Advances in the Canine Cranial Cruciate Ligament, 2nd edition

Surgical Treatment of Concurrent Meniscal Injury 297

Table 35.1Meniscal resection procedures used in dogs.

Procedure Illustration Indication

Partial meniscectomy All meniscal tears that allow for a

peripheral rim to be preserved

Segmental meniscectomy

(caudal hemimeniscectomy)

Caudal meniscal tears where a

functional rim cannot be preserved

Total meniscectomy All meniscal tears involving more

than caudal aspect and the rim

cannot be preserved

Note: Images have been reproduced from Johnsonet al. (2004), with permission from the American Veterinary Medical
Association.

Partial meniscectomy is indicated for longi-
tudinal, bucket-handle, radial, horizontal, and
complex tears for which an intact rim (periph-
eral circumferential collagen fiber integrity) can
be preserved after resection. Segmental menis-
cectomy is indicated for all types of tears in the
caudal aspect of the meniscus when an intact
rim cannot be preserved in conjunction with
complete resection of pathologic tissue. Total
meniscectomy is indicated for tears extending
beyond the caudal aspect of the meniscus, and
for which an intact rim cannot be maintained.
There are several key factors to consider
in order to optimize meniscal resection pro-
cedures. First, exposure and access must be
achieved, such that adjacent structures (articu-
lar cartilage, ligaments, etc.) are not damaged
during resection. Instrumentation specifically
designed for meniscal surgery is recommended
for minimizing iatrogenic damage to the artic-
ular cartilage during assessment and treat-
ment. Two important goals must then be bal-
anced in performing the resection: (i) remove
all grossly damaged, displaced, and pathologic

meniscal tissue; and (ii) preserve as much func-

tional meniscal tissue as possible. Damaged,

displaced, unstable, and pathologic meniscal

tissue can cause mechanical dysfunction in the

joint, direct articular cartilage damage, inflam-

mation and degradation, and resultant pain,

lameness, and progression of osteoarthritis.

However, loss or removal of meniscal tissue,

especially the peripheral rim, severely dimin-

ishes load-bearing, shock absorption, congru-

ency, stability, lubrication, tissue nutrition, and

the chondroprotection functions of the menis-

cus for the joint (see Chapter 4). Clearly, the

two goals for treatment of meniscal injuries

can be at odds to one another, and so care-

ful evaluation and decision-making with judi-

cious resection are critical to striking the opti-

mal balance for the patient. The evaluation is

based on preoperative imaging, in conjunction

with a careful inspection of the entirety of the

meniscus, probing and palpation of meniscal

tissue and its attachments, and an assessment

of the articular cartilage of the femoral condyle

and tibial plateau. Healthy, functional meniscal