It’s easy to be sold on the concept of ‘natural’ or ‘organic’ remedies. The least ‘organic’ remedy for ACL rupture is TPLO. A decision to avoid TPLO is justifiable for a cost-constrained owner. If there’s no financial constraint, we should ask what’s important to our patient. The answer should be “minimising pain and maximising the likelihood of an excellent long-term outcome”. A decision to avoid TPLO because another procedure is ‘organic’ (i.e. ‘less invasive’) isn’t justifiable.

Between 2004 and 2021, I treated 1648 patients with ACL injuries. I know the precise number because I’ve recorded a personal log for the past 18 years. Although I’m certain how I treated each patient, I can’t tell you precisely how many returned to normal. To do this, I’d need objective data provided by force plate analysis. Fortunately, other specialists have collected this data. When I quote their results, I know it comes from experts with equivalent experience. Bias doesn’t need objective data. It has testimonials.

Lateral suture is a fair option for patients with traumatic ACL injuries. It’s also less expensive than tibial osteotomy surgery, making it a fair choice for cost-constrained owners. These are the only relevant advantages. No surgery can promise a reduced risk of future injury in the opposite knee. Faster recovery, lower risk and better long-term function are proven advantages of tibial osteotomies. Bias is fortunate - it doesn’t need proof. It only needs to make the impossible seem plausible.