35

Surgical Treatment of

Concurrent Meniscal Injury

Samuel P. Franklin,James L. Cook, and Antonio Pozzi

Introduction

Meniscal pathology in conjunction with cru-
ciate ligament rupture (CR) is common and is
recognized in up to 83% of cases (Ritzoet al.
2014). When CR is present in dogs, the caudal
aspect of the medial meniscus is most predis-
posed to clinically important injury because
the femoral condyle subluxates caudally in the
unstable stifle (Reyet al. 2014). The types of
injury commonly seen in dogs include longitu-
dinal, bucket-handle, radial, horizontal, caudal
peripheral and complex tears (Figure 35.1). It
is imperative that meniscal problems are diag-
nosed and treated at the time of initial surgery
in order to ensure optimal relief of pain,
the debridement of abnormal tissue causing
inflammation and degradation, patient recov-
ery, and functional outcomes while minimizing
morbidity and the potential need for additional
surgeries.

Diagnosis

The preoperative diagnosis of meniscal pathol-
ogy, including complete physical examina-
tion, joint palpation, and imaging, should be
comprehensively pursued. These diagnostic

approaches are addressed in Chapters 15, 18,

19, 20, 21, and 22. Arthroscopy with prob-

ing is reported to be the ‘gold standard’ for

a definitive diagnosis of meniscal pathology

because it allows for complete examination with

magnification, manipulation of the tissue, is

minimally invasive with low morbidity, and

enables the identification of meniscal pathol-

ogy more commonly than arthrotomy (Thie-

manet al. 2006; Pozziet al. 2008a; Ritzoet al.

2014). Arthrotomy via medial, lateral, or cau-

domedial approaches with probing is recom-

mended if arthroscopy of the stifle is not pos-

sible. Various instruments are available to aid

in exposure and access for meniscal assessment

and treatment for both arthroscopic and open

approaches to stifle surgery. These instruments

include probes, Hohmann retractors, microp-

icks, self-retaining retractors, and distraction

devices. There is evidence that these instru-

ments can improve observation and identifica-

tion of meniscal tears, and so are highly recom-

mended (Pozziet al. 2008a; Winkelset al. 2016).

In addition, assessment of the menisci with the

joint in flexion and extension, with varus and

valgus stress of the joint, and with internal and

external rotation of the stifle can improve diag-

nostic accuracy. An accurate and comprehen-

sive assessment of the menisci is the critical first

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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