Advances in the Canine Cranial Cruciate Ligament, 2nd edition

Arthroscopy and Arthrotomy of the Stifle 179

(C)

MFC

SM

***

(A) (B)

LFC

*** SM

Figure 23.13 Arthroscopic-assisted arthrotomy facilitates assessment of intra-articular pathology at the time of
arthrotomy (A). The synovium can be evaluated for hyperplasia, hyperemia, and fibrosis. Synovial biopsies can be
obtained using arthroscopic assistance to ensure that optimal tissue samples are obtained. (B) Small osteophytes (∗∗∗)
along the attachment of the joint capsule to the lateral femoral condyle (LFC) can be seen in this patient having an early
cruciate ligament rupture. Minimal inflammation of the synovial membrane (SM) is seen. (C) Moderate-sized osteophytes
(∗∗∗) are present along the medial femoral condyle (MFC) in this patient with a chronic cruciate ligament rupture. The
synovial membrane (SM) appears hyperplastic in the area of the osteophytes.

view of the menisci (Figures 23.3, 23.4 and
23.14B,C). The joint is then explored using the
magnified view of the arthroscope. Controlling
the position of the arthroscope in the joint can
be more difficult with this technique, compared
with portal arthroscopy. Resting the surgeon’s
hand against the patient or resting the surgeon’s
elbow on a Mayo stand can help avoid a shaky
image and inadvertent withdrawal of the scope
from the joint (Figure 23.15). The surgeon can
also steady the image and prevent inadvertent
withdrawal of the arthroscope by grasping the
shaft of the arthroscope near the arthrotomy
incision (Figure 23.15).
Fluids are delivered through the arthroscope
cannula, similar to portal arthroscopy. The rate
of fluid flow should be lowered because of
reduced resistance to flow from the arthrotomy
incision. Fluid egress occurs freely from the inci-
sion and fluid collection should be performed.
Fluid egress can be captured using a drainage
pouch with suction attachment, floor drain, or
simply placing towels or absorbent towels on
the floor (Figure 23.15). A water-impervious
drapeshouldbeusedtoavoidsurgicalsitecon-
tamination (Figure 23.15). The tip of the arthro-
scope should be placed near the target tissue
to provide the best view. Bubbles may obscure
the view if the tip of the scope is drawn too
far away from the tissue (Figure 23.16A). Sur-
gical instruments are used with a combination

of direct and arthroscopic observation. Arthro-

scopic treatment also helps to minimize carti-

lage injury. A scrubbed assistant can help to

manipulate an instrument, such as a grasper

or probe, during surgery (Figure 23.16B). The

surgeon typically holds the arthroscope and

the cutting instrument or shaver. The menisci

should be carefully probed to assess for damage

(Figure 23.17). Damaged meniscal tissue, such

as a bucket-handle tear, should be removed by

partial meniscectomy (Figure 23.18). After treat-

ment, the affected area should be re-examined,

using the arthroscope to ensure complete treat-

ment. This is particularly important during

meniscectomy, as it is common to find a second

or third bucket-handle tear after removal of the

first tear (Figure 23.19). The meniscus should

be probed under arthroscopic viewing to ensure

that additional damaged meniscal tissue is not

left behind. Medial meniscal release can also be

performed more accurately using arthroscopic

guidance (Figure 23.20).

Surgical procedures require the use of surgi-

cal instruments. Surgeons often use a variety

of instruments for operative procedures in the

joint, including scalpel blades, hemostats, and

thumb forceps. Arthroscopic hand instruments

typically used for traditional arthroscopic

surgery may provide a benefit to surgeons using

arthroscopic-assisted arthrotomy. Arthroscopic

hand instruments are typically low profile, with