Advances in the Canine Cranial Cruciate Ligament, 2nd edition

288 Surgical Treatment

medial femoral condyle

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torn medial meniscus

2nd tear in meniscus

(A) (B)

Figure 33.20 Bucket-handle tears of the medial meniscus were commonly seen at follow-up arthroscopic examination
of patients treated with extracapsular stabilization of cranial cruciate ligament tears in dogs with clinical signs, and in
dogs thought to be without clinical signs. (A) Some meniscal tears were displaced and easily identified. Other
bucket-handle tears were latent and identified only after careful probing. This patient had two bucket-handle tears of the
medial meniscus. The first tear was displaced and easily identified. Partial menisectomy was performed. The second
bucket-handle tear was latent and was identified after carefully probing the medial meniscus after removal of the first
tear (B).

examination tended to show a stiff pelvic limb
gait, a reluctance to sit square, or a slight click
when flexing the stifle. It appears that some
dogs are quite effective in minimizing the clini-
cal signs of pain associated with a meniscal tear.
Medial patellar luxation has also been observed
at the time of follow-up arthroscopic examina-
tion after extracapsular stabilization. Arthro-
scopic evaluation of infected joints secondary to
an infected extracapsular suture provides valu-
able information regarding the intensity of the
synovitis and the degree of cartilage damage.

Follow-up arthroscopic examination

after intra-articular stabilization

Follow-up arthroscopy after intra-articular
stabilization has revealed similar findings
to extracapsular stabilization. Periarticular
osteophytes typically enlarge over time. Mild
to moderate synovitis is seen, and cartilage
erosion is variable. Some dogs show progres-
sive cartilage erosion of the medial and lateral
compartment. Erosion is seen to involve the
articular cartilage of the weight-bearing regions
of the medial and lateral femoral condyle and
tibial plateau. On the other hand, some dogs
show very little change in the appearance of
the articular cartilage. Intra-articular stabi-
lization techniques may be performed using
a prosthetic or a biological ligament replace-
ment. Prosthetic ligament replacements have

a high rate of failure. Follow-up arthroscopy

has found ruptured ligament fibers leading to

stretching, partial tear, or complete tear of the

prosthetic ligament. Biological replacement lig-

aments have also been found to experience fiber

tearing at follow-up arthroscopic examination.

Fibers of the ligament are often stretched, or the

ligament may have a partial or complete tear. A

minority of patients have a healthy-appearing

replacement ligament (Figure 33.21). Meniscal

tears are also common at the time of follow-

up arthroscopic examination in this group

of patients. Intra-articular repairs are most

CaCL

CrCL graft

Figure 33.21 The fascial lata graft appears healthy and

functional at follow-up arthroscopic examination in this

patient treated with intra-articular stabilization after

cruciate ligament rupture. Caudal cruciate ligament

(CaCL), cranial cruciate ligament (CrCL).