174 Surgical Treatment
Figure 23.3 A Leipzig stifle distractor can be used to
separate the space between the femoral condyle and
tibial plateau, giving an improved view and better access
to the menisci. The distractor is attached to the medial
femoral condyle and proximal tibia using threaded fixator
pins. Distraction is achieved using the turnbuckle device
on the distractor. An assistant is not required when using
this device.
a mini-arthrotomy may be more difficult if
the meniscus does not displace cranially suffi-
ciently. The risk of iatrogenic cartilage damage
may also be higher. The view obtained through
a mini-arthrotomy may limit the examination
of cruciate ligaments in the intercondylar
notch. These potential concerns become
less relevant as the surgeon becomes more
experienced.
Acaudo-medial stifle arthrotomy can be used
in selected cases, to improve exposure of the
caudal pole of the medial meniscus. The arthro-
tomy is made along the caudal border of the
medial collateral ligament. A needle is used to
palpate the tibia and a 2–3 cm-long incision is
made through the capsule. Asmall Gelpi retrac-
tor allows retraction and exposure of the medial
meniscus. This arthrotomy was found to be
more sensitive for meniscal diagnosis in stable
stifles, such as in dogs with partial CR (Pozzi
et al. 2008). This approach for medial menis-
cectomy can be used in combination with sti-
fle arthroscopy, when the surgeon is not able to
perform an arthroscopic meniscectomy.Arthroscopy of the stifle
Arthroscopy of the stifle is the method of choice
for joint exploration (Whitney 2003). The arthro-
scopic management of dogs with CR reduces
short-term postoperative morbidity compared
to arthrotomy (Hoelzleret al. 2004). The advan-
tages of arthroscopy include magnification and(A) (B)Figure 23.4 (A) An intra-articular stifle distractor (Arthrex Vet System) has been placed through the lateral arthroscope
port to distract the joint. (B) An extra-articular human ankle distractor (Arthrex) can also be used to distract the articular
surfaces. Intra-articular distractors offer the advantage of not requiring additional incisions or points of anchorage such as
pins, but are technically more difficult to use because of the limited intra-articular space.