23

Arthroscopy and Arthrotomy

of the Stifle

Brian S. Beale,Donald A. Hulse,Antonio Pozzi, and Peter Muir

Introduction

Arthroscopy has revolutionized the treatment
of joint disease in human beings and ani-
mals. Arthroscopic-assisted surgical techniques
improve diagnostic accuracy, reduce postoper-
ative pain and the duration of hospitalization,
and shorten the time required for return to func-
tion (Whitney 2003; Hoelzleret al. 2004; Pozzi
et al. 2008; Ertelt & Fehr 2009). Arthroscopy
in animals is used primarily by veterinarians
with advanced surgical training. General prac-
titioners who routinely perform joint surgery
have been slow to adopt arthroscopy due to the
learning curve involved. Consideration should
be given to implementing arthroscopy at the
time of arthrotomy to enhance surgical obser-
vation, improve treatment and assist in arthro-
scopic training. The arthroscopic procedure is
simplified when using arthroscopy at the time
of arthrotomy. Many conditions affecting joints
are best investigated arthroscopically, including
osteochondritis dissecans (OCD) of the shoul-
der and elbow, ligamentous and tendinous
injuries of the shoulder, fragmented medial
coronoid process, partial cruciate ligament rup-
ture (CR) and meniscal damage (Whitney 2003;
Hoelzleret al. 2004; Pozziet al. 2008; Ertelt &
Fehr 2009). Arthroscopy via a mini-arthrotomy

has been reported to be an effective method for

treating CR and meniscal injury (Whitney 2003;

Ertelt & Fehr 2009).

Stifle arthrotomy

Arthrotomy of the stifle can be performed in

a traditional open or in a minimally invasive

manner (Hoelzleret al. 2004; Pozziet al. 2008;

Ertelt & Fehr 2009; Johnson 2014). Traditional

arthrotomy can be performed via a medial or

lateral parapatellar approach depending on the

surgeon’s preference (Johnson 2014). A medial

parapatellar approach will typically facilitate

examination of the medial femoro-tibial joint. A

lateral arthrotomy may be best if lateral extra-

capsular stabilization is planned, as exposure

of the caudolateral aspect of the joint is easier

(Figure 23.1). Amedial arthrotomy may be most

convenient if a tibial osteotomy is to be per-

formed due to the need to have medial exposure

to the tibia.

Arthrotomy should be performed meticu-

lously. The skin is initially incised, followed

by subcutaneous tissue, deep fascia, and joint

capsule. Each tissue layer should be identified

and incised separately. If a lateral parapatellar

approach is used, the deep fascia is incised at

Advances in the Canine Cranial Cruciate Ligament, Second Edition. Edited by Peter Muir. © 2018 ACVS Foundation.
This Work is a co-publication between the American College of Veterinary Surgeons Foundation and Wiley-Blackwell.

171