33

Arthroscopic Follow-Up

after Surgical Stabilization

of the Stifle

Brian S. Bealeand Donald A. Hulse

Introduction

Cruciate ligament rupture (CR) is a common
cause of pelvic limb lameness in dogs (Aragon
& Budsberg 2005). The majority of veterinary
surgeons agree that return to optimal function is
best accomplished through surgical treatment.
A variety of surgical techniques have been
described to stabilize the cruciate-deficient sti-
fle, including extracapsular stabilization, intra-
articular cranial cruciate ligament (CrCL) recon-
struction, and techniques designed to reduce
the force causing cranial tibial translation
(cranial tibial thrust) during weight-bearing
(Warzeeet al. 2001; Reifet al. 2002; Jerram &
Walker 2003). Extracapsular stabilization and
tibial plateau leveling osteotomy (TPLO) are
the most common techniques used by veteri-
nary surgeons to treat CR. Although deemed
clinically successful in most cases, complica-
tions associated with these techniques have
been described (Pacchianaet al. 2003; Priddy
et al. 2003; Staufferet al. 2006). Follow-up arthro-
scopic evaluation of the stifle after surgical sta-
bilization has provided important evidence to
assess outcome after surgical treatment (Whit-
ney 2003; Raywardet al. 2004; Hulseet al. 2010).
Surgical recommendations should ideally be
made by applying the principles of evidence-

based medicine (Aragon & Budsberg 2005).

Follow-up arthroscopic evaluation of intra-

articular structures is performed as an out-

come measurement in experimental studies or

in client-owned dogs with clinical signs after a

previous surgical procedure. Follow-up arthro-

scopic evaluation is also occasionally used to

assess outcome in patients without clinical

signs. Advocates of follow-up arthroscopy in

this group of patients cite the low morbidity

associated with the technique, the frequent dis-

covery of unknown pathology, and the abil-

ity to better understand the patient’s true out-

come after surgery as justification. Follow-up

arthroscopy is typically only performed if the

patient is having clinical problems or is under-

going general anesthesia for another reason,

usually another surgical procedure. A common

example would be follow-up arthroscopy per-

formed on a stifle after previous CR stabi-

lization at the time of treatment of the con-

tralateral stifle for CR. Evidence of changes

seen within the joint can influence treatment

and activity recommendations for the patient.

In addition, simultaneous implant removal

can be performed, eliminating the potential

necessity for implant removal in the future.

Follow-up arthroscopy of the stifle has been

used most commonly to assess TPLO patients,

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.

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