Arthroscopy and Arthrotomy of the Stifle 175(A) (B) (C) (D)Figure 23.5 Stifle distraction is recommended to improve meniscal diagnostic accuracy and to perform meniscectomy
with lesser risk of iatrogenic cartilage damage. (A) At initial evaluation without joint distraction the meniscus appears
normal. (B) Following joint distraction using the Arthrex Stifle Distractor the meniscus appears abnormal and a complex
tear is evident. (C) A partial meniscectomy is performed. (D) Further probing of the meniscus allows detection of a
horizontal tear. This example shows the importance of probing the meniscus after partial meniscectomy. Horizontal tears
are common and can progress to bucket-handle or flap tears if left untreated.
illumination, greater access to anatomic regions
of the joint, evaluation of the joint structures in
a fluid medium, and reduced morbidity.
A magnified view of stifle anatomic struc-
tures allows a more accurate diagnosis and
more precise treatment of pathologic conditions
(Figure 23.6). Arthroscopic evaluation of the sti-
fle enables more thorough evaluation of the
patella, trochlear groove, femoral condyle, tibial
plateau, CrCL, CaCL, and menisci. Arthroscopy
of the stifle is often used to evaluate and treat
CR and meniscal tears.
Fiber rupture in both the CrCL and the CaCL
can clearly be assessed with arthroscopy, but
can easily be missed with arthrotomy (Fig-
ure 23.7). The identification of partial CR, early
inthecourseofthedisease,maybecriticalfor
treatment decision-making and patient man-
agement. Early surgical treatment with tibial
plateau leveling osteotomy may protect against
further CrCL fiber disruption and reduce the
incidence of meniscal injury and articular car-
tilage damage.
Examination of the menisci is also improved
as the arthroscope can be positioned adjacent to
the meniscus. Arthroscopy is superior to arthro-
tomy for the diagnosis of meniscal damage
(Pozziet al. 2008), especially when combined
with probing. Joint distraction can improve
meniscus exposure and facilitate the diagnosis
and treatment of meniscal injuries. Distrac-
tion can be performed with intra- or extra-
articular distractors. A joint distractor can be
placed through a lateral portal into the inter-
condylar notch and levered against the femoral
condyle to separate the joint surfaces and give
better access to the menisci if needed (Fig-
ure 23.8). Bucket-handle tears of the medial
meniscus are the most common type of menis-
cal damage associated with CR. Many of these
tears are not displaced cranially at surgery
and are easily missed. Examining the joint at(A) (B)Figure 23.6 (A) The cranial and
caudal cruciate ligaments are
more accurately assessed when
viewed with an arthroscope due
to magnification and evaluation in
a fluid medium. The flow of fluid
improves the appearance because
the tissues do not desiccate and
hemorrhage is flushed away. (B) A
bucket-handle tear of the medial
meniscus is better viewed and
more precisely removed using
arthroscopy.