Advances in the Canine Cranial Cruciate Ligament, 2nd edition

Surgical Treatment of Concurrent Meniscal Injury 299

Table 35.2Current best evidence for and against use of meniscal release in dogs.

Evidence FOR meniscal release Evidence AGAINST meniscal release

Significantly reduces the rate of subsequent meniscal

tears (Thiemanet al. 2006; Ritzoet al. 2014)

No clinically significant differences in subjective

outcome (Thiemanet al. 2006; Ritzoet al. 2014)

Does not eliminate subsequent tears (Thiemanet al. 2006)

Eliminates biomechanical functions of meniscus

equivalent to total meniscectomy (Pozziet al. 2006;

Pozziet al. 2008)

Released menisci will not functionally heal (Lutheret al.

2009; Cooket al. 2016)

Release alone associated with full-thickness cartilage

loss, radiographic osteoarthritis, and lameness (Luther

et al. 2009)

The authors suggest that the options, decision-
making process, and ramifications associated
with meniscal release should be discussed with
the client during the preoperative consultation
and consent to treatment (Table 35.2).

Conclusion

Meniscal injuries concurrent with CR in dogs
are very common. As a good rule of thumb, if
meniscal pathology is not recognized in at least

50% of patients with CR, it is very likely that

tears are being missed. Preoperative assessment

by palpation and imaging, combined with care-

ful and meticulous intraoperative assessment

with probing and palpation of meniscal tissue,

are the keys to a comprehensive diagnosis of

meniscal pathology. Once accurate and com-

plete assessment has been performed, a treat-

ment algorithm for meniscal injury concurrent

with CR can be applied based on the loca-

tion and severity of the pathology, the tech-

nical aspects of the various procedures, and

Cruciate ligament rupture

Preoperative Diagnostics

(Palpation, Radiographs, Ultrasound, MRI)

Surgical Assessment

(Arthroscopy or Arthrotomy with Probing)

Meniscal Pathology Present No Meniscal Pathology Seen

Resection Document and leave intact

Damaged tissue accessible Low subsequent tear rate

Release Release

Damaged tissue inaccessible Cannot fully assess

High subsequent tear rate

Repair Client communication

In vascular zone

Functional tissue

Kinematics restored

Technically feasible

Client communication

Figure 35.3 Algorithm for decision-making regarding the surgical treatment of meniscal injuries in dogs.