joint strength over time.

In a study of the cruciate ligaments being repaired using Dr. Dew’s fascial strip method, 94% returned to what the pet owners considered to be excellent or good function in the joint. None reported that the dog had poor function, and the other 6% considered the function adequate. Overall, success following cranial cruciate ligament surgery tends to be around 90% on the national average for all types of repairs, so the numbers clearly show that this method produces far better than average results. Additionally, Dr. Dew’s method has proven 110% of original cruciate ligament strength to be recovered, as opposed to the 30% that can be recovered using a procedure that places the fascia within the joint.

Following the fascial strip procedure, optimal function will be reached at about 26 weeks after surgery on average. During this time, activity restriction plays a crucial role in the healing of the stifle. As there are a variety of procedures that can be used to repair cranial cruciate ligament ruptures, your options can be explained in a veterinary orthopedic surgical consultation.