Advances in the Canine Cranial Cruciate Ligament, 2nd edition

Arthroscopy and Arthrotomy of the Stifle 177

(A) (B) (C)

MFC

BHT

MFC MFC

MM MM

TP TP

Figure 23.9 Meniscal tears can be difficult to see during routine arthrotomy. (A) This patient appeared to have a normal
meniscus on initial arthroscopic inspection. (B) Careful probing of the medial meniscus revealed a bucket-handle tear.
(C) A partial meniscectomy was performed, leaving the remaining healthy portion of the meniscus intact. MFC, medial
femoral condyle; MM, medial meniscus; TP, tibial plateau; BHT, bucket-handle tear of medial meniscus.

ligament, or by percutaneously incising trans-
versely across the medial meniscus, just caudal
to its attachment to the medial collateral liga-
ment (Whitney 2003) (Figure 23.10).
Magnification of intra-articular structures
allows for more accurate identification of patho-
logical changes to the articular cartilage. Early
degenerative changes to articular cartilage, not

MFC

MM

TP

Figure 23.10 A mid-body medial meniscal release was
performed using a #11 scalpel blade through a
percutaneous stab incision made in the caudal medial
aspect of the stifle joint. Meniscal release can be
accurately performed and assessed using arthroscopy.
MFC, medial femoral condyle; MM, medial meniscus; TP,
tibial plateau.

visible to the naked eye, are clearly seen arthro-

scopically (Figure 23.11). Fine and coarse fibril-

lation, superficial erosions and neovasculariza-

tion of the cartilage are readily evaluated and

documented (Figure 23.11).

Arthroscopic-assisted arthrotomy

Arthroscopy is easier to perform when com-

bined with arthrotomy. An arthroscope can

be introduced into the arthrotomy incision to

enhance the observation of all intra-articular

structures, which is the most important advan-

tage of this approach. Arthroscopic-assisted

arthrotomy provides the surgeon with intra-

articular images that are identical to those

obtained by traditional arthroscopy, and thus

enables complete documentation of the changes

observed and treatment provided. By combin-

ing these techniques, the arthrotomy incision

can be used for triangulation of the arthro-

scope and instruments, as well as fluid egress.

This approach not only shortens the learn-

ing curve regarding arthroscopic technique but

also reduces fluid leakage into the periarticu-

lar soft tissues, a common problem with por-

tal arthroscopy. Smaller arthrotomy incisions

can be made when combined with arthroscopy.

This may help reduce morbidity. The arthro-

scope can be quickly and easily moved in and

out of the joint as needed. Ease of alignment

of the arthroscope and the anatomic target is

improved. The arthroscope can be positioned