Advances in the Canine Cranial Cruciate Ligament, 2nd edition

Arthroscopy and Arthrotomy of the Stifle 173

longer and the deeper tissues must be incised.
Incised tissues cause pain due to the initiation of
inflammatory pathways and stimulation of sen-
sory innervation. The surgeon should strive to
minimize soft tissue trauma and surgical pain.
Smaller arthrotomy incisions and meticulous
surgical technique are recommended. Dessica-
tion of joint tissues should be avoided by fre-
quent lavage to minimize tissue injury.
Minimally invasive arthrotomy without
luxation of the patella can help to reduce post-
operative morbidity, although exposure of the
intra-articular structures is limited, compared
to arthrotomies with patella luxation. The
arthrotomy is made just medial or lateral to
the patellar tendon, extending from the distal
pole of the patella to the proximal tibia. A

small Gelpi retractor is used to retract the joint

capsule (Figure 23.2A). Retraction or resection

of the fat pad helps viewing of the joint. Care

should be taken during the surgical approach

to avoid injury to the cranial meniscotibial lig-

aments, the transverse meniscal ligament, and

the cranial poles of the menisci. Joint surfaces

should be distracted to facilitate meniscal eval-

uation and to perform meniscectomies without

damaging cartilage (Figures 23.2B–D and 23.3–

23.5). Potential concerns with mini-arthrotomy

are inadequate viewing and access to the

femoro-tibial joint compartment. This may

increase the possibility of missing a meniscal

tear unless a probe and an arthroscope is used

to improve meniscal examination. In addition,

a partial meniscectomy performed through

(A)

(C) (D)

(B)

Figure 23.2 (A) A minimally
invasive arthrotomy has been
used to explore the stifle. The
joint capsule is retracted using a
small Gelpi retractor. The fat pad
and cranial joint capsule are
retracted distally using a Senn
retractor. (B,C) Examination of
caudal parts of the menisci can
be difficult using an arthrotomy.
A Hohmann retractor can be
used to improve the view of the
menisci. The tip of the retractor is
inserted just caudal to or on the
caudal edge of the proximal tibia.
The body of the retractor is
levered against the trochlear
groove of the femoral condyle.
This action separates the joint
surfaces, giving a better view and
access to the menisci. An
assistant is required when using
this procedure. (D) Distraction
using the Hohmann retractor
provides a good view for
inspection of the menisci and
adequate access for partial
meniscectomy or meniscal
release.