180 Surgical Treatment
(A)(B)(C)Figure 23.14 Arthroscopy-assisted arthrotomy. (A) The
cranial cruciate ligament is inspected with a probe.
Diagnosis of partial cruciate ligament rupture is
facilitated because of the magnified view supplied by the
arthroscope. (B) A Hohmann retractor has been inserted
into the mini-arthrotomy adjacent to the arthroscope
allowing an improved view of the menisci. (C) The
menisci are probed while viewed with an arthroscope.
The magnified view and ability to position the
arthroscope into an optimal position next to the meniscus
increases the surgeon’s accuracy in identifying meniscal
tears.
smooth edges to enhance access to tight regions
of the joint without damaging articular carti-
lage. They also have been designed with more
secure grasping properties to allow a stronger
grasp of intra-articular structures, to apply
tension, or to remove damaged structures.
Hand instruments designed for arthroscopy
also tend to improve joint observation due to
their ergonomic design and shaft length.Stifle joint distraction
Distraction of the femoral and tibial joint sur-
faces during arthrotomy or arthroscopy is often
achieved using a narrow Hohmann retractor
with an appropriate contour and adequate
stiffness to prevent bending. The tip of the
Hohmann retractor is placed on the caudal
aspect of the tibial plateau. The blade of the
retractor is levered against the trochlear groove
of the femoral condyle, resulting in a separation
of the joint surfaces and improved viewing of
the menisci and the caudal femoro-tibial joint
space. Distraction must be maintained by the
surgeon during the procedure.Intra-articular joint distraction
This approach is useful for both arthrotomy and
arthroscopic techniques. Several instruments
are currently available that have an improved
design relative to a Hohmann retractor. These
instruments are placed in the intercondylar
notch to separate the tibial and femoral joint
surfaces, but distraction needs to be maintained
by a surgical assistant. A self-retaining retrac-
tor is also available for joint distraction (Gem-
mill & Farrell 2009). This instrument is typically
positioned through a medial parapatellar portal
incision or through the arthrotomy. The proxi-
mal jaw is placed in the intercondylar notch and
the distal jaw in the fat pad before joint distrac-
tion (see Figures 23.3 and 23.4).Extra-articular joint distraction
An extra-articular pin distractor (Bottcher ̈ et al.
2009; Winkelset al. 2016) can also be used to sep-
arate the joint surfaces of the femur and tibia.
Transcutaneous pins are placed in the distal