296 Surgical Treatment
(A) (B) (C)(D) (E)JC(F)Figure 35.1 Illustrations of longitudinal (A), bucket-handle (B), radial (C), horizontal (D), caudal peripheral (E), and
complex (F) tears. JC, Joint capsule. Copyright©Samantha J. Elmhurst atwww.livingart.org.uk.
step in the appropriate surgical treatment of
meniscal pathology in dogs. Indeed, at least two
studies have demonstrated that dogs in which
meniscal pathology is identified have a greater
likelihood of a successful outcome than dogs in
which meniscal pathology has not been identi-
fied (Ertelt & Fehr 2009; Ritzoet al. 2014).
Treatment
Once meniscal pathology is identified and char-
acterized, three major treatment options can be
considered, namely repair, resection, or release
(radial transection). The repair of longitudinal,
bucket-handle, and horizontal tears is techni-
cally feasible by open or arthroscopic placement
of sutures, can restore normal contact mechan-
ics in the stifleex vivo, and may be indicated in
selected cases (Cook & Fox 2007; Lutheret al.
2007; Thiemanet al. 2009; Thiemanet al. 2010).
However, the majority of meniscal pathology
in dogs is still treated via resection or release
because meniscal repair is perceived as being
prone to failure in most dogs, based on both bio-
logic and biomechanical factors. The primary
biologic factors involved are:
- The majority of tears occur in the axial
(inner) 75% of the meniscus, which has no
or poor inherent blood supply and low cell
density. - The majority of dogs with CR and meniscal
pathology have active osteoarthritis with
associated inflammation and degradation
processes at work.- Meniscal tears in dogs are typically chronic,
with associated microstructural changes
present in the tissue.
The biomechanical issues center on an inabil-
ity to restore normal joint kinematics to the
cranial cruciate ligament (CrCL)-deficient sti-
fle. Combined, these detriments to successful
healing and restoration of function to damaged
menisci suggest that careful decision-making
regarding meniscal repair in dogs is needed,
even when it is technically feasible to accom-
plish. As surgical techniques become more
refined and developed to be more effective and
consistent in stabilizing the CrCL-deficient sti-
fle, the role of meniscal repair may become more
pertinent.
The resection of pathologic meniscal tissue
is the most commonly recommended and per-
formed treatment for meniscal injuries in dogs
at this time. Partial meniscectomy, segmental
meniscectomy (caudal hemimeniscectomy),
and total meniscectomy are the three types of
resection procedure typically used for dogs
(Table 35.1). These can be accomplished arthro-
scopically or after arthrotomy. Scalpel blades
(#11, #15, or Beaver blades), meniscal knives,
and arthroscopic basket forceps, scissors,
meniscal cutting tools designed specifically
for meniscus removal in dogs, and shavers
can be used to perform the resections.