The only thing "new" about the tightrope is the name. It is essentially the same thing as the traditional extra-capsular repair surgery but with higher test filament and additional hardware for larger dogs vs the small breeds. The only surgeons I know that push for the tightrope are those who are not qualified to perform TPLO in my experience anyway. No way in hell would I suggest that to a young, active dog looking to continue that level of function. Some people are limited financially and that is why they opt for it, and those dogs CAN do well but it is certainly not what I would consider to be a first choice repair if given the option. I'd much rather opt for the TPLO or TTA with young, active dogs.