Advances in the Canine Cranial Cruciate Ligament, 2nd edition

Arthroscopy and Arthrotomy of the Stifle 183

the activation of nociceptors, particularly in the
synovium and joint capsule. In dogs with CR,
stifle synovitis also contributes to joint pain
and lameness. Surgical pain can be decreased
by applying appropriate pre-emptive analge-
sia, adjunctive nonsteroidal anti-inflammatory
drug (NSAID) therapy, and by meticulous sur-
gical technique. Arthroscopic-assisted surgery
is minimally invasive and helps to reduce sur-
gical morbidity. Persistent synovitis has been
identified in injured joints (elbow, hip, stifle)
long-term after arthrotomy or arthroscopy. This
may warrant long-term anti-inflammatory ther-
apy to decrease the insidious progression of
osteoarthritis. Anti-inflammatory treatment can
be provided using NSAIDs or supplements
that have anti-inflammatory properties. Recent
studies have demonstrated similar improve-
ments in the ground reaction forces of dogs with
osteoarthritis of the hips and stifles by treat-
ment using an NSAID or a fatty acid supple-
ment (Kwananochaet al. 2016).

Return to function

Early return to function is desirable to reduce
muscle atrophy and preserve the joint range of
motion after surgery. The loss of muscle mass
may alter forces acting on the joint and thus
influence the progression of stifle joint degener-
ation. Pain, tissue swelling, activity restriction

Figure 23.19 It is particularly important to reassess the

meniscus with a probe after performing a partial

meniscectomy to treat a bucket-handle tear of the medial

meniscus. It is relatively common to find a second or

even a third bucket-handle tear after removal of the first.

This patient had a triple bucket-handle tear of the medial

meniscus.

and bandaging contribute to postoperative loss

of joint range of motion. Early range of motion

exercise as part of a rehabilitation program (see

Chapter 42) is advantageous due to the ten-

dency for joints to become stiff after surgery.

Periarticular fibrosis may lead to an irreversible

loss of range of motion and morbidity, and

should be minimized. Arthroscopic-assisted

arthrotomy helps to preserve joint range of

motion due to its effect on reducing pain and

swelling after surgery. When combined with

surgical stabilization of the stifle, morbidity is

similar to traditional portal arthroscopy.

(A) (B)

MTL ***

MFC

MFC

TP

PK TP

PK

Figure 23.20 Medial meniscal release can also be performed more accurately using arthroscopic guidance. (A) A
meniscal release was performed by cutting the medial meniscotibial ligament using a meniscal push-knife. (B) The
caudal horn of the medial ligament has displaced caudally after cutting the ligament. Note the gap (∗∗∗) at the site of
transection of the meniscotibial ligament. MFC, medial femoral condyle; MTL, medial meniscotibial ligament; TP, tibial
plateau; PK, push-knife.