178 Surgical Treatment
PTG(A) (B) (C)TPTPMFCMMMFC************+++Figure 23.11 Arthroscopy improves the ability of the surgeon to assess the condition of articular cartilage. (A) A small
focal area of full-thickness erosion of the femoral cartilage (∗∗∗) is seen on the underside of the patella (P) adjacent to the
trochlear groove (TG) in this patient with medial patellar luxation. (B) Chondromalacia (∗∗∗) of the articular cartilage of
the tibial plateau (TP) can be seen in this patient with cruciate ligament rupture. (C) Fine fibrillation (∗∗∗) of the articular
cartilage of the medial femoral condyle (MFC) and fibrillation and erosion (+++) of the cartilage of the TP can be seen in
this patient with cruciate ligament rupture. Changes to cartilage as seen in panels B and C are typically only visible with
magnification. MM, medial meniscus.
in the desired location by gross observation,
while the anatomic structure of interest can be
assessed more completely using the magnifica-
tion and the enhanced viewing field provided
by the arthroscope. Instruments are placed adja-
cent to the arthroscope through the same arthro-
tomy incision or through an adjacent stab inci-
sion used to create an instrument portal. This
technique can be used to help secure the instru-
ment to facilitate surgical operative technique.
Triangulation, an arthroscopic skill that is diffi-
cult to learn, is much easier using arthroscopic-
assisted arthrotomy.
Arthroscopic-assisted arthrotomy typically
uses a mini-arthrotomy without luxation of the
patella (Figure 23.12A). The arthrotomy should
be made just medial or lateral to the patellar
tendon, extending from the distal pole of the
patella to the proximal tibia, preserving the
femoro-patellar ligament. A small Gelpi retrac-
tor is used to retract the joint capsule (Fig-
ure 23.12B). Retraction or resection of the fat
pad allows improved viewing. The proximal
joint pouch and medial and lateral gutters can
be examined by directing the arthroscope prox-
imally (Figure 23.12C). Synovitis and osteo-
phytes can be seen, assessed, and documented
with images obtained using the arthroscopic
camera (Figure 23.13A–C). The cruciate liga-
ments are inspected (Figure 23.14A). Ajoint dis-
tractor can be used to separate the joint sur-
faces of the femur and tibia, providing a better(A) (B) (C)Figure 23.12 (A) Arthroscopic-assisted arthrotomy can be used to evaluate the stifle with similar advantages to
arthroscopy, but with the ease of arthrotomy. The arthrotomy incision is typically small, as seen in this patient, but any
size arthrotomy incision can be used with arthroscopic assistance. (B) Gelpi retractors can be used to retract the joint
capsule and improve exposure to the joint. (C) The arthroscope is positioned in the proximal aspect of the joint to assess
the patella, trochlear groove, synovial membrane and the medial and lateral gutters for osteophytes. Fluid enters the joint
through the arthroscope cannula and drains from the arthrotomy incision.