172 Surgical Treatment
(A) (B)(D) (E)(C)Figure 23.1 (A) A lateral parapatellar incision is most commonly used to approach the stifle joint for extracapsular
treatment of cruciate ligament rupture. (B) The deep fascia is incised in a longitudinal direction cranial to the biceps
femoris muscle. The fascial incision is continued distally along the lateral edge of the patellar tendon. (C) The deep fascia
is incised and elevated from Gerdy’s tubercle at the lateral aspect of the proximal tibia. (D) The incision is continued
caudally in a transverse manner, exposing the lateral aspect of the stifle. (E) Retraction of the fascia allows adequate
access to the lateral fabella, the caudal joint capsule, lateral collateral ligament, fibular head, long digital extensor
tendon, extensor groove, and the cranial joint capsule.
the cranial border of the biceps femoris muscle
(Figure 23.1B). The fascial incision is continued
distally 5–10 mm lateral to the edge of the patel-
lar tendon. The deep fascia should be elevated
from the joint capsule and its bony attachment
to Gerdy’s tubercle at the craniolateral aspect
of the proximal tibia (Figure 23.1C). This allows
optimal exposure to the caudal aspect of the sti-
fle and closure of the joint capsule and deep fas-
cia in separate layers. The fascia and attached
biceps muscle is retracted caudally, giving good
exposure to the lateral fabella, lateral condyle
of the femur, fibular head, caudal joint capsule,
long digital extensor tendon extensor groove
and cranial joint capsule. This approach is par-
ticularly useful when performing extracapsular
stabilization. The joint capsule is incised longi-
tudinally just lateral to the patellar tendon along
its entire length. The patella is luxated medi-
ally. The proximal aspect of the femoropatel-
lar joint and medial and lateral gutters along
the femoral condyles are evaluated for trochlear
groove depth, cartilage integrity, periarticular
osteophytes, and degree of synovitis. The stifle
is flexed and a Gelpi retractor is used to retract
the joint capsule. A Senn retractor is used to
retract the patellar fat pad distally, allowing a
good view of the intercondylar notch, cranial
cruciate ligament (CrCL) and caudal cruciate
ligament (CaCL). If torn cruciate ligament fibers
obstruct viewing of the weight-bearing surfaces
of the femoral condyle and tibial plateau and
the menisci, they should be removed. A por-
tion of the fat pad can also be resected if needed
to improve examination of the joint. However,
care should be taken to avoid damage to the
intermeniscal ligament, which is hidden under
the fat pad. The use of a surgical assistant
will help improve joint exposure. Cranial trac-
tion on the Senn retractor or the crus can help
improve exposure of the intra-articular struc-
tures by inducing cranial tibial subluxation. In
stifles with substantial periarticular fibrosis this
improved exposure may be limited. The use of a
joint distractor will also help improve exposure.
After optimizing joint exposure, the menisci
should be examined, probed, and treated as
indicated while maintaining joint access.
Some increase in morbidity occurs with
arthrotomy. The initial skin incision must be