280 Surgical Treatment
CaCL CaCL CaCLCrCL(A) (B) (C)CrCLCrCL***Figure 33.1 (A) The insertion of the craniomedial band is torn (∗∗∗) in this dog with a partial tear of the cranial cruciate
ligament (CrCL). This patient has a normal amount of cranial tibial translation. The caudal cruciate ligament (CaCL) is
also visible. (B) The torn fibers of the ligament have been carefully debrided before performing a tibial plateau leveling
osteotomy. The intact fibers of the CrCL were probed and found to have normal integrity and were left intact. (C) The
CrCL appears healthy and functional at a follow-up arthroscopic examination of the same patient 2 years later.
but its use has also provided valuable infor-
mation in patients undergoing extracapsular or
intra-articular CR stabilization and treatment of
OCD of the femoral condyle.
Follow-up arthroscopic examination
after TPLO
Follow-up arthroscopic examination of the sti-
fle is performed using standard arthroscopic
techniques (Beale et al. 2003). Typically, the
same portals are used as the initial arthroscopy.
Exploration of the intra-articular structures is
performed, starting in the proximal aspect of
the joint with the stifle held in an extended
position. Periarticular osteophytes, cartilage
integrity and synovial membrane appearance
are evaluated. The intercondylar notch region
is evaluated with the stifle positioned in flex-
ion. The CrCL and caudal cruciate ligament
(CaCL) are assessed for fiber damage, inflam-
mation, remodeling, and vascular proliferation.
The menisci are carefully observed and probed
for the presence of fiber rupture or wear. A
Hohmann retractor can be inserted into the joint
just lateral to the proximal aspect of the patellar
tendon through an accessory instrument portal
to separate the joint surfaces and improve the
view and access to the menisci. Alternatively,
a stifle distractor can be used to improve
examination (see also Chapter 23). Bucket-
handle tears of the medial meniscus are the
most common type of meniscal tear seen, and
are typically treated by partial meniscectomy.
Radial tears are also common and are treated
by partial meniscectomy at the discretion of
the surgeon. Large radial tears are generally
treated, while small radial tears and small frays
are left untreated. Small frays of the axial bor-
der of the lateral meniscus are common in nor-
mal dogs without clinical signs. Small frays
may increase the susceptibility to larger radial
tears in the future in stifles experiencing insta-
bility. A medial meniscal release (MR) can
also be performed if deemed necessary by the
surgeon.
Follow-up arthroscopy was found to be
valuable in assessing patients treated with
TPLO (Hulseet al. 2010). Hulseet al. (2010)
used a second-look arthroscopic examination
to evaluate dogs with CrCL fiber rupture of
varying degrees after TPLO. Intra-articular
structures appeared normal or near-normal at
long-term follow-up after a TPLO procedure
in early partial tears of the CrCL (Hulseet al.
2010). The CrCL did not continue to rupture
after the plateau was leveled to approximately
6 ◦ (Figure 33.1). The blocking of CrCL fiber
tearing may be a consequence of decreased
loading of the CrCL after rotation of the tibial
plateau (Warzeeet al. 2001; Reifet al. 2002;
Wolfet al. 2008; Hayneset al. 2015; Bargeret al.
2016). When the tibial plateau is rotated to
approximately 6◦relative to the weight-bearing