304 Surgical Treatment
(B)(A)(D)(C)Figure 36.3 Representative gross appearances of India ink-stained articular cartilage surfaces in meniscal release (MR)
(A,B) and sham-operated (C,D) stifle joints. The photographs were taken immediately after tracings of the articular
surfaces and lesions were made. The percentage area of cartilage damage was significantly greater in MR stifles than in
sham stifles, as indicated here by the darkly stained regions on the medial femoral condyle and tibial plateau. Source:
Lutheret al.2009. Reproduced with permission from John Wiley & Sons, Inc.
occur due to misdiagnosis at the time of the ini-
tial joint evaluation (Thiemanet al.2006; Case
et al. 2008). Therefore, complete and careful
inspection for all types of pathology potentially
present is mandatory for comprehensive man-
agement of CR in dogs. Meticulous surgical
technique with an optimal view of the meniscus
(arthroscopy, head-lamp, appropriate surgical
lights) is also necessary to avoid iatrogenic dam-
age to the cartilage, the medial collateral liga-
ment and the caudal cruciate ligament (Austin
et al.2007).
The mid-body release can be performed
using an inside-to-outside or an outside-to-
inside technique. For the inside-to-outside
technique, a needle is inserted into the joint
from outside at the level of the caudal edge
of the medial collateral ligament. The needle
guides the blade inserted from inside the joint
through the entire meniscus. In the outside-to-
inside technique, the #11 blade is inserted just
caudal to the medial collateral ligament in a
direction towards the Gerdy tubercle. Aiming
at the Gerdy tubercle should allow the surgeon
to transect the meniscus at a 30◦cranio-medial
angle, which is necessary to accomplish a
complete release (Slocum & Slocum 1998). To
confirm that a complete release has been per-
formed, a probe is used to evaluate the extent
of radial transection.
Menisco-tibial release is used more com-
monly in conjunction with cranio-medial
arthrotomy or arthroscopy. This is the preferred
method of the present authors because of the
lower risk of cartilage damage during transec-
tion. The menisco-tibial ligament can be tran-
sected with a #11, #15, or Beaver scalpel blade,
meniscal knives, or arthroscopic basket forceps
or scissors. Radiofrequency probes and elec-
trosurgery devices have also been used but are
not recommended by the present authors due
to the potential for thermal damage to adjacent
tissues. The meniscal probe can be used while
releasing the meniscus to ensure that the whole
ligament is transected. The tip of the probe is
hooked onto the ligament and the probe is used
as a guide for the blade (Figure 36.4). An incom-
plete release is recognized using this technique
if the tip of the probe remains hooked after
transection. Another technique entails using
a pull-meniscal knife. This instrument allows
‘hooking’ and transecting the whole ligament