ACL surgery can get quite expensive — up to $4,500 for the TPLO or TTA options. The least expensive option is the lateral suture (ELSS) which hovers around $1,000 or $2,000, but this surgery is most often performed on small dogs under 35 pounds. Typically, the cost includes not only the surgery but also pre-surgical bloodwork, anesthesia, post-surgical care, and medications. Some hospitals may even include post-surgical physical therapy.