Meniscal Release 305(B)(A)Figure 36.4 (A) Photograph of right tibial plateau
illustrating the caudal menisco-tibial release using a
meniscal probe as a guide for the blade. The meniscal
release is completed as the tip of the probe is freed from
under the meniscal ligament. (B) Photograph of right
tibial plateau illustrating the caudal menisco-tibial release
using a pull-meniscal-knife. After hooking the ligament
with the knife, traction is applied until the ligament is
transected. Care should be taken to avoid hooking the
caudal cruciate ligament. The meniscal-tibial ligament
should be probed to confirm that the meniscal release is
complete. Both techniques can be performed via
arthrotomy or arthroscopy.
(Figure 36.4), and facilitates performing a com-
plete release, potentially decreasing the risk of
iatrogenic damage to the joint.
Clinical decision-making
The optimal treatment of meniscal injury
should alleviate pain while preserving meniscal
function. If this principle is applied to clinical
decision-making regarding an intact meniscus,
meniscal release should not be performed
because of its impact on meniscal function and
consequently joint function (Pozziet al.2006;
Thiemanet al.2006; Pozziet al.2008; Luther
et al.2009; Pozziet al.2010). This conservative
approach is further supported by the evidence
that dogs without meniscal injury and without
release have a better short- and long-term out-
come (Inneset al.2000; Lutheret al.2009). The
type of meniscal treatment may have a greater
impact on clinical outcome than does the CrCL
stabilization technique. Cases diagnosed and
treated for concurrent meniscal tears were 1.3-
fold more likely to have a successful long-term
outcome than cases in which a concurrent tear
was not identified (Ritzoet al.2014). These
results would support a recommendation of
meniscal release to decrease the likelihood of
postoperative meniscal tears (Ritzoet al.2014)
in selected cases when some postoperative
stifle laxity is to be expected.
A thorough evaluation of the meniscus
should be performed, especially if the menis-
cus is not released. Latent tears represent a fail-
ure of diagnosis at surgery and may result in
persistent lameness and require additional sur-
gical treatment. To decrease the risk of latent
tears, arthroscopy and meniscal probing are rec-
ommended for their high sensitivity and speci-
ficity (Mahnet al.2005; Pozziet al.2008). By
improving the diagnosis of tears at the initial
joint exploratory surgery, it may be possible to
decrease the incidence of late injuries to a point
that a release procedure may not be necessary.
Subsequent meniscal tears cause discomfort
to the patient and may require costly reop-
eration. Meniscal release decreases the rate
of these tears, thus eliminating the need for
revision surgeries in some dogs (Thiemanet al.
2006). For this reason, meniscal release could be
considered in cases of high rates of subsequent
meniscal injury and when a revision surgery
is not acceptable for the owner. However, in
these cases consideration should be given to
hemimeniscectomy in place of meniscal release
because meniscal tears may still occur despite
a meniscal release. The decision of releasing
an intact meniscus is complex and should be
made after considering several factors that
include the diagnostic approach, the type of