Cranial Cruciate Ligament Debridement 293Figure 34.2 Arthroscopic view of a chronic partially
ruptured cranial cruciate ligament with visible torn fibers.
Note the formation of a ‘drumstick’ proliferation of the
ruptured fibers.
ends of the torn ligament (Figure 34.2) are also
often present and might disturb normal motion.
Therefore, the debridement of totally ruptured
ligaments is still an appropriate and indicated
therapy that is usually performed before menis-
cal inspection, using a motorized shaver during
arthroscopy. Advances in human primary ACL
repair, including stabilization of the repaired
ligament with an internal dynamic femur to
tibia suture, is likely to be protective and may
allow healing (Kohlet al. 2013). The provi-
sion of a suitable biological environment by
the addition of collagen matrix-embedded stem
cells or platelet-rich plasma (PRP) to a primary
repair (Joshiet al. 2009), in combination with an
internal stabilizing implant, are possible future
directions that will change the debridement dis-
cussion in complete CrCL rupture.
Ligament debridement for partial CrCL
rupture
The debridement of torn fibers in partially rup-
tured CrCL is indicated (Figure 34.2). Short-
term negative consequences of partial debride-
ment compared to total debridement could not
be demonstrated (Wolfet al. 2008). Especially
with small partial tears, it is indicated to debride
visibly torn fibers using a motorized shaver
(Figure 34.3). A radiofrequency energy probe
can be used if shaver debridement is not sat-
isfactory. Application using the lowest possible
Figure 34.3 Arthroscopic view of a partially ruptured
cranial cruciate ligament during debridement of torn
fibers with a motorized shaver using a 2.0 mm full radius
resector blade. The blade is positioned with the back of
the shaver lying against the intact ligament part to protect
viable intact fibers.energy and an appropriate application velocity
is advised to reduce the risk of thermal injury
in the remaining tissue (Luet al. 2007). During
debridement of the partially ruptured CrCL it
is important to save the fat pad as much as pos-
sible, as this is one of the major origins of the
vascular supply of the CrCL (Kobayashiet al.
2006).
Dogs with partial cruciate ligament rupture
have a lesser incidence of meniscal injury com-
pared to dogs with complete rupture (Ralphs &
Whitney 2002). One reason for this could be that
the remaining ligament inhibits tibial transla-
tion to a certain degree, which in turn decreases
the risk of meniscal injury. Clinical observations
have shown that surgical interventions which
dynamically stabilize the stifle joint have an
influence on the remnants of the ligament (Eggli
et al. 2015). Dogs with palpably stable stifle
joints that have an arthroscopically diagnosed
partial CrCL rupture seem to benefit from the
debridement of visible torn fibers, followed by
a dynamic stabilization procedure such as tib-
ial plateau leveling osteotomy (TPLO). Subse-
quent meniscal injuries seem to be uncommon
in this patient group, supporting the theory that
CrCL remnants maintain a better stability of the
joint. Second-look arthroscopies have shown
an improved appearance of the intact part of
the CrCL, most likely because the TPLO pro-
cedure reduces the strain on the CrCL (Hulse